bluuebunny/crossref_metadata_2025_split huggingface dataset:
Test–Retest Reliability of Isokinetic Wrist Strength and Proprioception Measurements
Authors: Seven Barıs , Cobanoglu Gamze , Oskay Deran , Atalay-Guzel Nevin 
Published: January 2019

Context: The evaluation of the wrist strength and proprioception gives clinicians and researchers information about effectiveness of their rehabilitation protocol or helps diagnosis of various neuromuscular and somatosensorial disorders. Isokinetic dynamometers are considered the gold standard for these evaluations. However, the studies about test–retest reliability of isokinetic dynamometer are inadequate. Objective: The purpose of this study was to determine the test–retest reliability of isokinetic wrist strength and proprioception measurements using the Cybex isokinetic dynamometer. Design: Test–retest reliability study. Setting: University laboratory. Participants: Thirty participants were enrolled (age 23.2 [2.8] y, height 171.1 [7] cm, weight 66.6 [11.6] kg) in this study. Intervention: Cybex isokinetic dynamometer was used for strength and proprioception measurements. Main Outcome Measures: Concentric flexion–extension strength test was performed at 90°/s angular velocity, and eccentric flexion–extension strength test was performed at 60°/s angular velocity. The proprioception of the wrist was assessed via active joint position sense. The 30° extension of the wrist, which is accepted as the functional position of the wrist, was selected as the targeted angle. The intraclass correlation coefficient (ICC2,1) method was used for test–retest analysis (P < .05). Results: The active joint position sense measurements of dominant (ICC2,1: .821) and nondominant (ICC2,1: .763) sides were found to have good test–retest reliability. Furthermore, with the exception of dominant eccentric extension strength (moderate reliability) (ICC2,1: .733), eccentric and concentric flexion (dominant: ICC2,1 = .890–.844; nondominant: ICC2,1 = .800–.898, respectively), and extension (dominant: ICC2,1 = .791 [concentric], nondominant: ICC2,1 = .791–.818, respectively) strength measurements of both sides were found to have good reliability. Conclusions: This study shows that the Cybex isokinetic dynamometer is a reliable method for measuring wrist strength and proprioception. Isokinetic dynamometers can be used clinically for diagnosis or rehabilitation in studies which contain wrist proprioception or strength measurements.
Biology of Hand-to-Hand Bacterial Transmission
Authors: del Campo Rosa , Martínez-García Laura , Sánchez-Díaz Ana María , Baquero Fernando 
Published: January 2019

ABSTRACT

Numerous studies have demonstrated that adequate hand hygiene among hospital staff is the best measure to prevent hand-to-hand bacterial transmission. The skin microbiome is conditioned by the individual physiological characteristics and anatomical microenvironments. Furthermore, it is important to separate the autochthonous resident microbiota from the transitory microbiota that we can acquire after interactions with contaminated surfaces. Two players participate in the hand-to-hand bacterial transmission process: the bacteria and the person. The particularities of the bacteria have been extensively studied, identifying some genera or species with higher transmission efficiency, particularly those linked to nosocomial infections and outbreaks. However, the human factor remains unstudied, and intrapersonal particularities in bacterial transmission have not been yet explored. Herein we summarize the current knowledge on hand-to-hand bacterial transmission, as well as unpublished results regarding interindividual and interindividual transmission efficiency differences. We designed a simple
in vivo
test based on four sequential steps of finger-to-finger contact in the same person artificially inoculated with a precise bacterial inoculum. Individuals can be grouped into one of three observed transmission categories: high, medium, and poor finger-to-finger transmitters. Categorization is relevant to predicting the ultimate success of a human transmission chain, particularly for the poor transmitters, who have the ability to cut the transmission chain. Our model allowed us to analyze transmission rate differences among five bacterial species and clones that cause nosocomial infections, from which we detected that Gram-positive microorganisms were more successfully transmitted than Gram-negative.
Physiotherapist-delivered stress inoculation training integrated with exercise versus physiotherapy exercise alone for acute whiplash-associated disorder (StressModex): a randomised controlled trial of a combined psychological/physical intervention
Authors: Sterling Michele , Smeets Rob , Keijzers Gerben , Warren Jacelle , Kenardy Justin 
Published: January 2019

