bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intramedullary Fixation Techniques for the Anterior Pelvic Ring
Authors: Eastman Jonathan G. , Chip Routt Milton L. 
Published: August 2018

Summary:
The superior ramus is an irregularly shaped, undulating, and curvilinear osseous structure that can provide an osseous conduit for intramedullary screws. A wide spectrum of variability between the curve and obliquity of the superior ramus osseous fixation pathway (OFP) exists in both the anteroposterior and the coronal planes. A detailed understanding of the osseous topography and how it correlates with fluoroscopic imaging is mandatory. Obtaining the correct intraoperative inlet and combined obturator oblique–outlet fluoroscopic views specific to each patient's anatomy is necessary for safe implant insertion. Intramedullary screws can be inserted in either an antegrade or a retrograde direction depending on a number of variables, including fracture location, the proximity of patient's external genitalia to the skin insertion side, and the possible impact of thigh girth on the surgeons hand position. Multiple screw insertion techniques are possible, but a simple and reproducible technique is described. The size and number of screws that can be inserted is variable, differs between surgeons, but is ultimately dependent on the cortical limits of the superior ramus OFP. Standard screw insertion techniques are successful in most patients. If the osseous corridor or external anatomy impedes standard insertional techniques, several modifications exist that can allow successful screw insertion. A thorough understanding of each patient's anatomy, injury, and precise surgical technique with the appropriate fluoroscopic views are required to safely place intraosseous intramedullary implants into the superior ramus OFP.
Long Segment Blocking Screws Increase the Stability of Retrograde Nail Fixation in Geriatric Supracondylar Femur Fractures: Eliminating the “Bell-Clapper Effect”
Authors: Auston Darryl , Donohue David , Stoops Kyle , Cox Jacob , Diaz Miguel , Santoni Brandon , Mir Hassan 
Published: August 2018

Objectives:
To determine the change in stiffness and horizontal translations of a geriatric supracondylar femur fracture model with the addition of distal segment blocking screws versus proximal (long) segment blocking screws to the standard retrograde intramedullary nail construct.

Methods:
Unstable supracondylar femur fractures (OTA/AO 33-A3) were created; all specimens were instrumented with a retrograde intramedullary nail. Specimens were divided into 2 groups (6 matched pairs per group). Group 1 compared the standard construct (1 proximal screw and 3 distal screws) to a distally augmented construct, with blocking screws placed in the distal metaphyseal segment. Group 2 compared the distally augmented construct to one in which blocking screws were placed just proximal to the fracture (long segment blocking screws). Specimens were then axially loaded and cycled to failure or run-out.

Results:
There was no significant difference in baseline stiffness, survival through cyclic loading, stiffness after cyclic loading, or cycles to failure between femurs treated with distal blocking screws and femurs treated without blocking screws (group 1). Femurs with blocking screws in the long proximal segment had significantly greater baseline stiffness, stiffness after cyclic loading, and less horizontal translation at the fracture site (group 2). There was no difference in survival through cyclic loading or cycles to failure.

Conclusion:
Long segment blocking screws are biomechanically superior to blocking screws in the distal segment or no blocking screws initially and after cyclic loading in an unstable geriatric supracondylar femur fracture model treated with intramedullary nail.

Clinical Relevance:
Surgeons may use blocking screws to aid in fracture alignment during retrograde nail fixation. In addition, the placement of long segment blocking screws can help resist failure of fixation in geriatric patients by eliminating the “Bell-clapper effect.”
Posterior Spinal Fusion in a Scoliotic Patient With Congenital Heart Block Treated With Pacemaker
Authors: Wong Tat Seng , Abu Bakar Jaseemuddeen , Chee Kok Han , Hasan Mohd Shahnaz , Chung Weng Hong , Chiu Chee Kidd , Chan Chris Yin Wei , Kwan Mun Keong 
Published: August 2018

Study Design.
Case report.

Objective.
To describe the technical difficulties on performing posterior spinal fusion (PSF) on a pacemaker-dependent patient with complete congenital heart block and right thoracic scoliosis.

