bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Update on Measures of Preoperative Glycemic Control
Authors: Ngaage Ledibabari M. , Osadebey Emmanuel N. , Tullie Sebastian T.E. , Elegbede Adekunle , Rada Erin M. , Spanakis Elias K. , Goldberg Nelson , Slezak Sheri , Rasko Yvonne M. 
Published: May 2019

Summary:
Glycemic control represents a modifiable preoperative risk factor in surgery. Traditionally, hemoglobin A1c (HbA1c) and plasma glucose are utilized as measures of glycemic control. However, studies show mixed results regarding the ability of these conventional measures to predict adverse surgical outcomes. This may be explained by the time window captured by HbA1c and serum glucose: long-term and immediate glycemic control, respectively. Fructosamine, glycosylated albumin, and 1,5-anhydroglucitol constitute alternative metrics of glycemic control that are of growing interest but are underutilized in the field of surgery. These nontraditional measures reflect the temporal variations in glycemia over the preceding days to weeks. Therefore, they may more accurately reflect glycemic control within the time window that most significantly affects surgical outcomes. Additionally, these alternative measures are predictive of negative outcomes, even in the nondiabetic population and in patients with chronic renal disease and anemia, for whom HbA1c performs poorly. Adopting these newer metrics of glycemia may enhance the value of preoperative evaluation, such that the effectiveness of any preoperative glycemic control interventions can be assessed, and adverse outcomes associated with hyperglycemia better predicted. The goal of this review is to provide an update on the preoperative management of glycemia and to describe alternative metrics that may improve our ability to predict and control for the negative outcomes associated with poor glycemic control.
Adoption of Enhanced Recovery after Surgery Protocols in Breast Reconstruction in Alberta Is High before a Formal Program Implementation
Authors: Redwood Jennifer N. , Matkin Ashlee E. , Temple-Oberle Claire F. 
Published: May 2019

Background:
Enhanced recovery after surgery (ERAS) techniques have consistently demonstrated improved patient outcomes across multiple surgical specialties. We have lead international consensus guidelines on ERAS protocols for breast reconstruction and recently implemented these guidelines in Alberta. This study looks at adoption rates of ERAS pathways for breast reconstruction within Alberta, whereas also addressing barriers to ERAS implementation.

Methods:
A retrospective analysis of online operative reports in the Synoptec database consisting of patients undergoing alloplastic or autogenous breast reconstruction in Alberta was conducted. Primary outcomes of interest included whether ERAS protocols were utilized and what the reported barriers to ERAS utilization were.

Results:
Of the 372 patients undergoing breast reconstruction surgery, 215 (57%) patients were placed on an ERAS protocol. Autogenous reconstruction patients were more likely than alloplastic reconstruction patients to be placed on ERAS protocols (72% versus 53%, P = 0.002). A lack of resources was the most commonly cited reason for not adopting ERAS protocols for both autogenous and alloplastic reconstruction groups (53% and 53%). Surgeons in Southern Alberta were more likely than surgeons in Northern Alberta to utilize ERAS protocols for their alloplastic (73% versus 8%, P < 0.001) and autogenous (99% versus 4%, P < 0.001) reconstructions.

Conclusions:
Adoption of ERAS protocols in Alberta was strong (57% adherence) before a formal program implementation. We are encouraged that the recent official launch of ERAS protocols in breast reconstruction within the province will further enhance the uptake and care of this unique surgical population.
PEELING OF THE INTERNAL LIMITING MEMBRANE WITH FOVEAL SPARING FOR TREATMENT OF DEGENERATIVE LAMELLAR MACULAR HOLE
Authors: Morescalchi Francesco , Russo Andrea , Gambicorti Elena , Cancarini Anna , Scaroni Nicolò , Bahja Hassan , Costagliola Ciro , Semeraro Francesco 
Published: May 2019

Purpose:
To compare the functional and anatomical results of fovea-sparing internal limiting membrane peeling during vitrectomy with those of observation for degenerative lamellar macular hole with lamellar hole–associated epiretinal proliferation.

