bluuebunny/crossref_metadata_2025_split huggingface dataset:
Persistent Fistula After Anorectal Abscess Drainage: Local Experience of 11 Years
Authors: Sahnan Kapil , Askari Alan , Adegbola Samuel O. , Warusavitarne Janindra , Lung Phillip F.C. , Hart Ailsa , Faiz Omar , Phillips Robin K.S. , Tozer Phil 
Published: November 2018

BACKGROUND:
The characteristics of patients who develop a fistula-in-ano after an anorectal abscess are unclear.

OBJECTIVE:
Our study explored this relationship and patient factors associated with fistula development.

DESIGN:
International Classification of Diseases, 10th Revision, and Classification of Interventions and Procedures, version 4, codes were used to identify all of the patients with a primary anorectal abscess. Multivariable analysis was used to identify factors predictive of fistula formation.

SETTINGS:
The study was conducted in a district general hospital.

PATIENTS:
Patients with anorectal abscess who were admitted to our institution (2004–2015) were included.

MAIN OUTCOMES MEASURES:
The rate of subsequent fistula formation was measured.

RESULTS:
A total of 1970 abscess patients were identified; 70.0% (n = 1379) were men, and 7.3% (n = 144) had Crohn’s disease. Fistulas occurred in 16.2% (n = 319) at a median of 7 months (interquartile range, 3–7 mo). Patients with Crohn’s disease were more than twice as likely to develop a fistula than patients without Crohn’s disease (32.6% vs 14.9%; OR = 2.5 (95% CI, 1.7–3.7); p < 0.001). Patients with Crohn’s disease with a fistula were more likely to be women (55.3% vs 34.6%; p = 0.007) and aged <30 years (51.1% vs 24.3%; p< 0.001) versus patients without Crohn’s disease with a fistula. At multivariable analysis of the entire cohort, male sex (OR = 0.7 (95% CI, 0.5–0.9); p = 0.005) and diabetes mellitus (OR = 0.5 (95% CI, 0.3–0.9); p = 0.027) were associated with a reduced likelihood of developing a fistula after abscess formation.

LIMITATIONS:
The study was limited by its single-center scope, retrospective analysis, and lack of a standardized definition for Crohn’s disease.

CONCLUSIONS:
Abscesses are more common in men, but progression to fistula is more likely in women. The rate of fistula progression in Crohn’s disease is twice that in patients without Crohn’s disease. Identification of patients at risk may help delineate those who will benefit from a more conservative surgical approach, enhanced follow-up, or investigation after abscess drainage. See Video Abstract at http://links.lww.com/DCR/A798.
Predictors of Oral Function and Facial Aesthetics Post Maxillofacial Reconstruction with Free Fibula Flap
Authors: Alotaibi Ahmed , Aljabab Abdulsalam , Althubaiti Ghazi 
Published: November 2018

Background:
For maxillofacial reconstruction, free flaps have largely replaced pedicled flaps. In a Saudi Arabian sample, we (1) assessed patients’ postoperative oral function and facial aesthetics (OFFA), specifically pertaining to diet, speech intelligibility, oral opening, maxilla-mandibular occlusion, and facial aesthetics (all rated 0–2) following fibular free flap surgery; and (2) identified preoperative predictors of a novel 10-point OFFA rating scale combining these 5 parameters.

Methods:
We conducted a retrospective review of the medical records of all patients who underwent free fibula flap surgery for nontraumatic maxillofacial reconstruction from 2010 to 2017 and were followed postoperatively for at least 6 months or until death.

Results:
In 20 patients (10 female; mean age, 33.8; range, 7–56), the results were excellent, 19 of 20 patients ultimately resuming a normal diet, one a soft diet; good oral opening in 18; and normal speech, normal occlusion, and an aesthetically good result, each in 17 patients. Half the patients had a perfect (10/10) OFFA score at final assessment, whereas 2 scored 9/10, one 8/10, and two 6/10. On univariate analysis, patient age > 45, tumor of higher malignancy potential, comorbid illness, and adjuvant radiotherapy predicted a worse OFFA score, whereas a multivariate model combining comorbid illness (P = 0.002) and preoperative radiotherapy (P = 0.010) predicted a lower OFFA score, accounting for 57% of the variance (R2 = 0.57).