Summary of Background Data.
Congenital complete heart block requires pacemaker implantation at birth through thoracotomy, which can result in scoliosis. Corrective surgery in this patient was challenging. Height gain after corrective surgery may potentially cause lead dislodgement. The usage of monopolar electrocautery may interfere with the function of the implanted cardiac device.

Methods.
A 17-year-old boy was referred to our institution for the treatment of right thoracic scoliosis of 70°. He had underlying complete congenital heart block secondary to maternal systemic lupus erythematosus. Pacemaker was implanted through thoracotomy since birth and later changed for four times. PSF was performed by two attending surgeons with a temporary pacing inserted before the surgery. The monopolar electrocautery device was used throughout the surgery.

Results.
The PSF was successfully performed without any technical issues and complications. Postoperatively, his permanent pacemaker was functioning normally. Three days later, he was recovering well and was discharged home from hospital.

Conclusion.
This case indicates that PSF can be performed successfully with thoughtful anticipation of technical difficulties on a pacemaker-dependent patient with underlying congenital heart block.

Level of Evidence: 5
Sources of Patients’ Expectations of Lumbar Surgery
Authors: Mancuso Carol A. , Duculan Roland , Cammisa Frank P. , Sama Andrew A. , Hughes Alexander P. , Lebl Darren R. , Girardi Federico P. 
Published: August 2018

Study Design.
A cross-sectional, mixed methods analysis of sources of expectations of lumbar surgery.

Objective.
The aim of this study was to ascertain sources of expectations and compare them to clinical characteristics.

Summary of Background Data.
Understanding where patients obtain expectations of lumbar surgery is necessary in order to develop interventions to foster appropriate expectations.

Methods.
This was a qualitative-quantitative study of 428 patients interviewed preoperatively with a 20-item validated survey, which asks patients how much improvement they expect per item. Patients then were asked open-ended questions about how they came to have these expectations and, using qualitative analysis, responses were grouped into themes representing different sources of expectations. The likelihood of citing various sources was then assessed with odds ratios (ORs) based on demographic and clinical characteristics.

Results.
Patients’ mean age was 55 years, 80% had degenerative diagnoses and 24% had prior lumbar surgery. Patients volunteered multiple sources; most prevalent were current surgeon (83%), internet resources (55%), social network contacts (26%), other physicians (22%); and previous experience (65%) for the subgroup who had prior lumbar surgery. Patients were more likely to cite their surgeon if they had less disability [OR 2.8, confidence interval (CI) 1.3–5.8, P = 0.007], were treated with conservative care, such as physical therapy (OR 2.7, CI 1.6–4.7, P = 0.0003), and had symptoms for ≤12 months (OR 1.8, CI 1.1–3.0, P = 0.03). Patients who cited the internet were employed (OR 2.2; CI 1.5–3.3; P < 0.0001), were treated with physical therapy (OR 1.9; CI 1.2–3.1; P = 0.006), had a negative screen for depression (OR 1.8; CI 1.2–2.8; P = 0.004), and were younger (OR 1.6; CI 1.1–2.4; P = .02). Patients were less likely to expect complete improvement for most items of the survey if they had prior lumbar surgery (P = 0.002) or other orthopedic surgery (P = 0.02).

Conclusion.
Patients derive their expectations of lumbar surgery from multiple sources. Some sources are modifiable through enhanced communication with surgeons and potentially through novel modes of education, such as web-based resources that are specifically designed to address expectations.

Level of Evidence: 2
POLD1 and POLE Gene Mutations in Jewish Cohorts of Early-Onset Colorectal Cancer and of Multiple Colorectal Adenomas
Authors: Rosner Guy , Gluck Nathan , Carmi Shai , Bercovich Dani , Fliss-Issakov Naomi , Ben-Yehoyada Merav , Aharon-Caspi Sivan , Kellerman Efrat , Strul Hana , Shibolet Oren , Kariv Revital 
Published: August 2018

BACKGROUND:
Germline mutations in the DNA polymerase genes POLD1 and POLE confer high risk for multiple colorectal adenomas and colorectal cancer. However, prevalence and the clinical phenotype of mutation carriers are still not fully characterized.

