bluuebunny/crossref_metadata_2025_split huggingface dataset:
Home ovulation test use and stress during subfertility evaluation: Subarm of a randomized controlled trial
Authors: Weddell Sarah , Jones Georgina L , Duffy Sheila , Hogg Cameron , Johnson Sarah , Ledger William 
Published: March 2019

Objectives: A prospective, randomized controlled trial in women seeking to conceive examined the impact of using ovulation tests on self-reported levels of stress, psychological well-being, and quality of life in women with unexplained infertility. Method: The test group used a home ovulation test to detect the day of ovulation, whereas the control group were provided with a predicted day of ovulation based on the average length of menstrual cycle reported during study recruitment. Volunteers collected their first morning urine samples to evaluate biochemical levels of stress (urinary cortisol and estrone-3-glucouronide) and completed questionnaires over two complete menstrual cycles. Results: Overall, the use of digital ovulation tests by sub-fertile women under medical care had negligible negative effects and no detectable positive benefit on psychological well-being, according to multiple measurements of stress by questionnaire and biochemical markers. No significant differences were found between groups for all stress measures at the various study time points, except in relation to “couple concordance” where the test group scored much higher than the control group (mean difference at end of study was 21.25 (95% confidence interval: 9.25, 33.25; P = 0.0015)). The maximum difference in log cortisol: creatinine ratio between the test and control groups was −0.28 (95% confidence interval: −0.69, 0.13). Conclusions: These results do not support propositions that using digital ovulation tests can cause stress in women trying to conceive.
Cardiac rehabilitation in the elderly patient in eight rehabilitation units in Western Europe: Baseline data from the EU-CaRE multicentre observational study
Authors: Prescott Eva , Mikkelsen Nicolai , Holdgaard Annette , Eser Prisca , Marcin Thimo , Wilhelm Matthias , Gil Carlos Peña , González-Juanatey José R , Moatemri Feriel , Iliou Marie Christine , Schneider Steffen , Schromm Eike , Zeymer Uwe , Meindersma Esther P , Ardissino Diego , Kolkman Evelien K , Prins Leonie F , van der Velde Astrid E , Van 't Hof Arnoud WJ , de Kluiver Ed P 
Published: March 2019

Background Due to the progressive deconditioning, comorbidities and higher complication rates, elderly patients are in particular need of cardiac rehabilitation. We compared elderly patients (65+ years old) participating in cardiac rehabilitation, focusing on baseline characteristics, risk factor control and functional assessment. Methods The EU-CaRE study is a prospective study comparing cardiac rehabilitation in eight centres across Western Europe. Consecutive patients with acute coronary syndrome, stable coronary artery disease and heart valve replacement undergoing cardiac rehabilitation were included. Results Of 1633 patients (median age 72 years) participating, 54% had acute coronary syndrome, 33% had stable coronary artery disease and 13% followed valve replacement. Fifty-five per cent had undergone percutaneous coronary intervention and 29% coronary artery bypass grafting. Characteristics varied across centres: 23% (17–27%) were women, 4% (0–12%) were of non-European origin and 16% (4–32%) were living alone. Median time from index event to start of cardiac rehabilitation varied from 11 to 49 days ( p < 0.001). Mean VO2peak was relatively low (16 mL/kg per min) and varied significantly between the participating centres, largely unaffected by multivariable adjustment. Overall patients received guideline recommended treatment: 93% (87–97%) were on a statin and 70% (55–85%) an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. However, risk factor control was inadequate: 58% had three or more risk factors not controlled. Conclusion EU-CaRE provides a snapshot of the elderly population with heart disease participating in cardiac rehabilitation across countries in Western Europe. Risk factors and exercise capacity indicate the continued need for cardiac rehabilitation in these patients. Of concern, the lag-time to start of cardiac rehabilitation needs improvement in many centres.
