bluuebunny/crossref_metadata_2025_split huggingface dataset:
Injectable Corticosteroids in Sport
Authors: Olafsen Nathan P. , Herring Stanley A. , Orchard John W. 
Published: June 2018

Objective:
To review the literature guiding all aspects of the use of injectable corticosteroids for painful musculoskeletal conditions, with a focus on the treatment of athletes.

Data Sources:
An extensive search of the literature was completed including search terms of corticosteroid, steroid, athlete, and injection, among others. Additional articles were used after being identified from previously reviewed articles.

Main Results:
Injections of corticosteroids for a variety of painful conditions of the extremities and the axial spine have been described. Numerous minor and major complications have been reported, including those with a high degree of morbidity. There is a dearth of published research on the use of corticosteroid injections in athletes, with most of the research on this topic focused on older, nonathlete populations. Generally, these injections are well tolerated and can provide short-term pain improvement with little or no long-term benefits.

Conclusions:
Corticosteroid injections should be used cautiously in athletes and only after a full consideration of the pharmacology, pathogenesis of disease, potential benefits, complications, factors specific to the athlete, and rules of athletic governing bodies. Corticosteroid injections are just one component of a comprehensive rehabilitation plan available to the physician providing care to athletes.
Phototherapy on Management of Creatine Kinase Activity in General Versus Localized Exercise: A Systematic Review and Meta-Analysis
Authors: Machado Aryane Flauzino , Micheletti Jéssica Kirsch , Lopes Jaqueline Santos Silva , Vanderlei Franciele Marques , Leal-Junior Ernesto Cesar Pinto , Netto Junior Jayme , Pastre Carlos Marcelo 
Published: June 2018

Objective:
The main focus of this systematic review was to determine the efficacy of phototherapy in the management of creatine kinase (CK) activity after exercise and furthermore to identify for which exercise model protocol phototherapy provides the best results.

Design:
Meta-analysis comparing phototherapy with a control condition.

Setting:
The MEDLINE, EMBASE, SPORTDiscus, PEDro, and CENTRAL databases were searched from their earliest records to October 03, 2016. Data were pooled in a meta-analysis and described as standardized mean difference (SMD) with 95% confidence intervals (CIs) using a random effects model.

Participants:
Healthy subjects (no restrictions were applied, eg, age, sex, and exercise level).

Intervention:
Phototherapy (low-level laser therapy and/or light-emitting diode therapy) before or after exercise and a placebo or control condition.

Main Outcome Measures:
Creatine kinase activity (no restriction to any analysis, eg, serum, plasma, or capillary blood).

Results:
Fourteen studies were included for review. The results revealed that phototherapy has a more positive effect than control condition in management of CK activity [SMD = 0.77, 95% CI (0.32 to 1.22); P = 0.0007; I2 = 72%]. In exploratory analysis, the results showed that phototherapy was effective only in the exercise protocol with localized exercise with large effect size [localized exercise: SMD = 0.89, 95% CI (0.26 to 1.51); P = 0.0002; I2 = 76%; general exercise: SMD = 0.61, 95% CI (−0.05 to 1.26); P = 0.07; I2 = 67%].

Conclusions:
The available evidence suggest that phototherapy has beneficial effects on the management of CK activity and demonstrate a possible relationship based on damage caused by exercise, providing a greater effect in studies that used localized exercise.
Concussion Symptom Profiles Among Child, Adolescent, and Young Adult Athletes
Authors: Howell David R. , Kriz Peter , Mannix Rebekah C. , Kirchberg Tyler , Master Christina L. , Meehan William P. 
Published: June 2018

Objectives:
(1) To examine how age influences initial symptom presentation following concussion; and (2) to determine whether specific symptom profiles are associated with duration of postconcussion symptoms, and whether they vary by age group.

Design:
A total of 689 patients (20% children 7-12 years of age, 69% adolescents 13-18 years of age, and 11% young adults 19-30 years of age) were seen and diagnosed with a concussion within 21 days after injury. Patients completed the Post-Concussion Symptom Scale (PCSS) and were followed until they no longer required care.

Setting:
Two specialty care sport concussion clinical practices.

Main outcome measures:
Overall PCSS score was obtained, as well as severity ratings from somatic, vestibular–ocular, cognitive, sleep, and emotional symptom domains. We also calculated total symptom duration time.

