bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reduced Time to Surgery Improves Patient-Reported Outcome After Achilles Tendon Rupture
Authors: Svedman Simon , Juthberg Robin , Edman Gunnar , Ackermann Paul W. 
Published: August 2018

Background: Patient outcome after an acute Achilles tendon rupture (ATR) continues to be suboptimal and heterogeneous. Thus, prognostic factors are called for to optimize evidence-based ATR treatment protocols; however, the influence of delayed time from injury to surgery (TTS) on patient outcome after ATR remains largely unknown. Purpose: To determine whether patient outcomes and adverse events after surgical repair of acute ATR are related to delayed TTS. Study Design: Cohort study; Level of evidence, 3. Methods: Two hundred twenty-eight patients with ATR who were treated with uniform anesthetic and surgical techniques, within 10 days after injury, were retrospectively assessed. TTS depended on availability of the operating theater, and neither surgeon nor patient could influence the TTS. Patients were assigned to 1 of 3 groups: short TTS (<48 hours), intermediate TTS (48-72 hours), and long TTS (>72 hours). Patient-reported outcome at 1 year was assessed with the validated Achilles tendon Total Rupture Score, with scores higher than 80 on a 0- to 100-point scale indicating an overall good outcome. The incidences of adverse events (perioperative and postoperative) and deep venous thrombosis were assessed. Results: Short TTS was significantly associated with increased rate of good outcome and reduced risk of adverse events. Seventy-one percent (95% CI, 60%-83%) of the patients with short TTS attained a good outcome compared with 44% (95% CI, 33%-56%) of the patients with long TTS ( P = .002), with the intermediate TTS group in between, 63% (95% CI, 47%-78%). The incidence of adverse events was significantly reduced among patients with short TTS, 1.4% (95% CI, 1%-4%) compared with those with intermediate TTS, 11% (95% CI, 2%-21%) ( P = .035) and those with long TTS, 14.8% (95% CI, 7%-23%) ( P = .003). The risk of sustaining a deep venous thrombosis was not statistically significantly different among the 3 groups ( P = .15). Conclusion: Patients with acute ATR undergoing operation within 48 hours after injury had better outcomes and a lower number of adverse events compared with patients undergoing operation after 72 hours. These results align with evidence-based recommendations from other surgical disciplines and should be used as guidelines for optimizing ATR treatment protocols. Registration: NTC01317160 (ClinicalTrials.gov identifier).
Sequential Organ Failure Assessment Component Score Prediction of In-hospital Mortality From Sepsis
Authors: Gupta Tushar , Puskarich Michael A. , DeVos Elizabeth , Javed Adnan , Smotherman Carmen , Sterling Sarah A. , Wang Henry E. , Moore Frederick A. , Jones Alan E. , Guirgis Faheem W. 
Published: August 2018

Objectives: Early organ dysfunction in sepsis confers a high risk of in-hospital mortality, but the relative contribution of specific types of organ failure to overall mortality is unclear. The objective of this study was to assess the predictive ability of individual types of organ failure to in-hospital mortality or prolonged intensive care. Methods: Retrospective cohort study of adult emergency department patients with sepsis from October 1, 2013, to November 10, 2015. Multivariable regression was used to assess the odds ratios of individual organ failure types for the outcomes of in-hospital death (primary) and in-hospital death or ICU stay ≥ 3 days (secondary). Results: Of 2796 patients, 283 (10%) experienced in-hospital mortality, and 748 (27%) experienced in-hospital mortality or an ICU stay ≥ 3 days. The following components of Sequential Organ Failure Assessment (SOFA) score were most predictive of in-hospital mortality (descending order): coagulation (odds ratio [OR]: 1.60, 95% confidence interval [CI]: 1.32-1.93), hepatic (1.58, 95% CI: 1.32-1.90), respiratory (OR: 1.33, 95% CI: 1.21-1.47), neurologic (OR: 1.20, 95% CI: 1.07-1.35), renal (OR: 1.14, 95% CI: 1.02-1.27), and cardiovascular (OR: 1.13, 95% CI: 1.01-1.25). For mortality or ICU stay ≥3 days, the most predictive SOFA components were respiratory (OR: 1.97, 95% CI: 1.79-2.16), neurologic (OR: 1.72, 95% CI: 1.54-1.92), cardiovascular (OR: 1.38, 95% CI: 1.23-1.54), coagulation (OR: 1.31, 95% CI: 1.10-1.55), and renal (OR: 1.19, 95% CI: 1.08-1.30) while hepatic SOFA (OR: 1.16, 95% CI: 0.98-1.37) did not reach statistical significance ( P = .092). Conclusion: In this retrospective study, SOFA score components demonstrated varying predictive abilities for mortality in sepsis. Elevated coagulation or hepatic SOFA scores were most predictive of in-hospital death, while an elevated respiratory SOFA was most predictive of death or ICU stay >3 days.
Differences in Adverse Effect Profiles of Corticosteroids in Palliative Care Patients
Authors: Jaward Leanna R. , O’Neil Thomas A. , Marks Adam , Smith Michael A. 
Published: August 2018

