bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antibiotic-Loaded Collagen Sponges in Clinical Treatment of Chronic Osteomyelitis
Authors: van Vugt T.A.G. , Walraven J.M.B. , Geurts J.A.P. , Arts J.J.C. 
Published: January 2019

Background:
Chronic osteomyelitis is caused by bacterial infection of the bone and is a major problem in orthopaedic surgery. Treatment of chronic osteomyelitis requires surgical debridement accompanied by local and systemic administration of antibiotics. A widely established biodegradable local antibiotic carrier is antibiotic-loaded collagen sponges (fleeces). These sponges are commonly used in the treatment of chronic osteomyelitis, but a systematic review of their clinical efficacy and assessment of the quality of evidence have not been conducted, to our knowledge.

Methods:
This systematic review, performed according to the PRISMA statement, examined the clinical efficacy of and quality of evidence regarding different antibiotic-loaded collagen sponges in the clinical treatment of chronic osteomyelitis. Clinical efficacy was defined as eradication of infection with bone and wound-healing. In addition, the in vivo pharmacokinetics of the various collagen sponges were evaluated. Quality was based on the Level of Evidence, methodological quality, and risks of bias.

Results:
A total of 813 articles were screened, and 10 were included. Gentamicin-sulfate sponges and gentamicin-sulfate/gentamicin-crobefate sponges were studied. A total of 413 patients were treated, with a success rate of 91%. Reported complications were fistulas, prolonged wound drainage, and wound-healing problems. In vivo pharmacokinetic profiles showed an average local antibiotic concentration that was above the minimum inhibitory concentration for only 5 days. The general quality of the included studies was low to moderate, and there was a moderate to high risk of bias.

Conclusions:
The evidence quality and Level of Evidence of the included studies were low, and the risk of bias in these studies was high. This makes the evidence regarding these sponges inconclusive, and no clinical decision-making can be based on these studies. Utilization of antibiotic-loaded collagen sponges in the treatment of chronic osteomyelitis should only be carried out with caution; studies with high-level evidence are needed.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
The Sensitivity of Orthopaedic Surgeons to the Secondary Prevention of Fragility Fractures
Authors: Mo Jian , Huang Kangmao , Wang Xumeng , Sheng Xinyu , Wang Qiang , Fang Xiangqian , Fan Shunwu 
Published: January 2019

Background:
Orthopaedic surgeons must play an important role in the secondary prevention of fragility fractures; however, some surgeons are more aware than others of their responsibility regarding fracture prevention. The purpose of the present study was to identify which factors can lead to a higher sensitivity for fracture prevention.

Methods:
A cross-sectional survey was distributed to orthopaedic surgeons via online invitation or at academic conferences in China from July through October 2015. A total of 452 surgeons responded. As the primary outcome measure, we created a sensitivity scoring system for fracture prevention based on the respondents’ answers to 5 questions regarding behavior in the following areas: risk-factor evaluation, pharmacologic therapy, nonpharmacologic therapy, patient education, and follow-up. Multivariable linear regression and multivariable logistic regression analyses were used to identify factors related to surgeon sensitivity to fracture prevention.

Results:
Very few surgeons reported having received adequate training regarding fracture prevention or reading guidelines or other fracture prevention literature (22% and 30%, respectively). Most respondents initiated pharmacologic or nonpharmacologic therapy (82% and 75%, respectively) for the treatment of confirmed osteoporosis among patients with fragility fractures, but only half performed a risk-factor evaluation, patient education, or timely patient follow-up (51%, 52%, and 48%, respectively). In the multivariable linear regression model, the orthopaedic surgeon’s age (β = 0.09, p = 0.003), self-rated knowledge level regarding osteoporosis or related issues (β = 0.16, p < 0.001), self-perceived effectiveness in using preventive measures for patients with a fragility fracture (β = 0.62, p < 0.001), and use of clinical pathways for fragility fractures in his or her workplace (β = 1.24, p < 0.001) were independently associated with sensitivity scores for fracture prevention. Similar results were obtained from a multivariable logistic regression model.

