bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of the NSQIP Surgical Risk Calculator in Predicting Microvascular Head and Neck Reconstruction Outcomes
Authors: Ma Yue , Laitman Benjamin M. , Patel Vir , Teng Marita , Genden Eric , DeMaria Samuel , Miles Brett A. 
Published: July 2018

ObjectiveThis study evaluated the accuracy of the Surgical Risk Calculator (SRC) of the ACS NSQIP (American College of Surgeons National Surgical Quality Improvement Program) in predicting head and neck microvascular reconstruction outcomes.Study DesignRetrospective analysis.SettingTertiary medical center.Subjects and MethodsA total of 561 free flaps were included in the analysis. The SRC‐predicted 30‐day rates of postoperative complications, hospital length of stay (LOS), and rehabilitation discharge were compared with the actual rates and events. The SRC's predictive value was examined with Brier scores and receiver operating characteristic area under the curve.ResultsA total of 425 myocutaneous, 134 osseous (84 fibula, 47 scapula, and 3 iliac crest), and 2 omental free flaps were included in this study. All perioperative complications evaluated had area under the curve values ≤0.75, ranging from 0.480 to 0.728. All but 2 postoperative complications had Brier scores >0.01. SRC‐predicted LOS was 9.4 ± 2.38 days (mean ± SD), which did not strongly correlate with the actual LOS of 11.98 ± 9.30 days (r = 0.174, P <. 0001).ConclusionThe SRC is a poor predictor for surgical outcome among patients undergoing microvascular head and neck reconstruction.
Platelet‐Rich Plasma Fat Graft versus Cartilage Perichondrium for Repair of Medium‐Size Tympanic Membrane Perforations
Authors: Mandour Mahmoud Fawzy , Elsheikh Mohamed Nasser , Khalil Mohamed Fathy 
Published: July 2018

ObjectivesTo compare clinical and audiologic outcomes among patients who underwent myringoplasty with fat graft enriched with platelet‐rich plasma and cartilage perichondrium graft.Study DesignProspective randomized controlled study.SettingDepartment of Otolaryngology–Head and Neck Surgery, Tanta University, Egypt.Subjects and MethodsThe study comprised 50 patients who had tympanic membrane perforation of medium size (25%‐50% of its surface area) without evidence of active otitis media or ossicular abnormalities and who had surgery between December 2016 and December 2017. Patients randomly underwent myringoplasty with fat graft enriched with platelet‐rich plasma (group 1) or cartilage perichondrium graft (group 2).ResultsTwenty‐five patients were included in each group. Rates of successful closure at 3‐month follow‐up were 88% (group 1) and 92% (group 2). The mean overall improvement in pure tone average was 18.08 dB (95% CI, 16.9‐19.25) for group 1 and 18.24 dB (95% CI, 16.94‐19.53) for group 2.ConclusionFat graft enriched with platelet‐rich plasma can be recommended as an alternative choice for first‐line treatment of medium‐size central perforations of the tympanic membrane, with healing and hearing results comparable to those of conventional cartilage perichondrium myringoplasty.
Effectiveness and feasibility of acupuncture for knee osteoarthritis: a pilot randomized controlled trial
Authors: Lin Lu-Lu , Li Yong-Ting , Tu Jian-Feng , Yang Jing-Wen , Sun Ning , Zhang Shuai , Wang Tian-Qi , Shi Guang-Xia , Du Yi , Zhao Jing-Jie , Xiong Da-Chang , Hou Hai-Kun , Liu Cun-Zhi 
Published: July 2018

