bluuebunny/crossref_metadata_2025_split huggingface dataset:
The ‘safe death’: An ethnographic study exploring the perspectives of rural palliative care patients and family caregivers
Authors: Rainsford Suzanne , Phillips Christine B , Glasgow Nicholas J , MacLeod Roderick D , Wiles Robert B 
Published: September 2018

Background: In rural settings, relationships between place and self are often stronger than for urban residents, so one may expect that rural people would view dying at home as a major feature of the ‘good death’. Aim: To explore the concept of the ‘good death’ articulated by rural patients with life-limiting illnesses, and their family caregivers. Design: Ethnography, utilising open-ended interviews, observations and field-notes. Participants: In total, 12 rural (town and farm) patients with life-limiting illnesses, 18 family caregivers and 6 clinicians, in the Snowy Monaro region of New South Wales, Australia, participated in this study over the course of the deaths of the patients. Interviews were transcribed and analysed with observational data using an emergent thematic process. Results: A ‘safe death’ was central to a ‘good death’ and was described as a death in which one could maintain (1) a connection with one’s previous identity; (2) autonomy and control over decisions regarding management of end-of-life care and (3) not being overwhelmed by the physical management of the dying process. For all participants, the preferred place of death was the ‘safe place’, regardless of its physical location. Conclusion: Safety, in this study, is related to a familiar place for death. A home death is not essential for and does not ensure a ‘good death’. We all have a responsibility to ensure all places for dying can deliver the ‘safe death’. Future research could explore the inter-relationships between safety and preference for home or home-like places of death.
Revisiting singing proficiency in three-year-olds
Authors: Gudmundsdottir Helga R. 
Published: September 2018

The present study employed a protocol specially developed for testing toddlers’ singing competence. The protocol was designed to increase responsivity of toddlers during testing. The singing ranges and singing accuracy of three-year-old children were measured using the protocol ( N = 39). A large proportion of the three-year-olds participated in at least one item (89.7%), which is a high rate of participation for this age group, validating the appropriateness of the protocol applied. The most successful test item was the Self-selected song as it elicited the highest response rate of all items (87%). Furthermore, the Self-selected song resulted in more accurate renditions in terms of preservation of melodic contour (85%) and intervals (24%) than another item consisting of a familiar standard song phrase. In ascending pitch glides, 73% of the toddlers lifted their voice above C5 and the highest produced pitch was C6 (two octaves above middle C). Pitch matching accuracy was highly pitch dependent, with middle C as the most accurately matched pitch (53%) and C above middle C the least accurately matched pitch (11%). The findings support previous research that describes three-year-olds as capable singers while contradicting more widely accepted views of three-year-olds having poorly developed singing skills.
Percutaneous Cholecystostomy for Severe Acute Cholecystitis: A Useful Procedure in High-Risk Patients for Surgery
Authors: Aroori S. , Mangan C. , Reza L. , Gafoor N. 
Published: September 2018

Background: Acute cholecystitis has the potential to cause sepsis and death, particularly in patients with poor physiological reserve. The gold standard treatment of acute cholecystitis (cholecystectomy) is often not safe in high-risk patients and recourse is made to percutaneous cholecystostomy as either definite treatment or temporizing measure. The aim of this study is to evaluate early and late outcomes following percutaneous cholecystostomy in patients with acute cholecystitis treated at our institution. Methods: All patients who underwent percutaneous cholecystostomy for acute cholecystitis (excluding patients with malignancy) between January 2005 and September 2014 were included in the study. Results: A total of 53 patients (22 female, median age, 74 years; range, 27–95 years) underwent percutaneous cholecystostomy during the study period. In total, 12 patients (22.6%) had acalculous cholecystitis. The main indications for percutaneous cholecystostomy were significant co-morbidities (n = 28, 52.8%) and patients too unstable for surgery (n = 21, 39.6%). The median time to percutaneous cholecystostomy from diagnosis of acute cholecystitis was 3.6 days (range, 0–45 days). The median length of hospital stay was 27 (range, 4–87) days. The overall 90-day mortality was 9.3% with two further deaths at 12-month follow up. The mortality was significantly higher in patients with American Society of Anesthesiology grade 4–5 (18% vs 0% in American Society of Anesthesiology grade 2–3, p = 0.026) and in patients with acalculous cholecystitis (25% vs 4.5%, p = 0.035). The overall readmission rate was 18%. A total of 24 (45.2%) patients had surgery: laparoscopic cholecystectomy, n = 11; laparoscopic converted to open, n = 5; open total cholecystectomy, n = 5; open cholecystectomy, n = 1; laparotomy and washout, n = 1; laparotomy partial cholecystectomy and closure of perforated small intestine and gastrostomy, n = 1. Conclusion: Percutaneous cholecystostomy is a useful temporary or permanent procedure in patients with acute cholecystitis of both calculous and acalculous origin, who are unfit for surgery.
Comparing the results of intradiscal ozone injection to treat different types of intervertebral disc herniation based on MSU classification
Authors: Hosseini Behnam , Taheri Mehrdad , Sheibani Kourosh 
Published: September 2018