ISCHIOFEMORAL IMPINGEMENT IN ADOLESCENTS: FROM CLINICAL PRESENTATION TO RETURN TO SPORTS
Authors: Besomi Javier , Garin Alan , Herrera Cristhian , Salgado Pedro , Abara Selim , Tobar Carlos , Lara Joaquin 
Published: March 2019

Background: Ischiofemoral impingement is an often unrecognized cause of hip pain in adolescents. It is caused by abnormal contact between the proximal femur and the ischium. The aim of our work is to describe clinical presentation, imaging findings and functional outcomes of ischiofemoral impingement in adolescents. Methods: We performed a retrospective study. Clinical files were reviewed (age, sex, type and duration of symptoms and hip physical examination). Imaging findings were evaluated in pelvis radiographs (presence of coxa profunda, acetabular protrusio, Wiberg angle, femoral neck shaft angle and acetabular retroversion) and in MRI (quadratus femoris edema, measurement of ischiofemoral and quadratus femoris space). Lower extremity functional scale (LEFS) were used to measured response to a physiotherapy protocol. Also relapse and time to sports return were recorded. Results: 24 hips, two bilateral in 20 female patients and 2 male patients, with 13 years-old on average (9-18) were obtained. Main symptom was hip pain with latency to consultant of 9 days on average (2-14). All patients practiced school sports, the most frequent was gymnastics. Positive FADIR test, ischiofemoral impingement test and pain on palpation of the ischium and gluteus medius were found in everyone. The median of Wiberg angle was 37º (25-48), femoral shaft angle 138º (128-144), and coxa profunda was present in 5 hips. MRI showed 13 hips with quadratus femoris edema, one with muscle atrophy, ischiofemoral space was 20 mm on average (16-25) and quadratus femoris space 17 mm on average (13-21). Our physiotherapy protocol was followed for all patients with a median of 18 sessions (10-30). LEFS improved from 56.4% (30-93) to 92% (80-100) (p=0,02). Time to turn asymptomatic was 6 months on average (3-13). With 2 years follow up, 2 hips had recurrence of symptoms. Time to sports return was 5 months on average (3-7). Conclusions: Ischiofemoral impingement is cause of hip pain in active female adolescents. X-rays are inespecific and MRI shows typically quadratus femoris edema. Conservative treatment with physiotherapy is an effective method that allows sports return in few months. This is the first report in the literature regards ischiofemoral impingement in pediatric population including results of treatment and return to sports.
ARE SELF-REPORTED PAIN SCALES IN PEDIATRICS VALID?
Authors: Sabatino Meagan J. , Jo Chan-Hee , Wilson Philip L. , Ellis Henry B. 
Published: March 2019

Background: Pain is the most common symptom for presentation to an orthopaedic practice and orthopedists rank 4th among top prescribers of opiates. Pain acuity, etiology and severity have been published as guiding factors for pain assessment and management. In an attempt to address the underassessment and undertreatment of pain, pain was even considered the 5th vital sign for a period of time. Assessment of pain using validated severity assessment instruments including the Visual Analogue Scale and the Wong-Baker FACES® Scale, is common in orthopaedic practices. The purpose of this study is to evaluate the validity and sensitivity of self-reported pain assessment tools administered to pediatric and adolescent patients presenting with a primary complaint of knee pain. Methods: A retrospective review of 211 patients with a primary complaint of knee pain in a single practice over a nine-month period was completed. Medical records were reviewed for demographics, sport, laterality, symptoms, and factors described as influencing the pain. Prior to orthopaedic evaluation, patients were given an electronic tablet to complete patient reported outcomes measures and the visual analog scale (VAS). Patients were asked, electronically, “Do you have pain today?” and to verbally rate the pain using a Wong-Baker FACES® Pain Rating Scale (FACES). The FACES scale, typically a 0-5 rating, was normalized to a 0-10 scale for comparison to both the VAS and the pain component of the pedi-IKDC (Pain-pIKDC). A Pearson’s correlation was used to compare the VAS and the Pain-pIKDC with the FACES scores to determine validity. A paired t-test was used to identify differences between the three measures. Results: Of the 211 subjects, 112 were females and 99 were males, with a mean age of 13.9 years (range 7-18). 