Background: Corticosteroids are frequently utilized in the palliative care setting to combat symptoms such as fatigue, dyspnea, pain, weakness, anorexia, cachexia, nausea, and vomiting. Often times, adverse effects arise with corticosteroid use, and it is unclear whether switching to another corticosteroid would reduce the risk of specific adverse effects or what measures can be taken to alleviate the adverse effects. Objective: This article aims to review the differentiating pharmacokinetics, potency, and adverse effect profiles of corticosteroids and summarize their clinical applicability. Methods: A literature review of “corticosteroids” and “palliative care” was performed using the PubMed database through July 2018. Original studies relevant to the purpose of this study were identified and those that met inclusion criteria were included. Results: Although corticosteroids share many common factors, including similar pharmacokinetic, pharmacodymanic, and adverse effect profiles, they have significant differences when the details of these variables are reviewed. Providers that prescribe corticosteroids for symptom management should be aware of these differences and the recommended management strategies. Conclusions: Recognition of corticosteroid induced adverse effect profiles and possible management strategies is crucial to optimal symptom management in palliative care patients.
Effect of intramuscular administration of medetomidine and xylazine on tear flow measured by the Schirmer tear test I in healthy cats
Authors: Kanda Teppei , Shimizu Yuki , Hanazono Chisa , Maki Saya , Maeta Noritaka , Itoi Takamasa , Furumoto Kayo , Okamura Yasuhiko , Itoh Yoshiki , Furukawa Toshinori 
Published: August 2018

Objectives This study aimed to investigate the effects of intramuscular medetomidine and xylazine on tear flow in healthy cats. Methods Five cats each received medetomidine 10, 20, 40 and 80 µg/kg IM; xylazine 1.0, 2.0, 4.0 and 8.0 mg/kg IM; and physiological saline (2.0 ml IM) in a randomised order separated by intervals of at least 1 week. The Schirmer tear test (STT) I was performed in both eyes before and 0.25, 0.5, 0.75, 1, 2, 3, 4, 5, 6, 7, 8 and 24 h after each dose. Results The STT I value decreased significantly at 0.5 and 1.0 h and at 0.75 and 1.0 h in both eyes after administration of medetomidine at 10 or 40 µg/kg. After administration of medetomidine 80 µg/kg, there was a significant decrease in the STT I reading at 0.75, 2 and 3 h in the left eye and 0.75, 1, 2 and 3 h in the right eye. The STT I value decreased significantly at: 0.5, 0.75, 1 and 2 h in the left eye and 0.75 h in the right eye after administration of xylazine 1.0 mg/kg; 0.5, 0.75, 1 and 2 h in the left eye and 0.5, 0.75, 1 and 3 h in the right eye after administration of xylazine 2.0 mg/kg; 0.5, 0.75, 1 and 2 h in both eyes after administration of xylazine 4.0 mg/kg; and 0.5, 0.75, 1, 2 and 3 h in the left eye and 0.75, 1, 2, 3 and 4 h in the right eye after administration of xylazine 8.0 mg/kg. Conclusions and relevance Both medetomidine and xylazine significantly decreased feline tear flow measured by STT I. Therefore, the ocular surface should be monitored carefully and protected appropriately in cats treated with these sedatives.
Implications of anticoagulant and antiplatelet therapy in patients presenting with hip fractures: a current concepts review
Authors: Gulati Vivek , Newman Simon , Porter Kenneth J , Franco Luis C S , Wainwright Tom , Ugoigwe Chika , Middleton Robert 
Published: August 2018