Results:
No significant main effect of age, or age by sex associations were identified among the symptom domains. Females endorsed a higher somatic symptom severity rating than males (9.8 ± 6.7 vs 8.1 ± 6.7; P = 0.03). For patients between 7 and 12 years of age, higher somatic [β-coefficient = 1.57, 95% confidence interval (CI), 1.47-1.67] and cognitive (β-coefficient = 2.50, 95% CI, 2.32-2.68) symptom severities were associated with longer duration of concussion symptoms. Among adolescents, longer total symptom duration was associated with more severe somatic (β-coefficient = 1.25, 95% CI, 0.34-2.15) and vestibular–ocular (β-coefficient = 2.36, 95% CI, 1.49-3.23) symptoms.

Conclusions:
Within 21 days after concussion, symptom-reporting behavior seems to be similar across the age spectrum, but the relationship between symptom profiles and time to symptom resolution varies by age. Although overall symptom ratings are beneficial in determining clinical pathways, symptom domain use may provide a beneficial method to determine individualized patient care that differs between children and adolescents after concussion.
Abdominal Obesity is More Predictive of Advanced Colorectal Neoplasia Risk Than Overall Obesity in Men
Authors: Kim Nam Hee , Jung Yoon Suk , Park Jung Ho , Park Dong Il , Sohn Chong Il 
Published: June 2018

Goals:
We aimed to ascertain whether waist circumference (WC) is associated with risk of colorectal neoplasia (CRN), independent of body mass index (BMI).

Background:
Although several studies have reported the association between abdominal obesity, measured by WC, and CRN, it remains unclear whether their association is biased by BMI.

Study:
A cross-sectional study was performed on 154,552 asymptomatic examinees who underwent colonoscopy for a health check-up.

Results:
The mean age was 42.6 years, and the proportion of males was 65.2%. The prevalence rate of CRN in subjects in WC quartiles 1, 2, 3, and 4 was 15.6%, 18.1%, 20.4%, and 22.0% among men and 7.8%, 9.4%, 12.2%, and 15.8% among women, respectively. WC and BMI were independent risk factors for overall CRN and nonadvanced CRN in both men and women. In men, the association of BMI with advanced CRN was attenuated to null after adjusting for WC [Q2, Q3, and Q4 vs. Q1; odds ratios (95% confidence intervals), 0.93 (0.79-1.10), 0.85 (0.71-1.03), and 0.99 (0.80-1.22), respectively; P
trend=0.822], whereas the association of WC with advanced CRN significantly persisted even after adjusting for BMI [Q2, Q3, and Q4 vs. Q1; 1.20 (1.02-1.42), 1.45 (1.20-1.75), and 1.64 (1.32-2.04), respectively; P
trend<0.001]. In women, neither WC nor BMI was associated with the risk of advanced CRN.

Conclusions:
Abdominal obesity is associated with an increased risk of advanced CRN, independent of overall obesity (BMI) in men. Our findings suggest that abdominal obesity is more strongly predictive of advanced CRN than overall obesity in men.
Why Effective Interventions Do Not Work for All Patients
Authors: Edlind Merritt , Mitra Nandita , Grande David , Barg Frances K. , Carter Tamala , Turr Lindsey , Glanz Karen , Long Judith A. , Kangovi Shreya 
Published: June 2018

Background:
Half of all Americans have a chronic disease. Promoting healthy behaviors to decrease this burden is a national priority. A number of behavioral interventions have proven efficacy; yet even the most effective of these has high levels of nonresponse.

Objectives:
In this study, we explore variation in response to an evidence-based community health worker (CHW) intervention for chronic disease management.

Research Design:
We used a convergent parallel design that combined a randomized controlled trial with a qualitative process evaluation that triangulated chart abstraction, in-depth interviews and participant observation.

Subjects:
Eligible patients lived in a high-poverty region and were diagnosed with 2 or more of the following chronic diseases: diabetes, obesity, hypertension or tobacco dependence. There were 302 patients in the trial, 150 of whom were randomly assigned to the CHW intervention. Twenty patients and their CHWs were included in the qualitative evaluation.

Results:
We found minimal differences between responders and nonresponders by sociodemographic or clinical characteristics. A qualitative process evaluation revealed that health behavior change was challenging for all patients and most experienced failure (ie, gaining weight or relapsing with cigarettes) along the way. Responders seemed to increase their resolve after failed attempts at health behavior change, while nonresponders became discouraged and “shut down.”