Design:
A prospective, randomized, comparative pilot study.

Methods:
Thirty-six eyes were randomized to undergo surgery with foveal internal limiting membrane sparing (Group S) or observation only (Group C). The main outcome measures were foveal retinal sensitivity, visual acuity, and central retinal thickness.

Results:
After 6 months, a significant difference was found in foveal retinal sensitivity between Group S (12.8 ± 1.7 dB) and Group C (9.39 ± 1.8 dB; P < 0.001). Similarly, best-corrected visual acuity improved in Group S and remained stable in Group C (respectively, 0.17 ± 0.13 and 0.46 ± 0.21 logMAR; P < 0.001). A significant increase in central retinal thickness was observed in Group S, but not in Group C (272 ± 24 vs. 147 ± 20 µm, P < 0.001).

Conclusion:
Fovea-sparing internal limiting membrane peeling is a feasible treatment for degenerative lamellar macular hole with lamellar hole–associated epiretinal proliferation, yielding better improvements in best-corrected visual acuity and foveal retinal sensitivity than observation alone. Further studies are needed to optimize this new surgical approach.
Translation, Adaptation, and Validation of the Malay Version of the Cardiac Rehabilitation Barriers Scale
Authors: CHAI Li Sze , SIOP Sidiah , PUTIT Zabidah , LIM Lily , GUNGGU Azylina , TIE Suk Fong 
Published: May 2019

ABSTRACT

Background
The rate of cardiac rehabilitation attendance at the Sarawak Heart Centre was identified as very low, and the reason has not been investigated. A scale is needed to identify barriers to participation in cardiac rehabilitation among patients with heart disease in Sarawak, Malaysia.

Purpose
The purposes of this study were to translate, adapt, and evaluate the Malay-language version of the Cardiac Rehabilitation Barriers Scale (CRBS) and to measure the psychometric properties of the Malay-version CRBS to justify its use in Sarawak.

Methods
A forward and back-translation method was used. Content validity was assessed by three experts. Psychometric testing was conducted on a sample of 283 patients who were eligible to participate in cardiac rehabilitation. A construct validity test was performed using factor analysis. Cronbach's alpha was used to examine the internal consistency. The test–retest reliability was calculated using the intraclass correlation coefficient on 22 participants. Independent-samples t test and analysis of variance were conducted to assess the criterion validity. Mean scores for total barriers of the scale and each individual factor were compared among the different patient characteristics.

Results
The Malay-version CRBS showed an item level of content validity index of 1.00 for all of the items after improvements were made based on the experts' suggestions. The factor analysis, using principal component analysis with direct oblimin rotation, extracted four factors that differed from the original study. These four factors explained 52.50% of the cumulative percentage of variance. The Cronbach's alphas ranged from .74 to .81 for the obtained factors. Test–retest reliability was established using the intraclass correlation coefficient value of .78. Criterion validity was supported using the significant differences in the mean score for total barriers among educational level, driving distance, travel time to the hospital, and cardiac rehabilitation attendance.

Conclusions/Implications for Practice
This study found the Malay-version CRBS to be a valid and reliable instrument. It may be used with inpatients to identify barriers to participation in cardiac rehabilitation to promote rehabilitation attendance and improve patient care.
Assessment of Dietary Habits in Patients With Chronic Heart Failure
Authors: UYSAL Hilal , ÖZ ALKAN Havva , ENÇ Nuray , YIĞIT Zerrin 
Published: May 2019

ABSTRACT

Background
Nutritional deficiency is a critical factor in the development and prognosis of heart failure. An optimal diet should be ensured and maintained to manage the symptoms of heart failure.

Purpose
This study assessed the dietary habits of patients with chronic heart failure using diet quality indices with the goal of determining their nutritional status.

Methods
Forty-four female patients and 56 male patients (mean age: 66 ± 11.38 years) who had been admitted to the cardiology clinics of a university hospital in Istanbul between March 2012 and August 2014 were included in this study.

