bluuebunny/crossref_metadata_2025_split huggingface dataset:
Formal Balance Assessment and Intervention in Patients With Newly Implanted Left Ventricular Assist Devices: A Retrospective Analysis
Authors: Appel Jessica , Vatwani Archana , Sutton Kristin , Hall Amy , Russell Stuart D. 
Published: July 2018

Purpose:
The purpose of this study was to retrospectively review the implementation of a formal balance assessment and directed interventions in a sample of patients with newly implanted left ventricular assist devices (LVADs).

Methods:
Electronic medical records were reviewed in patients with newly implanted LVADs from January 2014 through August 2015. Patients were assessed using Tinetti Performance Oriented Mobility Assessment (Tinetti) and AM-PAC Inpatient Basic Mobility Short Form (AM-PAC). Patients participated in formal balance interventions. Data was analyzed using Microsoft Excel (Kirkland, WA) using a Student t test with 2-sided tail or paired t test, with a P-value of <.05 indicating statistical significance.

Results:
Of those patients included in the study, 94% of patients demonstrated initial fall risk, and 82% of patients demonstrated initial high fall risk. The initial Tinetti score was 13.7 (SD 7.2), increasing to 24.5 (SD 4.0) (P < .001) after intervention. Patients with high fall risk had an average length of stay of 27.36 days (SD 24.42 days) compared with those with lower fall risk with an average length of stay of 19.67 days (SD 6.55 days) (P = .62).

Conclusions:
A balance deficit was observed in patients with newly implanted LVADs. Following standardized intervention, deficits improve. These results warrant further exploration into proper dosing of intervention, additional outcome measures, and further research development.
Blood Pressure Attitudes, Practice Behaviors, and Knowledge of Outpatient Physical Therapists
Authors: Arena Sara K. , Reyes Alicia , Rolf Matthew , Schlagel Nicole , Peterson Edward 
Published: July 2018

Purpose:
The purpose of this study is to describe and determine correlations among blood pressure (BP) attitudes, practice behaviors, and knowledge among physical therapists (PTs) practicing in the outpatient (OP) settings.

Methods:
A survey was mailed to 1440 OP PTs matching inclusion criteria and through random selection from the American Physical Therapy Association Listserv. Self-reported demographics, attitudes, practice behaviors, and knowledge regarding BP measures of survey respondents were recorded. Descriptive statistics analyzed demographics and question responses; whereas a nonparametric Spearman version of the correlation coefficient analyzed correlations between variables.

Results:
Three hundred thirteen surveys from males (41.3%), females (58.7%), and PTs with greater than 10 years' of experience (57.8%). Although 51.8% of respondents did not feel importance in measuring BP during evaluation, 94.2% felt confident in their ability to do so. In addition, 85.0% of respondents did not routinely measure BP during evaluations. One-third and two-third of respondents correctly identified criteria matching a prehypertensive or hypertensive BP, respectively. Furthermore, a positive correlation (r = 0.84, P < .001) was identified between attitude and practice behaviors; however, not between attitude or practice behavior and knowledge.

Conclusion:
Initiatives to address misinformed BP attitudes and behaviors as well as gaps in knowledge of PTs providing care in OP settings is warranted.
Short Physical Performance Battery Can Be Utilized to Evaluate Physical Function in Patients After Cardiac Surgery
Authors: Katijjahbe Md Ali , Granger Catherine L. , Denehy Linda , Royse Alistair , Royse Colin , Clarke Sandy , El-Ansary Doa 
Published: July 2018

Purpose:
The Short Physical Performance Battery (SPPB) is a test used to assess physical function; however, the minimal clinically important difference (MCID) in patients after cardiac surgery is unknown. The aim of this study was to determine the MCID of the SPPB after cardiac surgery.

Methods:
Seventy-two participants performed the SPPB at 4 weeks and 3 months postoperatively. The Short Form-36 version 2 was used to assess physical function and the Global Rating of Change (GRC) scale was used to assess patients' perceived change. Distribution-based methods were used to determine the MCID.

Results:
The mean (95% confidence intervals [CIs]) change of the SPPB between testing time points was +1.04 (0.67–1.42) points. Ninety-eight percent of patients rated their function as “changed” on the GRC scale. The MCID calculated using distribution-based methods ranged from 0.44 points (95% CI [0.191, 0.613]) for the effect size-based estimate to 1.35 points for the standard error of measurement–based estimate. No participants scored 0/12; however, 45% and 69% of participants scored 12/12 at 4 weeks and 3 months postoperatively, respectively.

