bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhancing Medical Learners’ Knowledge of, Comfort and Confidence in Holding Serious Illness Conversations
Authors: Tam Vivian , You John J. , Bernacki Rachelle 
Published: July 2019

Objectives: Having early discussions with seriously ill patients about their priorities and values can improve their peace of mind and family outcomes during bereavement; however, physicians and medical students report feeling underprepared to hold serious illness conversations. We evaluated the impact of the Serious Illness Care Program clinician training workshop on medical learners’ knowledge of comfort and confidence in holding such conversations. Methods: Eligible learners were penultimate- or final-year medical students or first-year residents of generalist programs (Family Medicine, Internal Medicine). Learners participated in a 2.5-hour workshop involving reflection on serious illness discussions, didactic teaching and demonstration of the Serious Illness Conversation Guide (SICG), role play with standardized patients, direct observation, and feedback from experts. Participants completed pre- and post-intervention questionnaires with Likert-type scale and open-ended questions, which were analyzed using paired t tests and qualitative content analysis, respectively. Results: We enrolled 25 learners. The intervention was associated with an increase in knowledge ( P < .001) and self-efficacy ( P < .001). All learners reported gaining new skills, with a majority specifically identifying a framework for structuring serious illness conversations in the qualitative analysis (n = 14, 56%). Participants stated the workshops would improve their comfort in holding serious illness conversations (n = 24, 96%), and that it would be valuable to integrate the workshops into their formal curricula (n = 23, 92%). Conclusions: Training on the use of the SICG is novel for medical students and first-year residents and associated with the improvement in their knowledge of and perceived capacity to hold serious illness conversations. This study suggests that the integration of SICG training into medical curricula may have educational value.
Intraoperative Assessment of the Axial Rotational Positioning of a Modern Ankle Arthroplasty Tibial Component Using Preoperative Patient-Specific Instrumentation Guidance
Authors: Gagne Oliver J. , Veljkovic Andrea , Townshend Dave , Younger Alastair , Wing Kevin J. , Penner Murray J. 
Published: July 2019

Background: The use of patient-specific instrumentation (PSI) in modern total ankle replacement (TAR) has augmented positioning of the tibial component, eliminating the need for complex jigs. Coronal and sagittal alignment are intuitive with this design and have been studied, but axial rotation has not. The purpose of this study was to assess the relationship between the planned preoperative axial rotation as set by the PSI guide and the rotation determined intraoperatively with non-PSI instrumentation. Methods: This was a prospective cohort study of 22 consecutive cases. The axial rotation angle between the medial gutter and the tibial implant position on the preoperative CT-scan based plan was extracted. At the time of surgery, the medial gutter alignment instrument from the non-PSI instrumentation was inserted and an intraoperative axial photograph obtained to record the angle between the medial gutter and the axial rotation guide pins set by the PSI instrumentation. The 2 measurements were compared and further statistical analysis included Pearson correlation and paired Student t test. Results: The average axial rotation angle between the medial gutter and the implant on the PSI preoperative plan was 5.4 ± 2.9 degrees, whereas the intraoperative photograph from the medial gutter alignment instrument to the pin was 5.9 ±3.8 degrees. This demonstrated a Pearson correlation of R = 0.54 and a P value of .53. The average difference between the two was −0.46 (95% CI: –2.04, 1.10), meaning that components were either slightly externally rotated or that the fork was aimed internally. Based on this group, 50% (11/22) were within 2 degrees of the target and 77% (17/22) were within 4 degrees of the target. Conclusion: Patient-specific guides allowed for reproducible rotational tibial component implantation in modern TAR. Further work is needed to better understand the biomechanical effects of the rotational profile and consequences on survivorship. Level of Evidence: Level IV, case series.
Circulating endothelial and progenitor cells in age-related macular degeneration
Authors: Mucciolo Dario Pasquale , Marcucci Rossella , Sodi Andrea , Cesari Francesca , Murro Vittoria , Rogolino Angela , Rizzo Stanislao , Giusti Betti , Virgili Gianni , Prisco Domenico , Gori Anna Maria 
Published: July 2019