Conclusions:
In China, the sensitivity of orthopaedic surgeons to the secondary prevention of fragility fractures is relatively low. Implementation of a comprehensive prevention approach and targeted continuing medical education are required to encourage surgeons to take greater responsibility for screening, treating, educating, and following their patients with fragility fractures.
Self-Reported Marijuana Use Is Associated with Increased Use of Prescription Opioids Following Traumatic Musculoskeletal Injury
Authors: Bhashyam Abhiram R. , Heng Marilyn , Harris Mitchel B. , Vrahas Mark S. , Weaver Michael J. 
Published: January 2019

Background:
Cannabinoids are among the psychoactive substances considered as alternatives to opioids for the alleviation of acute pain. We examined whether self-reported marijuana use was associated with decreased use of prescription opioids following traumatic musculoskeletal injury.

Methods:
Our analysis included 500 patients with a musculoskeletal injury who completed a survey about their marijuana use and were categorized as (1) never a user, (2) a prior user (but not during recovery), or (3) a user during recovery. Patients who used marijuana during recovery indicated whether marijuana helped their pain or reduced opioid use. Prescription opioid use was measured as (1) persistent opioid use, (2) total prescribed opioids, and (3) duration of opioid use. Persistent use was defined as the receipt of at least 1 opioid prescription within 90 days of injury and at least 1 additional prescription between 90 and 180 days. Total prescribed opioids were calculated as the total morphine milligram equivalents (MME) prescribed after injury. Duration of use was the interval between the first and last opioid prescription dates.

Results:
We found that 39.8% of patients reported never having used marijuana, 46.4% reported prior use but not during recovery, and 13.8% reported using marijuana during recovery. The estimated rate of persistent opioid use ranged from 17.6% to 25.9% and was not associated with marijuana use during recovery. Marijuana use during recovery was associated with increases in both total prescribed opioids (regression coefficient = 343 MME; 95% confidence interval [CI] = 87 to 600 MME; p = 0.029) and duration of use (coefficient = 12.5 days; 95% CI = 3.4 to 21.5 days; p = 0.027) compared with no previous use (never users). Among patients who reported that marijuana decreased their opioid use, marijuana use during recovery was associated with increased total prescribed opioids (p = 0.008) and duration of opioid use (p = 0.013) compared with never users.

Conclusions:
Our data indicate that self-reported marijuana use during injury recovery was associated with an increased amount and duration of opioid use. This is in contrast to many patients’ perception that the use of marijuana reduces their pain and therefore the amount of opioids used.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Opioids in Arthroplasty
Authors: Agrawal Yuvraj , Smith R. Malcolm , Garbuz Donald S. , Masri Bassam A. 
Published: January 2019

➤ From 1999 to 2016, >200,000 people died in the U.S. from overdoses related to prescription opioids.➤ Pain is a cognitive, emotional, and behavioral response to nociception. Maladaptive behaviors, such as pain catastrophizing, interfere with the patient’s ability to cope with pain.➤ Less adaptive coping strategies such as catastrophic thinking lead to greater pain intensity for a given nociception.➤ Preoperative or postoperative opioid use for a prolonged period is associated with a higher risk of dependency and death.➤ Prolonged use of opioid medication in the perioperative period is also associated with revision surgery in arthroplasty.➤ Family physicians and orthopaedic surgeons are urged to review their prescription practices; to develop guidelines for responsible prescription management, with upper limits set on opioids; and to have a clearly understood and agreed-on pain management program for each patient.
Extended Oral Antibiotic Prophylaxis in High-Risk Patients Substantially Reduces Primary Total Hip and Knee Arthroplasty 90-Day Infection Rate
Authors: Inabathula Avinash , Dilley Julian E. , Ziemba-Davis Mary , Warth Lucian C. , Azzam Khalid A. , Ireland Philip H. , Meneghini R. Michael 
Published: January 2019

Background:
Total joint arthroplasty (TJA) episodic payment models shift risk and cost of periprosthetic joint infection (PJI) to surgeons and hospitals, causing some to avoid treating high-risk patients. Furthermore, there are little data to support optimization of host factors preoperatively to decrease PJI, and recent literature supports using extended antibiotic prophylaxis following reimplantation TJA. The purpose of this study was to evaluate whether extended oral antibiotic prophylaxis minimized PJI after primary TJA in high-risk patients.