Conclusion:
In Saudi Arabia, fibular free flaps yielded overall very good to excellent results in 19 of 20 patients undergoing nontraumatic maxillofacial reconstruction.
Stripped Mesenteric Flap: A Novel Option for Preventing Anastomotic Leakage in Circumferential Pharyngeal Reconstruction
Authors: Fukunaga Yutaka , Higashino Takuya , Oshima Azusa , Hayashi Ryuichi 
Published: November 2018

Summary:
Reconstruction of a circumferential pharyngeal defect with a free jejunal flap is a well-established procedure. However, anastomotic leakage often occurs, which can lead to abscess formation, pharyngocutaneous fistula formation, and carotid rupture. Previous reports have described covering the anastomotic site with a mesenteric flap to prevent anastomotic leakage. However, the mesentery is covered by a serosal membrane, which interferes with adhesion and vascular communication. Therefore, we stripped off the serosal membrane to accelerate adhesion to the anastomotic site. We retrospectively studied patients who had a history of radiotherapy and who had received a stripped mesenteric flap in a circumferential pharyngeal reconstruction procedure. We collected the following data: operative time, blood loss, postoperative complications, interval to resumption of oral intake, and duration of hospital stay. We obtained data for 11 patients. The jejunal flap failed in one patient because of arterial thrombosis. One of the other 10 patients developed anastomotic leakage caused by congested mucous membrane necrosis. The patient was treated conservatively and showed no clinical symptoms of infection or inflammation. The 9 remaining patients had no anastomotic leakage. In the present series, although anastomotic leakage was observed in one of 10 patients who underwent circumferential pharyngeal reconstruction using a stripped mesenteric flap, the severity of the leakage was minimized.
Early Masseter to Facial Nerve Transfer May Improve Smile Excursion in Facial Paralysis
Authors: Zhang Shuhao , Hembd Austin , Ching Christina W. , Tolley Philip , Rozen Shai M. 
Published: November 2018

Background:
Masseter-to-facial nerve transfer has been shown to be an effective and safe treatment option in patients with acute and subacute facial palsy. The present article aims to characterize whether there is a benefit in early nerve transfers while minimizing other confounding variables; we present a study that consist of only patients with complete facial nerve paralysis resulting from intratemporal facial nerve resections.

Methods:
Between 2012 and 2016, 7 masseter-to-facial nerve transfers were performed for complete facial nerve palsy after intratemporal proximal nerve resections. Pre- and postoperative photographic and video evaluations were performed using both the Sunnybrook facial grading scale and the MEEI FACE-gram software for more objective metric measurements. Statistical analysis was performed to determine which patient and surgical variables had significant effects on outcome.

Results:
Mean 14-month follow-up revealed that patients who underwent nerve transfer prior to 6 months’ denervation achieved postoperative oral commissural excursion of 11.1 mm versus 6.5 mm in patients who underwent nerve transfer after 6 months (P = 0.003). Performing masseter-to-facial nerve transfer to the main facial nerve trunk resulted in a significantly higher improvement in the modiolus-philtral ratio (31.6% versus 6.1%) than selective transfer in patients (P = 0.01) at the latest follow-up.

Conclusions:
Early masseter-to-facial nerve transfers, before 6 months of palsy duration, can potentially improve smile excursion and symmetry of open mouth smile. Additionally, truncal coaptations may provide improved tone over coapting to selective facial nerve branches. These findings necessitate larger studies regarding the importance of denervation time with fifth-to-seventh nerve transfers.
Evaluating the Introduction of the Safewards Model to a Medium- to Long-Term Forensic Mental Health Ward
Authors: Maguire Tessa , Ryan Jo , Fullam Rachael , McKenna Brian 
Published: November 2018