The increasing use of anticoagulant and antiplatelet therapy for the prevention of thromboembolic disease poses a significant challenge to orthopaedic surgeons treating elderly patients presenting with proximal femoral fractures. Early surgical intervention is known to be beneficial from a clinical perspective and has been encouraged in the UK through the introduction of best practice tariffs providing increased remuneration for prompt treatment. An understanding of the necessary delay to surgery or reversal options for each type of antiplatelet or anticoagulant agent is therefore important. A number of professional bodies have recently produced guidelines that help clinicians manage these patients during the peri-operative period. We review the guidelines relating to antiplatelet and anticoagulant agents during the perioperative period with respect to hip fracture surgery. Antiplatelet agents should not interfere with timing of surgery, but may affect the choice of anaesthetic performed. The action of warfarin should be reversed to expedite surgery. Newer direct oral anticoagulants are more problematic and surgical delay may be necessary, though reversal agents are becoming available.
The routes for embolization of dural carotid cavernous fistulas when the endovascular approach is indicated as a first-line strategy
Authors: Castro-Afonso Luís Henrique de , Trivelato Felipe Padovani , Rezende Marco Túlio , Ulhôa Alexandre Cordeiro , Nakiri Guilherme Seizem , Monsignore Lucas Moretti , Abud Daniel G 
Published: August 2018

Introduction Multiple ways to access the dural carotid cavernous fistula have been described. The aim of the present study was to assess the results of embolization of a dural carotid cavernous fistula via different routes using endovascular accesses as a first-line strategy. Methods A retrospective data analysis of a consecutive series of 63 patients presenting with dural carotid cavernous fistula was performed. Results The dural carotid cavernous fistula was accessed by an endovascular approach in 58 patients (92.1%) and by direct puncture in five patients (7.9%). The inferior petrosal sinus was the main route accessed (65%). A recanalization of an occluded inferior petrosal sinus was obtained in 20.6% of cases. The access via either facial ophthalmic veins or the superior petrosal sinus was obtained in 20.6% and 3.1% of cases, respectively. Complete angiographic occlusion of a dural carotid cavernous fistula immediately after treatment was achieved in 53 patients (84.1%), whereas 10 patients (15.9%) displayed a partial occlusion. Treatment-related complications were observed in two patients (3.2%). Conclusions In this study, the endovascular approach allowed dural carotid cavernous fistula embolization in most patients. The inferior petrosal sinus, even when thrombosed, was the main route used to access the dural carotid cavernous fistula, followed by the facial vein, direct cavernous sinus puncture, and the superior petrosal sinus.
3,4-Methylenedioxymethamphetamine (MDMA, Ecstasy) Intoxication in a Young Adult with Giant Coronary Aneurysms from Kawasaki Disease
Authors: Eigsti Renee , Firchau Dennis J. , Nashelsky Marcus B. 
Published: August 2018

Kawasaki disease is an acute vasculitis of unknown etiology that usually occurs in children less than five years old. Coronary artery aneurysm due to arteritis is the most common cardiac complication. Chronic aneurysms are associated with an increased risk of developing luminal thrombosis and ischemic myocardial injury. We present a case of an 18-year-old male with a history of Kawasaki disease complicated by chronic giant aneurysms of the right and left coronary arteries. Serial echocardiographic studies and treadmill electrocardiogram stress tests as recent as 1.5 years before death revealed excellent cardiac function by clinical criteria. The decedent sustained a witnessed collapse after ingesting 3,4-methylenedioxymethamphetamine (MDMA) and ethanol. He was pronounced dead in the emergency department after unsuccessful resuscitative efforts. Autopsy revealed large aneurysms of the three main epicardial coronary arteries with extensive foci of severe stenosis by intimal fibrosis and organizing thrombus. Microscopic examination revealed multifocal severe myocyte hypertrophy. There were remote microinfarcts in the anterior and posterior aspects of the left ventricle and a recent, healing microinfarct in the posterior aspect of the left ventricle. Toxicology examination of postmortem femoral blood revealed MDMA, ethanol, and amiodarone. This case illustrates the residual, lasting effects of cardiac disease due to Kawasaki disease and a potential complication in the setting of use of an illicit stimulant, MDMA, an amphetamine derivative that produces sympathetic activation and cardiovascular effects including tachycardia, vasoconstriction, dysrhythmias, and coronary artery spasm. Kawasaki disease-related abnormalities of the heart likely resulted in a lower threshold for developing a fatal cardiac dysrhythmia under the circumstance of stimulant use.
Comparing the Effectiveness of Four Different Design Media in Communicating Desired Performance Outcomes With Clinical End Users
Authors: Wingler Deborah , Machry Herninia , Bayramzadeh Sara , Joseph Anjali , Allison David 
Published: August 2018