OBJECTIVE:
The purpose of this study was to assess the prevalence of germline mutations and to describe the genotype-phenotype correlation in POLD1 and POLE genes in Jewish subjects with multiple colorectal adenomas and/or early-onset mismatch repair proficient colorectal cancers.

DESIGN:
This study is a comparison of genetic and clinical data from affected and control groups.

SETTINGS:
The study was conducted at a high-volume tertiary referral center.

PATIENTS:
The study cohort included 132 subjects: 68 with multiple colorectal adenomas and 64 with early-onset mismatch repair proficient colorectal cancers. The control group included 5685 individuals having no colorectal cancer or colorectal adenomas.

MAIN OUTCOME MEASURES:
Study and control subjects were tested for POLD1 and POLE mutations and a clinical correlation was assessed.

RESULTS:
Eleven of the 132 study subjects (8.3%) carried either a POLD1 or a POLE mutation: 7 of 68 (10.3%) subjects with multiple colorectal adenomas and 4 of 64 (6.2%) subjects with early-onset mismatch repair proficient colorectal cancer. Three mutations were detected, showing statistical significance in frequency between study and control groups (p < 0.001). Eight of the 11 mutation carriers were Ashkenazi Jews carrying the same POLD1 mutation (V759I), implicating it as a possible low-to-moderate risk founder mutation. Phenotype of mutation carriers was notable for age under 50 at diagnosis, a propensity toward left-sided colorectal cancer, and extracolonic tumors (64%, 100%, and 27% of cases).

LIMITATIONS:
The study cohort was limited by its relatively small size.

CONCLUSIONS:
Germline mutations in POLD1 and POLE were found to be relatively frequent in our Jewish cohorts. Further studies are needed to clarify the importance of POLD1 and POLE mutations and to define the most suitable surveillance program for Jewish and other POLD1 and POLE mutation carriers. See Video Abstract at http://links.lww.com/DCR/A658.
Enhanced Recovery Protocols for Adults Undergoing Colorectal Surgery: A Systematic Review and Meta-analysis
Authors: Greer Nancy L. , Gunnar William P. , Dahm Philipp , Lee Alice E. , MacDonald Roderick , Shaukat Aasma , Sultan Shahnaz , Wilt Timothy J. 
Published: August 2018

BACKGROUND:
Enhanced surgical recovery protocols are designed to reduce hospital length of stay and health care costs.

OBJECTIVE:
This study aims to systematically review and summarize evidence from randomized and controlled clinical trials comparing enhanced recovery protocols versus usual care in adults undergoing elective colorectal surgery with emphasis on recent trials, protocol components, and subgroups for surgical approach and colorectal condition.

DATA SOURCES:
MEDLINE from 2011 to July 2017; reference lists of existing systematic reviews and included studies were reviewed to identify all eligible trials published before 2011.

STUDY SELECTION:
English language trials comparing a protocol of preadmission, preoperative, intraoperative, and postoperative components with usual care in adults undergoing elective colorectal surgery were selected.

INTERVENTION:
The enhanced recovery protocol for colorectal surgery was investigated.

MAIN OUTCOME MEASURES:
Length of stay, perioperative morbidity, mortality, readmission within 30 days, and surgical site infection were the primary outcomes measured.

RESULTS:
Twenty-five trials of open or laparoscopic surgery for cancer or noncancer conditions were included. Enhanced recovery protocols consisted of 4 to 18 components. Few studies fully described the various components. Length of stay (mean reduction, 2.6 days; 95% CI, –3.2 to –2.0) and risk of overall perioperative morbidity (risk ratio, 0.66; 95% CI, 0.54–0.80) were lower in enhanced recovery protocol groups than in usual care groups (moderate-quality evidence). All-cause mortality (rare), readmissions, and surgical site infection rates were similar between protocol groups (low-quality evidence). In predefined subgroup analyses, findings did not vary by surgical approach (open vs laparoscopic) or colorectal condition.