Purpose To evaluate the therapeutic efficacy of intradiscal ozone injection in reducing pain and improving patients’ performance in different types of intervertebral disc herniation based on Michigan State University (MSU) classification. Patients and methods Consecutive patients with low back pain and radiculopathy treated in our center with ozone chemonucleolysis from May 2017 through to January 2018 entered the study. Patients had a disc herniation classified as group 1-A, 2-A, 1-B, 2-B, 1-C, 2-C, 1-AB or 2-AB based on MSU classification in magnetic resonance imaging. In all patients entering the study the severity of pain was recorded according to the visual analog scale criteria before and one and three months after the end of treatment. Oswestry Low Back Pain Disability Index (ODI) was used to compare patients’ performance before and after the treatment. Results In total 128 patients (60 females and 68 males) with mean age of 40.1 ± 10.7 entered the study. The patients were divided into eight groups based on MSU classification each including 16 patients. The reduction of pain severity and ODI score compared to baseline was statistically significant in all groups both in the first month and the third month after treatment. There was also a statistically significant difference between groups regarding the reduction of pain and ODI score indicating significantly worse treatment outcomes in groups 1-C, 2-C and 2-AB. Conclusion Based on our findings it seems that MSU classification can be used in patients’ selection to achieve the best treatment outcome after intradiscal ozone injection among patients with lumbar disc herniation.
Induction of Endometriosis in Nude Mice by Transplantation of Human Peritoneal Endometriotic Tissue
Authors: Defrère Sylvie , Colette Sébastien , Lousse Jean-Christophe , Van Langendonckt Anne , Donnez Jacques 
Published: September 2018

Purpose Ectopic endometrial tissue is biochemically and functionally distinct from eutopic endometrium, including differences in receptivity to steroids and invasive potential. For this reason, using ectopic endometrial tissue to induce endometriosis in animal models may be of interest to understand better the pathogenesis of this disease. The aim of this study was to evaluate the potential of human pelvic endometriotic lesions (specifically red lesions) to implant into the peritoneal cavity of nude mice. Methods Human peritoneal endometriotic tissue (red lesions) was injected into the pelvic cavity of nude mice. The mice were euthanized after 5 or 14 days, lesions were recovered, and histological analysis was performed. Proliferative activity and neoangiogenesis of lesions were assessed after Ki67 and CD34 immunohistological staining, respectively. Results After 5 and 14 days, endometriotic tissue was found to have implanted onto intact mesothelium and reorganized into structured glands and stroma, forming endometriosis-like lesions. These lesions showed considerable proliferative activity and effective neoangiogenesis. Conclusion This model represents a promising tool to study in vivo implantation of human ectopic endometrium, which is dissimilar to eutopic endometrium. Moreover, this study shows that glands and stroma detached from red endometriotic lesions are able to implant in other peritoneal sites, as in a metastatic process.
Haptoglobin Concentration in Peritoneal Fluid of Women with Endometriosis
Authors: Ferrero Simone , Gillot David J. , Remorgida Valentino , Grudzinskas Jurgis Gediminas 
Published: September 2018

