bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dynamic Anterior Shoulder Stabilization With the Long Head of the Biceps Tendon: A Biomechanical Study
Authors: Mehl Julian , Otto Alexander , Imhoff Florian B. , Murphy Matthew , Dyrna Felix , Obopilwe Elifho , Cote Mark , Lädermann Alexandre , Collin Philippe , Beitzel Knut , Mazzocca Augustus D. 
Published: April 2019

Background: The concept of dynamic anterior shoulder stabilization (DAS) combines a Bankart repair with the additional sling effect of the long head of the biceps (LHB) tendon to treat anterior glenohumeral instability. This surgical technique was created to close the gap between the indications for isolated Bankart repair and those requiring bone transfer techniques. Purpose: To biomechanically investigate the stabilizing effects of the DAS technique in comparison with the standard Bankart repair in different defect models. Study Design: Controlled laboratory study. Methods: Twenty-four fresh-frozen cadaveric shoulders (mean ± SD age, 60.1 ± 8.6 years) were mounted in a 6 degrees of freedom shoulder testing system. With cross-sectional area ratios, the rotator cuff muscles and LHB tendon were loaded with 40 N and 10 N, respectively. Anterior and inferior glenohumeral translation was tested in 60° of abduction and 60° of external rotation (ABER position) while forces of 20 N, 30 N, and 40 N were applied to the scapula in the posterior direction. Total translation and relative translation in relation to the native starting position were measured with a 3-dimensional digitizer. Maximal external rotation and internal rotation after application of 1.5-N·m torque to the humerus were measured. All specimens went through 4 conditions (intact, defect, isolated Bankart repair, DAS) and were randomized to 1 of 3 defect groups (isolated Bankart lesion, 10% anterior glenoid defect, 20% anterior glenoid defect). The DAS was performed by transferring the LHB tendon through a subscapularis split to the anterior glenoid margin, where it was fixed with an interference screw. Results: Both surgical techniques resulted in decreased anterior glenohumeral translation in comparison with the defect conditions in all defect groups. As compared with isolated Bankart repair, DAS showed significantly less relative anterior translation in 10% glenoid defects at translation forces of 20 N (0.3 ± 1.7 mm vs 2.2 ± 1.8 mm, P = .005) and 30 N (2.6 ± 3.4 mm vs 5.3 ± 4.2 mm, P = .044) and in 20% glenoid defects at all translation forces (20 N: –3.2 ± 4.7 mm vs 0.8 ± 4.1 mm, P = .024; 30 N: –0.9 ± 5.3 mm vs 4.0 ± 5.2 mm, P = .005; 40 N: 2.1 ± 6.6 mm vs 6.0 ± 5.7 mm, P = .035). However, in 20% defects, DAS led to a relevant posterior and inferior shift of the humeral head in the ABER position and to a relevant increase in inferior glenohumeral translation. Both surgical techniques did not limit the rotational range of motion. Conclusion: In the context of minor glenoid bone defects, the DAS technique demonstrates less relative anterior translation as compared with an isolated Bankart repair at time zero. Clinical Relevance: The new DAS technique seems capable of closing the gap between the indications for isolated Bankart repair and bone transfer techniques.
A Terminal Care Support Team in a Paris University Hospital: Care Providers’ Views
Authors: Salomon Laurence , Belouet Caroline , Vinant-Binam Pascale , Sicard Didier , Vidal-Trécan Gwenaëlle 
Published: April 2019

Objectives Following three years of a terminal care support team (TCST) activity: (a) to describe current management of terminally ill patients from the care providers’ viewpoint, (b) to compare the views of head nurses and physicians about this management, and (c) to identify ways of further improving palliative care. Methods A questionnaire was sent to all head nurses and physicians of the hospital. Results Care-providers consider that the TCST provides therapeutic counselling, training, and psychological help to patients, staff, and families. Few care providers were reluctant to request advice in the management of their patients. Most were satisfied with the partnership with the TCST and deemed it effective. Further improvements suggested for terminally ill patient care included greater assistance from the TCST, especially for nurses, and expanding TCST activities to outpatient management and home care programs. Conclusion Health care providers consider the implementation of the TCST to have been successful.
Receiving Bad News: Experiences of Family Members
Authors: Friedrichsen Maria J. , Strang Peter M. , Carlsson Maria E. 
Published: April 2019