ABSTRACT
Care and treatment in forensic mental health wards can present with challenges when loss of hope and freedom, and aggression are present, which can then influence ward atmosphere and feelings of safety. Safewards is a model designed to address a range of conflict (e.g., aggression and self-harm) and containment (e.g., use of restrictive interventions) events and may provide a suitable approach to delivery of care in a forensic setting, while also addressing aggression, restrictive interventions, and ward atmosphere. The aim of this study was to evaluate the introduction of Safewards to a forensic mental health ward to determine suitability, and to explore if changes to conflict, containment, and ward atmosphere occurred. A mixed methods approach was used involving the collection of incident data related to conflict and containment, an assessment of the degree to which interventions were implemented, and an assessment of the social climate before and after implementation. Results suggested that there were fewer conflict events after Safewards was introduced; however, there did not appear to be any changes in the already low use of restrictive interventions. The Safewards interventions were implemented to a high degree of fidelity, and there was indication of an increase in a positive perception of ward atmosphere, supported by themes of positive change, enhanced safety, and respectful relationships. Safewards may assist in contributing to an improvement in the perception of ward atmosphere. To enhance implementation in a forensic mental health setting, there may be a need to consider additional elements to Safewards, pertinent to this setting.
Extreme Control and Instability: Insight Into Head Injury From Intimate Partner Violence
Authors: St. Ivany Amanda , Kools Susan , Sharps Phyllis , Bullock Linda 
Published: November 2018

Aim:
The aim of this study was to understand the social context of the lives of women who experienced a head injury from intimate partner violence.

Background:
Sixty percent to 92% of survivors of intimate partner violence receive head trauma during the abuse. Little research exists regarding the episodes of abuse when women receive a head injury, or the reasons women might not seek medical care for the head injury or the abuse.

Method:
Twenty-one interviews from nine women who self-reported passing out from being hit in the head were analyzed using thematic analysis.

Findings:
Themes of extreme control and manipulation from abusers emerged, and women described living with instability from cycles of incarceration, drug and alcohol use, and fear of losing their children. Women did not receive medical care for head injury because the abusers often used forced sex immediately after the head injury to instill fear and authority.

Implications for Forensic Nursing:
Hitting women in the head is not only about physical abuse, but also about exerting dominance and creating an environment of extreme control. Forensic nurses are uniquely positioned to screen for head injuries during initial assessments and follow-up visits and connect women with appropriate resources.
Combatting the Opioid Crisis From Prison: Initiating Opioid Agonist Therapy
Authors: McIntyre Jessica L. 
Published: November 2018

ABSTRACT
Presented is a case report of a young man dependent on fentanyl who did not receive opioid agonist therapy (OAT) during incarceration. Highlighted are the barriers to accessing OAT in custody, which exacerbates problems with drug-seeking behavior, diversion, and recidivism. Discussed are the implications for correctional healthcare, including the benefits of utilizing telehealth services to maximize accessibility to OAT in correctional institutions that will not only enhance the quality of patient care but also address the growing opioid epidemic across Canada.
Child Sexual Abuse Perpetrators: What Forensic Nurses Need to Know
Authors: Hornor Gail , Zeno Rosie 
Published: November 2018

ABSTRACT
Child sexual abuse is a problem of epidemic proportions resulting in lifelong physical and mental health consequences for victims. Most child sexual abuse victims never disclose and do not receive needed treatment. Clearly, pediatric healthcare providers must understand the dynamics of child sexual abuse to better identify and protect potential victims. Forensic nurses are at the forefront of caring for victims of sexual abuse and are strong voices in the education of parents, community members, and other healthcare professionals regarding sexual abuse. Forensic nurses with a deeper understanding of child sexual abuse perpetrators will be better able to educate the public and advocate for children at risk for sexual abuse. In this article, specific types of child sexual abuse perpetration will be explored, and implications for forensic nursing will be discussed.
Return to Sport After Surgical Management of Proximal Hamstring Avulsions: A Systematic Review and Meta-analysis
Authors: Coughlin Ryan P. , Kay Jeffrey , Shanmugaraj Ajaykumar , Memon Muzammil , Naji Leen , Ayeni Olufemi R. 
Published: November 2018

Objective:
To assess the rates and timing of return to sport for the surgical management of proximal hamstring avulsions (PHAs).