Purpose: To evaluate circulating endothelial and circulating progenitor cells as biomarkers in age-related macular degeneration patients (both exudative and atrophic forms) in order to establish the possible clinical implication of their assessment. Methods: We have enrolled 44 age-related macular degeneration patients: 22 patients with a recently diagnosed exudative (neovascular) form (Group A) and 22 patients with an atrophic (dry) form (Group B). The control group consisted of 22 age and sex-matched healthy subjects (Group C). The number of circulating endothelial progenitor cells (CD34+/KDR+, CD133+/KDR+, and CD34+/KDR+/CD133+), circulating progenitor cells (CD34+, CD133+, and CD34+/CD133+), and circulating endothelial cells were determined in the peripheral venous blood samples by flow cytometry. Neovascular age-related macular degeneration patients were evaluated at baseline and 4 weeks after a loading phase of three consequent intravitreal injections of ranibizumab. Results: Comparing age-related macular degeneration patients with the control group, endothelial progenitor cell and circulating progenitor cell levels were not significantly different, while age-related macular degeneration patients showed significantly higher levels of circulating endothelial cells ( p = 0.001). Anti–vascular endothelial growth factor treatment with intravitreal ranibizumab was associated with a significant reduction of endothelial progenitor cell levels, with no significant influence on circulating progenitor cells and circulating endothelial cells. Conclusion: We reported higher levels of circulating endothelial cells in age-related macular degeneration patients in comparison with the control group, thereby supporting the hypothesis of an involvement of endothelial dysregulation in the age-related macular degeneration and a reduction of the endothelial progenitor cell level in neovascular age-related macular degeneration patients after three intravitreal injections of ranibizumab.
Effect of marital status on patient-reported outcomes following total hip arthroplasty: a matched analysis with minimum 2-year follow-up
Authors: Lall Ajay C , Schwarzman Garrett R , Battaglia Muriel R , Chen Sarah L , Maldonado David R , Domb Benjamin G 
Published: July 2019

Introduction: Mental health and patient expectation have been identified as key predictors of recovery following THA; however, there is limited literature examining the effects of social support and marital status on patient-reported outcomes (PROs). Methods: Data were prospectively collected and retrospectively reviewed for patients who underwent THA between July 2008 and January 2016. Patients were included if they underwent primary THA during this period and if they had documented preoperative marital status of married, divorced, or never married. Married patients were group matched to non-married patients (divorced or never married) with similar sex, age, body mass index (BMI), gender distribution, and frequency of surgical approach. Results: There were 414 married patients and 98 non-married patients who were eligible and had minimum 2-year follow-up. Mean PROs were significantly worse in the non-married group than the married group for the following measures: modified Harris Hip Score ( p = 0.002), Harris Hip Score ( p = 0.002), Forgotten Joint Score ( p = 0.04), and the physical portions of the Veterans RAND ( p = 0.025) and Short Form ( p = 0.02) surveys. Conclusions: Our study demonstrated inferior absolute PRO scores at latest follow-up for patients who were non-married compared to married following THA. These results show that while total hip replacement may still yield clinical benefit in all patients, non-married patients may ultimately achieve an inferior functional status, and expectations should be adjusted accordingly. Physicians should assess levels of psychosocial support in their patients prior to undergoing hip arthroplasty in order to optimise results.
Squeaking and other noises in patients with ceramic-on-ceramic total hip arthroplasty
Authors: Baruffaldi Fabio , Mecca Rosaria , Stea Susanna , Beraudi Alina , Bordini Barbara , Amabile Marilina , Sudanese Alessandra , Toni Aldo 
Published: July 2019

Introduction: Noise in ceramic-on-ceramic (CoC) total hip arthroplasty (THA) is a potential symptom of abnormal bearing wear. Squeaking and other prosthetic hip noises are multi-factorial phenomena that can be analysed and may provide prognostic information. Methods: 46 patients with noisy CoC bearings were investigated using X-ray, computed tomography and joint fluid analysis, and classified into either high or low risk of ceramic liner fracture groups according to previously published guidelines. Noise events from the bearings of 16 high risk cases which were subsequently revised were compared with 30 patients in the low risk control group who did not undergo revision. Noise events were analysed for their physical characteristics using a standardised protocol and classified as either low frequency and short duration ‘clicking’ or long duration and high frequency ‘squeaking’. Results: The peak frequency of squeaking during forward walking was significantly higher for patients in the case group who were revised, compared with the control group. The patient-reported onset of squeaking (46 months postoperatively) was earlier than short-noise emissions (82 months). In the standardised sequence of movements, short-noise always occurred more frequently than squeaking. Small heads (28 mm) were more likely to develop short-noise, while large heads (⩾32 mm) were more likely to develop squeaking. Discussion: Noise evaluation may provide additional value for predicting failure of CoC bearings, though some questions should be better investigated in a dedicated prospective trial.
Two-stage total hip arthroplasty following skeletal traction after extensive soft tissue release for severe limb-length discrepancy
Authors: Lee Soong Joon , Yoon Kang Sup 
Published: July 2019