Results
In terms of body mass index, 34% of the participants were normal weight, 37% were overweight, and 21% were obese. Furthermore, this study found the mean daily total energy intake to be inadequate and the total mean score of the Healthy Eating Index to be 74.6 ± 9.32. The diet quality of most participants fell into the “needs improvement” category.

Conclusions
This study used the Healthy Eating Index, a measure developed to assess diet quality, to assess the food consumption patterns of patients with chronic heart failure. The findings support using this index before providing diet recommendations to patients.
Concerns and Needs of Support Among Guardians of Children on Cancer Treatment in Dar es Salaam: A Qualitative Study
Authors: Masika Golden M. , Gottvall Maria , Kohi Thecla W. , von Essen Louise , Dol Justine S. 
Published: May 2019

Background
Cancer in children in Tanzania is a concerning health issue, yet there is a shortage of information about the experiences of the guardians of children who receive cancer treatment.

Objective
To explore concerns and needs of support among guardians of children on cancer treatment in Dar es Salaam, Tanzania.

Method
Using a qualitative design, 3 focus group discussions were held with 22 guardians of children aged 9 to 17 years. Guardians were recruited from Muhimbili National Hospital, Dar es Salaam, where their children were receiving cancer treatment. Data were analyzed using thematic content analysis.

Results
Guardians experienced several issues during the initial stages of their child’s cancer treatment, including the process of seeking a diagnosis, and experiences with care at the peripheral (regional) hospitals and national hospital. They also shared what they felt would lessen their difficult experiences. Seven themes emerged in this study: financial concerns, emotional concerns, barriers to cancer care, need for improved cancer care, need for information, need for tangible support, and gratitude and hope.

Conclusion
Guardians of children with cancer experience challenges during initial stages when seeking a diagnosis and have concerns and needs related to cancer care and treatment.

Implications for practice
Improvements are needed regarding care at regional hospitals, the cancer diagnosis, and the recognition of early signs of cancer and quick referral to diagnostic centers, compassionate caring behaviors by healthcare workers, budgetary support from the government to meet the medication supply demands, and meeting stakeholders’ support needs.
Self-adjustable Spectacle Wearing Compliance and Associated Factors among Rural School Children in Ghana
Authors: Ilechie Alex Azuka , Abokyi Samuel , Boadi-Kusi Samuel , Enimah Eugene , Ngozi Ezinne 
Published: May 2019

SIGNIFICANCE
Self-adjustable spectacles are increasingly being used in refractive service delivery programs in developing countries. Despite the success of self-refraction as a refraction technique, compliance with actual wear of adjustable spectacles has not been evaluated. Findings in this study have significant programmatic implications for the effectiveness and sustainability of this mode of correction in developing countries.

PURPOSE
The purpose of this study was to assess compliance with wearing of adjustable spectacles and factors associated with compliance in pre-teen schoolchildren at 6 months after spectacles were dispensed.

METHODS
A cohort of 86 children aged 6 to 12 years with presenting vision worse than or equal to 6/12 in the better eye that could be improved to better than or equal to 6/7.5 by subjective refraction and who were identified from a randomized sample of 18 primary schools in the coastal areas of Cape Coast in Ghana received free FocusSpecs adjustable spectacles after successfully completing self-refraction and cycloplegic subjective refraction. Follow-up examination to assess compliance and to determine reasons for noncompliance was conducted at 6 months after spectacle provision. Logistic regression models assessed factors associated with spectacle wear compliance (95% confidence intervals [CIs]).

RESULTS
Spectacle wear compliance was 33.7% (95% CI, 31.3 to 36.1%); an additional 29% had their spectacles with them but were not wearing them. The major reasons given by the children for noncompliance were “loss” (32%; 18/57) and “breakage” (23%; 13/57). Modest compliance (49%) was observed among the poorer children who attend public schools. Attending public school was the only predictor of compliance to spectacle wear (odds ratio, 3.096; 95% CI, 1.228 to 7.805; P = .02).