Objective To determine the concentration of haptoglobin (Hp) in peritoneal fluid (PF) of women with and without endometriosis and its correlation with the phase of the menstrual cycle. The expression of Hpβe (determined by two-dimensional polyacrylamide gel electrophoresis) was correlated to total PF Hp concentration. Materials and methods PF samples were obtained from 240 women with or without endometriosis. PF Hp concentration was measured by a sandwich enzyme-linked immunosorbent assay. Hpβe expression in PF was estimated by two-dimensional polyacrylamide gel electrophoresis. Results PF Hp concentration was similar in women with and without endometriosis; it was significantly higher during the luteal phase of the menstrual cycle than in the follicular phase in control subjects, but not in women with endometriosis. There was a positive correlation between serum progesterone level and PF Hp concentration in control subjects during the luteal phase of the menstrual cycle. There was a mild positive correlation between PF Hp concentration and Hpβe expression in controls but not in women with endometriosis. PF Hp concentration was not correlated with the ASRM stage of endometriosis and the type of endometriotic lesions. Conclusions Women with and without endometriosis have similar PF Hp concentration. There is a mild positive correlation between PF Hp concentration and Hpβe expression in control subjects but not in women with endometriosis. Future investigations should aim to produce antibodies against specific epitopes of Hpβe that might allow its measurement by ELISA. (Journal of Endometriosis 2010; 2: 26–32)
Uterine Anomalies in Women with Endometriosis
Authors: Matalliotakis Ioannis M. , Goumenou Anastasia G. , Matalliotakis Michail , Arici Aydin 
Published: September 2018

Objective Uterine anomalies are associated with higher rate of infertility, spontaneous abortion, premature birth and endometriosis. We report our experience in 13 cases with uterine malformations and endometriosis. Methods The medical files of 425 cases with endometriosis and 200 without endometriosis, all of them studied by laparoscopy, were studied retrospectively in Yale University Hospital. Thirteen cases were observed and analyzed. Outcome measures Presenting symptoms, stage of endometriosis, menstrual characteristics, obstetrics outcome, family history, the type of uterine anomaly and presence of other anomalies were studied. Results In our series, we found 13/425 (3%) of women with endometriosis and congenital malformation. The mean age was 29.6 years (range 25–30). In this population, septate uterus (54%) was the most common malformation, followed by didelphic uterus (23%), unicornuate uterus (15.3%) and bicornuate uterus (7.7%). In 3 (23%) of these patients, we observed anomalies of the urinary tract. In the control group, we found only one case (0.5%) with septate uterus. Seven out of 13 (54%) of patients had severe endometriosis. The main symptom of all patients was infertility. Five out of thirteen conceived after assisted reproductive technology (ART) procedures. Five cases (38%) were found with first-degree family history with endometriosis. Conclusions Our results seem to support a link between uterine anomalies and subsequent development of endometriosis with infertility. The role of ART needs to be better evaluated. The co-existence of uterine anomalies with endometriosis and familiar aggregation of endometriosis should be examined in future studies, in order to improve our understanding of the genetic aspect of these diseases.
“Voluntarily Admitted Against My Will”: Patient Perspectives on Effects of, and Alternatives to, Coercion in Psychiatric Care for Self-Injury
Authors: Gerle Ellen , Fischer Anne , Lundh Lars-Gunnar 
Published: September 2018

Introduction: Various forms of coercion are used in the psychiatric care of patients with self-injurious behaviors, but there is little research on how these are perceived by the patients. The aim of this study was to investigate how 6 patients, who had received care for self-injurious behavior, perceived coercion and how they think coercion could be avoided. Methods: This study employed a qualitative design with 6 semistructured interviews and interpretative phenomenological analysis. Results: Three main themes were identified: keep voluntary care voluntary, apportioning control and responsibility, and dialogue and participation. Constant supervision was described as the most destructive form of coercion. To enable self-responsibility, a reduction of control and supervision was advocated. Calls were made for a treatment based on the assumption that there is a desire, on behalf of the patients, to get better. Conclusions: The use of coercion in the psychiatric care of patients with self-injurious behavior can be reduced by increasing predictability, by listening to the patient with genuine interest, and by involving the patient in decisions regarding their treatment.
Isokinetic functional outcomes of open versus percutaneous repair following Achilles tendon tears
Authors: Baumfeld Daniel , Baumfeld Tiago , Nery Caio , Maffulli Nicola 
Published: September 2018

