bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endovascular Treatment Versus Open Surgery for Isolated Iliac Artery Aneurysms: A Systematic Review and Meta-Analysis
Authors: Xiang Yuwei , Chen Xiyang , Zhao Jichun , Huang Bin , Yuan Ding , Yang Yi 
Published: March 2019

Objective: The aim of this review was to compare the outcomes of endovascular treatment (ET) versus open surgery (OS) for patients with isolated iliac artery aneurysms (IIAAs). Methods: Studies that reported ET and OS for IIAAs were searched in databases until December 5, 2018. Studies were included for reporting both ET and OS for patients with IIAAs, and at least one of the following outcomes: postoperative mortality, postoperative ischemic complications (PIC), wound complications, blood transfusion, and length of hospital stay (LHS). We adopted Inverse Variance method to calculate the mean difference (MD) of LHS, and adopted Mantel–Haenszel method for odds ratios (ORs) of postoperative mortality, PICs, wound complications, and blood transfusion. Results: Nine studies were included, and all of them were observational studies, 7 studies were available for meta-analysis. When compared with OS, ET was associated with a higher risk of PICs (OR: 3.24, 95% confidence interval [CI]: 1.05-10.02), a lower risk of blood transfusion (OR: 0.22, 95% CI: 0.08-0.58), and a much shorter LHS (MD: −4.39, 95% CI: −6.18 to −2.60). The postoperative mortality and wound complication were similar between groups. Conclusion: Both ET and OS were safe and effective methods to repair IIAAs with similar postoperative mortality. Compared with OS, ET can reduce the need for transfusion and the time of LHS, but it was associated with a higher risk of PICs. The comparisons of primary patency and reintervention rates were still unclear between the 2 groups.
Can silicone models replace animal models in hands-on training for endovascular stroke therapy?
Authors: Sandmann Johanna , Müschenich Franziska Sonja , Riabikin Alexander , Kramer Martin , Wiesmann Martin , Nikoubashman Omid 
Published: March 2019

Purpose Since thrombectomy has become a standard treatment technique for stroke, there is great demand for well-trained interventionalists. We offer practical courses on both silicone models and porcine models, and conducted a survey to evaluate whether ex vivo training models could replace in vivo models in the future. Methods In total, 110 neurointerventionalists participating in 30 training courses were included in our survey using a semi-structured questionnaire. Results The level of experience in thrombectomy maneuvers was almost balanced in our sample (52% experienced and 48% less-experienced participants). Silicone models were regarded as useful training tools regardless of the participants' experience ( p = 1.000): 94% of less-experienced and 92% of experienced participants considered a silicone model to be a useful introduction for training with animal models. Of the participants, 95% indicated that training on animal models was helpful and necessary, even if they already had experience in performing interventions in humans ( p = 1.000). After joining this course, 97% of all participants felt well prepared to perform thrombectomies in humans. Conclusion Even experienced participants benefit from silicone models. Silicone models are a good preparation for animal models but cannot replace them. Categorizing participants depending on their experience and their individual needs before practical training may allow for more efficient endovascular training.
Patient outcomes in GuideLiner facilitated percutaneous coronary intervention stratified by the SYNTAX score: A retrospective analysis
Authors: Liu Shuangbo , Parr Christopher , Zhang Hannah , Elbarouni Basem , Shah Ashish , Kass Malek , Ravandi Amir 
Published: March 2019