Conclusion:
The MCID for SPPB is estimated to be between 0.44 and 1.35 points out of 12 for patients in the early postoperative period. Nearly half of the participants scored the maximum score at 4 weeks, increasing to two-thirds at 3 months meaning that the SPPB may be too easy as time from surgery increases and patients recover. Further research is required to confirm the MCID in patients closer to surgery where the ceiling effect is likely to be lower.
Six-Minute Walk Test as a Predictive Measure of Exercise Capacity in Adults With Type 2 Diabetes
Authors: Nolen-Doerr Eric , Crick Kent , Saha Chandan , de Groot Mary , Pillay Yegan , Shubrook Jay H. , Donley David , Hornsby W. Guyton 
Published: July 2018

Objective:
The 6-minute walk test (6MWT) is a measure that is routinely used to assess a response to treatment for cardiopulmonary diseases such as pulmonary fibrosis and congestive heart failure. The measure has never been verified as a valid measure of exercise capacity in the highly prevalent patient population of type 2 diabetes (T2DM). This study investigated the correlation between the 6MWT and graded exercise testing (GXT) in an effort to validate the 6MWT as a quality tool for assessing exercise capacity in adults with T2DM.

Research Design and Method:
This is a secondary data analysis of Program ACTIVE II, a randomized controlled trial designed to assess the effectiveness of 2 behavioral interventions on depression and glycemic outcomes in adults with T2DM. The correlation of 6MWT and predicted VO2 max (PVO2M) using GXT was examined in a subsample of participants at the time of study enrollment and at postintervention.

Results:
PVO2M showed a significant correlation with 6MWT distance both at baseline (r = 0.57, P = .014) and postintervention (r = 0.66, P = .037). The regression analysis of baseline data revealed that 6MWT distance alone explained 45% (F = 13.03, P = .0024) of the variability in PVO2M. When combined with the SF-12 physical health component score (Physical Components Subscale [PCS]), 6MWT explained 66% (F = 13.62, P < .001) of the variance in PVO2M. After adjusting for PCS, 6MWT distance explained an additional 30% variability in PVO2M.

Conclusions:
Findings from this study indicate that the 6MWT and predicted exercise capacity are significantly correlated. The 6MWT can be used to estimate exercise capacity in adults with T2DM.
Comparison of Physical Fitness and Cardiopulmonary Exercise Test Performance Using Arm Versus Leg Cycling in Patients With Cardiovascular or Pulmonary Disease–A Systematic Review and Meta-analysis
Authors: Tolstrup Larsen Rasmus , Hermann Tang Lars , Keller Camilla , Christensen Jan , Taylor Rod S. , Doherty Patrick , Langberg Henning , Zwisler Ann-Dorthe 
Published: July 2018

Purpose:
Alternative modes of cardiopulmonary exercise testing are needed and an arm cycle (AC) is a promising alternative to the gold standard of the leg cycle (LC). The aim of this study was to undertake a systematic review comparing maximal oxygen consumption (VO2max) obtained from AC and LC in patient populations with cardiovascular disease (CVD) and pulmonary disease (PD).

Methods:
A systematic review was undertaken with literature searches on December 5, 2016. Studies were included if they directly compared aerobic capacity values obtained from AC and LC in patients with CVD or PD. Results across studies were pooled using random effects meta-analysis and univariate meta-regression were used to assess potential associations between variables.

Results:
A total of 14 studies in 411 patients were included. On average, VO2max of LC exceeded AC mean difference by 3.48 mL·kg−1·min−1, (95% confidence interval [CI]: 1.94, 5.03) and a mean AC/LC ratio of 0.83, (95% CI: 0.77, 0.90). VO2max differences between AC and LC were similar in patients with CVD compared with PD but were found to be higher in older individuals and those with higher VO2max.

Conclusions:
Although AC offers an important alternative form of exercise testing for patients with CVD or PD, clinicians must take into account that VO2max values obtained from AC are consistently lower than those obtained on LC. However, the results of this article offer an evidence-based estimation for the proportional differences between AC values and LC values for groups with CVD or groups with PD.
A 1-Month Physical Therapy–Based Outpatient Program for Adults Awaiting Lung Transplantation: A Retrospective Analysis of Exercise Capacity, Symptoms, and Quality of Life
Authors: Byrd Rebecca , Smith Patrick , Mohamedaly Omar , Snyder Laurie D. , Pastva Amy M. 
Published: July 2018

Purpose:
Rehabilitation can improve health outcomes in candidates for lung transplantation. The purpose of this study was to retrospectively evaluate the effect of a 1-month physical therapy (PT)–based outpatient program on exercise capacity, symptoms, quality of life (QOL) and examine predictors of functional outcome changes in adults awaiting lung transplantation.