Category: Sports Introduction/Purpose: Rupture of the Achilles Tendon (AT) is frequent in young recreational athletes. Conservative management, open surgery and percutaneous/minimally invasive approaches are all advocated, and conflicting data are available. This study compared functional and anthropometric outcomes of patients who underwent open or percutaneous repair. Methods: A retrospective comparative study, in which 38 patients underwent open and percutaneous techniques to manage AT ruptures. For functional assessment, the calf circumference of both injured and uninjured legs was evaluated. Isokinetic testing included total plantar flexion work, peak plantar flexion torque, total dorsiflexion work peak and dorsiflexion torque. The Achilles Tendon Rupture Score (ATRS) and the America Orthopedic Foot and Ankle Score (AOFAS) were evaluated at a final minimum follow-up of 12 months. Results: No major complications were observed. The average time to return to sport was 9 months. AOFAS and ATRS values did not differ statistically between groups. Isokinetic variables and circumference were similar in the operated and non-operated limb in both groups, and did not differ either when comparing open and percutaneous repair. Conclusion: Open and percutaneous repair of a torn Achilles tendon produced similar functional outcomes.
Patient Reported Outcomes of Tenodesis to Reconstruct Peroneal Tendon Tears
Authors: Danna Natalie , Rizkalla James , Abebe Ermias , Brodsky James 
Published: September 2018