Little is known about how next-of-kin experience receiving bad news. The aim of this study was to explore the experiences of family members when receiving information about ending tumour treatment, with a focus on their role in this context. Methods Semi-structured interviews were performed and analyzed using a qualitative phenomenographic method. Results Twenty family members of patients with incurable progressive cancer admitted to hospital-based home care were included in the study. Data showed that family members want to protect, represent, or act on behalf of the patient. Some described themselves as assuming prominent roles: the demander-of-truth role, the secret-keeper role, and the controller role. Others assumed more passive roles: the surrendering role, the considerate listener role, and the excluded outsider role. Conclusion This study has revealed possible explanations as to why family members are dissatisfied with information. The results of this study may help doctors in clinical practice recognize the different types of behaviour family members exhibit when receiving bad news.
Evaluation of a Nystatin-Containing Mouth Rinse for Terminally Ill Patients in Palliative Care
Authors: Butticaz Gaël , Zulian Gilbert B. , Preumont Marie , Budtz-Jørgensen Ejvind 
Published: April 2019

Purpose To evaluate the antifungal effect of a nystatin mouth rinse to control oral candidiasis of elderly patients in palliative care. Materials and Methods 52 cancer patients (mean age: 83 years) hospitalized in a long term care facility for chronically ill geriatric patients. Mouth rinsing with 15 ml nystatin solution (4,000 Ul/ml) was carried out for one minute, six times daily, over two weeks. Yeasts were collected and seeded on CHROMagar. Growth was read qualitatively and quantitatively after two days’ incubation at 37°C. Results Clinical signs of oral candidiasis were observed in 31% of cases. High yeast scores were observed in 58% of the residents. There was an association between signs of oral candidiasis and high yeast scores (p<0.001). Treatment for two weeks caused no clinical changes nor reduced yeast scores. Conclusions No clinical or antifungal effect from the nystatin suspension suggests that the concentration of nystatin in the mouth rinse was too low. A more effective procedure should be employed for antifungal treatment of terminally ill patients. Appropriate antimicrobial solutions with lubricating activity should be developed and applied to prevent oral diseases.
Breaking Bad News: Impact of a Continuing Medical Education Workshop
Authors: Ladouceur Roger , Goulet Franqois , Gagnon Robert , Boulé Richard , Girard Gilles , Jacques André , Frenette Jacques , Carrier Robert , Lalonde Viateur , Bélisle Claude 
Published: April 2019

Objective To evaluate the impact of an interactive continuing medical education workshop designed to help physicians in breaking bad news to their patients. Methodology Analysis of post-workshop questionnaires from 539 physicians assessing the retention of the key concepts and the perception of the potential impact of the workshop on their practice immediately after the workshop and six months later. Results The most significant concepts retained by the respondents are: the need to take into consideration the whole patient (42.7% post-workshop and 45.6% of follow-up responses), the need to be prepared for the consultation (11.6% and 15%), the importance of better guiding the interview (18.8% and 13.6%), and the value of taking more time during the consultation (5.8% and 8.3%). Analysis of paired responses on the post-workshop and the follow-up questionnaires shows that 35% of the concepts retained are identical. Conclusion The majority of physicians retained the key concepts, both immediately following the workshop and in the longer term.
Factors Associated with Caregiver Burden among Caregivers of Terminally Ill Patients with Cancer
Authors: Goldstein Nathan E. , Concato John , Fried Terri R. , Kasl Stanislav V. , Johnson-Hurzeler Rosemary , Bradley Elizabeth H. 
Published: April 2019