Methods:
Participants (n = 141) completed a 23-session exercise and educational program over 1 month. Outcomes included 6-minute walk distance (6MWD), San Diego shortness of breath questionnaire (SOBQ), Center for Epidemiological Studies-Depression Scale (CESD), and Ferrans and Powers QOL Index Pulmonary Version III.

Results:
Participants were older (median age 63) with restrictive (59%) or obstructive (24%) disease. Moderate-to-large improvements in 6MWD were observed (69 m, P < .001, d = 0.72), independent of demographics, symptoms, and QOL. Lower initial 6MWD and lower oxygen utilization were associated with greater 6MWD improvements, with largest gains occurring in initial 6MWD <305 m. Small-to-moderate improvements were observed on CESD (P < .001, d = 0.26) and in overall QOL (P < .001, d = 0.27), with a nonsignificant improvement observed on SOBQ (P = .248, d = 0.13).

Conclusions:
Completion of a 1-month PT-based outpatient rehabilitation program was associated with improved exercise capacity, depressive symptoms, and QOL.
Evaluation of Limb Muscle Strength and Function in People With Chronic Obstructive Pulmonary Disease
Authors: Mathur Sunita , Dechman Gail , Bui Kim-Ly , Camp Pat G. , Saey Didier 
Published: July 2018

Purpose:
Muscle weakness is an observable consequence of limb muscle dysfunction in people with chronic obstructive pulmonary disease (COPD). The purpose of this review is to describe clinically applicable methods of muscle strength testing and functional tests that are associated with muscle strength in people with COPD.

Summary of Key Points:
Several tests and devices for evaluating muscle strength have been described in COPD. Isometric quadriceps strength testing, which is associated with clinical outcomes in COPD, can be reliably tested using fixed dynamometers or strain gauges in clinical and laboratory settings. Functional tests that are correlated with muscle strength in COPD include the Stair Climb Power Test, Sit-to-Stand test, and Timed Up and Go test. These tests are easy to conduct in the clinical setting and are relevant to daily activities; however, performance depends on factors such as balance and coordination in addition to leg muscle strength.

Conclusions:
Muscle strength assessment should be considered an integral part of the evaluation of people with COPD. Clinicians and researchers can select from a variety of valid and reliable tests to evaluate muscle strength based on their available resources and goals of the patient.
Correlation Between Functional Ability and Physical Activity in Individuals With Transtibial Amputations: A Cross-Sectional Study
Authors: Pepin Marie-Eve , Devour Alegra , Coolsaet Robin , Galen Sujay 
Published: July 2018

Purpose:
The aim of this study was to investigate the association between functional ability and physical activity (PA) in individuals with transtibial amputations.

Methods:
Twenty participants with unilateral transtibial amputation were recruited from outpatient prosthetic fitting clinics. Subjects completed the amputee mobility predictor (AMP), the L-Test, timed up and go (TUG), 2-minute walk test (TMWT), and self-reported activity restrictions questionnaire (Prosthesis Evaluation Questionnaire-Mobility Subscale). The subject's PA was monitored continuously for 7 days using a body-worn PA monitor. Descriptive statistics, comparison of mean values, and analysis of associations were performed with significance set at P < .05.

Results:
Data from 19 subjects were used for analysis. Descriptive analysis indicated that the participants spent on average 19.7 (SD = 0.5) hours per day laying/sitting, 3.5 (SD = 0.4) hours standing, 0.77 (SD = 0.07) hours stepping, and walked an average of 3145 (SD = 378) steps/day. There was a moderate to good correlation between the AMP and the average steps/day (r = 0.535, P = .009) and a fair correlation between the TMWT, the TUG, and steps per day (r = 0.404 and r = −0.442, respectively, P < .05).

Conclusions:
Individuals with transtibial amputations on average recorded 3145 steps/day, placing them in the sedentary category. The number of steps per day had a moderate to good correlation with the AMP and a fair correlation with the TUG and TMWT.
Spatial Distribution of Pancreatic Stones in Chronic Pancreatitis
Authors: Zeng Xiang-Peng , Zhu Xing-Yi , Li Bai-Rong , Pan Chun-Shu , Hao Lu , Pan Jun , Wang Dan , Bi Ya-Wei , Ji Jun-Tao , Xin Lei , Liao Zhuan , Du Ting-Ting , Lin Jin-Huan , Zhang Di , Ye Bo , Zou Wen-Bin , Chen Hui , Xie Ting , Zheng Zhao-Hong , Li Zhao-Shen , Hu Liang-Hao 
Published: July 2018

Objectives
The aim of this study was to establish a standard to describe the spatial distribution of pancreatic stones in chronic pancreatitis (CP).