Objectives To determine patient outcomes in GuideLiner facilitated percutaneous coronary intervention stratified by the SYNTAX score. Design Single centre retrospective cohort analysis. Participants A total of 540 consecutive cases facilitated by GuideLiner at a single center. Main outcome measures Successful stent delivery, in-hospital, 30 day and 1 year mortality rates stratified by SYNTAX score. Results The most common indication for GuideLiner was need for increased support for balloon or stent delivery (82%), 6% for non-coaxial guide, 9% for chronic total occlusion and 3% for selective vessel engagement. Successful stent delivery was achieved in 91% of all cases, with no complications occurred due to GuideLiner use. In-hospital, 30 day and 1 year mortality rates were 2.8%, 2.1% and 4.5%, respectively. The high SYNTAX group was associated with higher rates of initial TIMI score of 0–1; however, the final TIMI score rate of successful delivery and complications did not differ between groups. In-hospital and 1 year mortality rates were higher in the higher SYNTAX groups. Conclusions The GuideLiner is an easy to use guide catheter extension system with high rates of success and low rates of complications, across all SYNTAX groups.
Discrepancies between patients’ and pharmacists’ perceptions of the role of community pharmacists as advisors on the use of pharmaceuticals in Japan: A comparison prior to and following revision of the Pharmacists’ Act
Authors: Oshima Shinji , Yamagishi Mari , Okita Mitsuyoshi , Akimoto Hayato , Negishi Akio , Horii Norimitsu , Mutoh Mizue , Sannomaru Yasuko , Numajiri Sachihiko , Inoue Naoko , Ohshima Shigeru , Wada Masahiro , Kobayashi Daisuke 
Published: March 2019

Objectives: In 2014, immediately prior to the revision of Article 25-2 of the Pharmacists’ Act, we conducted a survey on pharmacists’ and patients’ perceptions of pharmacists’ roles. A role discrepancy between the two was identified. The objective was to examine changes in role perceptions and awareness of pharmacists as medication specialists following revision to the Pharmacists’ Act. Methods: The survey was conducted using an Internet-based questionnaire. A total of 469 patients and 354 pharmacists responded to 12 questions about the perceived roles of pharmacists. Results: Analysis revealed that the only evaluation that changed as a result of revisions was pharmacists’ role as “family or regular pharmacist,” with scores dropping by about half. As in 2014, the high rating rate for pharmacists surpassed the high rating of patients for all other items. The greatest discrepancy in role perception was observed for the same three items (“Understanding the effects of the drugs the patients are taking,” “Understanding the health changes caused by the drugs dispensed to the patients,” and “Consciously protecting patients from the adverse effects of drugs”) as 2014. Conclusion: A major role discrepancy continues to exist between patients and pharmacists, and it is necessary for pharmacists to take on a more advanced role in patient care. Results suggest that pharmacists must monitor changes in patients’ lifestyles and provide clear explanations for patients to rate them highly as medication specialists.
Exploring the effect of streamlining multidisciplinary care pathways on orbital trauma outcomes at a regional referral centre
Authors: Gillam Matthew , Mandal Niraj , Lee Vickie , Vora Vihba , Perry Michael 
Published: March 2019

Introduction Complex orbital fractures require multi-specialty input. The United Kingdom currently has no agreed best practice guidelines. A systematic review and meta-analysis found a significantly increased adverse outcome of persistent diplopia in patients operated on more than 14 days after initial injury. At our tertiary centre, we felt patient outcomes may be affected by investigative and referral pathway limitations so evaluated to assess and attempt to improve these. Methods This was a two-stage service evaluation study of all orbital trauma patients requiring specialist oculoplastic and orbital input. The initial phase included all orbital trauma patients referred to our department in April–November 2014. We assessed relevant key performance indicators and then implemented changes to our referral system, educated referring departments and formed a multidisciplinary team clinic to manage complex trauma. We then re-evaluated, collecting data on all patients referred March–May 2015. Results Most patients were male and victims of assault. Following intervention, there was a significant reduction in the injury to eye clinic review time (3.45 weeks to 2.22 weeks, p = 0.01) and multidisciplinary team review time (3.86 weeks to 2.71 weeks, p = 0.04). Injury to discharge time was significantly reduced from 6.15 weeks to 3.36 weeks (p = 0.002). Discussion Our study shows that a multidisciplinary team approach and structured pathways can improve assessment and intervention times for orbital trauma patients. This may have a beneficial effect on patient outcomes. In the absence of guidelines in the United Kingdom, we believe similar improvements could be implemented by other national centres and outcomes evaluated to assist future guidance formation.
The influence of the CT scan in the evaluation and treatment of nondisplaced femoral neck fractures in the elderly
Authors: Zamora Tomas , Klaber Ianiv , Ananias Joaquin , Bengoa Francisco , Botello Eduardo , Amenabar Pedro , Schweitzer Daniel 
Published: March 2019