Methods:
Three databases, PubMed, MEDLINE, and EMBASE, were searched from database inception until October 7, 2017, by 2 reviewers independently and in duplicate. The inclusion criteria were studies reporting return to sport outcomes for surgical management of acute, chronic, complete, and partial PHA. The rate of return to sports was combined in a meta-analysis of proportions using a random-effects model.

Results:
Overall, 21 studies with a total of 846 patients met the inclusion criteria, with a mean age of 41.4 years (range, 14-71 years) and a mean follow-up of 37.8 months (range, 6-76 months). Two studies were of prospective comparative design (level II), 2 were retrospective comparative (level III), 8 were prospective case series (level IV), and 9 were retrospective case series (level IV). The overall mean time to return to sport was 5.8 months (range, 1-36 months). The pooled rate of return to any sport participation was 87% [95% confidence interval (CI), 77%-95%]. The pooled rate of return to preinjury level of sport was 77% (95% CI, 66%-86%).

Conclusions:
Pooled results suggest a high rate of return to sport after surgical management of PHA; however, this was associated with a lower preinjury level of sport. No major differences in return to sport were found between partial versus complete and acute versus chronic PHA.
Epidemiology of Concussions in High School Boys' Ice Hockey, 2008/09 to 2016/17 School Years
Authors: Kerr Zachary Y. , Pierpoint Lauren A. , Rosene John M. 
Published: November 2018

Objective:
This study examined the epidemiology of concussions in high school boys' ice hockey during the 2008/09 to 2016/17 school years.

Design:
Prospective cohort study. Athletic trainers from an average 33 high schools annually reported boys' ice hockey concussion and athlete-exposure (AE) data for the High School Reporting Information Online system.

Setting:
Convenience sample of high school boys' ice hockey programs during the 2008/09 to 2016/17 school years.

Patients or Other Participants:
High school boys' ice hockey players (aged ∼14-18 years).

Independent Variables:
Concussion data on event type, injury mechanism, symptom resolution time, and time loss were obtained.

Main Outcome Measures:
Concussion rates with 95% confidence intervals (CIs) and distributions were calculated.

Results:
Overall, 348 concussions were reported in boys' ice hockey during the 2008/09 to 2016/17 academic years, leading to a concussion rate of 0.68/1000 AEs (95% CI, 0.61-0.75). Most occurred in competitions (85.6%), particularly after the first period (72.1% of all competition concussions). Among practice concussions, most occurred after the first hour of practice (60.0%). Most concussions were due to player contact (47.7%) and boards/glass contact (31.9%). Although 69.0% of concussed athletes had symptoms resolve in less than 7 days, only 14.1% returned to activity within a week.

Conclusions:
Most concussions occurred within the second and third periods. Preventive strategies that counter an increased risk of concussion due to a greater intensity of gameplay coupled with increased fatigue may be warranted. Moreover, athletes may further benefit from prevention efforts that focus on anticipating impacts during gameplay.
Language Outcomes Improved Through Early Hearing Detection and Earlier Cochlear Implantation
Authors: Yoshinaga-Itano Christine , Sedey Allison L. , Wiggin Mallene , Mason Craig A. 
Published: November 2018

Hypothesis:
Early identification and intervention, earlier cochlear implantation, and mother's level of education will directly and/or indirectly impact the language outcomes of children with cochlear implants (CIs).

Background:
Identifying factors that contribute to the wide range of language outcomes in children who use CIs will assist healthcare and rehabilitation professionals in optimizing service delivery for this population. Universal newborn hearing screening provides an opportunity to examine the relationship between meeting the early hearing detection and intervention (EHDI) 1-3-6 guidelines and child language outcomes. These guidelines recommend screening by 1 month, confirmation of hearing loss by 3 months, and intervention by 6 months of age.

Methods:
Participants were 125 children with CIs ranging from 13 to 39 months of age. Language ability was measured using the Child Development Inventory and MacArthur-Bates Communicative Development Inventories.

Results:
Meeting EHDI 1-3-6, higher levels of maternal education and earlier cochlear implant activation had a direct, positive impact on language outcomes. Meeting the EHDI 1-3-6 guidelines also had an indirect positive effect on language outcomes via increasing the probability that the children's CIs would be activated earlier. Maternal education did not significantly predict age of cochlear implant activation nor whether a child met EHDI 1-3-6.