Objective To identify factors associated with caregiver burden among those caring for terminally ill patients with cancer. Design Cross-sectional study of interviews with primary caregivers (n=206) of consecutive patients with cancer enrolled in the largest hospice in Connecticut. Methods Data were collected on the caregivers’ sociodemographic characteristics, social network index, and number of restrictions in their own activities due to their caregiving role. The outcome was a nine-item questionnaire adapted from the Zarit Burden Inventory. Results The highest burden was reported among caregivers with more limited social networks (OR 1.38, CI 1.02–1.87), more restrictions in their daily activities (OR 1.35, CI 1.13–1.61), and who were younger (OR 1.46, CI 1.10–1.93). Conclusions Variations exist in the intensity of caregiver burden based on subjective experiences and social support, rather than on the amount of assistance provided. Clinicians should consider factors such as these when targeting caregivers for interventions to alleviate burden.
Predicting Family Caregiver Psychosocial Functioning in Palliative Care
Authors: Hudson Peter L. , Hayman-White Karla , Aranda Sanchia , Kristjanson Linda J. 
Published: April 2019

Background Health professionals are expected to support family caregivers of patients requiring palliative care. However, there is a dearth of empirical evidence to help clinicians identify caregivers who might be at risk of poor psychosocial functioning. Purpose This secondary analysis of baseline data from a larger study sought to determine if it was possible to predict the psychosocial functioning of family caregivers who were supporting a relative with advanced incurable cancer. Method Data from 35 primary family caregivers obtained at the start of home-based palliative care services and five weeks later was used in the analysis. Instruments to measure caregiver preparedness, competence, mastery, social support, anxiety, and self-efficacy were used. Results Cluster and logistic analyses revealed that self-reported “anxiety” and “competence” subscale total scores at time of commencement of home-based palliative care services were associated with caregivers at risk of lower levels of psychosocial functioning five weeks later. Conclusions This study suggests that it may be possible to identify family caregivers who are at risk for poorer psychosocial functioning. However, replication in a larger sample is required before this screening approach can be recommended for clinical use.
Self-Perceived Burden to Others: Patient and Family Caregiver Correlates
Authors: Mcpherson Christine J. , Wilson Keith G. , Lobchuk Michelle M. , Brajtman Susan 
Published: April 2019

Aims To provide further evidence about the prevalence and correlates of the sense of “self-perceived burden” (SPB) to others, and to examine its association with caregiver reports of burden. Methods The participants were 65 patients with advanced cancer and their family caregivers. Patients completed measures of SPB and family members completed a caregiver burden scale. Results SPB was experienced at minimal to mild levels by 35% of patients, and at moderate to extreme levels by another 28%. It was correlated with some physical symptoms, but more frequently with psychological symptoms. The family members of patients who reported that SPB was a significant problem had higher scores on the caregiver burden scale than family members of other patients (p=0.048), although the overall correlation was modest. Conclusions SPB is a common and distressing concern for many patients receiving palliative care and is associated with a number of other distressing concerns.
Research Priorities in Pediatric Palliative Care: A Delphi Study
Authors: Steele Rose , Bosma Harvey , Johnston Meaghen Fletcher , Cadell Susan , Davies Betty , Siden Hal , Straatman Lynn 
Published: April 2019

Background Pediatric palliative care is increasingly recognized to be a specialized type of care requiring specific skills and knowledge, yet, as found in several countries, there is little available research evidence on which to base care. Objectives The goal of the project was to achieve consensus among palliative care practitioners and researchers regarding the identification of pertinent lines of research. Method A Delphi technique was used with an interdisciplinary panel (n=14–16) of researchers and frontline clinicians in pediatric palliative care in Canada. Results Four priority research questions were identified: What matters most for patients and parents receiving pediatric palliative services? What are the bereavement needs of families in pediatric palliative care? What are the best practice standards in pain and symptom management? What are effective strategies to alleviate suffering at the end of life? Conclusions These identified priorities will provide guidance and direction for research efforts in Canada, and may prove useful in providing optimal care to patients and families in pediatric palliative care.
Death Late in the 20th Century
Authors: Roy David J. 
Published: April 2019