ObjectiveThere are few effective treatments for acute whiplash-associated disorders (WAD). Early symptoms of postinjury stress predict poor recovery. This randomised controlled trial (StressModex) investigated whether physiotherapist-led stress inoculation training integrated with exercise is more effective than exercise alone for people with acute WAD.Methods108 participants (<4 weeks) at risk of poor recovery (moderate pain-related disability and hyperarousal symptoms) were randomly assigned by concealed allocation to either physiotherapist-led stress inoculation training and guideline-based exercise (n=53) or guideline-based exercise alone (n=55). Both interventions comprised 10 sessions over 6 weeks. Participants were assessed at 6 weeks and at 6 and 12 months postrandomisation. Analysis was by intention to treat using linear mixed models.ResultsThe combined stress inoculation training and exercise intervention was more effective than exercise alone for the primary outcome of pain-related disability at all follow-up points. At 6 weeks, the treatment effect on the 0–100 Neck Disability Index was (mean difference) −10 (95% CI −15.5 to −4.48), at 6 months was −7.8 (95% CI −13.8 to −1.8) and at 12 months was −10.1 (95% CI −16.3 to −4.0). A significant benefit of the stress inoculation and exercise intervention over exercise alone was also found for some secondary outcomes.ConclusionA physiotherapist-led intervention of stress inoculation training and exercise resulted in clinically relevant improvements in disability compared with exercise alone—the most commonly recommended treatment for acute WAD. This contributes to the case for physiotherapists to deliver an early psychological intervention to patients with acute WAD who are otherwise at high risk of a poor outcome.Trial registration numberACTRN12614001036606.
Exercise-induced laryngeal obstruction in athletes treated with inspiratory muscle training
Authors: Sandnes Astrid , Andersen Tiina , Clemm Hege Havstad , Hilland Magnus , Vollsæter Maria , Heimdal John-Helge , Eide Geir Egil , Halvorsen Thomas , Røksund Ola Drange 
Published: January 2019

BackgroundExercise-induced laryngeal obstruction (EILO) is common in athletes and presents with dyspnoea, chest tightness, inspiratory stridor and sometimes panic reactions. The evidence for conservative treatment is weak, but case reports suggest effects from inspiratory muscle training (IMT). We aimed to explore effects from IMT used in athletes with EILO.MethodTwenty-eight athletes, mean age 16.4 years, diagnosed with EILO at our clinic, participated in a 6-week treatment programme, using a resistive flow-dependent IMT device (Respifit S). Four athletes competed at international level, 13 at national and 11 at regional levels. Video-recorded continuous transnasal flexible laryngoscopy was performed from rest to peak exercise (continuous laryngoscopy exercise (CLE) test) and scored before and 2–4 weeks after the training period. Ergospirometric variables were obtained from this CLE set-up. Lung function was measured according to guidelines. Symptom scores and demographic variables were obtained from a questionnaire.ResultsAfter the treatment period, symptoms had decreased in 22/28 (79%) participants. Mean overall CLE score had improved after treatment (p<0.001), with the scores becoming normal in five athletes but worse in two. Most of the improvement was explained by changes at the glottic laryngeal level (p=0.009). Ergospirometric variables revealed significantly higher peak minute ventilation explained by higher tidal volumes and were otherwise unchanged.ConclusionThis explorative study underlines the heterogeneous treatment response of EILO and suggests that IMT may become an efficient conservative treatment tool in subgroups, possibly contributing to better control of the vocal folds. The signals from this study should be tested in future controlled interventional studies.
Evaluation of a simulation-based Risk Management and Communication Masterclass to reduce the risk of complaints, medicolegal and dentolegal claims
Authors: Jolly John , Bowie Paul , Dawson Lauren , Heslington Lorna , Dinwoodie Mark 
Published: January 2019