Objective: The purpose of this study was to compare the effectiveness of four different design communication media in helping clinical end users understand spatial and functional information and in supporting their ability to provide design feedback. Background: It is critical to involve clinical end users early in the design process to test design solutions and ensure the design of a new healthcare facility supports their ability to deliver high-quality care. Traditional architectural design communication media such as floor plans and perspectives can be challenging for clinical design team members to understand. Physical and virtual mock-ups are becoming more popular as design communication media. However, nominal evidence exists comparing the effectiveness of different design media in supporting clinical end-user engagement and contribution during the design process. Method: An exploratory, qualitative study was conducted with clinical end users to evaluate the effectiveness of four different media commonly used in design communication. Results: Traditional architectural representations convey limited useful information to clinical end users, impacting the amount and type of feedback they can provide. More immersive media, such as physical and virtual mock-ups, support an increasingly holistic understanding of proposed design solutions, inciting more design solutions that range from the inclusion and exclusion of design features to location, position, and functionality of those features. Conclusions: When used in combination, each media can contribute to eliciting clinical end-user feedback at varying scales. The overall preference and higher effectiveness in eliciting design feedback from clinical end users highlights the importance of physical mock-up in communicating healthcare design solutions.
Octogenarian women with acute coronary syndrome present frailty and readmissions more frequently than men
Authors: Vicent Lourdes , Ariza-Solé Albert , Alegre Oriol , Sanchís Juan , López-Palop Ramón , Formiga Francesc , González-Salvado Violeta , Bueno Héctor , Vidán María T , Díez-Villanueva Pablo , Abu-assi Emad , Martínez-Sellés Manuel 
Published: August 2018

Background: A worse prognosis has been reported among women with acute coronary syndrome compared to men. Our aim was to address the role of frailty and sex in the management and prognosis of elderly patients with non-ST-segment elevation acute coronary syndrome. Methods: A prospective registry in 44 Spanish hospitals including patients aged 80 years and older with non-ST-segment elevation acute coronary syndrome. Frailty assessment was performed using the FRAIL scale. Results: Of a total of 535 patients, 207 (38.7%) were women. Mean age was 84.8±4.0 years, similar in men and women. A prior history of coronary artery disease was more common in men (146, 44.9%) than in women (46, 22.2%), P<0.001. Frailty was less frequent in men (65, 20.2%) than in women (77, 37.8%), P<0.001. Female sex was an independent predictor of death/hospitalisation (hazard ratio (HR) 1.7, 95% confidence interval (CI) 1.1–2.4) and of hospitalisation at 6 months (HR 1.6, 95% CI 1.04–2.4). In men, compared to non-frail patients, both a prefrail status (HR 3.47, 95% CI 1.22–9.89) and frailty (HR 3.19, 95% CI 1.08–9.43) were independently associated with higher mortality. In women only frailty was independently associated with higher mortality (HR 5.68, 95% CI 1.91–16.18, compared to prefrailty or robustness). Frailty was associated with readmissions in men (HR 3.34, 95% CI 1.79–6.22) but not in women. Conclusions: In octogenarians with acute coronary syndrome female sex was independently associated with death/hospitalisation at 6 months. Frailty was more common in women and was a predictor of poor prognosis. In men prefrailty also predicted a poor prognosis.
Ravulizumab (ALXN1210) in patients with paroxysmal nocturnal hemoglobinuria: results of 2 phase 1b/2 studies
Authors: Röth Alexander , Rottinghaus Scott T. , Hill Anita , Bachman Eric S. , Kim Jin Seok , Schrezenmeier Hubert , Terriou Louis , Urbano-Ispizua Álvaro , Wells Richard A. , Jang Jun Ho , Kulasekararaj Austin G. , Szer Jeff , Aguzzi Rasha , Damokosh Andrew I. , Shafner Lori , Lee Jong Wook 
Published: August 2018