Background: The management of nondisplaced femoral neck fractures (FNFs) has evolved, with emphasis in radiographic features such as posterior displacement. However, the role of advanced imaging in this scenario is still not well defined. Therefore, our objective is to assess the impact of a computed tomography scan (CT) on interobserver agreement (IA) of fracture classification, posterior tilt measurement, and treatment decisions in nondisplaced FNF in elderly patients. Methods: Eleven patients with a nondisplaced (Garden 1–2) FNF were assessed by six hip surgeons. On a first stage, fracture classification, posterior tilt, and treatment plan (fixation/arthroplasty) were determined only with clinical information and X-rays. On a second stage, a CT was added. The kappa coefficient ( κ) and intraclass correlation coefficient (ICC) were used to determine IA. Results: IA for Garden classification was only slight in X-rays and with the addition of a CT, with a κ = 0.13 (0–0.28) and 0.18 (0.03–0.33), respectively. Conversely, posterior tilt measurement agreement was excellent in both schemes, with an ICC = 0.92 (0.83–0.98) and 0.92 (0.82–0.98). The IA for the proposed treatment was slight with X-rays ( κ = 0.44; 0.29–0.6), but moderate with the addition of a CT scan ( κ = 0.67; 0.52–0.82). Changes in surgical decision where made in 14 of 66 evaluations with an OR = 1.4 (0.62–3.2) for choosing an arthroplasty if a CT was used. Conclusion: IA for fracture classification and posterior tilt evaluation in nondisplaced FNF was not altered by the usage of a CT. There is improvement in treatment agreement when a CT scan is added to conventional imaging, with changes in treatment in 21% of cases.
Surgical outcomes of cervical myelopathy due to ossification of posterior longitudinal ligament: Anterior decompression and fusion versus posterior laminoplasty
Authors: Xu Ping , Zhuang Jing-Shen , Huang Yu-Sheng , Tu Chen , Chen Jian-Ting , Zhong Zhao-Ming 
Published: March 2019

Background: The purpose of this study was to compare the surgical outcomes of anterior decompression and fusion (ADF) with that of posterior laminoplasty (LAMP) for cervical myelopathy caused by ossification of posterior longitudinal ligament (OPLL). Methods: We retrospectively assessed the medical records of patients who underwent surgery for cervical myelopathy owing to OPLL between 2007 and 2016 at our institution. Fifty patients were included in this study, including 17 patients in ADF group and 33 patients in LAMP group. Surgical outcomes were assessed under the Japanese Orthopaedic Association (JOA) score. The radiologic and clinical data were compared between two groups. Results: There was no significant difference in age, follow-up time, operation time, blood loss, length of stay, preoperative JOA score, occupying ratio of OPLL, diameter of spinal canal, preoperative and final follow-up C2-C7 Cobb angles, and the change of C2-C7 Cobb angle before and after operation between ADF and LAMP groups. The final follow-up JOA score and the neurological recovery rate were significantly higher in ADF group than in LAMP group, particularly in patients with segmental-type OPLL. Cerebrospinal fluid leakage is a major complication after ADF, C5 paralysis, and axial pain frequently results from LAMP. Conclusion: Compared with LAMP, ADF shows better improvement of neurological function in patients with cervical myelopathy due to OPLL, especially in patients with segmental-type cervical OPLL.
Role of CYP3A4 in bone marrow microenvironment–mediated protection of FLT3/ITD AML from tyrosine kinase inhibitors
Authors: Chang Yu-Ting , Hernandez Daniela , Alonso Salvador , Gao Minling , Su Meng , Ghiaur Gabriel , Levis Mark J. , Jones Richard J. 
Published: March 2019

