bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stenotic Intercondylar Notch as a Risk Factor for Physeal-Sparing ACL Reconstruction Failure: A Case-Control Study
Authors: Tuca María , Gausden Elizabeth , Luderowski Eva , Valderrama Ignacio , Pineda Tomas , Potter Hollis , Cordasco Frank , Green Daniel 
Published: July 2021

Introduction:
Identifying risk factors is crucial for developing strategies that minimize reinjury after anterior cruciate ligament reconstruction (ACLR). This study aims to determine whether certain features of intercondylar notch geometry are associated with failure of physeal-sparing ACLRs in skeletally immature athletes.

Methods:
Nine failed physeal-sparing ACLRs were compared with a control subject group of 15 age- and sex-matched intact physeal-sparing ACLRs. Notch width index (NWI), notch angle (NA), and intercondylar notch roof inclination angle (RA) were measured on preoperative MRIs.

Results:
Median NWI was smaller in the failed ACLR versus control subject group in coronal (0.23 versus 0.27; P < 0.05) and axial planes (0.25 versus 0.27; P = 0.055). Median NA was smaller in the failed ACLR versus control subject group in coronal (49.6 versus 61.0°; P < 0.05) and axial planes (48.6° versus 54.9°; P < 0.05). Median RA was steeper in the failed ACLR versus control subject group (132.0° versus 125.7°; P < 0.05).

Conclusion:
NWI, NA, and RA were associated with ACLR failure in skeletally immature patients undergoing physeal-sparing reconstruction. A smaller, narrower, and steeper notch may predispose these patients to reinjury.
Surgical Complications After Reverse Total Shoulder Arthroplasty and Total Shoulder Arthroplasty in the United States
Authors: Ma Gabrielle C. , Bradley Kendall E. , Jansson Hayley , Feeley Brian T. , Zhang Alan L. , Ma C. Benjamin 
Published: July 2021

Introduction:
Shoulder arthroplasty has become popular in the treatment of degenerative shoulder conditions in the United States. Shoulder arthroplasty usage has expanded to younger patients with increased surgical indications.

Methods:
Reverse total shoulder arthroplasty (RTSA) and TSA patient records with the 1-year follow-up between 2015 and 2018 were queried from the nationwide PearlDiver Mariner Shoulder Database using International Classification of Disease-10 codes. Chi-square analysis was done to compare the demographics, surgical complications, and revision procedures between RTSA and TSA.

Results:
From 2010 to 2018, there was an increase in shoulder arthroplasty cases because of RTSA. The overall surgical complication and revision procedure rates were 2.26% and 3.56% for RTSA, and 6.36% and 2.42% for TSA. Patients older than 50 years had statistically lower surgical complications after RTSA than TSA (2.25% versus 3.94%, P < 0.05), whereas no statistical difference between RTSA and TSA for patients younger than 50 years (10.06% versus 7.45%, P = 0.19). Male patients had higher RTSA complication rates (3.12% versus 2.28%, P < 0.05), whereas female patients had higher TSA (4.86% versus 5.92%, P < 0.05). History of tobacco, depression, and obesity were risk factors for higher complications.

Conclusion:
RTSA has become more commonly done than TSA in the United States. Older patients who underwent shoulder arthroplasty had lower surgical complication. TSA had a higher surgical complication rate than RTSA for patients older than 50 years.
Utilization of Maternal Health Care Services In an Urban Slum of Bangalore- A Cross-Sectional Study
Authors: Swetha NB  , Shobha S  , Sriram S  
Published: July 2021