Introduction: To maximise limb-length discrepancy (LLD) resolution during total hip arthroplasty (THA) for untreated developmental hip dysplasia or septic hip sequelae, THA following limb lengthening was introduced using different methods. We aimed to evaluate 2-stage THA results following limb lengthening via skeletal traction after extensive soft tissue release. Method: In total, 24 hips with severe LLD in 10 men and 14 women (mean age, 49.6 ± 15.2 years) underwent 2-stage THA and were followed thereafter (mean 6.3 ± 3.7 years). The entire abductor muscle origin was subperiosteally released from the ilium, and the soft tissue around the hip joint, including the psoas tendon, short external rotator, joint capsule, and adductor tendon, was extensively released. 2-stage THA was performed after 2-week skeletal traction using proximal tibial pins. During the final THA, 7 hips necessitated subtrochanteric shortening osteotomy (STO) for hip joint reduction. We evaluated the clinical and radiological results and especially focused on LLD and neurological complications. Results: The Harris Hip Score improved from 57.1 ± 9.6 to 88.3 ± 6.3 points. No patients showed worse abductor power. LLD improved from 5.0 ± 2.0 to 1.4 ± 1.0 cm. No permanent neurological complications occurred except for 1 transient peroneal nerve palsy during traction, which resolved fully after cessation of traction. There were 2 hips with STO nonunion treated with osteosynthesis and stem revision. Conclusion: 2-stage THA following skeletal traction after extensive soft tissue release showed favourable results in terms of neurologic complication prevention and LLD resolution. However, a large proportion of patients still necessitated shortening osteotomy with a risk for nonunion at the osteotomy site. Though surgical procedures might be complicated and necessitate longer hospital stays, 2-stage THA with extensive soft tissue release might be an alternative treatment option for patients with severe LLD willing to resolve their limb length discrepancy.
The effect of a stability and coordination training programme on balance in older adults with cardiovascular disease: a randomised exploratory study
Authors: Segev Daria , Hellerstein Devora , Carasso Rafi , Dunsky Ayelet 
Published: July 2019

Background:Cardiovascular diseases are considered a leading factor in mortality and morbidity. The older adult population with cardiovascular diseases has a higher risk of falls as compared to a matched age healthy population.Objective:To investigate the effect of stability and coordination training within a cardiac rehabilitation programme on fall risk in older adults with cardiovascular diseases enrolled in cardiac rehabilitation.Methods:Twenty-six people with cardiovascular diseases (age 74±8) were divided randomly into intervention and control groups. The intervention group received 20 min of stability and coordination exercises as part of their 80 min cardiac rehabilitation programme, while the control group performed the traditional cardiac rehabilitation programme, twice a week, for 12 weeks. Balance assessment was based on three tests: the Timed Up and Go, Functional Reach and Balance Error Scoring System, which were measured twice before the intervention, once following the intervention and once four weeks after the termination of the intervention. A two-way analysis of variance (group × time) with repeated measures was performed to examine differences between groups and between assessments.Results:Seventy per cent of participants in the intervention group adhered to the programme, with significant improvement post-intervention in the Timed Up and Go ( p < .01) and the Balance Error Scoring System ( p < .05) with no changes among the control group.Discussion:Stability and coordination training alongside a traditional cardiac rehabilitation programme may improve static and dynamic balance, and muscle strength, skills that are considered major components in postural control. Clinicians who work in cardiac rehabilitation centres should consider including this training alongside the routine cardiac rehabilitation programme.
Evaluating the convergent and discriminant validity of three versions of the frailty phenotype in heart failure: results from the FRAME-HF study
Authors: McDonagh Julee , Salamonson Yenna , Ferguson Caleb , Prichard Roslyn , Jha Sunita R , Macdonald Peter S , Davidson Patricia M , Newton Phillip J 
Published: July 2019

Background: Frailty is an important predictive measure of mortality and rehospitalisation in people with heart failure. To date, there are no frailty instruments validated for use in people with heart failure. Aim: The aim of this study was to evaluate the convergent and discriminant validity of three versions of the frailty phenotype in those with heart failure. Methods: A single site, prospective cohort study was undertaken among individuals with a confirmed diagnosis of heart failure. Frailty was assessed concurrently using three versions of the frailty phenotype: the original frailty phenotype and two modified versions; the Survey of Health, Ageing and Retirement in Europe frailty instrument (SHARE-FI) and the St Vincent’s frailty instrument. Convergent and discriminant validity were assessed by reporting the correlations between each version and related heart failure subconstructs, and by evaluating the ability of each version to discriminate between normal and abnormal scores of other physical and psychosocial scales specific to heart failure-related subconstructs. Results: The New York Heart Association classes were moderately correlated with the St Vincent’s frailty instrument ( r=0.47, P⩽0.001), SHARE-FI ( r=0.42, P⩽0.001) and the frailty phenotype ( r=0.42, P⩽0.001). The SHARE-FI and the St Vincent’s frailty instrument were both able to discriminate consistently between normal and abnormal scores in three out of five of the physical and psychosocial subconstructs that were assessed. The SHARE-FI was also able to discriminate between inpatients and outpatients who were classified as frail. Conclusions: Both the SHARE-FI and the St Vincent’s frailty instrument displayed good convergent and discriminant validity.
The Quality of Interactions Between Staff and Residents With Cognitive Impairment in Nursing Homes
Authors: Paudel Anju , Resnick Barbara , Galik Elizabeth 
Published: July 2019