AbstractAn intriguing aspect of the clinical activity of FMS-like tyrosine kinase 3 inhibitors (FLT3 TKIs) is their apparent higher activity against peripheral blasts from FLT3/internal tandem duplication (ITD) acute myeloid leukemia than marrow disease in the same patients. Accordingly, studies showed that the bone marrow microenvironment plays a role in FLT3 TKI resistance, although the underlying mechanisms are unclear. We recently identified a previously undescribed mechanism by which the bone marrow microenvironment can contribute to drug resistance: expression of cytochrome P450 enzymes (CYPs). In fact, bone marrow stromal cells (BMSCs) expressed most CYPs, including CYP3A4. Because hepatic CYP3A4 plays a role in the inactivation of several FLT3 TKIs, we explored the potential role of CYP3A4 in bone marrow microenvironment–mediated FLT3 TKI resistance. We found that CYP3A4 plays a major role in BMSC-mediated inhibition in the activity of 3 different FLT3 TKIs (sorafenib, quizartinib, and gilteritinib) against FLT3/ITD acute myeloid leukemia (AML). Furthermore, clarithromycin, a clinically active CYP3A4 inhibitor, significantly reversed the protective effects of BMSCs. We show, for the first time, that bone marrow stromal CYP3A4 contributes to FLT3 TKI resistance in the bone marrow. These results suggest that combining FLT3 TKIs with CYP3A4 inhibitors could be a promising strategy toward improving the activity of FLT3 TKIs.
Efficacy of heel lifts versus calf muscle eccentric exercise for mid‐portion Achilles tendinopathy (the HEALTHY trial): study protocol for a randomised trial
Authors: Rabusin Chantel L. , Menz Hylton B. , McClelland Jodie A. , Evans Angela M. , Landorf Karl B. , Malliaras Peter , Docking Sean I. , Munteanu Shannon E. 
Published: March 2019

AbstractBackgroundMid‐portion Achilles tendinopathy is a common musculoskeletal condition characterised by degeneration of the Achilles tendon, which causes pain and disability. Multiple non‐surgical treatments have been advocated for this condition including calf muscle eccentric exercise and in‐shoe heel lifts. Although adherence is challenging, there is evidence to suggest that calf muscle eccentric exercise is effective in decreasing pain and improving function in people with Achilles tendinopathy. Heel lifts reduce ankle joint dorsiflexion and Achilles tendon strain, however their efficacy in the management of Achilles tendinopathy is unclear. This article describes the design of a parallel‐group randomised trial comparing the efficacy of heel lifts to calf muscle eccentric exercise for Achilles tendinopathy.MethodsNinety‐two participants with Achilles tendinopathy will be randomised to one of two groups: (i) a heel lift group that will receive pre‐fabricated 12 mm in‐shoe heel lifts (Clearly Adjustable®), or (ii) an exercise group that will be advised to carry out a calf muscle eccentric exercise program (twice a day, 7 days a week, for 12 weeks). Outcome measures will be obtained at baseline, 2, 6 and 12 weeks; the primary endpoint for assessing efficacy being 12 weeks. The primary outcome measure will be the total score of the Victorian Institute of Sport Assessment – Achilles (VISA–A) questionnaire. Secondary outcome measures will include thickness and integrity of the Achilles tendon (using ultrasound tissue characterisation [UTC]), participant perception of treatment effect on pain and function (using the 7‐point Patient Global Impression of Change scale), severity of pain at the Achilles tendon (using a 100 mm visual analogue scale) in the previous week, health status (using the EuroQol‐5D‐5L™ questionnaire), physical activity levels (using the 7‐day Recall Physical Activity Questionnaire) and calf muscle function (using the standing heel rise test). Data will be analysed using the intention to treat principle.DiscussionThe HEALTHY trial (Heel lifts versus calf muscle eccentric Exercise for AchiLles TendinopatHY) is the first randomised trial to compare the efficacy of heel lifts to calf muscle eccentric exercise in reducing pain and improving function in people with Achilles tendinopathy. A pragmatically designed trial was developed to ensure that if the interventions are found to be effective, the findings can be readily implemented in clinical practice.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12617001225303. Registered on August 22nd, 2017.
A pragmatist's guide to the assessment of decision-making capacity
Authors: Zhong Rocksheng , Sisti Dominic A. , Karlawish Jason H. 
Published: March 2019