LIMITATIONS:
Protocols varied across studies and little information was provided regarding compliance with, or implementation of, specific protocol components.

CONCLUSIONS:
Enhanced recovery protocols for adults undergoing colorectal surgery improve patient outcomes with no increase in adverse events. Evidence was insufficient regarding which components, or component combinations, are key to improving patient outcomes. PROSPERO registration number: CRD42017067991.
Silicone Migration and Late Hematoma following Silicone Implant Rupture: Case Report and Literature Review
Authors: Dean Riley A. , Glener Adam D. , Thomas Analise B. , Glener Steven R. , Kurtovic Silvia , Erdmann Detlev 
Published: August 2018

Summary:
Distant silicone migration and late postoperative hematoma are rare but serious complications following breast implant rupture. This study describes a case report of both these complications occurring in the same patient. After a review of pertinent literature, the authors found 19 other case reports (20 total patients) with distant silicone migration following breast implant rupture. Median age at the time of presentation was 48 years (range, 21–76), and median time between initial breast augmentation and presentation with silicone migration was 10 years (range, 1–30 years). Sites of migrated silicone included arm/forearm (n = 11), thoracic cavity (n = 4), abdominal wall (n = 3), legs (n = 2), and back (n = 1). A total of 67% of patients had documented trauma to the chest before presentation. Our study highlights the need to consider distant silicone migration in the differential diagnosis when extracapsular implant rupture is suspected.
Development and Psychometric Testing of the Registered Nurses’ Perceptions of Rewarding Scale
Authors: SEITOVIRTA Jaana , LEHTIMÄKI Aku-Ville , VEHVILÄINEN-JULKUNEN Katri , MITRONEN Lasse , KVIST Tarja 
Published: August 2018

ABSTRACT

Background:
Rewarding is a powerful way to recognize, manage, and retain staff. However, the perceptions of registered nurses (RNs) toward rewarding have not yet been extensively examined in nursing studies. It is important to identify optimal and potentially innovative ways to reward RNs by taking their perceptions into consideration.

Purpose:
The aim of this study was to develop and psychometrically test the Registered Nurses’ Perceptions of Rewarding Scale (RNREWS).

Methods:
A cross-sectional study design was used. The scale was developed in the three phases of item generation, content validity testing, and examination of psychometric properties. Tests of the scale included evaluation of content validity, exploratory factor analysis, parallel analysis, and internal consistency tests using Cronbach’s alpha. Survey participants included 402 RNs working in Finnish healthcare in Autumn 2015.

Results:
The RNREWS was found to have acceptable construct validity and good internal consistency. Exploratory factor analysis indicated that a 66-item scale with a 14-factor structure fits the data best. The final scale includes two subscales. The first is “reward type preferences” with 61 items covering 13 factors, and the second is “significance of rewarding” with five items covering one factor. The two sets of items accounted for 73.1% and 58.5% of the variance in responses and earned Cronbach’s α values of .90 and .80, respectively.

Conclusions:
The RNREWS is a valid and reliable instrument for acquiring knowledge regarding the perspective of RNs on rewarding in the nursing context. The results enhance the understanding of the range of rewards that may be implemented in the nursing profession and may assist human resources managers and administrators to formulate effective reward systems for their RNs to improve the rewarding and retention of nursing professionals. However, cultural equivalence and linguistic differences must be considered if this scale is to be applied in other countries or environments.
Development and Validity Testing of an Assessment Tool for Domestic Elder Abuse
Authors: YI Qinqiuzi , HONDA Junko , HOHASHI Naohiro 
Published: August 2018

ABSTRACT

Background:
The older adult population is increasing in number, and elder abuse is expected to become a more pressing problem. Developing tools to assess the presence and severity of elder abuse is important to both effectively prevent this abuse and provide increased support for families.

Purpose:
This study was intended to test the validity of an Assessment Tool for Domestic Elder Abuse (ATDEA). The items that constitute this tool were derived from a literature review.