82% of patients reported presenting for pain due to a specific injury and not of spontaneous origin. The mean FACES score was 1.26 (normalized to 2.52) with a median score of 0. Compared to the FACES, the mean VAS was 4.22 (p<0.001) and Pain-pIKDC was 3.66 (p<0.001) noted to be both a statistically and clinically significant difference. When comparing the FACES to VAS, a weak correlation was noted (0.360, p<0.001). A stronger correlation was noted between the VAS and the Pain-pIKDC (0.752, p<0.001). 66.4% of patients reported no pain on the FACES but reported pain >1 on the Pedi-IKDC. 80.5% of patients reported no pain on FACES but pain of >1 on the VAS. Only 12.2% on VAS and 16.2% on Pain-pIKDC reported no pain . For both the VAS and Pain-pIKDC, the sensitivity of detecting “no pain” is low at 19.2% and 30.2% respectively. Conclusion: Though pain is widely accepted as an important factor for patient care management, clinicians should be aware that self-reported pain assessment tools in pediatrics and adolescents, without verbal confirmation, may inflate reported pain intensity and lead to possible overtreatment.
INCREASED LIKELIHOOD OF PEDIATRIC RECURRENT PATELLAR DISLOCATIONS BASED ON SEVERITY OF RADIOGRAPHIC MEASURES
Authors: Albiero William , Morscher Melanie A. , Elias John , Riley Pat , Adamczyk Mark , Jones Kerwyn 
Published: March 2019

Background: The etiology for recurrent patellar dislocations in children with patellofemoral instability (PFI) is not always apparent. Radiographic and other imaging measures help guide the clinician. However, the imaging parameters for pathologic pediatric PFI and the significance of these measures based on severity are not clearly defined. This study compares common imaging measures for PFI in a non-pathologic and known patellar dislocation pediatric population and determines the likelihood of symptoms based on the severity of each individual measure. Methods: An IRB-approved retrospective review of knee MRIs and radiographs at a single pediatric institution identified 108 limbs (102 patients) meeting inclusion criteria. Sixty-nine limbs had no known patellar pathology (control group) and 39 had surgery for recurrent patellar dislocations (surgical group). MRI measures included tibial tuberosity-trochlear groove distance (TT-TG), tibial tuberosity-posterior cruciate ligament distance (TT-PCL), and lateral trochlear inclination (LTI). Radiographic measures included the Caton-Deschamps Index (CDI) and Insall-Salvati Index (ISI). These measures are representative of PFI risk factors, specifically patellar tendon malalignment, trochlear dysplasia, and patella alta. Binomial logistic regression was used to relate the anatomical parameters to the probability of PFI. Results: The surgical and control groups were similar in terms of age, height and weight. The logistic regression analysis indicated that the TT-TG (p=0.001) and LTI (p<0.001) were correlated with PFI. The odds ratio (95% confidence interval) was 1.19 (1.07 -1.31) for TT-TG, giving the increased probability of a knee to experience PFI for each 1 mm increase. The odds ratio was 0.85 (0.77-0.93) for LTI, showing a decrease in the probability of instability with each 1° increase. Neither CDI nor ISI measures significantly correlated with probability of PFI (p=0.30 and p=0.18, respectively). The two parameters of TT-TG and LTI accounted for 42% (Nagelkerke R2) of the variance between the control and surgical groups. Conclusion/Significance: Comparing pediatric patients with recurrent patellar dislocations to controls, logistic regression analysis suggests the likelihood of PFI correlates with the severity of specific radiographic measures, specifically those representing the degree of patellar tendon alignment (TT-TG) and trochlear dysplasia (LTI). Knowing this correlation can help guide the treatment of PFI in pediatric patients by providing physicians and families with a continuum on which to base their decisions.