Methods
Two hundred forty-seven CP patients with pancreatic stones from June to December 2012 were enrolled. Two-dimensional images from coronal projection of 3-dimensional computed tomography images of pancreatic stones were gained. The number (n) of all stones and the geometric standard deviation (σ) of distances between the centroid of all stones and the centroids of every stone that represented the spatial distribution nonuniformity were calculated by Stone Reconstruction and Identification Programming System.

Results
The mean value of n and σ were 13.6 and 22.5; n > 13.6 and σ > 22.5 were determined as “multistones” and “nonuniform,” respectively. Compared with alcoholic CP, idiopathic CP was less prone to multistones (odds ratio [OR], 0.310) and more prone to nonuniform (OR, 3.247). Pancreatic pseudocyst (OR, 2.211) in CP course was a risk factor of multistones, whereas diabetes mellitus in first-/second-/third-degree relatives (OR, 0.382) was a protective factor. Age at diagnosis of pancreatic stones (OR, 1.022) was a risk factor of nonuniformity.

Conclusions
Compared with idiopathic CP, alcoholic CP patients were prone to more pancreatic stones that distribute more uniformly.
Adverse Oncologic Impact of New-Onset Diabetes Mellitus on Recurrence in Resected Pancreatic Ductal Adenocarcinoma
Authors: Lee Seungho , Hwang Ho Kyoung , Kang Chang Moo , Lee Woo Jung 
Published: July 2018

Objectives
Diabetes mellitus (DM) is prevalent with pancreatic ductal adenocarcinoma (PDAC). Importantly, new-onset DM is characteristic of the disease and could be an early sign of PDAC. The clinical outcome of PDAC with new-onset DM may differ from that in patients without DM or long-standing DM.

Methods
We retrospectively reviewed medical records of PDAC patients who underwent curative resection between 2006 and 2014. New-onset DM was defined as a diagnosis of DM within 24 months before the diagnosis of PDAC. Survival analysis and Cox regression were performed to evaluate oncologic outcomes.

Results
No significant differences in clinical characteristics were found in 3 groups. Overall survival of patients with new-onset DM was worse than non-DM (22 vs 33 months, P = 0.039). New-onset DM was highly associated with early recurrence (hazard ratio, 1.451; 95% confidence interval, 1.054–1.999; P = 0.022). Poor oncologic outcome of new-onset DM was more pronounced in low T stage patients (overall survival in low vs high T stage, 33 vs 18 months; P = 0.129).

Conclusions
Pancreatic ductal adenocarcinoma with new-onset DM has worse oncologic outcomes than non-DM or long-standing DM. These results suggest that new-onset DM represents aggressive tumor biology, especially in the early stage of PDAC.
A Clinical Model for the Early Diagnosis of Acute Pancreatitis in the Emergency Department
Authors: Jin David X. , Lacson Ronilda , Cochon Laila R. , Alper Emily C. , McNabb-Baltar Julia , Banks Peter A. , Khorasani Ramin 
Published: July 2018

Objective
This study aimed to develop a diagnostic model that predicts acute pancreatitis (AP) risk before imaging.

Methods
Emergency department patients with serum lipase elevated to 3 times the upper limit of normal or greater were identified retrospectively (September 1, 2013–August 31, 2015). An AP diagnosis was established by expert review of full hospitalization records. Candidate predictors included demographic and clinical characteristics at presentation. Using a derivation set, a multivariable logistic regression model and corresponding point-based scoring system was developed to predict AP. Discrimination accuracy and calibration were assessed in a separate validation set.

Results
In 319 eligible patients, 182 (57%) had AP. The final model (area under curve, 0.92) included 8 predictors: number of prior AP episodes; history of cholelithiasis; no abdominal surgery (prior 2 months); time elapsed from symptom onset; pain localized to epigastrium, of progressively worsening severity, and severity level at presentation; and extent of lipase elevation. At a diagnostic risk threshold of 8 points or higher (≥99%), the model identified AP with a sensitivity of 45%, and a specificity and a positive predictive value of 100%.