Objective: To evaluate the effectiveness of acupuncture for pain relief and function improvement in patients with knee osteoarthritis and to determine the feasibility of an eight-week acupuncture intervention. Design: Pilot randomized controlled trial. Setting: Three teaching hospitals in China. Subjects: Patients with knee osteoarthritis (Kellgren grade II or III). Interventions: Patients were randomly assigned to an eight-week (three sessions per week) intervention of either traditional Chinese acupuncture or sham acupuncture. Main measures: The primary outcome was response rate—the proportion of patients achieving score ⩾36% decrease in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function at week 8 compared with baseline. Secondary outcomes included pain, function and quality of life. Results: Of 42 patients randomized, 36 (85.7%) completed the study. There was no significant difference in response rate between the traditional Chinese acupuncture and control groups: 61.9% (13 of 21) versus 42.9% (9 of 21) achieved score ⩾36% decrease in WOMAC pain and function at week 8 ( P = 0.217). The sum of WOMAC pain and function scores at week 8 was 11.6 (9.1) in the traditional Chinese acupuncture group compared with 16.3 (10.9) in the control group ( P = 0.183). There was no significant difference between groups. Three adverse events were recorded and were classified as mild. Conclusion: It showed that three sessions per week acupuncture intervention of knee osteoarthritis was feasible and safe. No difference was observed between groups due to small sample size. Larger (sample size ⩾ 296) randomized controlled trials of this intervention appear justified.
Assessment of Anthropometric Data Following Investments to Ensure Quality: Kenya Demographic Health Surveys Case Study, 2008 to 2009 and 2014
Authors: Leidman Eva , Mwirigi Louise Masese , Maina-Gathigi Lucy , Wamae Anna , Imbwaga Andrew Amina , Bilukha Oleg O. 
Published: July 2018

Background: Evidence-based nutrition programs depend on accurate estimates of malnutrition derived from data collected in population representative surveys. The feasibility of obtaining accurate anthropometric data as part of national, multisectoral surveys has been a debated issue. Objectives: The study aimed to evaluate changes in anthropometric data quality corresponding to investments by the Kenya Ministry of Health and nutrition sector partners for the 2014 Kenya Demographic Health Survey. Methods: Anthropometric data collected during the 2008 to 2009 and 2014 Kenya surveys were reanalyzed to assess standard parameters of quality: standard deviation, skewness, and kurtosis of z-score values for 3 anthropometric indicators (weight for height, height for age, and weight for age), percentage of children with missing measurements and outlier values, digit preference, and heaping of age. Results: A total of 9936 households were selected in 2008 to 2009, and 39 679 households were selected in 2014. Standard deviation of z-scores for all 3 indicators was smaller in 2014 than in 2008 to 2009. Applying original Demographic and Health Survey exclusion criteria, weight for height z-scores were 1.16 in 2014, 10.1% narrower than 2008 to 2009. The percentage of outlying values declined significantly from 2008 to 2009 to 2014 for both height for age and weight for height ( P < .001). Digit preference scores in 2014 improved for both weight ( P = .011) and height ( P < .001) suggesting less rounding of terminal digits. Conclusions: All tests of data quality suggest an improvement in 2014 relative to 2008 to 2009, despite the complexity implied by the larger sample. This improvement corresponds with efforts to enhance training and supervision of anthropometry, suggesting a positive effect of these enhancements.
Attitudes toward Supplemental Nutrition Assistance Programs in Caregivers of Children with Moderate–Acute Malnutrition Younger than 5 Years in Denpasar, Bali: A Qualitative Study
Authors: Dewi Satiawati K. Desak Ketut , Januraga Pande Putu 
Published: July 2018

Background: Providing additional nutriment represents one strategy for overcoming moderate–acute malnutrition (MAM) in children younger than 5 years. However, it is important to examine how well received such Supplemental Nutrition Assistance Programs (SNAP) are by caregivers in order to ensure optimal results. Objective: This study explores SNAP’s reception by caregivers of MAM children younger than 5 years. Methods: Qualitative research was conducted through semi-structured, in-depth interviews with 16 selected caregivers and 5 Nutritional Executives from October to November, 2016 at 4 health centers in Denpasar, Bali, Indonesia. The results are presented to highlight the underlying patterns of SNAP’s acceptance. Results: Overall, the informants responded negatively to SNAP, reporting that it was of limited usefulness. The results show 4 main themes relating to the receipt of SNAP. The first relates to the caregiver’s preferences in terms of the types of supplementary food on offer. Second, caregiver’s perceptions that the child was not, in fact, in a state of illness or disease due to a medical issue. Third, that the caregiver does not require supplementary food as they maintain that they are able to buy it independently. Fourth, factors related to the lack of support for health-care workers working with malnourished children. Conclusion: The study finds that strengthening the role of health workers in terms of enabling them to effectively communicate the benefits of supplementary food to caregivers as well as adjusting the range of foods available according to the recipient’s preferences is critical in overcoming malnutrition in children younger than 5 years.
Specific Cognitive–Psychopathological Phenotypes in Patients With Early Stages of Subcortical Vascular Neurocognitive Disorders: A Hospital-Based Case–Control Study
Authors: Levada Oleg A. , Troyan Alexandra S. , Cherednichenko Nataliya V. 
Published: July 2018