Conclusion:
Ensuring families meet the EHDI 1-3-6 guidelines is an early step that can lead to higher language outcomes and also earlier cochlear implantation.
Significance of 1 kHz Pure-tone Threshold in Acute Low-frequency Sensorineural Hearing Loss
Authors: Lee Chi Kyou , Lee Jong Bin , Park Kye Hoon , Lee Ho Yun , Choi Mi-Jin , Ban Wonwoo , Choi Seong Jun 
Published: November 2018

Objectives:
To analyze risk factors for acute low-frequency hearing loss (ALFHL), and compare treatment outcomes in the presence or absence of such risk factors.

Study Design:
A case series featuring retrospective chart review.

Setting:
An academic university hospital.

Patients:
We included 170 ALFHL patients without vertigo. All of the patients received one of four treatments: low-dose steroid (LD-steroid), high-dose steroid (HD-steroid), LD-steroid and diuretics (LD-combination therapy), and ITDI (intratympanic dexamethasone injection) and diuretics (ITDI-combination therapy). To identify risk factors, we reviewed the clinical features of patients such as age, sex, chief complaint, accompanying symptoms, diabetes, hypertension, time from disease onset, the extent of hearing loss, treatment methods, and 1 kHz involvement.

Interventions:
ALFHL was diagnosed based on the average hearing loss >30 dB at 250 and 500 Hz.

Results:
The overall rates of hearing recovery were 70–80% in the four treatment groups. In terms of the prognosis of ALFHL patients, we found that a longer time from disease onset and 1 kHz involvement were independent risk factors for poor prognosis. In addition, we compared treatment outcomes of four treatment methods in the presence or absence of risk factors. In ALFHL patients with risk factors, we found statistically significant differences (p = 0.042) among treatment methods; effectiveness ranged in the order if ITDI-combination therapy, LD-combination therapy, HD-steroid, and LD-steroid.

Conclusions:
Risk factors for poor hearing recovery in ALFHL included longer symptom duration and 1 kHz involvement. In ALFHL with such risk factors, combination therapy was more effective than oral steroid therapy.
A Cohort Study of Hearing Outcomes Between Middle Fossa Craniotomy and Transmastoid Approach for Surgical Repair of Superior Semicircular Canal Dehiscence Syndrome
Authors: Zhang Lisa , Creighton Francis X. , Ward Bryan K. , Bowditch Stephen , Carey John P. 
Published: November 2018

Objective:
To compare postoperative hearing outcomes between transmastoid and middle fossa craniotomy (MFC) approaches for surgical repair of superior semicircular canal dehiscence syndrome (SCDS) in a tertiary referral center.

Study Design:
Historical cohort study.

Setting:
Tertiary referral center.

Patients:
Twelve consecutive SCDS cases who underwent transmastoid plugging of the superior canal; “controls” were 18 audiogram-matched patients who underwent MFC plugging and resurfacing.

Main Outcome Measures:
Differences between preoperative, 7-day postoperative, and long-term (>6 wk) postoperative air and bone conduction, speech discrimination scores (SDS), and pure-tone averages (PTA) in TM cases versus MFC controls.

Methods:
MFC controls were selected by matching preoperative bone conduction (BC) pure-tone thresholds from the TM cases within 10-dBs NHL in ≥80% of recorded frequencies. Wilcoxon signed-rank tests were performed to compare primary outcomes between matches, with a Bonferroni corrected p value of 0.004 (n = 13 variables measured at each time period).

Results:
No statistically significant differences were found in long-term postoperative air conduction and BC thresholds at any frequency both during the immediate postoperative period as well as at long-term follow-up (p > 0.004). Similarly, there were no differences in long-term SDS or PTA (p > 0.004).

Conclusions:
In this pilot study, there were no long-term significant differences in hearing outcomes between the two repair techniques for SCDS. We recommend continuing with the established practice for recommending surgical repair based on individual patient characteristics and preferences in managing both vestibular and auditory function.