Conclusions
In emergency department patients with lipase elevated to 3 times the upper limit of normal or greater, this model helps identify AP risk before imaging. Prospective validation studies are needed to confirm diagnostic accuracy.
Pathologic Evaluation of Surgical Margins in Pancreatic Cancer Specimens Using Color Coding With Tissue Marking Dyes
Authors: Takahashi Daigoro , Kojima Motohiro , Sugimoto Motokazu , Kobayashi Shin , Takahashi Shinichiro , Konishi Masaru , Gotohda Naoto , Nagino Masato 
Published: July 2018

Objectives
Processing of pancreatoduodenectomy specimens is not standardized; the clinical impact of pathologic surgical margins remains controversial. We used the color-coding method using tissue-marking dyes to evaluate margin status of resected specimens to assess its association with postoperative recurrence.

Methods
We developed a unified processing approach to assess pancreatoduodenectomy specimens. Five surgical margins of resected pancreatic specimens were marked with 5 colors. Microscopic resection margin distance (RMD) from margin closest to the tumor was evaluated for each surgical margin. Forty patients assessed using nonunified protocols, and 98 patients assessed using unified protocols were included.

Results
The frequency of tumors with RMD of 1 mm or less in posterior margin was significantly lower and that in portal vein/superior mesenteric vein margin was significantly higher in unified protocol group than in nonunified protocol group (P < 0.001). In unified protocol group, tumors with RMD of 1 mm or less correlated with locoregional recurrence (P = 0.025) and recurrence-free survival (P = 0.030). Multivariate analysis revealed that tumor size and lymph node metastasis were independent indicators for disease recurrence.

Conclusions
Resection margin distance of 1 mm or less was a predictor for disease recurrence, particularly for locoregional recurrence. Early detection of small-sized tumors without lymph node metastasis is necessary for improved clinical outcomes in pancreas cancers.
Palliative Care and Stroke
Authors: Molidor Stephanie , Overbaugh Kristen J. , James Deborah , White Carole L. 
Published: July 2018

Stroke survivors often experience life-altering functional and cognitive changes and burdensome symptoms. Palliative care could provide additional support to improve outcomes of stroke patients and their families. The purpose of this review was to describe how palliative care is conceptualized and implemented within stroke care.
An integrative review of the literature published between 1990 and 2016 using the terms “palliative care,” “stroke,” or “acute stroke” was conducted. Of the 363 articles identified, 44 were screened, 21 met inclusion criteria, and 2 additional articles were identified through reference list review, resulting in a final sample of 23 articles.
Palliative care was predominantly understood as end-of-life care and was most commonly offered in acute stages when patients were expected to die. Patients, families, and providers reported challenges surrounding decision making, uncertainty regarding transitions to palliative care, and needs related to communication and physical and psychosocial support. The quality of the research was moderate to good but was limited by retrospective designs, reliability of data collection procedures and tools, recall bias, and generalizability.
This review highlights gaps in access to palliative care throughout the illness trajectory and underscores the need for study of models that integrate palliative care into stroke care.
Functional Maturation and In Vitro Differentiation of Neonatal Porcine Islet Grafts
Authors: Hassouna Tarek , Seeberger Karen L. , Salama Bassem , Korbutt Gregory S. 
Published: July 2018

Background
There is a strong rationale to pursue the use of neonatal porcine islets (NPIs) as an unlimited source of islets for clinical xenotransplantation. Because NPIs are composed of immature insulin producing beta (ß) cells and ductal precursor cells, they provide an ideal model to examine culture conditions to enhance ß cell proliferation and/or ß cell neoformation from ductal cells. In an attempt to optimize the potential of NPIs as a source of ß cell grafts, we used an in vitro differentiation protocol and measured its effect on the functional maturation and differentiation of NPIs.

Methods
Pancreata from 1- to 3-day-old neonatal pigs were digested and cultured in standard Ham's F10 media for 5 days. Each independent preparation was then further cultured in Dulbecco's modified Eagle medium nutrient mixture-F12 differentiation media containing growth factors added in a stepwise fashion, or cultured in control Ham's F10 media. After 20 days in culture, islets were assessed for insulin secretory capacity, cellular composition, gene expression, and metabolic activity after transplantation in immunodeficient mice with diabetes.

Results
Compared with control islets, differentiated islets exhibited a significantly higher proportion of endocrine cells, proliferating cell nuclear antigen double positive ß cells, and an enhanced glucose-stimulated insulin secretory activity. Mice transplanted with differentiated islets had significantly lower blood glucose values at weeks 18 and 20 compared with nondifferentiated controls and were shown to be more glucose tolerant.

Conclusions
Culturing NPIs in a 20-day stepwise differentiation media increases the proportion of endocrine cells and augments both in vitro and in vivo function of the islets.