Background: Diagnosis of subcortical vascular neurocognitive disorders’ (ScVNCDs) is currently based on neuropsychological and neuroimaging approaches; nevertheless, clinical features, apart from cognitive impairments (CI), may provide additional information about ScVNCD phenotypes. We aimed to determine whether CI and neuropsychiatric symptoms (NPS) form such clinical phenotypes in the mild and early stage of major ScVNCD. Methods: Our sample included 88 cognitively normal elderly individuals, 100 patients with mild ScVNCD, and 60 patients with early major ScVNCD. All participants had neuropsychological, neuropsychiatric, neurological, and functional evaluations. The prevalence of NPS was based on the neuropsychiatric inventory. The statistical analyses included parametric and nonparametric tests and multivariate regression. Results: The severity of executive dysfunction increased through stages of ScVNCD progression ( P < .0001). The NPS with significant predictive value for mild ScVNCD membership was depression (odds ratio [OR] = 7.4), whereas for early major ScVNCD were depression (OR = 5.5) and apathy (OR = 7.6). Those distinguishing NPS and impairments of executive tests’ performance significantly correlated ( P < .05) in patients with mild/major ScVNCD. Conclusion: Significant correlation between pathognomonic cognitive and NPS in compared groups suggest that dysexecutive-depressive syndrome can be the main phenotype in mild ScVNCD, while dysexecutive-depressive-apathetic syndrome in the early stage of major ScVNCD. Obtained cognitive–psychopathological phenotypes may allow a better comprehension of the ScVNCD pathophysiology and improve the diagnostic and therapeutic approach.
A Study of Neonatal Thrombocytopenia in a Tertiary Care Hospital: A Prospective Study
Authors: Kumar Ray Rajib , Panda Suchismita , Patnaik Rashmi , Sarangi Gadadhara 
Published: July 2018

Objective: Finding out etiology, clinical course, immediate outcome, and association of maternal and neonatal factors that predispose to neonatal thrombocytopenia. Setting: Neonatal Intensive Care Unit (NICU), Hi-Tech Medical College and Hospital, Bhubaneswar, Odisha (between November 2014 and October 2016). Design: Prospective observational study. Results: In the NICU setting, severe (39%) thrombocytopenia and very severe thrombocytopenia (51%) are very common. Neonatal sepsis (67%) is the leading cause of thrombocytopenia followed by prematurity (52%) with overlaps. Maternal pregnancy-induced hypertension is significantly associated with neonatal thrombocytopenia. The outcome is very poor in severe thrombocytopenia. Platelet transfusion remains the main stay of therapy. Conclusion: Septicemia is the most common preventable cause of thrombocytopenia in our setting. Birth asphyxia, which is the third most common cause, is partly preventable. Low platelet count was found to be an independent risk factor for the poor outcome in neonates admitted in the NICU. The mortality rate is very high among very severe thrombocytopenic infants.
A Retrospective Study of Therapeutic Hypothermia in Neonatal Hypoxic Ischemic Encephalopathy
Authors: Maheshwari Rajesh , D’Cruz Daphne , Goyen Traci-anne , Gibbs Emma , Luig Melissa 
Published: July 2018

Objectives: Therapeutic hypothermia (TH) is now standard treatment for moderate to severe hypoxic ischemic encephalopathy (HIE), secondary to intrapartum hypoxia, and has been performed in our neonatal unit since 2008. Objectives of this study included the assessment of compliance with the TH protocol and the evaluation of 2-year outcomes. Materials and Methods: Medical records of all the infants who underwent TH (2008-2014) were reviewed and relevant data were extracted. The laboratory database was used to extract blood test results. Follow-up clinic records were reviewed to gather data for 2-year outcomes. Outcome at 2 years was dichotomized as normal (survival with no or mild impairment) and abnormal (death or survival with moderate or severe impairment). Regression analysis was performed to determine the association of perinatal variables with an abnormal outcome. Results: Seventy-seven infants were treated with TH with 40/77 (52%) cooled as per the protocol. Treatment with TH for stage 1 HIE was the most common reason for protocol noncompliance. A total of 71 infants had HIE ( n = 26, 24, and 21 with modified Sarnat stages 1, 2, and 3 respectively). Sixteen infants with HIE (22.5%) died; all had stage 3 HIE. Forty-one infants were seen at ≥2 years. Of these, 34 infants (83%) had a normal outcome. The clinical stage of HIE was the strongest predictor of an abnormal outcome. Normal 2-year outcome was seen in 94%, 84%, and 5% of stages 1, 2, and 3 HIE respectively. Conclusions: We noted a high degree of variation from the TH protocol. Clinical staging of HIE remains the strongest predictor of long-term outcome.
Getting to the Heart of the Matter: A Regional Survey of Current Hospice Practices Caring for Patients With Heart Failure Receiving Advanced Therapies
Authors: Groninger Hunter , Gilhuly Devin , Walker Kathryn A. 
Published: July 2018