Conclusions:
Failure is a common and consequential aspect of health behavior change; a deeper understanding of failure should inform chronic disease interventions.
Associations of CAHPS Composites With Global Ratings of the Doctor Vary by Medicare Beneficiaries’ Health Status
Authors: Hays Ron D. , Mallett Joshua S. , Haas Ann , Kahn Katherine L. , Martino Steven C. , Gaillot Sarah , Elliott Marc N. 
Published: June 2018

Research Objective:
Care coordination among health care providers is essential for high-quality care and it is strongly associated with overall ratings of doctors. Care coordination may be especially important for sicker and chronically ill patients because of the multiple providers involved in their care. This study examines whether the association of care coordination with global ratings of one’s personal doctor varies by number of chronic conditions and self-rated health.

Study Design:
We used nationally representative Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data to evaluate care coordination, doctor communication, getting needed care, getting care quickly, count of 6 chronic conditions (angina, cancer, chronic obstructive pulmonary disease, diabetes, heart attack, stroke), self-rated general health (5-point scale, poor to excellent, scored linearly), and interactions among them as predictors of the CAHPS global rating of personal doctor (scored 0–100 with 100 being best possible personal doctor) using linear regression models. The analytic sample included 242,871 Medicare fee-for-service and managed care beneficiaries in 2013: 56% female; 14% 18–64, 47% 65–74, 27% 75–84, and 11% 85 and older; and 48% high school education or less.

Results:
The CAHPS composites (of care coordination, doctor communication, getting needed care, and getting care quickly) and number of chronic conditions were significantly positively associated with ratings of personal doctor (P<0.05). Care coordination and doctor communication had a stronger association with positive ratings of the personal doctor among those with worse self-rated health (P<0.001).

Discussion:
Results were consistent with the hypothesis that patients in worse health weigh care coordination more heavily in global physician assessments than patients in better health. Emphasis on improving care coordination, especially for patients in poorer health, may improve patients’ overall assessments of their providers. The study provides further evidence for the importance of care coordination experiences in the era of patient-centered care.
Hopelessness, Death Anxiety, and Social Support of Hospitalized Patients With Gynecologic Cancer and Their Caregivers
Authors: Uslu-Sahan Fatma , Terzioglu Fusun , Koc Gulten 
Published: June 2018

Background
Gynecologic cancer can create hopelessness and death anxiety and alter the lifestyle of the affected women and their caregivers. Perceived social support may facilitate coping with this illness.

Objective
The aim of this study was to determine whether hospitalized patients with gynecologic cancer and their caregivers differ in feelings of hopelessness and death anxiety and how those conditions may be related to their social support.

Methods
Two hundred patients with gynecologic cancer and their 200 caregivers from 1 university hospital were enrolled in this descriptive correlational study. Study measures included a demographic form, the Perceived Social Support Scale, the Beck Hopelessness Scale, and the Thorson-Powell's Death Anxiety Scale. Data were analyzed using Student t test, Pearson correlation test, and linear regression analyses.

Results
Patients had higher hopelessness and death anxiety compared with caregivers (P < .001). Patients' perceived social support explained 35% of the total variance in hopelessness and 28% of the variance in death anxiety; caregivers' perceived social support explained 40% of the total variance in hopelessness and 12% of the variance in death anxiety.

Conclusion
Patients felt hopelessness and death anxiety in greater rates than caregivers. Social support had a significant effect on hopelessness and death anxiety of patients and their caregivers.

Implications for Practice
Nurses, who are the healthcare professionals spending time with patients and families from diagnosis forward, need to evaluate patients and their caregivers for hopelessness and death anxiety and consider their social support systems during this evaluation.
Effectiveness of App-Based Self-acupressure for Women With Menstrual Pain Compared to Usual Care: A Randomized Pragmatic Trial
Authors: Blödt Susanne , Pach Daniel , von Eisenhart-Rothe Sanna , Lotz Fabian , Roll Stephanie , Icke Katja , Witt Claudia M. 
Published: June 2018