Methods:
Two rounds of self-administered questionnaire surveys were conducted with nurses working at home-visit nursing stations. Round 1 was used to evaluate the face validity, and Round 2 was used to test the content using the content validity index (CVI).

Results:
Two hundred forty nurses participated in the two studies. In Round 1, 56 nurses evaluated 38 items derived from a literature review, resulting in the development of a 36-item ATDEA. In Round 2, 184 nurses evaluated the content validity of the 36-item ATDEA. The Item-CVI (I-CVI) scores ranged from .61 to 1. Twenty-eight of the items met or exceeded the I-CVI threshold of .78, whereas the eight items assessing self-neglect did not. The overall Scale-CVI score for the assessment tool was .90, which met the threshold of .90.

Conclusions/Implications for Practice:
The results of validity testing established the preliminary validity of this assessment tool. In addition, as self-neglect is known to damage the well-being of older adults, six of the eight items assessing self-neglect were retained in the ATDEA despite their failure to meet the threshold I-CVI of .78. The remaining two self-neglect items were not included in the ATDEA because of excessively low I-CVI scores (< .70). Thus, the final version of the ATDEA includes 34 items. The authors recommend that nursing professionals use the ATDEA as a checklist to assess the presence of elder abuse and to discern the subtypes and severity of this abuse. When evaluating elder abuse, the higher the degree of severity, the greater the urgency to provide support.
Predictors of Successful Completion of the Master of Physician Assistant Studies in the Netherlands
Authors: van den Brink Geert TWJ , Jans Elisabeth GJM 
Published: August 2018

Purpose
The selection of applicants for the Master of Physician Assistant Studies program in the Netherlands is nationally regulated. The minimum criteria are 2 years of experience in health care and a bachelor's degree in nursing or allied health care. However, when students lack the requisite degree, entering a physician assistant (PA) program is possible through an additional assessment process that includes a test of cognitive ability and personality traits. Since 2004, a national registry has tracked all PA students into their employment setting. An evaluation of Master of Physician Assistant graduates who processed through both portals, traditional and alternative, was compared for validation of criteria.

Methods
The success rate of PA students with a bachelor's degree was compared with the success of the cohort that completed the alternative assessment. Descriptive statistics and Pearson's chi square statistics were applied to ascertain differences between the 2 cohorts.

Results
From 2004 to 2014, there were 1241 students enrolled in a PA program in the Netherlands; 184 nurses and nurse anesthetists were enrolled through the alternate pathway. Of the cohort with an assessment, 167 of 184 students (91%) graduated. Of the group with a prerequisite bachelor's degree, 944 students graduated (89%). Differences were considered negligible.

Conclusions
It seems that the nondegree alternative assessment of PA education is a reliable predictor of program completion. Because the nondegree alternative assessment is a national standard screening test, it was decided that there is no need to change the admission procedure for PA applicants.
Implementing vaccine hesitancy screening for targeted education
Authors: Connors John T. , Hodges Eric A. , D'Auria Jennifer , Windham Laura 
Published: August 2018

ABSTRACT

Background and purpose:
Little research has been performed investigating the effect of using a vaccine hesitancy (VH) screening tool to address specific vaccination concerns. The purpose of this study was to determine whether using a VH screening tool in conjunction with provider discussions addressing parental concerns affected the parental intent to vaccinate (ITV).

Methods:
This study used a pretest/posttest design to measure and categorize VH and ITV.

Conclusions:
The total sample size was 89. Differences between previsit and postvisit questionnaires showed mean responses for questions that measured specific VH categories had slight increases in the level of VH. A regression analysis was conducted to predict the postvisit ITV. Questions measuring parental trust in the provider, beliefs on vaccine efficacy, and beliefs about the prevalence of vaccine preventable disease (VPD) in the community predicted 72% of the postvisit ITV responses.

Implications for practice:
The utilization of a VH screening tool used in conjunction with provider education in an educated and mildly VH population did not positively affect the level of VH or the parental ITV. Additional research should investigate the role of parental trust in the provider, beliefs on vaccine efficacy, and the prevalence of VPD in the community affect parental ITV.