Methods:
A retrospective cohort study was performed of 2,181 primary total knee arthroplasties (TKAs) and primary total hip arthroplasties (THAs) carried out from 2011 through 2016 at a suburban academic hospital with modern perioperative and infection-prevention protocols. Beginning in January 2015, extended oral antibiotic prophylaxis for 7 days after discharge was implemented for patients at high risk for PJI. The percentages of patients diagnosed with PJI within 90 days were identified and compared between groups that did and did not receive extended oral antibiotic prophylaxis, with p ≤ 0.05 indicating significance.

Results:
The 90-day infection rates were 1.0% and 2.2% after the TKAs and THAs, respectively. High-risk patients without extended antibiotic prophylaxis were 4.9 (p = 0.009) and 4.0 (p = 0.037) times more likely to develop PJI after TKA and THA, respectively, than high-risk patients with extended antibiotic prophylaxis.

Conclusions:
Extended postoperative antibiotic prophylaxis led to a statistically significant and clinically meaningful reduction in the 90-day infection rate of selected patients at high risk for infection. We encourage further study and deliberation prior to adoption of a protocol involving extended oral antibiotic prophylaxis after high-risk TJA, with the benefits weighed appropriately against potential adverse consequences such as increasing the development of antimicrobial resistance.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Association of Body Mass Index with Risk of Long-Term Revision and 90-Day Mortality Following Primary Total Hip Replacement
Authors: Mouchti Sofia , Whitehouse Michael R. , Sayers Adrian , Hunt Linda P. , MacGregor Alexander , Blom Ashley W. 
Published: January 2019

Background:
The influence of obesity on outcomes following total hip replacement is unclear. Restriction of total hip replacement on the basis of body mass index (BMI) has been suggested. The purpose of this study was to assess the influence of BMI on the risk of revision and 90-day mortality.

Methods:
This was a population-based, longitudinal cohort study of the National Joint Registry (NJR) for England, Wales, Northern Ireland and the Isle of Man. Using data recorded from April 2003 to December 2015, linked to Office for National Statistics data, we ascertained revision and 90-day mortality rates following primary total hip replacement by BMI category. The probability of revision was estimated using Kaplan-Meier methods. Associations of BMI with revision and mortality were explored using adjusted Cox proportional hazards regression models.

Results:
We investigated revision and 90-day mortality among 415,598 and 413,741 primary total hip replacements, respectively. Each data set accounts for approximately 52% of the total number of recorded operations in the NJR. Thirty-eight percent of the patients were classified as obese. At 10 years, class-III obese patients had the highest cumulative probability of revision (6.7% [95% confidence interval (CI), 5.5% to 8.2%]), twice that of the underweight group (3.3% [95% CI, 2.2% to 4.9%]). When the analysis was adjusted for age, sex, American Society of Anesthesiologists [ASA] grade, year of operation, indication, and fixation type, compared with patients with normal BMI, significantly elevated hazard ratios (HRs) for revision were observed for patients in the BMI categories of class-I obese (≥30 to <35 kg/m2) (HR, 1.14 [95% CI, 1.07 to 1.22]), class-II obese (≥35 to <40 kg/m2) (HR, 1.30 [95% CI, 1.19 to 1.40]), and class-III obese (≥40 to ≤60 kg/m2) (HR, 1.43 [95% CI, 1.27 to 1.61]) (p < 0.0005 for all). Underweight patients had a substantially higher cumulative probability of 90-day mortality (1.17%; 95% CI, 0.86% to 1.58%) compared with patients with normal BMI (0.43%; 95% CI, 0.39% to 0.48%). The risk of 90-day mortality was significantly higher for the underweight group (HR, 2.09 [95% CI, 1.51 to 2.89]; p < 0.0005) and significantly lower for patients who were categorized as overweight (HR, 0.70; 95% CI, 0.61 to 0.81; p < 0.0005), class-I obese (HR, 0.69 [95% CI, 0.59 to 0.81]; p < 0.0005), and class-II obese (HR, 0.79 [95% CI, 0.63 to 0.98]; p = 0.049) compared with patients with normal BMI.