(Abstracted from Am J Obstet Gynecol 2018;218:227.e1–227.e9)
Up to 81% of women of reproductive age are affected by primary dysmenorrhea. Approximately 15% of patients experience severe menstrual pain, which has a significant impact on their quality of life.
Inherited Metabolic Disorders: Implications for the Obstetrician-Gynecologist
Authors: Hopkins Maeve K. , Dugoff Lorraine , Kuller Jeffrey A. 
Published: June 2018

Importance
Inherited metabolic disorders, or inborn errors of metabolism, can result in significant morbidity and mortality. Advances in genetic testing, including newborn screening and prenatal carrier screening, continue to increase awareness and highlight the importance of these conditions. Increasingly, women born with these conditions are surviving to adulthood, and many become pregnant. The practicing obstetrician-gynecologist should be familiar with the most common and the most relevant inherited metabolic disorders affecting women.

Objective
The objective of this review is to define inherited metabolic disorders that have relevance to the obstetrician-gynecologist. We discuss the diagnosis, presentation, epidemiology, and special concerns to the obstetrician-gynecologist managing patients affected by these conditions.

Evidence Acquisition
A MEDLINE search of “inherited metabolic disorders” and “inborn errors of metabolism” and specific conditions reported in the review was performed.

Results
The evidence cited in this review includes 8 case reports or case series, 4 text books, 1 systematic review, 1 American College of Obstetricians and Gynecologists committee opinion, and 18 additional peer-reviewed journal articles that were original research or expert opinion summaries.

Conclusions and Relevance
Inherited metabolic disorders manifest in diverse ways that have clinical implications for the obstetrician-gynecologist. Knowledge of these disorders and their pathophysiology and genetic basis can improve care provided for women affected by this diverse group of conditions. It is critical to assemble a multidisciplinary team of providers to optimize care for patients with inherited metabolic disorders.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completing this activity, the learner should be better able to compare selected types of inherited metabolic disorders regarding their impact on reproductive endocrinology, pregnancy, and gynecology; apply the basic principles of Mendelian inheritance when taking a family history and refer women with a personal or family history of inherited metabolic disorders to the appropriate genetics services and specialists; educate patients and other health care providers about the association of delayed menstruation, infertility, premature ovarian insufficiency, and high-risk pregnancy in women with a personal or family history of inherited metabolic disorders; and provide general preconception counseling to women with a known diagnosis of selected inherited metabolic disorders and appropriately refer them to a specialized team during gestation and postpartum.
Leak Compensation During Volume Guarantee With the Dräger Babylog VN500 Neonatal Ventilator*
Authors: Szakmar Eniko , Morley Colin J. , Belteki Gusztav 
Published: June 2018

Objectives:
To investigate how compensating for endotracheal tube leaks by targeting the leak-compensated tidal volume affects measured physiologic and ventilator variables during neonatal mechanical ventilation.

Design:
Retrospective observational study.

Setting:
A level III Neonatal ICU.

Patients:
We enrolled 30 neonates who were ventilated using synchronized intermittent positive pressure mode with volume guarantee and had at least 12 hours of continuous detailed recording of ventilation variables.

Interventions:
Infants were treated using the Dräger VN500 ventilator (Dräger, Lübeck, Germany), which uses a proprietary algorithm to measure and compensate for endotracheal tube leaks. Eleven were ventilated without leak compensation and 19 with leak compensation.

Measurements and Main Results:
Detailed ventilation data were collected and analyzed at 1 Hz, with intermittent blood gas values. The percentage of leak was less than 20% in 73% of leak-compensated inflations, and the volume of the leak compensation was less than 1 mL/kg in 97.3% of inflations. Between the two groups, ventilation variables were comparable, except the percentage of leak that was significantly (p = 0.005) higher in the recordings with leak compensation. Without leak compensation, the mean expired tidal volume was maintained very close to the set level up to 50% leak, but with leaks greater than 50%, it declined progressively. With leak compensation, the mean leak-compensated expired tidal volume was well maintained even with leak greater than 90% although with large variability. Without leak compensation, the difference between the maximum allowed inflating pressure and the peak inflating pressure decreased progressively as the leak increased. This did not occur with leak compensation. The median Pco
2 was slightly higher with leak compensation.