PATELLAR FACET MORPHOLOGY IN EARLY PEDIATRIC DEVELOPMENT
Authors: Wilson Philip L. , Ellis Henry B. , Ganley Theodore J. , Green Daniel W. , Fabricant Peter D. , Yen Yi-Meng , Tompkins Marc , Mayer Stephanie W. , Shea Kevin 
Published: March 2019

Background: The relative influence of patella and trochlear shape on the development of each structure is poorly understood. Articular morphology is felt to be an important factor influencing patellar instability. The purpose of this study was to evaluate the development of patellar facets in relation to age and sulcus depth in the pediatric knee. Methods: Dissection of 57 immature knees (1 month – 11 years; 36 male) was performed by fellowship-trained orthopaedic surgeons. A coordinated laser scanner, and analysis software (Hexagon Romer V3 CMM; Polyworks) were used to record cartilage anatomy. Patellar facets were identified as distinct regions of surface contour. In a subset of 30 specimens (2 years – 11 years; 22 male) trochlear cartilage sulcus angles were analyzed at points on the trochlea in relation to orientation angle from the femoral axis [F90° (perpendicular to the femoral axis, correlated to the posterior condylar axial slice), F120° (30° flexion), and F150° (60° flexion)]. Spearman’s correlations and nonparametric Mann-Whitney tests were evaluated for specimen age, patellar articular surface lengths, and trochlear sulcus angles. Results: There was strong correlation of patellar facet development with the angle of the cartilaginous femoral sulcus at 30° of flexion (p<0.001, rs=-0.696). With deepening femoral sulcus angles (range 137°-163°), there was an increase in the number of patellar facets present. Additionally, the presence of multiple medial facets was correlated with the sulcus angle at 30° (p<0.01) (Fig. 1). In the 13 specimens with a sulcus angle < 150°, all demonstrated well-formed patella with 5-7 facets identified. Within the group including those specimens younger than 2 years old, age (p<0.001) and width of the patellar articular surface (p<0.001) were correlated with the number of facets present. Multiple facet development on the lateral side of the patella was most strongly correlated with patellar articular surface width (p<0.001). Gender and the superior-most sulcus angle (F90°) didn’t correlate with patellar morphological development. The average number of facets identified was 3.8 (+/- 1.6), and the median number present was 4 (range 0-7). The most common patellar shape was 5 facets (n=16, age range 3 months – 11 years); medial, inferior-medial, lateral, inferior-lateral, and odd. Conclusion: Complex patellar morphology with multiple facets present is not uncommon in early pediatric development, with patellar width and the femoral sulcus angle at 30° as correlates. Significance: Patellar maturation may occur early and further investigation of the relationship of patellofemoral dysplasia on the early development of the corresponding structures is warranted. [Figure: see text]
A COMPARISON OF EMERGENCY PREPAREDNESS AND MEDICAL COVERAGE BETWEEN HIGH SCHOOL AND CLUB SPORT COACHES
Authors: Post Eric G. , Schaefer Dan , Biese Kevin M. , Cadmus-Bertram Lisa , Watson Andrew , McGuine Timothy A. , Brooks Alison , Bell David 
Published: March 2019

BACKGROUND: Recent studies have demonstrated that a large population of high-school aged athletes participate on club sport teams. Studies have documented emergency preparedness and medical coverage standards in the high school athletic setting. However, similar examinations do not exist for youth club sport teams. PURPOSE: To determine if differences in emergency preparedness and medical coverage exist between high school team coaches and high school-aged club team coaches. A secondary purpose was to compare emergency training characteristics between high school and club coaches. METHODS: A total of 769 coaches (female N=266, 34.6%, age: 41.0±11.5 years) completed an anonymous online questionnaire regarding their emergency preparedness and training. Coaches from 3 sports were surveyed (basketball N=290, volleyball N=256, soccer N=223). The questionnaire consisted of 1) demographics and information regarding the teams that the respondent coaches, 2) emergency preparedness factors such as automated external defibrillator (AED) availability, emergency action plan (EAP) awareness, and medical coverage, and 3) emergency care training requirements (CPR, AED, first aid). Chi-square tests were used to compare response frequencies to various emergency preparedness questions between high school and club coaches. RESULTS: Overall, 64.6% (N=497) respondents were coaches of a high school team, and 35.4% (N=272) were coaches of a club team with high school-aged athletes. High school coaches were more likely than club coaches to be aware of the EAP for their practice venue (83.9% vs. 54.4%, p<.001), but most coaches in both categories had not practiced their EAP in the past 12 months (70.0% vs. 68.9%, p=.54). During competitions, high school coaches were more likely than club coaches to be aware of the EAP (47.5% vs. 37.1%, p=.02). However, the majority of coaches in each category reported that they were never aware of EAPs during competition. High school coaches were more likely than club coaches to 1) have an AED available at practice (87.9% vs. 58.8%, p<.001), 2), to report that athletic trainers were responsible for medical care at practices (31.2% vs. 8.8%, p<.001) and competitions (57.9% vs. 31.2%, p<.001), and 3) to be required to have CPR, AED, or first aid training (p<.001). Nearly all (98.8%) high school coaches were required to have CPR training, and overall, 58.6% of high school coaches were required to have training in all 3 categories (CPR, AED, first aid) compared to 23.9% of club coaches (p<.001). CONCLUSIONS: High school sport coaches displayed greater levels of emergency preparedness and training compared to coaches of high school-aged club teams. Significant attention and effort is needed to improve emergency preparedness and medical coverage at the club sports level among basketball, soccer, and volleyball coaches.
HOW DO IMAGING PRACTICES VARY ACROSS THE UNITED STATES WHEN DIAGNOSING A MEDIAL EPICONDYLE FRACTURE?
Authors: Patel Neeraj M. , Talwar Divya , Lawrence J. Todd 
Published: March 2019

Background: A number of controversies surround the evaluation of medial epicondyle fractures, including the use of advanced imaging at the time of diagnosis. In an era of increased focus on resource utilization, an analysis of diagnostic testing for this injury is timely. The purpose of this study is to evaluate national variation in diagnostic imaging for pediatric medial epicondyle fractures. Methods: The Pediatric Health Information System, a national database consisting of 49 children’s hospitals, was queried for all patients with a medial epicondyle fracture between 2004 and 2015. Demographic information was collected as well as data regarding diagnostic imaging at initial presentation. United States Census guidelines were used to categorize hospitals geographically into regions and divisions. Univariate analysis was followed by purposeful entry multivariate regression to control for confounders. Results: A total of 7799 patients underwent 9961 imaging procedures at initial presentation, of which 9627 were plain radiographs (1.2 x-rays per patient). Additionally, 286 patients (3.7%) obtained a computed tomography (CT) scan and 46 (0.6%) received magnetic resonance imaging (MRI). After controlling for confounders in a multivariate model, patients in cities with a pediatric population below 300,000 were 2.5 times more likely to undergo CT scan than in a city with over 1 million children (95% CI 1.7, 3.9; p<0.001). Geography was also predictive, with children in the Northeast at 3.1 times higher odds of receiving a CT scan (95% CI 2.2, 4.3; p<0.001). When region was further stratified into Census division, those in New England had 4.6 times higher odds of undergoing CT (95% CI 2.5, 8.7; p<0.001). Patients treated at a hospital with 300 or fewer beds were 2.6 times more likely to receive MRI than in larger hospitals (95% CI 1.2, 5.4; p=0.01). Older age was associated with higher odds of receiving a CT (p<0.001) while younger age was associated with higher likelihood of MRI (p=0.006). Conclusions: There is substantial variation in imaging practices across the United States when diagnosing a medial epicondyle fracture. CT scans are more likely to be ordered in smaller cities and in older children, while MRI is more likely to be obtained in smaller hospitals and in younger children. CT is ordered most frequently in the Northeast, especially in New England. Improved evidence relating to the initial evaluation of medial epicondyle fractures may help reduce the current variation in resource utilization.