Background: Pregnancy is golden period in woman’s life. They must not face any complications during this period. In spite of the developed health care system in India, it is disgraceful to see many mothers who succumb to pregnancy and child birth. Although there is decline in maternal mortality, still India contributes to lot of maternal deaths. Accessibility and utilization of services are two major issues to be addressed immediately.
Objective: The study was to assess the utilization of maternal health care services in urban slum.
Methods: This was a Cross-sectional study. Study was conducted among the postnatal women of an urban slum area in Bangalore. Sample size was 125. Data was collected using a pre-tested questionnaire by interview method. Data regarding socio-demographic profile, antenatal visits, health services utilized, type of health center and also regarding postnatal visits were obtained.
Results: Registration of pregnancy 124 (99.2%), 4 antenatal visits-123 (98.6%), TT doses-121 (96.4%), Institutional delivery was found to be 100%. IFA tablets consumption was only seen in 86 (68.6%). Minimum 3 postnatal visits in 6 months duration were completed by only 93 (74.5%) subjects. Family planning services was adopted by 57 (45.6%). 98 (78%) of the study participants followed Exclusive breastfeeding.
Conclusion: The insights provide an opportunity to develop strategies to address the inadequacies and inequitable distribution of health care services.
Person-Centered Care at the End of Life
Authors: Epperly Ted 
Published: July 2021

Person-centered care at the end of life is an area of medicine we must all be familiar and comfortable with. This is the case as it will involve not only the people we care for but also our own family members, loved ones, and eventually ourselves. Forty percent of all health care dollars in the United States health care system are spent in the last two years of a person’s life unless meaningful person-centered discussions occur. Providing person-centered care for the remaining months of a person’s life is of extreme importance in helping people achieve their wishes and goals, maximize palliation, comfort, dignity, and quality of life. This paper will focus on maximizing person-centered approaches of active listening and discussion, advanced care planning, clear communication, timely engagement of support services, family support, and compassion. Our goal with person-centered care at the end of life is to allow as many people as possible a good death.
Person – Centered Perspective in the Madrid Declaration
Authors: Christodoulou George , Christodoulou Angeliki 
Published: July 2021

Principles of ethics are more important than rules, declarations and codes for a variety of reasons but basically because it is the principles that provide the basis for the latter and determine the ethical stance of each individual practitioner through whom the rules, declarations and codes are filtered. The essence of the above conclusion is reflected in the preamble of the Madrid Declaration, the ethical code of the World Psychiatric Association, where the psychiatrist’s individual sense of responsibility is identified as the basis of ethical practice.Ethical psychiatric practice (as described or implied in the Madrid Declaration and in other similar texts) is personified par excellence. Yet, there are certain parts of the Declaration that are more relevant to the person-centered approach. These are the following:Paragraph 1. Advocating therapeutic interventions that are least restrictive to the freedom of the patient.Paragraph 3. Suggesting that the patient be accepted as a partner by right in the therapeutic process. Empowering the patient to make informed decisions on the basis of one’s personal values and preferences.Paragraph 4. Safeguarding the dignity and human rights of the patient.Paragraph 5. Informing the patient about the purpose of an assessment (especially if the psychiatrist is involved in third-party situations).Paragraph 6. Safeguarding the privacy of information obtained through the therapeutic relationship.Paragraph 7. Safeguarding the autonomy and physical and mental integrity of the patient in research.The two person-centered ethics principles that are prominently highlighted in the Madrid Declaration are the principle of autonomy and the Hippocratic principle of “do no harm”.
Person-Centered Primary Health Care: Now More Than Ever
Authors: Epperly Ted , Roberts Richard , Rawaf Salman , Van Weel Chris , Phillips Robert , Mezzich Juan E. , Pongsupap Yongyuth , Ghebrehiwet Tesfamicael , Appleyard James 
Published: July 2021