Background: No guidelines exist regarding care for patients with advanced heart failure (HF) receiving hospice care while continuing advanced HF therapies such as left ventricular assist devices (LVADs) or continuous inotropes. Objective: We surveyed hospice providers in our tristate region to determine hospice demographics, current practices for care of patients with advanced HF, and perceived challenges of providing advanced HF therapies. Design: Cross-sectional survey of hospice clinical and administrative leaders. Results: Forty-six respondents representing 23 hospices completed the survey. Over half (27/46) held leadership administrative roles, and most (37/46) had more than 5 years of hospice experience. Although lack of experience and cost were cited as primary barriers to providing inotrope therapy in home hospice, about half of respondents (24/46) said they would manage inotropes. All participants said their respective hospices accept patients with implantable cardioverter-defibrillators; over half (28/46) said they accept patients with LVADs into hospice care. Lack of experience with LVADs was the most frequently cited barrier. Most participants were interested in training and support by an advanced HF program to facilitate hospice care of patients receiving these advanced therapies. General access to hospice services for patients with HF at their organization was considered adequate by 30 of 46 participants. Most (32/46) reported that referrals are made too late. Conclusions: Hospice specialists reported widely varied practice experiences caring for patients with HF receiving advanced therapies, noted specific challenges for care of these patients, and expressed a desire for targeted HF education.
Children Enrolled in Hospice Care Under Commercial Insurance: A Comparison of Different Age Groups
Authors: Lindley Lisa C. , Cohrs Austin C. , Keim-Malpass Jessica , Leslie Douglas L. 
Published: July 2018

Background: Although most children at end of life have commercial insurance, little is known about their demographic and clinical characteristics, what care they are receiving, and how much it costs. Objectives: To describe commercially insured children who enrolled in hospice care during their last year of life and to examine differences across age-groups. Methods: A retrospective cohort study was conducted using 2005 to 2014 data from the MarketScan Commercial Claims and Encounters database from Truven Health Analytics. Variables were created for demographics, health, utilization, and spending. Analyses included χ2 and analysis of variance tests of differences. Results: Among the 17 062 children who utilized hospice, 49% had a preferred provider organization (PPO). Hospice length of stay averaged less than 5 days. Over 80% of children visited their primary care physician. Eight percent had hospital readmissions, and 38% had emergency department (ED) visits. Average expenditures were US$3686 per month or US$44 232 annually. The most common condition for children less than 1 year was cardiovascular (21.96%). Neuromuscular conditions were the most frequent (7.89%) in children aged 1 to 5 years, while malignancies (10.53% and 11.32%, respectively) were prevalent in ages 6 to 14 and 15 to 17. Children less than 1 year had the highest frequency of hospital readmissions (16.25%) with the lowest ED visits (28.67%) while incurring the highest expenses (US$11 211/month). Conclusions: The findings suggest that commercially insured children, who enroll in hospice, have flexible coverage with a PPO. Hospital readmissions and ED visits were relatively low for a population who was seriously ill. There were significant age-group differences.
Prospective study of the E-liac Stent Graft System in patients with common iliac artery aneurysms: 30-Day results
Authors: Brunkwall Jan , Vaquero Puerta Carlos , Heckenkamp Joerg , Egaña Barrenechea Jose Maria , Szopinski Piotr , Mertikian Gerard , Seifert Sven , Rümenapf Gerhard , Buz Semih , Assadian Afshin , Majd Payman , Mylonas Spyridon , Revilla Calavia Alvaro , Theis Thorsten , de Blas Bravo Mariano , Pleban Eliza , Schupp Jasper , Esche Mirko , Kocaer Cetin , Hirsch Kornelia , Oberhuber Alexander , Schäfer Jost-Philipp 
Published: July 2018