ObjectivesTo understand clinicians’ experiences, learning and professional impacts following participation in a Risk Management and Communication Masterclass (RMCM) designed and delivered by Medical Protection Society. To identify the course’s strengths and areas for enhancement.DesignMixed method study including semistructured telephone interviews. Interviews were conducted between October and December 2017, 6–30 months after course participation. Data were subjected to a thematic analysis. Quantitative analysis of participants’ feedback ratings (n=486) on RMCMs delivered between December 2014 and May 2017 was also undertaken.SettingRMCMs were delivered to Doctors and Dentists based in the UK and Ireland and South Africa. Participants: A sample of 12 volunteer doctors (Obstetricians/Gynaecologists, Orthopaedic/Spinal Surgeons, General Surgeons, Paediatricians, General Practitioners) and dentists chosen to represent different clinical specialities accepted the invitation to participate.ResultsStudy participants reported examples of person-centred communication skills such as empathy, shared-decision making and managing patient expectations in their workplaces following participation in the RMCM. Many clinicians gave examples describing how they used the communication models they learned when back at work. They also demonstrated a better understanding of the motivations for patients to complain or claim. RMCM course participants’ high feedback ratings provided further evidence that the course was valuable and met learning objectives.ConclusionsIt may prove difficult to demonstrate quantitatively that liability improves as a direct result of risk management and communications training. Our results on other dimensions (reactions, learning, behaviour change and impact) suggest that the RMCM has a positive and durable effect based on participant feedback.
Developmental origins of endometriosis: a Swedish cohort study
Authors: Gao Menghan , Allebeck Peter , Mishra Gita D , Koupil Ilona 
Published: January 2019

BackgroundEndometriosis is a chronic condition affecting women of reproductive age and is associated with multiple health burdens. Yet, findings regarding its ‘developmental origins’ are inconsistent. We aimed to investigate the associations of birth characteristics with endometriosis. We also explored potential mediation by adult social and reproductive factors.MethodsThis cohort study consisted of 3406 women born in Uppsala, Sweden, between 1933 and 1972. We used data from archived birth records and endometriosis diagnoses at ages 15–50 recorded in the national patient registers. Socioeconomic and reproductive characteristics were obtained from routine registers. HRs were estimated from Cox regression.ResultsDuring the follow-up, 111 women have been diagnosed with endometriosis, and most cases are external endometriosis (ie, outside the uterus, n=91). Lower standardised birth weight for gestational age was associated with increased rate of endometriosis (HR 1.35 per standard deviation decrease; 95% CI 1.08 to 1.67). This increased rate was also detected among women with fewer number of live births (HR 2.38; 95% CI 1.40 to 4.07 for one child vs ≥2 children; HR 6.09; 95% CI 3.88 to 9.57 for no child vs ≥2 children) and diagnosed infertility problem (HR 2.00; 95% CI 1.10 to 3.61) prior to endometriosis diagnosis. All the observed associations were stronger for external endometriosis. However, no evidence was found that number of births was the mediator of the inverse association between standardised birth weight and endometriosis.ConclusionThis study supports the developmental origins theory and suggests that exposure to growth restriction during the fetal period is associated with increased risk of endometriosis during reproductive years.
Characterization of strut indentation during mechanical thrombectomy in acute ischemic stroke clot analogs
Authors: Weafer Fiona M , Duffy Sharon , Machado Ines , Gunning Gillian , Mordasini Pasquale , Roche Ellen , McHugh Peter E , Gilvarry Michael 
Published: January 2019