Background: Person-centered primary health care provides first contact care that is comprehensive, continuous, accessible, compassionate, caring, team-based, and above all else person-centered. Primary care by its very nature is integrative in design and process. It connects and coordinates care for the person and uses shared decision making to help value and respect the person’s choices as they navigate through a complex and fragmented health care system. Objectives: To demonstrate the effectiveness of primary care in achieving the triple aim of better health, better health care, and lower cost. Methods: Critical literature review and evidence based analysis of person-centered primary health care across the world. Results: Primary care is a systems integrator and improves both the quality of care and the lowering of cost to both people and populations. It has been found that the better a country’s primary care system is, the country will have better overall health care outcomes and lower per capita health care expenditures. Evidence also demonstrates that person-centeredness contributes to higher quality care and better health outcomes. Comprehensiveness of care leads to better health outcomes, lower all-cause mortality, better access to care, less re-hospitalization, fewer consultations with specialists, less use of emergency services, and better detection of adverse effects of medical interventions. The use of the relationship of trust established through primary care health professionals in shared decision making is an effective and efficient means to promote behavior change that results in the triple aim of better health, improved healthcare, and lower costs. Conclusions: All nations must build a robust and vibrant person-centered primary health care system based on the principles of continuity, comprehensiveness, and person-centeredness. This is important now more than ever to prioritize and rebalance health care systems to address the health care needs of the people that are served.
Person-centred Communications: How do People as Patients Want to be Spoken to?
Authors: Groves Joanna 
Published: July 2021

Background:The World Health Organization's (WHO) World Health Report of 2008 titled, “Primary Health Care – Now More Than Ever” put renewed emphasis on the values of achieving health for all and putting people at the centre of healthcare (1). In order to do this it is necessary to understand what people expect and want from healthcare and pertinent communications so that health systems can be designed that can respond to patients' needs, wishes and preferences. Objectives:To consider the initiatives which are being taken forward by numerous national and global initiatives to further person-centred healthcare and consideration of the evidence for this approach with particular regard to the role of communication in enabling healthcare to meet people's needs, wishes and preferences. Methods: Review of person-centred healthcare initiatives and evidence for its impact and consideration of principles of person-centred care as they relate to healthcare communications. Results:There is evidence for a person-centred approach to healthcare. There are fundamental principles relating to how communications can impact on patients being empowered to make informed decisions about their healthcare. Patient experiences and outcomes are improved when they have the opportunity for their wishes and preferences to inform shared decision-making in mutually trusting and equal partnerships with health professionals about their health and well being. Conclusions:Person-centred healthcare requires communication which enables respect for people's needs, preferences, dignity, values, autonomy and independence. Empowering patients and health professionals so that they can work in partnership to reach an informed decision on what the patient wants and expects from treatment should be the priority for policy-makers, health professionals and patients. There are some fundamental principles and many tools and initiatives that can support good communication and enable shared decision-making.
Training Medical Specialists in Communication about Medically Unexplained Physical Symptoms: Patient Outcomes from a Randomized Controlled Trial
Authors: Weiland Anne , Blankenstein Annette H , Van Saase Jan L , Van der Molen Henk T , Kosak David , Vernhout René M , Arends Lidia R 
Published: July 2021

Objectives: Medically unexplained physical symptoms (MUPS) burden patients in their well-being and functioning and have a prevalence of approximately 25-50% in primary and specialist care. Medical specialists often find patients with unexplained symptoms difficult to deal with, whereas patients are not always understood. We report effects on patient outcomes of an evidence-based MUPS-focused communication training for medical specialists.Methods: In a multi-center randomized controlled trial medical specialists and residents allocated to the intervention received a 14-hour MUPS-focused communication training. They practiced a patient-centered approach, including multi-factorial symptom exploration and explanation of MUPS with perpetuating factors. To study intervention effects, each doctor had to include three MUPS patients before and three after the intervention and to ask them to complete questionnaires at baseline and at 3 and 6 months follow-up. The questionnaires included illness worries (Whitely Index), symptom severity (Visual Analogue Scale), distress, depression, anxiety and somatization (4DSQ) and daily functioning (SF-36).Results: A sufficient number of 123 medical specialists and residents participated in the study. They included 478 MUPS patients. Out of them, 297 patients filled out questionnaires at baseline, 165 patients at 3-months follow-up and 71 patients at 6-months follow-up. Recruitment of patients was lower than expected and patients’ non-response to baseline and follow-up questionnaires was higher than estimated. No significant effects were found on patient outcomes.Conclusions: It remains unclear whether medical specialist training results in better patient outcomes in MUPS as the trial was underpowered. New research with special attention to patient recruitment and retention is needed to answer this question.
ETHICS OF TERMINATION OF PREGNANCY (TOP) IN MYASTHENIA GRAVIS: A CASE REPORT
Authors: Nalliah Sivalingam , Ling Sim Miao , Thuraisingham Chandramani 
Published: July 2021