SummaryChoice, understanding, appreciation and reasoning compose the standard model of decision-making capacity. Difficulties in determining capacity can arise when patients exhibit partial impairment. We suggest that a pragmatic approach, focusing on how capacity status affects the ultimate decision to override the patient's wishes, can help evaluators resolve difficult cases.Declaration of interestNone.
Experiences of in-patient mental health services: systematic review
Authors: Staniszewska Sophie , Mockford Carole , Chadburn Greg , Fenton Sarah-Jane , Bhui Kamaldeep , Larkin Michael , Newton Elizabeth , Crepaz-Keay David , Griffiths Frances , Weich Scott 
Published: March 2019

BackgroundIn-patients in crisis report poor experiences of mental healthcare not conducive to recovery. Concerns include coercion by staff, fear of assault from other patients, lack of therapeutic opportunities and limited support. There is little high-quality evidence on what is important to patients to inform recovery-focused care.AimsTo conduct a systematic review of published literature, identifying key themes for improving experiences of in-patient mental healthcare.MethodA systematic search of online databases (MEDLINE, PsycINFO and CINAHL) for primary research published between January 2000 and January 2016. All study designs from all countries were eligible. A qualitative analysis was undertaken and study quality was appraised. A patient and public reference group contributed to the review.ResultsStudies (72) from 16 countries found four dimensions were consistently related to significantly influencing in-patients' experiences of crisis and recovery-focused care: the importance of high-quality relationships; averting negative experiences of coercion; a healthy, safe and enabling physical and social environment; and authentic experiences of patient-centred care. Critical elements for patients were trust, respect, safe wards, information and explanation about clinical decisions, therapeutic activities, and family inclusion in care.ConclusionsA number of experiences hinder recovery-focused care and must be addressed with the involvement of staff to provide high-quality in-patient services. Future evaluations of service quality and development of practice guidance should embed these four dimensions.Declaration of interestK.B. is editor of British Journal of Psychiatry and leads a national programme (Synergi Collaborative Centre) on patient experiences driving change in services and inequalities.
Cross-sectional and prospective relationships of passive and mentally active sedentary behaviours and physical activity with depression
Authors: Hallgren Mats , Nguyen Thi-Thuy-Dung , Owen Neville , Stubbs Brendon , Vancampfort Davy , Lundin Andreas , Dunstan David , Bellocco Rino , Lagerros Ylva Trolle 
Published: March 2019

BackgroundSedentary behaviour can be associated with poor mental health, but it remains unclear whether all types of sedentary behaviour have equivalent detrimental effects.AimsTo model the potential impact on depression of replacing passive with mentally active sedentary behaviours and with light and moderate-to-vigorous physical activity. An additional aim was to explore these relationships by self-report data and clinician diagnoses of depression.MethodIn 1997, 43 863 Swedish adults were initially surveyed and their responses linked to patient registers until 2010. The isotemporal substitution method was used to model the potential impact on depression of replacing 30 min of passive sedentary behaviour with equivalent durations of mentally active sedentary behaviour, light physical activity or moderate-to-vigorous physical activity. Outcomes were self-reported depression symptoms (cross-sectional analyses) and clinician-diagnosed incident major depressive disorder (MDD) (prospective analyses).ResultsOf 24 060 participants with complete data (mean age 49.2 years, s.d. 15.8, 66% female), 1526 (6.3%) reported depression symptoms at baseline. There were 416 (1.7%) incident cases of MDD during the 13-year follow-up. Modelled cross-sectionally, replacing 30 min/day of passive sedentary behaviour with 30 min/day of mentally active sedentary behaviour, light physical activity and moderate-to-vigorous activity reduced the odds of depression symptoms by 5% (odds ratio 0.95, 95% CI 0.94–0.97), 13% (odds ratio 0.87, 95% CI 0.76–1.00) and 19% (odds ratio 0.81, 95% CI 0.93–0.90), respectively. Modelled prospectively, substituting 30 min/day of passive with 30 min/day of mentally active sedentary behaviour reduced MDD risk by 5% (hazard ratio 0.95, 95% CI 0.91–0.99); no other prospective associations were statistically significant.ConclusionsSubstituting passive with mentally active sedentary behaviours, light activity or moderate-to-vigorous activity may reduce depression risk in adults.