Key Points
Ravulizumab provided rapid and sustained reduction in complement-mediated hemolysis at dosing intervals up to 12 weeks. Patients receiving higher trough exposures experienced greater frequency of LDH normalization, with no episodes of breakthrough hemolysis.
Sick pets as potential reservoirs of antibiotic-resistant bacteria in Singapore
Authors: Hartantyo Sri Harminda Pahm , Chau Man Ling , Fillon Laurent , Ariff Ahmad Zhafir Bin Mohamad , Kang Joanne Su Lin , Aung Kyaw Thu , Gutiérrez Ramona Alikiiteaga 
Published: August 2018

AbstractAn analysis of 186 diagnostic reports collected from a veterinary clinic in Singapore between 2014 to 2016 showed that sick companion animals can carry bacteria that are of significance to human health. Among the 186 specimens submitted, 82 showed polymicrobial growth (45%, 82/186) and in total, 359 bacteria were isolated. Of the 359 bacteria reported, 45% (162/359) were multi-drug resistant and 18% (66/359) were extended-spectrum-beta-lactamase species. Resistance to broad-spectrum antibiotics were also observed among individual species. Namely, methicillin-resistance among Staphylococcus pseudintermedius (63%, 32/51) and Staphylococcus aureus (50%, 4/8); fluoroquinolone-resistance among Escherichia coli (40%, 17/42) and carbapenem-resistance among Klebsiella pneumoniae (7%, 2/30) were noted. Our analysis suggests that sick pets may contribute to the pool of clinically relevant antibiotic-resistant bacteria and play a role in the spread of antibiotic resistance in Singapore. A more extensive study to better understand the extent of distribution and the factors affecting transmission of antibiotic-resistant bacteria to and from pets is necessary.
Can We Use Administrative Data to Accurately Identify Patients Who Receive a Prostate Biopsy?
Authors: Lavallée Luke T. , Breau Rodney H. , Fergusson Dean , Walsh Cynthia , van Walraven Carl 
Published: August 2018

Purpose Administrative health data can be a valuable resource for health research. Because these data are not collected for research purposes, it is imperative that the accuracy of codes used to identify patients, exposures, and outcomes is measured. Patients and Methods Code sensitivity was determined by identifying a cohort of men with histologically confirmed prostate cancer in the Ontario Cancer Registry and linking them to the Ontario Health Insurance Plan (OHIP) to determine whether a prostate biopsy code had been claimed. Code specificity was estimated using a random sample of patients at The Ottawa Hospital for whom a prostate biopsy code was submitted to OHIP. A simulation model, which varied the code false-positive rate, true-negative rate, and proportion of code positives in the population, was created to determine specificity under a range of combinations of these parameters. Results Between 1991 and 2012, 97,369 of 148,669 men with histologically confirmed prostate cancer in the Ontario Cancer Registry had a prostate biopsy code in OHIP within 1 week of their diagnosis (code sensitivity, 86.0%). This increased significantly over time (63.8% in 1991 to 87.9% in 2012). The false-positive rate of the code for index prostate biopsies was 1.9%. The simulation model found that the code specificity exceeded 95% for first prostate biopsy but was lower for secondary biopsies because of more false positives. False positives primarily were related to placement of fiducial markers for patients who received radiotherapy. Conclusion Administrative data in Ontario can accurately identify men who receive a prostate biopsy. The code is less accurate for secondary biopsy procedures and their sequelae.
Elevated Troponin I Levels in Diabetic Ketoacidosis Without Obstructive Coronary Artery Disease
Authors: Manikkan Ajaydas T 
Published: August 2018

Abstract
Elevated troponin levels have been observed in a wide spectrum of patients who do not have ischemic heart disease, including nonacute coronary syndrome and cardiovascular and noncardiovascular conditions. The cases of two patients with diabetic ketoacidosis who had elevated troponin levels in the absence of coronary artery disease are presented. This clinical scenario can pose a diagnostic dilemma for the physician. The objective of the present report is to highlight the mechanism of troponin elevation in patients with diabetic ketoacidosis, in addition to the clinical and prognostic significance of this finding.