Introduction: Myasthenia gravis (MG), an autoimmune disorder characterised by muscle weakness caused by impairment of the acetylcholine receptors at the neuromuscular junction as a result of autoantibodies acting against the ACh receptors, is twice as common in women, occurring in the second and third decades. Successful pregnancy outcomes are possible with patient compliance to medication and care by a multidisciplinary team.Objective: The article demonstrates the ethical dilemma doctors face when dealing with termination of pregnancy in myasthenia gravis in pregnancy.Discussion: During pregnancy, MG exacerbates in one third of patients during the first trimester, and tends to improve during the second and third trimesters, with most women achieving normal delivery. The authors put up a case where decision for termination of pregnancy (TOP) could have been avoided through application of an ethical decision making framework. The patient could have decided otherwise if a clear alternative line of management had been offered. Fully informed consent is essential preserving was not given and patient autonomy in such complex decisions. The emotive effects on the patient that biomedical imaging like showing a normal and active foetus through ultrasonography also needs to be considered.Analysis: A possible ethical framework using some of the principles of ethical decision-making, under the headings of i). Clear justification according to the norms and values of the individual, law and society for the intervention ii). Patient autonomy iii). Incongruence between parents in the abortion decision iv). The foetus as a person v). Directive counselling vi). Principle-based ethics, and, vii). Case-based ethics and case-based reasoning could be applied when confronted with the issue of termination of pregnancy in MG. While principle-based ethics is a useful starting point, care-based ethics also has a place in decisions on TOP.
Using Parallel Streams of Evidence to Inform Guideline Development: The Case of the 2021 American College of Rheumatology Management of Rheumatoid Arthritis Guideline
Authors: Yaacoub Sally , Khamis Assem M. , Al‐Gibbawi Mounir , Kahale Lara A , Bathon Joan , England Bryant R , Fraenkel Liana , St. Clair E. William , Turner Amy S. , Akl Elie A. 
Published: July 2021

ObjectiveWe aim to describe an evidence synthesis approach using parallel streams of evidence that informed the development of the 2021 American College of Rheumatology (ACR) guideline for the management of rheumatoid arthritis (RA).MethodsWe developed the evidence synthesis approach using parallel streams of evidence in multiple rounds of discussion, piloting, feedback, and revisions. A number of working groups involving ACR staff, content experts, and methodologists coordinated to develop and implement the approach.ResultsWe used a major stream of evidence that identified evidence specific to the clinical questions being addressed in the guideline (ie, we were able to match relevant articles to specific questions). We also used additional streams that identified data that applied across multiple questions. We describe in this article the different steps of the major stream, ie, screening and tagging, matching articles to question clusters, matching articles to individual questions, data abstraction and analysis, and Grading of Recommendations Assessment, Development and Evaluation (GRADEing). We then describe how we packaged the parallel streams of evidence into standardized structured tables to facilitate formulating the recommendations. These tables included information for the following factors: desirable effects, undesirable effects, certainty of evidence, valuation of outcomes, cost of interventions, and cost‐effectiveness of interventions. The approach allowed us to match eligible articles for 47 of 81 clinical questions. We identified no eligible articles that addressed the remaining 34 questions.ConclusionWe were successful in using parallel streams of evidence to inform the development of the 2021 ACR guideline for the management of RA.
Perioperative Glucocorticoids in Patients With Rheumatoid Arthritis Having Total Joint Replacements: Help or Harm?
Authors: Chukir Tariq , Goodman Susan M. , Tornberg Haley , Do Huong , Thomas Charlene , Sigmund Alana , Sculco Peter , Figgie Mark , Mehta Bella , Russell Linda , Stein Emily 
Published: July 2021