A question: “Is ‘to be’ the same as ‘to be alive'?” An answer: “In death what is called a ‘man’ simply ceases to exist: ‘man’ in the full and unadulterated sense of the word exists only as a living being.” Yet, “We must not relinquish the truth that the spiritual soul is indestructible.” Joseph Pieper (1). A question: “Is, then, being a ‘man’ just a phase of one's being?”
Neurocognitive Predictors of Understanding of Intentions in Parkinson Disease
Authors: Kosutzka Zuzana , Kralova Maria , Kusnirova Alice , Papayova Mariana , Valkovic Peter , Csefalvay Zsolt , Hajduk Michal 
Published: April 2019

Objectives: Theory of Mind (ToM), the ability to understand other people’s mental states, is essential in everyday social interactions. The relationship between cognitive domains and ToM impairment in Parkinson disease (PD) has been receiving growing attention with ambiguous findings. The objective of the current study was to ascertain which cognitive domain predicts understanding of intentions and the impact of PD-specific clinical measures on ToM performance. A secondary aim was to evaluate whether cognitive impairment mediates the relationship between severity of illness and ToM impairment. Methods: Fifty-one nondemented patients with idiopathic PD, ranging from early to advanced stages, were enrolled. A comprehensive neurocognitive battery and 2 ToM tasks (Hinting Task and Comic Strip Task) were administered during the patients’ best “on” medication state. Results: Only the task of measuring working memory capacity was significantly associated with both ToM tasks (Hinting Task Spearman rank correlation [ rs] = 0.309, P ≤ .05; Comic Strip Task rs = 0.595, P ≤ .01). Patients with more progressed disease and higher doses of dopaminergic medication performed significantly worse in the Comic Strip Task. Based on the mediation analysis, relationship between the severity of the illness and understanding of intentions was mediated by cognitive flexibility. Conclusion: In PD, understanding of intentions is related to neurocognition, with working memory and cognitive flexibility playing a crucial role. The severity of PD predicts ToM performance.
Integration of elicited expert information via a power prior in Bayesian variable selection: Application to colon cancer data
Authors: Boulet Sandrine , Ursino Moreno , Thall Peter , Landi Bruno , Lepère Céline , Pernot Simon , Burgun Anita , Taieb Julien , Zaanan Aziz , Zohar Sarah , Jannot Anne-Sophie 
Published: April 2019

Background Building tools to support personalized medicine needs to model medical decision-making. For this purpose, both expert and real world data provide a rich source of information. Currently, machine learning techniques are developing to select relevant variables for decision-making. Rather than using data-driven analysis alone, eliciting prior information from physicians related to their medical decision-making processes can be useful in variable selection. Our framework is electronic health records data on repeated dose adjustment of Irinotecan for the treatment of metastatic colorectal cancer. We propose a method that incorporates elicited expert weights associated with variables involved in dose reduction decisions into the Stochastic Search Variable Selection (SSVS), a Bayesian variable selection method, by using a power prior. Methods Clinician experts were first asked to provide numerical clinical relevance weights to express their beliefs about the importance of each variable in their medical decision making. Then, we modeled the link between repeated dose reduction, patient characteristics, and toxicities by assuming a logistic mixed-effects model. Simulated data were generated based on the elicited weights and combined with the observed dose reduction data via a power prior. We compared the Bayesian power prior-based SSVS performance to the usual SSVS in our case study, including a sensitivity analysis using the power prior parameter. Results The selected variables differ when using only expert knowledge, only the usual SSVS, or combining both. Our method enables one to select rare variables that may be missed using only the observed data and to discard variables that appear to be relevant based on the data but not relevant from the expert perspective. Conclusion We introduce an innovative Bayesian variable selection method that adaptively combines elicited expert information and real world data. The method selects a set of variables relevant to model medical decision process.
The role of responsibility in oncological emergency telephone calls
Authors: Pedersen Birgith , Uhrenfeldt Lisbeth , Jacobsen Heidi Ramlov , Jørgensen Lone 
Published: April 2019