BackgroundAlthough it is common practice to wait for an ‘embedding time’ during mechanical thrombectomy (MT) to allow strut integration of a stentriever device into an occluding thromboembolic clot, there is a scarcity of evidence demonstrating the value or optimal timing for the wide range of thrombus compositions. This work characterizes the behavior of clot analogs of varying fibrin and cellular compositions subject to indentation forces and embedding times representative of those imparted by a stentriever during MT. The purpose of this study is to quantify the effect of thrombus composition on device strut embedding, and to examine the precise nature of clot integration into a stentriever device at a microstructural level.MethodClot analogs with 0% (varying densities), 5%, 40%, and 80% red blood cell (RBC) content were created using ovine blood. Clot indentation behavior during an initial load application (loading phase) followed by a 5-min embedding time (creep phase) was analyzed using a mechanical tester under physiologically relevant conditions. The mechanism of strut integration was examined using micro-computed tomography (µCT) with an EmboTrap MT device (Cerenovus, Galway, Ireland) deployed in each clot type. Microstructural clot characteristics were identified using scanning electron microscopy (SEM).ResultsCompressive clot stiffness measured during the initial loading phase was shown to be lowest in RBC-rich clots, with a corresponding greatest maximum indentation depth. Meanwhile, additional depth achieved during the simulated embedding time was most pronounced in fibrin-rich clots. SEM imaging identified variations in microstructural mechanisms (fibrin stretching vs rupturing) which was dependent on fibrin:cellular content, while µCT analysis demonstrated the mechanism of strut integration was predominantly the formation of surface undulations rather than clot penetration.ConclusionsDisparities in indentation behavior between clot analogs were attributed to varying microstructural features induced by the cellular:fibrin content. Greater indentation was identified in clots with higher RBC content, but with an increased level of fibrin rupture, suggesting an increased propensity for fragmentation. Additional embedding time improves strut integration, especially in fibrin-rich clots, through the mechanism of fibrin stretching with the majority of additional integration occurring after 3 mins. The level of thrombus incorporation into the EmboTrap MT device (Cerenovus, Galway, Ireland) was primarily influenced by the stentriever design, with increased integration in regions of open architecture.
Bone lead associations with blood lead, kidney function and blood pressure among US, lead-exposed workers in a surveillance programme
Authors: Barry Vaughn , Todd Andrew C , Steenland Kyle 
Published: January 2019

ObjectivesBone lead and past blood lead levels may be more strongly associated with current health effects than current blood lead, representing recent exposure. We examined whether current bone lead was correlated with maximum past blood lead and compared how three lead measures predicted current blood pressure (BP) and kidney function among workers with past occupational lead exposure.MethodsAdult men in a lead surveillance programme residing near New York City were enrolled. Current bone and blood lead, BP and estimated glomerular filtration rate (eGFR) were measured. Maximum past blood lead was obtained from surveillance data. Regression models were used to determine associations of health with different lead measures.ResultsAmong 211 participants, median (IQR) bone, maximum past blood and current blood leads were 13.8 (9.4–19.5) µg lead per bone mineral gram, 29.0 (14.0–38.0) µg/dL and 2.5 (1.5–4.4) µg/dL, respectively. Maximum past and current blood lead were significantly associated with current bone lead in adjusted analyses (both p<0.0001), with associations driven by high blood lead. Bone lead was associated with increased continuous systolic BP (coefficient=0.36; 95% CI 0.05 to 0.67; p=0.02); categorical analyses indicated this was driven by the top two bone lead quartiles. Bone lead was non-significantly associated with decreased (worse) eGFR (coefficient=−0.15; 95% CI −0.36 to 0.07; p=0.18).ConclusionsBone lead was significantly associated with past maximum and current blood lead. The association between bone and current blood lead was possibly driven by bone lead resorption into blood. Bone lead, but not past or current blood lead, was associated with elevated systolic BP.
IgG4-related diseases: state of the art on clinical practice guidelines
Authors: Iaccarino Luca , Talarico Rosaria , Scirè Carlo Alberto , Amoura Zahir , Burmester Gerd , Doria Andrea , Faiz Karim , Frank Charissa , Hachulla Eric , Hie Miguel , Launay David , Montecucco Carlomaurizio , Monti Sara , Mouthon Luc , Tincani Angela , Toniati Paola , Van Hagen Pieter Martin , Van Vollenhoven Ronald F , Bombardieri Stefano , Mueller-Ladner Ulf , Schneider Matthias , Smith Vanessa , Cutolo Maurizio , Mosca Marta , Alexander Tobias 
Published: January 2019

Immunoglobulin G4-related diseases (IgG4-RD) are a group of chronic relapsing–remitting inflammatory conditions, characterised by tissue infiltration with lymphocytes and IgG4-secreting plasma cells, fibrosis and a usually favourable response to steroids.In this narrative review, we summarise the results of a systematic literature research, which was performed as part of the European Reference Network ReCONNET, aimed at evaluating existing clinical practice guidelines (CPGs) and recommendations in IgG4-RD. From 167 publications initially obtained from a systematic literature search, only one was identified as a systematic multispecialist, evidence-based, consensus guidance statement on diagnosis and treatment of IgG4-RD, which may be recommended for use as CPG in IgG4-RD.With the recognition of a limited evidence based in this increasingly recognised disease, the group discussion has identified the following unmet needs: lack of shared classification criteria, absence of formal guidelines on diagnosis, no evidence-based therapeutic recommendations and lack of activity and damage indices. Areas of unmet needs include the difficulties in diagnosis, management and monitoring and the scarcity of expert centres.
Cluster-randomised trial of a nurse-led advance care planning session in patients with COPD and their loved ones
Authors: Houben Carmen H M , Spruit Martijn A , Luyten Hans , Pennings Herman-Jan , van den Boogaart Vivian E M , Creemers Jacques P H M , Wesseling Geertjan , Wouters Emiel F M , Janssen Daisy J A 
Published: January 2019