CONCLUSIONS
Despite accurate self-refraction by most children, only a small proportion was compliant with actual wear of the spectacles. Loss and breakage were the major reasons for noncompliance. The poorer children who attend public schools, who stand to benefit most from the technology, were the ones more likely to be compliant with wear.
Impact of Dry Eye on Visual Acuity and Contrast Sensitivity: Dry Eye Assessment and Management Study
Authors: Szczotka-Flynn Loretta B. , Maguire Maureen G. , Ying Gui-shuang , Lin Meng C. , Bunya Vatinee Y. , Dana Reza , Asbell Penny A. 
Published: May 2019

SIGNIFICANCE
Identification of the association of specific signs of dry eye disease with specific visual function deficits may allow for more targeted approaches to treatment.

PURPOSE
The purpose of this study was to explore the association of dry eye signs and symptoms with visual acuity (VA) and contrast sensitivity in the Dry Eye Assessment and Management study.

METHODS
Baseline data from participants in the Dry Eye Assessment and Management study were used in this secondary cross-sectional analysis. Standardized procedures were used to obtain results on the Ocular Surface Disease Index (OSDI), high-contrast logMAR VA, contrast sensitivity, tear film debris, tear breakup time (TBUT), corneal fluorescein staining, meibomian gland evaluation, conjunctival lissamine green staining, and Schirmer test scores. Generalized linear models that included age, refractive error status, and cataract status were used to assess the association between VA and contrast sensitivity with OSDI score and each dry eye sign. The Hochberg procedure was used to account for multiple comparisons.

RESULTS
Among 487 participants (974 eyes), worse VA was associated with worse mean score on the OSDI vision subscale (39.4 for VA 20/32 or worse vs. 32.4 for VA 20/16 or better; adjusted linear trend, P = .02); scores were not associated with contrast sensitivity. Severe meibomian gland plugging and abnormal secretions were associated with worse mean log contrast sensitivity (1.48 for severe vs. 1.54 for not plugged [P = .04] and 1.49 for obstructed vs. 1.57 for clear [P = .002], respectively). Longer TBUT was associated with better mean log contrast sensitivity (1.57 for TBUT >5 seconds and 1.51 for TBUT ≤2 seconds, P < .0001).

CONCLUSIONS
Worse VA rather than worse contrast sensitivity drives vision-related symptoms in dry eye. Greater tear film instability was associated with worse contrast sensitivity.
The Effect of Vertically Yoked Prisms on Binocular Vision and Accommodation
Authors: Schmid Katrina L. , Beavis Stephanie D. , Wallace Sophia I. , Chen Joy , Chien Yi-Tang , Nguyen Terry , Tran Amy , Varnas Saulius R. , Atchison David A. 
Published: May 2019

SIGNIFICANCE
Vertically yoked prisms have been used in treatment of binocular vision dysfunction despite minimal supporting evidence. In people with normal binocular vision, the impact on phorias has been assessed but not the impact on accommodation, accommodation vergence interactions, or the horopter. We found that vertically yoked prisms have minor effects during short-term wear in young adults.

PURPOSE
The purpose of this study was to determine effects of vertically yoked prisms on accommodative response and several binocular vision tasks.

METHODS
There were 45 participants aged 18 to 24 years. The 23 myopes wore distance-corrected soft contact lenses. In a random arrangement, each person wore spectacles containing planopower lenses with either 8 Δ base-up, 4 Δ base-up, zero, 4 Δ base-down, and 8 Δ base-down prisms. Before spectacle wear, baseline measurements of near heterophoria, accommodation response, negative and positive relative accommodations, fusional vergence, and Nonius-horopter spatial perception were taken. Measurements were repeated after a 40-minute wear, spectacles were removed, and tests were performed 20 minutes later. On a 22-participant subset, on a separate occasion, measurements of heterophoria, accommodation response, and relative accommodation were made immediately after spectacles were fitted.

RESULTS
Most changes relative to baseline were not significant. Where effects occurred, these were nearly all associated with prism presence rather than adaptation. There were significant effects on accommodation response, but these seem to be refraction effects produced by pantoscopic tilt–induced power changes rather than perceptual effects altering accommodation. There were statistically significant effects on negative relative accommodation (P < .01), with zero prism giving more negative relative accommodation than 8 Δ base-down prisms. Tendencies were noted for prisms to move horopter limits toward the observer. Effects were small and likely not of clinical relevance.