Conclusions:
Although long-term revision rates following total hip replacement were higher among obese patients, we believe that the rates remained acceptable by contemporary standards and were balanced by a lower risk of 90-day mortality.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Evolution and Interpretation of the Gustilo and Anderson Classification
Authors: Yim Guang H. , Hardwicke Joseph T. 
Published: January 2019

Background:
The Gustilo classification is the most established system for classifying open fractures. Despite this, the classification has changed in how it has been described and interpreted. We have traced how this classification has slowly evolved throughout the literature over the past 4 decades.

Methods:
A systematic search of the literature was undertaken with the MEDLINE, Embase, and PubMed databases to source relevant articles that have evolved the interpretation of the Gustilo classification. The references from these articles were consecutively hand-searched to find other articles that describe the Gustilo classification.

Results:
There was a total of 393 results from the Healthcare Databases Advanced Search (HDAS): 95 from MEDLINE, 49 from Embase, and 249 from PubMed. Fifty-six articles were initially selected; an additional 67 articles were retrieved through reference checking and further checking of relevant articles until no additional relevant articles could be found.

Conclusions:
The original Gustilo and Anderson classification initially was modified by Gustilo before subtle changes were made to the descriptors in the 1990s. Some authors have used the Gustilo classification to create alternative classifications, but these have not gained traction. Other contemporaneous literature has modified the Gustilo-IIIB subtypes to better stratify functional and reconstructive outcomes following vascular injury. The impact and longevity of such recent modifications are yet to be known.
The Use of a Self-Administered Questionnaire to Reduce Consultation Wait Times for Potential Elective Lumbar Spinal Surgical Candidates
Authors: Coyle Matthew J. , Roffey Darren M. , Phan Philippe , Kingwell Stephen P. , Wai Eugene K. 
Published: January 2019

Background:
In a public health-care system, patients often experience lengthy wait times to see a spine surgeon for consultation, and most patients are found not to be surgical candidates, thereby prolonging the wait time for those who are. The aim of this study was to evaluate whether a self-administered 3-item questionnaire (3IQ) could reprioritize consultation appointments and reduce wait times for lumbar spinal surgical candidates.

Methods:
This prospective, pragmatic, blinded, randomized controlled quality improvement study was conducted at a single Canadian academic health-care center. This study enrolled 227 consecutive eligible participants with an elective lumbar condition who were referred for consultation with a spine surgeon. All participants were mailed the 3IQ after their referral was received. Patients were randomized into the intervention group, in which leg-dominant pain reported on the 3IQ resulted in an upgrade in priority to be seen, or into the control group, in which no change to wait-list priority occurred. The main outcome measured was time to consultation for participants who were deemed surgical candidates following consultation.

Results:
There were no significant differences between groups with regard to demographics, overall group wait times, proportion of surgical candidates, or disability. A total of 33 patients were deemed surgical candidates after consultation. The median wait from referral to consultation was shorter for the 16 surgical candidates in the intervention group (2.5 months; interquartile range [IQR]: 2.0 to 4.8 months) compared with the 17 surgical candidates in the control group (4.5 months; IQR: 3.4 to 6.9 months; p = 0.090). The odds of seeing a surgical candidate within the acceptable time frame of 3 months were 5.4 times greater (95% confidence interval: 1.2 to 24.5 times; p = 0.024) in the intervention group.

Conclusions:
The use of a simple, self-administered questionnaire to reprioritize referrals resulted in shorter consultation wait times for patients who required a surgical procedure and significantly increased the number of surgical candidates seen within the acceptable time frame. It may be valuable to consider adding the 3IQ to clinical care practices to better triage these patients on waiting lists.
Identification of Areas of Epiphyseal Cartilage Necrosis at Predilection Sites of Juvenile Osteochondritis Dissecans in Pediatric Cadavers
Authors: Tóth Ferenc , Tompkins Marc A. , Shea Kevin G. , Ellermann Jutta M. , Carlson Cathy S. 
Published: January 2019

Background:
The pathogenesis of human juvenile osteochondritis dissecans (JOCD) remains poorly understood, with multiple factors implicated, including ischemia, repetitive trauma, and genetic predisposition. Similarities in the predilection site and the diagnostic and clinical features of JOCD to the well-characterized veterinary counterpart, osteochondrosis dissecans, suggest that, similar to the animal disease, the pathogenesis JOCD may also be initiated in the first few years of life, when disruption of blood supply to the epiphyseal growth cartilage leads to failure of endochondral ossification. To gather data in support of the hypothesis that JOCD and osteochondrosis dissecans have a shared pathogenesis, biopsy specimens obtained from predilection sites of JOCD in juvenile human cadavers were histologically examined to determine whether they contained lesions similar to those found in animals diagnosed with subclinical osteochondrosis dissecans.