ObjectiveThe optimal strategy for perioperative glucocorticoid (GC) management in patients with rheumatoid arthritis (RA) on chronic GCs is unknown. Although there is a concern for hypotension if inadequate doses are used, higher GC exposure may increase perioperative complications. We aimed to investigate the relationships between perioperative GCs with hemodynamic instability and short‐term postoperative complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA) in patients with RA.MethodsThis retrospective study included patients with RA who underwent THA and TKA. GC exposure was assessed by the total cumulative dose (in prednisone equivalents) during hospitalization. Perioperative complications and hypotension were assessed.ResultsOf 432 patients, 387 (90%) received supraphysiologic perioperative GC. Thirty percent of patients were using chronic GCs (mean daily dose, 7 ± 4 mg). Half (54%) underwent TKA. The median age was 65 years, and 79% were women. The median cumulative GC dose during hospitalization was 37 mg (interquartile range, 27‐53.3). A lower cumulative dose of GC did not increase odds of hypotension during hospitalization (unadjusted odds ratio, 1.00 [95% confidence interval, 0.99‐1.01]; P = 0.66)]. However, postoperative complications were higher among patients who received higher cumulative doses after adjustment for age, body mass index, home GC use, smoking, and Charlson Comorbidity Index. Risk of short‐term complications increased by 8.4% (P = 0.017) for every 10‐mg increase in GC dose.ConclusionA lower GC dose was not associated with increased hypotension. However, patients with higher GC exposure were more likely to have hyperglycemia and other complications. These findings suggest that harms may be associated with high perioperative GC doses. Further research is needed to determine the optimal perioperative regimen for patients with RA.
Combinations of Anticyclic Citrullinated Protein Antibody, Rheumatoid Factor, and Serum Calprotectin Positivity Are Associated With the Diagnosis of Rheumatoid Arthritis Within 3 Years
Authors: Bettner Leah F. , Peterson Ryan A. , Bergstedt Dylan T. , Kelmenson Lindsay B. , Demoruelle M. Kristen , Mikuls Ted R. , Edison Jess D. , Parish Mark C. , Feser Marie L. , Frazer‐Abel Ashley A. , Moss Laura K. , Mahler Michael , Holers V. Michael , Deane Kevin D. 
Published: July 2021

ObjectiveTo evaluate the prevalence of elevations of anti‐cyclic citrullinated peptide‐3 (anti‐CCP3) antibody, rheumatoid factor IgM (RF‐IgM) and serum calprotectin (sCP) in pre–rheumatoid arthritis (RA) as well as the diagnostic accuracies of these biomarkers for the timing of diagnosis of future RA.MethodsA total of 215 RA cases, each with approximately three pre‐RA diagnoses and one post–RA diagnosis serum sample, and controls were identified from the Department of Defense Serum Repository. All case samples and a single sample from each control subject were tested for anti‐CCP3 (IgG), RF‐IgM, and sCP. The diagnostic accuracies of biomarkers for future RA were evaluated.ResultsAnti‐CCP3, RF‐IgM, and sCP were elevated in pre‐RA, with anti‐CCP3 and sCP significantly elevated compared with RF‐IgM at the earliest time points. Within the cases, the combination of anti‐CCP3 and RF‐IgM positivity had a positive predictive value (PPV) of 35.6% for a diagnosis of RA in 3 years or less, which is significantly higher than the PPV of 18.7% for anti‐CCP3 positivity alone (P < 0.001). A combination of anti‐CCP3, RF‐IgM, and sCP had the highest PPV (53.0%) for a diagnosis of RA in 3 years or less; however, this was not significantly higher than the PPV for anti‐CCP3 and RF‐IgM positivity (P = 0.248).ConclusionAnti‐CCP3, RF‐IgM, and sCP are elevated in pre‐RA; furthermore, combinations of elevations of these biomarkers are more commonly seen in the period of less than or equal to 3 years to diagnosis. This may be considered in creating inclusion criteria in prevention trials in RA. In addition, the biologic relationships of these biomarkers in pre‐RA need exploration.