RationaleAdvance care planning (ACP) is uncommon in patients with chronic obstructive pulmonary disease (COPD).ObjectivesTo assess whether a nurse-led ACP-intervention can improve quality of patient-physician end-of-life care communication in patients with COPD. Furthermore, the influence of an ACP-intervention on symptoms of anxiety and depression in patients and loved ones was studied. Finally, quality of death and dying was assessed in patients who died during 2-year follow-up.MethodsA multicentre cluster randomised-controlled trial in patients with advanced COPD was performed. The intervention group received an 1.5 hours structured nurse-led ACP-session. Outcomes were: quality of patient-physician end-of-life care communication, prevalence of ACP-discussions 6 months after baseline, symptoms of anxiety and depression in patients and loved ones and quality of death and dying.Results165 patients were enrolled (89 intervention; 76 control). The improvement of quality of patient-physician end-of-life care communication was significantly higher in the intervention group compared with the control group (p<0.001). The ACP-intervention was significantly associated with the occurrence of an ACP-discussion with physicians within 6 months (p=0.003). At follow-up, symptoms of anxiety were significantly lower in loved ones in the intervention group compared with the control group (p=0.02). Symptoms of anxiety in patients and symptoms of depression in both patients and loved ones were comparable at follow-up (p>0.05). The quality of death and dying was comparable between both groups (p=0.17).ConclusionOne nurse-led ACP-intervention session improves patient-physician end-of-life care communication without causing psychosocial distress in both patients and loved ones.
Early specialist palliative care on quality of life for malignant pleural mesothelioma: a randomised controlled trial
Authors: Brims Fraser , Gunatilake Samal , Lawrie Iain , Marshall Laura , Fogg Carole , Qi Cathy , Creech Lorraine , Holtom Nicola , Killick Stephanie , Yung Bernard , Cooper David , Stadon Louise , Cook Peter , Fuller Elizabeth , Walther Julie , Plunkett Claire , Bates Andrew , Mackinlay Carolyn , Tandon Anil , Maskell Nicholas A , Forbes Karen , Rahman Najib M , Gerry Stephen , Chauhan Anoop J 
Published: January 2019

PurposeMalignant pleural mesothelioma (MPM) has a high symptom burden and poor survival. Evidence from other cancer types suggests some benefit in health-related quality of life (HRQoL) with early specialist palliative care (SPC) integrated with oncological services, but the certainty of evidence is low.MethodsWe performed a multicentre, randomised, parallel group controlled trial comparing early referral to SPC versus standard care across 19 hospital sites in the UK and one large site in Western Australia. Participants had newly diagnosed MPM; main carers were additionally recruited. Intervention: review by SPC within 3 weeks of allocation and every 4 weeks throughout the study. HRQoL was assessed at baseline and every 4 weeks with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30. Primary outcome: change in EORTC C30 Global Health Status 12 weeks after randomisation.ResultsBetween April 2014 and October 2016, 174 participants were randomised. There was no significant between group difference in HRQoL score at 12 weeks (mean difference 1.8 (95% CI −4.9 to 8.5; p=0.59)). HRQoL did not differ at 24 weeks (mean difference −2.0 (95% CI −8.6 to 4.6; p=0.54)). There was no difference in depression/anxiety scores at 12 weeks or 24 weeks. In carers, there was no difference in HRQoL or mood at 12 weeks or 24 weeks, although there was a consistent preference for care, favouring the intervention arm.ConclusionThere is no role for routine referral to SPC soon after diagnosis of MPM for patients who are cared for in centres with good access to SPC when required.Trial registration numberISRCTN18955704.