Methods:
In this descriptive laboratory study, 59 biopsy specimens (6 mm in diameter) were harvested from the central aspect (i.e., the notch side) of the femoral condyles of 26 human cadavers (1 month to 11 years old). Specimens were histologically evaluated for the presence of areas of cartilage necrosis and the morphology of cartilage canal blood vessels.

Results:
Locally extensive areas of necrotic epiphyseal cartilage were identified in 4 specimens obtained from 3 donors (ages 2 to 4 years). Areas of cartilage necrosis accompanied by focal failure of endochondral ossification or surrounded by subchondral bone were identified in biopsy specimens from 4 donors (ages 4 to 9 years).

Conclusions:
The identification of epiphyseal cartilage necrosis identical to that described in animals with subclinical osteochondrosis, found in biopsy specimens obtained from femoral predilection sites of JOCD in pediatric cadavers, suggests a shared pathogenesis of JOCD in humans and osteochondrosis dissecans in animals.

Clinical Relevance:
These findings imply that the pathogenesis of human JOCD likely starts 5 to 10 years prior to the development of clinical symptoms. Enhanced understanding of the temporal features of JOCD pathogenesis provides an opportunity for earlier diagnosis and treatment, likely resulting in improved outcomes for this condition in the future.
Obowiązki organów administracji publicznej w zakresie przetwarzania danych w systemach zinformatyzowanych przed i po wejściu w życie RODO i nowelizacji ustawy o ochronie danych osobowych
Authors: Skoczylas Dominika 
Published: January 2019

Celem artykułu jest wskazanie konsekwencji prawnych w zakresie dotyczącym zapewnienia bezpieczeństwa przetwarzania danych osobowych w systemach zinformatyzowanych. Ustawodawca wyznaczył administratorom danych osobowych, konkretne obowiązki w kwestii ustalenia odpowiednich środków organizacyjnych, osobowych, rzeczowych i technicznych, które mają uniemożliwić posługiwanie się danymi osobowymi przez nieuprawnione podmioty w nielegalnym celu. Od maja 2018 r. obowiązuje Rozporządzenie Parlamentu Europejskiego i Rady 2016/679 o ochronie danych osobowych. Wprowadza nowe regulacje prawne np. ustanawia inspektora ochrony danych. Pierwsza część artykułu wskazuje zadania administratorów danych polegające na użyciu środków zabezpieczających dane osobowe w systemach zinformatyzowanych, przed wejściem w życie RODO i ustawy z 10.5.2018 r. o ochronie danych osobowych. W drugiej zawarto najważniejsze zmiany odnoszące się do administratorów danychosobowych, określone w RODO i ustawie o ochronie danych osobowych. Metody badawcze obejmują komparatystyczną analizę podstawowych tekstów aktów prawnych z wykorzystaniem literatury przedmiotu (zastosowano metodę porównawczo-prawną).
Definicje normatywne biopaliw ciekłych i biokomponentów oraz ich wzajemne zależności
Authors: Kruk Artur 
Published: January 2019

Głównym celem artykułu jest scharakteryzowanie definicji normatywnych biopaliw ciekłych oraz biokomponentów, a także wzajemnych zależności i ich wpływu na obowiązki reglamentacyjne wytwarzania obu tych substancji i inne aspekty normatywne i pozanormatywne dotyczące tych sektorów. Podjęty problem jest niezwykle złożony, pozostaje przedmiotem zainteresowania wielu dyscyplin, a ponadto omawiane przepisyzawierają pewną sprzeczność, która może powodować obejścia prawa lub nieporozumienia interpretacyjne. Ważna jest więc możliwie jak najszersza analiza przytoczonych zagadnień, dlatego w artykule zostaną wskazane nie tylko odpowiednie akty prawne, ale także niezbędne informacje technologiczne oraz ekonomiczne, oddające istotę zagadnienia.