Objectives To study the safety and feasibility of the E-liac Stent Graft System® in patients with aorto/iliac aneurysms. Methods A prospective multicentric European registry of patients receiving the E-liac Stent Graft System® was conducted. Endpoints of the study included the technical success as well as periprocedural events and 30-day endoleaks, reinterventions, internal and external iliac artery patency and mortality. Results Between July 2014 and June 2016, a total of 45 patients (93% men, mean age 72 years, range 53–90 years) were enrolled at 11 sites in four European countries. Five patients received an isolated iliac treatment. Thirty-seven patients were treated with a combination of an abdominal stent graft and a unilateral E-liac and three in combination with bilateral E-liac. All E-liac Stent Grafts (48) were implanted in the intended position and the internal iliac arteries were successfully bridged. Two patients did not receive clinical success, due to endoleak type Ia of the aortic stent graft. At 30-day follow-up, clinical success rate was 96%. Three successful endovascular reinterventions were performed within the 30-day follow-up: one due to a type Ia endoleak in the common iliac artery, one due to type Ia endoleak of the aortic stent graft, and one due to bilateral lower limb claudication provoked by stent graft limb stenosis. At 30-day, a 100% survival rate and complete absence of pelvic or buttock ischemia/claudication were reported. Primary patency at 30 days was 100% for the internal iliac artery and 98% for the external iliac artery with an assisted patency of 100% in the latter. Conclusions The high clinical success rate, low rates of device-related reinterventions (2%), and excellent patency rate demonstrate the safety and feasibility of the E-liac Stent Graft System. Long-term results are awaited to state efficacy and durability. Clinical Trials.gov. Identifier no. NCT02209194.
Communication with invasive mechanically ventilated patients and the use of alternative devices: integrative review
Authors: Salem Aziza , Ahmad Muayyad M 
Published: July 2018

Background Communication with patients has always been a major concern in nursing care. Invasive mechanically ventilated (IMV) patients suffer from a communication barrier due to the presence of the endotracheal tube (ETT), which makes them unable to communicate through speech. Aim The purpose of this review is to examine available evidence regarding existing knowledge, skills, perceptions and barriers to IMV patient communication in order to guide the development of strategies that enhance effective communication with these patients. Methods A review of the published literature was conducted between January 2010 and December 2016. Results The literature support clear and concise communication in all areas of care, especially when patients suddenly become speechless. Invasive mechanically ventilated patients want to be heard, have control over their treatment and contribute to decisions concerning their health. Conclusion There is a need for the establishment of an effective nurse -patient communication strategy, which may include determining the mode of communication used by the patient, waiting and giving time to allow a patient to participate in the communication, confirming the message that was communicated with a patient himself/ herself, and the use of assistive and augmented communication to support comprehension when needed.
Role of screw proximity in the fixation of transverse patellar fractures with screws and a wire
Authors: Chang Chih-Wei , Chen Yen-Nien , Li Chun-Ting , Chung Yu-Hsuan , Chang Chih-Han , Peng Yao-Te 
Published: July 2018

Purpose: Clinical and biomechanical studies have reported that using supportive screws and a wire instead of the common Kirschner wires for modified tension band wiring improves the stability of fractured patellae. However, the effect of screw proximity on the fixation of a fractured patella remains unclear. Therefore a numerical study was conducted to examine the effects of screw proximity on biomechanical responses in a simulated patellar fracture fixed using two parallel cannulated screws and anterior tension band wiring. Methods: A patellar model with a transverse fracture and loads simulating patellar tendon forces applied on the patella were used in the present simulation. The surgical fixation consisted of two 4.0-mm parallel partially threaded cannulated screws with a figure-of-eight tension band made using a 1.25-mm stainless steel wire. Biomechanical responses at two screw proximities, 5 and 10 mm from the leading edge of the patella, were investigated. Results: Superficial screw placement (5 mm) yielded higher stability, lower wire loads, and lower bone contact pressures than the deep placement (10 mm). The deep placement of screws exerted a higher load on the wire but a lower force on the screw than superficial placement did. Conclusion: This is the first numerical study to examine the effects of screw location on the fixation of a fractured patella using cannulated screws and tension band wiring. Considering the favorable biomechanical responses, superficial placement (5 mm below the leading edge of the patella) is recommended for screw insertion when treating a transverse fractured patella.