Background: Positive and effective staff–resident interactions are imperative to adequately assess and meet the needs of cognitively impaired residents in nursing homes and optimize their quality of life. Aim: The purpose of this study was to quantify, describe, and analyze the interaction between staff and cognitively impaired residents in nursing homes, using the Quality of Interaction Schedule (QuIS). Method: This descriptive analysis utilized baseline data from the first 2 cohorts in a randomized clinical trial including 341 residents from 35 nursing homes. Results: Five hundred fifty-six staff–resident interactions were evaluated; majority were positive (n = 466, 83.8%) and the remaining were either neutral (n = 60, 10.8%) or negative (n = 30, 5.4%). The quality of interactions varied by interaction location, interpersonal distance, and resident participation. Conclusion: Future research should focus on decreasing the negative/neutral interactions and explore staff characteristics (eg, gender, level of experience) and facility factors (eg, size, ownership) that might influence the quality of interactions.
Comparison of Ultrasound-Accelerated Versus Multi-Hole Infusion Catheter-Directed Thrombolysis for the Treatment of Acute Limb Ischemia
Authors: Chait Jesse , Aurshina Afsha , Marks Natalie , Hingorani Anil , Ascher Enrico 
Published: July 2019

Objective: Thrombolytic therapy is widely used in the treatment of arterial occlusions causing acute limb ischemia (ALI); however, knowledge regarding the efficacy of the different catheter systems available is scarce. The objective of this study was to compare the safety and efficacy of 2 catheter-directed infusion systems for intra-arterial thrombolysis in the setting of ALI. Methods: A retrospective analysis was conducted to study all catheter-directed thrombolysis procedures performed over 32 months in patients diagnosed with ALI. Patients with thrombosis in both native arteries and bypass grafts were included. Patients with contraindications to thrombolysis, or those receiving thrombolysis for deep venous thrombosis, were excluded. The duration of thrombolysis, amount of thrombolytic agent, and technical success rate were recorded. Technical success was defined as complete or near-complete resolution of thrombus burden, allowing for further intervention. Data were stratified to include location of thrombus, procedural complications, mortality, and rates of limb loss. Results: Ninety-one patients met inclusion criteria. Among them, Uni-Fuse and EKOS catheters were used in 69 and 22 patients, respectively. The mean age of the population was 71 (standard deviation [SD]: ±1.5) for patients treated with the EKOS catheter and 70 years (SD: ±2.6) for patients receiving thrombolysis with Uni-Fuse. There was no significant difference in the mean infusion duration (1.65 vs 1.9 days), volume of tissue plasminogen activator (44.6 vs 48.2 mg), or technical success rate (72% vs 86%) between the Uni-Fuse and EKOS cohorts ( P > .3). Furthermore, there was no difference in major limb loss or compartment syndrome between each group ( P > .4). The overall complication rate was 14% in both groups, with a 30-day mortality rate of 4% when treated with either catheter system. Conclusion: This study suggests that a standard multi-hole infusion catheter demonstrates similar clinical safety and efficacy as the ultrasound-accelerated EKOS system in the treatment of ALI.
Allergy-Related Diseases and Risk of Breast Cancer: The Role of Skewed Immune System on This Association
Authors: Sadeghi Fatemeh , Shirkhoda Mohammad 
Published: July 2019

Background The role of allergy in breast cancer (BC) development remains inconclusive. A comprehensive review article is required to present and discuss all findings on this topic and to clarify the association between allergic disorders and the risk of BC. Objective We aimed to explain the association between atopy, different types of allergic disorders, and the risk of BC. Moreover, we explored the immunological mechanism behind this association. Methods We electronically reviewed publications in PubMed from 1979 to 2018 relating to atopy, allergy, asthma, atopic dermatitis, allergic rhinitis, food allergy, drug allergy, immunoglobulin E (IgE) or prick test, and BC. Results Most of the identified studies demonstrated nonsignificant results. However, the pattern of the results indicated an increased risk of BC in individuals with a history of allergies. The majority of studies reported higher prevalence of atopic dermatitis and allergic rhinitis among individuals with BC compared to the control groups. Similarity, most of the studies revealed an increased risk of BC among people with a positive history of atopic using IgE specific or prick test. However, a null association was reported in most of the asthmatic studies, and controversial results were detected in the individuals with history of food and drug allergies. Conclusion The majority of findings were not statistically significant. Moreover, bias and other methodological problems are the major issues, which make it challenging to compare the findings of different studies and reach a strong conclusive result. However, the pattern of the results from most studies indicated that allergic diseases might be associated with an increased risk of BC. Skewed immune system toward T-helper 2 might have an important role in this association.