Conclusions:
During volume guarantee ventilation with a Dräger VN500 ventilator, without leak compensation the expired tidal volume declined after 50% leak. With leak compensation, the tidal volume was maintained even with a large leak. With leak compensation, there was a more stable peak inflating pressure, although the Pco
2 was slightly higher.
Cluster Analysis Using Anti–Aminoacyl-tRNA Synthetases and SS-A/Ro52 antibodies in Patients With Polymyositis/Dermatomyositis
Authors: Ohashi Keiji , Sada Ken-Ei , Nakai Yu , Matsushima Shun , Asano Yosuke , Hayashi Keigo , Yamamura Yuriko , Hiramatsu Sumie , Miyawaki Yoshia , Morishita Michiko , Katsuyama Takayuki , Katsuyama Eri , Watanabe Haruki , Tatebe Noriko , Narazaki Mariko , Matsumoto Yoshinori , Sunahori Watanabe Katsue , Kawabata Tomoko , Wada Jun 
Published: June 2018

Objective
Although several autoantibodies have been identified for polymyositis/dermatomyositis (PM/DM) diagnosis, the clinical impact of these antibodies is yet to be elucidated.

Methods
Patients with PM/DM at Okayama University Hospital from 2012 to 2016 were historically enrolled, and antibody profiles were analyzed using line immunoassay. Hierarchical cluster analysis was performed based on serological analysis of anti-aminoacyl-tRNA synthetase (ARS) antibodies, including anti-Jo-1, PL-7, PL-12, EJ, OJ, and SS-A/Ro-52 antibodies. Clinical symptoms and relapse proportions were compared among these clusters.

Results
Sixty-one patients were enrolled in this study: 28 were diagnosed with PM, and 33 were diagnosed with DM. The following 3 clusters were determined: 1 (n = 10), anti-Jo-1 and anti-SS-A/Ro-52 antibodies double positive (10/10, 100%); 2 (n = 24), anti-SS-A/Ro-52 antibody positive (20/24, 83%), anti-Jo-1 antibody negative (24/24, 100%), and anti-ARS antibodies (excluding anti-Jo-1 antibody) positive (15/24, 63%); and 3 (n = 27), anti-Jo-1 and anti-SS-A/Ro52 antibodies double negative (26/27, 96%). The proportion of patients who relapsed was significantly lower in cluster 3 than it was in clusters 1 and 2 (risk ratio, 0.37; 95% confidence interval, 0.17-0.83; p = 0.026 and risk ratio, 0.42; 95% confidence interval, 0.20-0.89; P = 0.019, respectively). There was no difference in the proportion of relapsed patients between clusters 1 and 2.

Conclusions
Our cluster analysis shows that anti-SS-A/Ro52 or any anti-ARS antibodies or both might be relevant to clinical outcomes.
Diagnostic Criteria and Treatment Algorithm for Susac Syndrome
Authors: Egan Robert A. 
Published: June 2018

Background:
Susac syndrome (SS) classically presents with the clinical triad of retinal artery occlusion, sensorineural hearing loss, and encephalopathy and the neuroimaging triad of white matter lesions, deep gray matter lesions, and leptomeningeal disease. However, patients can present with an incomplete clinical or neuroimaging triads making diagnosis difficult in certain situations. A standard treatment paradigm also is lacking in this illness. It is important for neuro-ophthalmologists to recognize clinical and radiographic findings that are pathognomonic for this syndrome and have a basic understanding of the available treatment options.

Evidence Acquisition:
Review of medical literature.

Results:
A definite diagnosis of SS is made when the clinical triad or the neuroimaging triad is present. There are numerous reports of 2 other imaging findings in this condition: arteriolar wall hyperfluorescence (AWH) on fluorescein angiography in retinal arterioles remote from retinal ischemia and central callosal lesions on MRI. Both of these imaging findings are diagnostic of SS. Gass plaques in retinal arterioles are almost always seen in the acute phase of the illness but are not pathognomonic for SS. The most common medications used in this syndrome are corticosteroids and intravenous immunoglobulin. A number of other medications have been used including mycopheolate, rituximab, azathioprine, and cyclophosphamide.

Conclusions:
In the absence of the clinical triad or magnetic resonance imaging triad for SS, AWH remote from retinal vascular injury and central callosal lesions are confirmatory of the diagnosis because they have never been described in any other condition. The presence of Gass plaques in retinal arterioles should strongly suggest the diagnosis. Despite the lack of clinical trial data, patients with SS must be treated promptly and aggressively. In more fulminant cases, addition of mycophenolate mofetil or rituximab is required, followed by cyclophosphamide when disease is refractory to other medications.