Category: Ankle Introduction/Purpose: Peroneal tendon tears are a common cause of lateral ankle pain. When the tear involves more than 50% of the tendon’s cross-sectional area, the treatment algorithm recommends tenodesis of the torn peroneal tendon to the intact peroneal tendon. Previous assessments in the literature of functional outcomes after peroneal tenodesis have widely used the American Orthopedic Foot and Ankle Score (AOFAS) survey as a measurement tool. However, this score was not designed for patient-reported outcomes and its validity and reliability have been questioned. The Medical Outcomes Shortform-36 (SF-36) and PROMIS are tools that have been extensively studied and validated. We sought to assess patient outcomes after peroneal tenodesis using validated tools: SF-36, PROMIS and AOS Disability scores. Methods: Prospective data was collected on patients undergoing peroneal tenodesis for peroneal tendon tears, and who follow up of at least one year. Patients who underwent concomitant procedures (hindfoot fusion, total ankle arthroplasty) were excluded from the study. Baseline patient-reported outcomes (PRO) scores were obtained preoperatively and compared to scores obtained at one year postoperatively. Results: We identified seventeen patients who underwent peroneal tenodesis for peroneal tendon tears. Average age was 62.1 years. SF-36 Physical Function scores increased from an average of 42.0 preop to 60.0 postop (p = 0.0095). PROMIS scores increased from 40.3 to 42.7 (p = 0.3049). There was no statistically significant improvement in postoperative SF-36 Pain scores (p = 0.3216). AOS Disability Scores dropped from 49.6 preop to 38.2 postop (p = 0.3178). AOS Pain scores decreased from 40.7 to 27.0 (p = 0.1779). Total AOS score decreased from 45.1 to 32.6 (p = 0.2204). Conclusion: The SF-36 Physical Function score, which is a validated outcome measure, showed statistically significant improvement postoperatively. Some of the other PROs for peroneal tenodesis failed to show statistically significant improvements, and this is most likely due to low numbers, rendering the cohort somewhat under-powered. Though the data is preliminary, the non-significant scores trended toward improvement. Despite the preliminary nature of this study, satisfactory outcomes of peroneal tenodesis using validated patient-reported outcome scores are demonstrated for the first time. Further study is underway to enlarge the scope of this investigation.
Survival of the Scandinavian Total Ankle Replacement (STAR)
Authors: Frigg Arno , Germann Ursula , Huber Martin , Horisberger Monika 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: The purpose of this study was to evaluate survival and clinical outcome of the Scandinavian total ankle replacement (STAR) prosthesis after a minimum of ten years up to a maximum of 19 years. Methods: Fifty STAR prostheses in 46 patients with end stage ankle osteoarthritis operated between 1996 and 2006 by the same surgeon (MH) were included. Minimal follow-up was ten years (median 14.6 years, 95% confidence interval [CI] 12.9-16.4). Clinical (Kofoed score) and radiological assessments were taken before the operation and at one, ten (+2), and 16 (±3) years after implantation. The primary endpoint was defined as exchange of the whole prosthesis or conversion to arthrodesis (def. 1), exchange of at least one metallic component (def. 2), or exchange of any component including the inlay (due to breakage or wear) (def. 3). Survival was estimated according to Kaplan-Meier. Further reoperations related to STAR were also recorded. Results: The ten year survival rate was (def. 1) 94% (CI 82- 98%), (def. 2) 90% (CI, 77-96%), and (def. 3) 78% (CI 64-87%). The 19-year survival rate was (def. 1) 91% (CI 78-97%), (def. 2) 75% (CI 53-88%), and (def. 3) 55% (CI 34-71%). Considering any re-operations related to STAR, 52% (26/50) of prostheses were affected by re-operations. Mean pre-operative Kofoed score was 49, which improved to 84 after one year (n = 50), to 90 after ten years (n = 46), and to 89 after 16 years (n = 28). Conclusion: The survival rate for def. 1 and 2 was high. However, re-operations occurred in 52% of all STAR prosthesis.
Institutional Costs Associated with Ankle Fusion Nonunion
Authors: Gagné Oliver , Penner Murray , Wing Kevin , Younger Alastair , Veljkovic Andrea 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: Ankle arthrodesis is the most favored surgical treatment for several tibiotalar pathologies. Nonunion requiring revision occurs in 5.7% - 6.5% of patients. Nonunion is a challenging surgical complication and bone graft substitutes are costly. This study aimed to summarize all institutional expenditures related to ankle fusion nonunion needing revision, presuming that cost and skin-to-skin time would exceed that of the index surgery. Methods: Reviewing electronic charts from a foot and ankle center, a patient list with two or more entries for tibiocalcaneal, pantalar and tibiotalar fusions was generated. Out of 44 cases found, 21 patients had bilateral surgery and were excluded. Three had TAR or surgery in the periphery as index surgery; four had revision not for nonunion.Demographic factors and skin-to-skin time of the 16 remaining patients were compiled. Supplemental clinic visits and investigations were included either after CT to assess union, or 365 days post-index procedure in the absence of CT. Total cost of the revision was calculated from surgical billing codes, length of operation, and period of hospitalization. Post-revision outpatient fees were all included. This cohort included 16 patients (6F: 10 M) with an average age of 60 years (52 - 67) and BMI of 33 (29 - 38). 14 revisions were performed open; 13 patients received bone graft. Results: Average hospitalization post-operatively was 5.5 days (1.87 - 9.28). The additional cost associated with nonunion were $1,538 (CAD) for imaging, $737 for pre-revision visits, $12,483 for the revision and hospital stay, and $1,990 for post-revision follow-up. The total average amount was $14,982, equivalent to 10 nights of acute inpatient stay. Index average skin to skin time was 2:00:50 and for revisions 2:18:20, for a p-value of 0.26. The cost of nonunion per 100 primary procedures is therefore $85,397 to $97,383. If an intervention reduces the incidence of nonunion by 50% the cost saved would be $486 per procedure. As grafting or bone graft substitutes cost over $1,000, grafting should be limited to at risk patients. Conclusion: Additional care related to ankle fusion nonunion represents a financial burden equivalent to 10 nights of acute inpatient stay. Revision surgery is not significantly longer intraoperatively than index surgery. Bone graft and/or substitute should only be considered if it’s cost is less than $486 CAD at our institution.