CONCLUSIONS
Vertically yoked prisms have minor effects on accommodation and binocular vision, at least during short-term wear in young adults with normal binocular vision.
Use of Decision Analysis and Economic Evaluation in Upper Extremity Surgery: A Systematic Review
Authors: Safran Tyler , Retrouvey Helene , Gorsky Kevin , Baltzer Heather L. 
Published: May 2019

Background:
Decision analysis allows clinicians to apply evidence-based medicine to guide objective decisions in uncertain scenarios. There is no comprehensive review summarizing the various decision analysis tools used. The authors aimed to appraise and review the decision analytic models used in hand surgery.

Methods:
A search of English articles on the PubMed, Ovid, and Embase databases was performed. All articles, regardless of date of publishing, were considered. Two reviewers, based on strict inclusion criteria, independently assessed each article.

Results:
The search resulted in 5525 abstracts, which yielded 30 studies that met inclusion criteria. Included studies were grouped according to medical indications, with scaphoid fractures (n = 6) and carpal tunnel syndrome (n = 5) being the most commonly reported. Included articles used decision analysis (n = 15) and/or economic analyses (n = 23) to discuss diagnostic strategies or compare treatments. The three most common outcomes reported were utility (n = 12), cost per quality-adjusted life-year (n = 16), and quality-adjusted life-years (n = 16). The decision analysis models compared diagnostic strategies, management options, and novel treatments.

Conclusions:
Decision analysis is increasingly popular in hand surgery. It is useful for comparing surgical strategies through evaluation of quality-of-life outcomes and costing data. The most common model was a simple decision tree. The quality of decision analysis models can be improved with the addition of sensitivity analysis. Surgeons should be familiar with the principles of decision analysis, so that complex decisions can be evaluated using rigorous probabilistic models that combine risks and benefits of multiple strategies.
Interaction of Adipose-Derived Stromal Cells with Breast Cancer Cell Lines
Authors: Teufelsbauer Maryana , Rath Barbara , Moser Doris , Haslik Werner , Huk Ihor , Hamilton Gerhard 
Published: May 2019

Background:
Assisted lipotransfer for breast reconstruction involves the isolation and supplementation of adipose-derived stromal cells. This procedure has raised concerns regarding safety with respect to promotion of tumor growth and relapse. Several in vitro and animal experimental studies have indicated increased survival, growth, and invasive characteristics of breast cancer cells on interaction with adipose-derived stromal cells. These results seem to be in poor concordance with clinical observations of a low rate of cancer recurrences after assisted lipotransfer.

Methods:
The authors investigated the effects of adipose-derived stromal cells and adipose-derived stromal cells differentiated into adipocytes and fibroblasts on five breast cancer cell lines (i.e., T47D, MCF-7, BT20, MDA-MB-231, and ZR-75-1) and MCF-10A, a nonmalignant counterpart.

Results:
Conditioned media of adipose-derived stromal cells stimulated the proliferation of breast cancer cell lines depending on the individual adipose-derived stromal cell–breast cancer cell line combination. Conditioned media of adipose-derived stromal cells differentiated into adipocytes gave a lower response, and conditioned media of fibroblasts were also active. A putative cancer stem cell–like phenotype was not increased by adipose-derived stromal cell–conditioned media, no physical interaction of cancer cells with adipose-derived stromal cells was detectable on scanning electron microscopy, and cell migration was not enhanced. Adipogenic differentiation of adipose-derived stromal cells indicated that hepatocyte growth factor, insulin-like growth factor-binding protein-3, insulin-like growth factor-binding protein-6, interleukin-6, CCL2/MCP-1, and macrophage colony-stimulating factor are not linked to the proliferative activity of conditioned media.

Conclusion:
The results indicate that the adipose-derived stromal cells used for assisted lipotransfer are not expected to increase the risk of tumor recurrence to a major degree in correspondence with the clinical observation of the affected breast cancer patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.