Background: Patients and their caregivers are expected to take joint responsibility for reporting symptoms and seeking medical assistance, for example, by calling oncology emergency telephones or other helplines during a cancer trajectory. Research objective: The aim was to explore the meaning of responsibility as it appeared in patients’ or caregivers’ experiences of calling an oncological emergency telephone. Design, participants and context: Inspired by qualitative description and qualitative content analysis, a secondary analysis of data from interviews with 12 participants calling the oncological emergency telephone at a Danish university hospital was performed. Ethical considerations: The project observes demands for safekeeping data and all regulations concerning research ethics in agreement with the Nordic Nurses Federation and the Danish Health Act. Findings: Two main themes emerged: (1) to act responsibly as a patient or caregiver was to ‘be watchful and alert’, ‘report symptoms the right way’ and ‘do crosschecking’ and (2) to deal with the burden of responsibility was to ‘feel safe when dealing with the burden of responsibility’ and ‘be relieved from the burden of responsibility’. Discussion: Too much responsibility and a potential imbalance between healthcare professionals’ expectations and callers’ knowledge and capacity to act may place additional burdens on the callers, which may be eased by person-centred care. Conclusion: The meaning of responsibility appeared in the participants’ capacity to act, where they observed, assessed and reported symptoms and controlled prescribed treatments as well as shared or handed over the responsibility to the healthcare providers. Thus, the analysis provided essential knowledge for healthcare professionals on how patients and caregivers handle this responsibility when faced with a cancer disease that is treated on an outpatient basis.
Do Country ETFs Influence Foreign Stock Market Index? Evidence from India ETFs
Authors: Narend S. , Thenmozhi M. 
Published: April 2019

We examine the influence of country exchange traded funds (ETFs) on the country’s stock market indices, irrespective of their underlying benchmark. A pooled ordinary least square (OLS) analysis of a sample of 28 India ETFs listed in the US, UK, Canada, France, Japan, Israel and Singapore reveals that India ETFs have a significant impact on the country’s stock indices. We also document reverse causal dynamics between country ETFs and the country’s stock indices. The results are robust even after controlling for global effects, stock market volatility, foreign institutional investor (FII) flows, foreign exchange rate and asset size of India ETFs. The findings of the study have implications for global investors and policymakers in both emerging and developed markets. Policymakers would find it compelling to monitor country ETFs’ fund flows into the underlying country, as withdrawal of country ETFs could have a cascading effect on the economy. JEL Classification: G11, G15, G23
A Foxtail-Shaped Vermilion Flap to Reconstruct the Medial Tubercle in Asymmetric Bilateral Cleft Lip With Contralateral Lesser Form Defect
Authors: Nakajima Yuta , Yuzuriha Shunsuke , Nagai Fumio , Fujita Kenya , Noguchi Masahiko 
Published: April 2019

Objective: There have been few reports addressing asymmetric bilateral cleft lip repair with contralateral lesser form defects. Two studies have described the thin medial tubercle as the most common remaining labial deformity. In this study, we aimed to evaluate the use of a foxtail-shaped vermilion flap to reconstruct the median tubercle in primary repair. Design: A blinded retrospective study of photography and chart review. Setting: Shinshu University Hospital, tertiary care. Private practice. Patients: Forty-nine patients with asymmetric bilateral cleft lip with lesser form defects treated using a primary “unilateral” repair by the senior author (S.Y.) between 2007 and 2017. Interventions: The foxtail-shaped vermilion flap was applied at the time of the primary nasolabial repair. This flap is similar to Noordhoff laterally based triangular vermilion flap but with modifications to the shape and length. The body of the flap is wider than the pedicle to add tissue to the center of the vermilion, and the length is sufficiently elongated to reach the lesser side. Main Outcome Measure: Lip shape was graded on a 4-point scale when patients were 1 year old. Results: Twenty-two patients were treated with the foxtail-shaped vermilion flap (group A) and 27 patients with Noordhoff triangular vermilion flap (group B). Group A had a better lip shape than group B ( P = .006). Conclusions: The foxtail-shaped vermilion flap is useful to reconstruct the median tubercle in asymmetric bilateral cleft lip repair with contralateral lesser form defects.