bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evidence-Based Performance Measures and Outcomes in Patients With Acute Ischemic Stroke
Authors: Wang Yilong , Li Zixiao , Zhao Xingquan , Liu Liping , Wang Chunxue , Wang Chunjuan , Peterson Eric D. , Schwamm Lee H. , Fonarow Gregg C. , Smith Sidney C. , Bettger Janet , Wang David , Li Hao , Xian Ying , Wang Yongjun 
Published: December 2018

Background:
Stroke is the leading cause of death in China. Despite the wide dissemination of evidence-based guidelines, data about adherence to these in routine clinical practice are scarce. We conducted a study using a nationwide registry to evaluate the implementation of evidence-based stroke performance indicators and associated guidelines, for patients with an ischemic stroke in China.

Methods and Results:
The China National Stroke Registry is a prospective cohort study, including 12 416 patients diagnosed with acute ischemic stroke from 132 hospitals across China, for 1 year beginning September 2007. Twelve performance indicators were selected to evaluate the quality of stroke care. Multivariable Cox models were used to determine the association between optimal compliance and clinical outcomes. Conformity with performance measures ranged from a median of 6.5% for the use of intravenous tPA (tissue-type plasminogen activator) to 81.8% for early use of antithrombotics. The optimal compliance with all in-hospital measures was associated with 1-year death after admission (hazard ratio, 0.66; 95% CI, 0.55–0.79). The optimal compliance with all discharge measures was associated with the 1-year death after discharge (hazard ratio, 0.55; 95% CI, 0.44–0.69), 1-year stroke recurrence (hazard ratio, 0.81; 95% CI, 0.70–0.93), and favorable functional outcomes (defined as modified Rankin Scale score of ≤2) (hazard ratio, 1.10; 95% CI, 1.04–1.16).

Conclusions:
Adherence to evidence-based ischemic stroke care measures in China revealed substantial gaps, and select measures were associated with improved outcomes. These findings support the need for ongoing quality measurement and improvement in stroke care in China.
Pneumolabyrinth and Recurrent Paroxysmal Positional Vertigo After Traumatic Stapes Fracture
Authors: Comacchio Francesco , Guidetti Giorgio , Guidetti Riccardo , Mion Marta 
Published: December 2018

Objectives: The development of pneumolabyrinth without previous head trauma is a rare event; the associated symptoms may be nonspecific, and they can simulate various cochleo-vestibular pathological entities. The aim of the present study is to describe one of these rare occurrences, characterized by a peculiar onset. Methods: We report a case of stapes fracture secondary to ear pick penetration into the middle ear with a pneumolabyrinth that caused a recurrent paroxysmal positional vertigo (PPV) mimicking a canalolithiasis. Results: The patient developed a profound left sensorineural hearing loss and an intractable PPV with “migrant” features. A pneumolabyrinth was visualized with high-resolution computed tomography. A perilymphatic fistula (PLF) with stapes fracture was found while performing an explorative tympanotomy. After the surgical treatment of the PLF, the patient no longer complained of vestibular symptoms. Conclusions: To our knowledge, this is the fifth case of traumatic pneumolabyrinth simulating a canalolithiasis without previous history of temporal bone trauma and/or middle ear surgery. A pneumolabyrinth should be suspected in case of patients presenting recurrent intractable PPV after ear trauma.
Ethnicity, Gender, and Oil: Comparative Dynamics in the Ecuadorian Amazon
Authors: Vallejo Ivette , Cielo Cristina , García Fernando 
Published: December 2018

During the past decade, Ecuador’s Alianza PAÍS socialist government, primarily under the leadership of Rafael Correa, was committed to moving toward a post-neoliberal economy and implementing a “New Amazon” free of poverty, with expanded infrastructure and services, as part of the redistribution of oil revenues. However, in sites of state development projects, gender hierarchies and territorial dispossession in fact became more acute. Analysis of two place-based indigenous political ecologies—one in the central Amazon, where the state licensed new oil blocks in Sapara territory to a Chinese company in 2016, and the other in the Kichwa community of Playas de Cuyabeno in the northern Amazon, where the state company PetroAmazonas has operated since the 1970s—shows how women have reconfigured their ethnic and gender identities in relation to oil companies and the state in the context of rising and falling oil prices and in doing so reinforced or challenged male leaders’ positions in the internal structures of their communities and organizations. Durante la última década, el gobierno socialista de Alianza PAÍS de Ecuador, principalmente bajo el liderazgo de Rafael Correa, se comprometió a avanzar hacia una economía posneoliberal e implementar una “Nueva Amazonía” libre de pobreza, con infraestructura y servicios ampliados, como parte de la redistribución de los ingresos petroleros. Sin embargo, en los sitios de proyectos estatales de desarrollo, las jerarquías de género y el despojo territorial de hecho se hicieron más agudos. Análisis de dos ecologías políticas indígenas basadas en el lugar—una en la Amazonía central, donde el estado otorgó licencias de nuevos bloques petroleros en el territorio de Sapara a una compañía china en 2016, y la otra en la comunidad Kichwa de Playas de Cuyabeno, en el norte de la Amazonía, donde la compañía estatal PetroAmazonas ha operado desde la década de 1970—muestra cómo las mujeres han reconfigurado sus identidades étnicas y de género en relación con las compañías petroleras y el estado en el contexto del alza y la caída de los precios del petróleo y, al hacerlo, refuerzan o desafían las posiciones de los líderes masculinos en la estructura interna de sus comunidades y organizaciones.
Status survey on enema reduction of paediatric intussusception in China
Authors: Tang Xiao Bing , Zhao Jia Yu , Bai Yu Zuo 
Published: December 2018

Objective Intussusception is a common paediatric abdominal emergency in infants. The first-line treatment of choice in uncomplicated paediatric intussusception is enema reduction. The study aim was to provide an overview of the current national practice of enema reduction of paediatric intussusception in China. Methods A questionnaire on enema reduction of paediatric intussusception was sent to respondents (members of the Pediatric Anorectal Group, the Neonatal Group, the Society of Pediatric Surgery and the China Medical Association). Results Data from 128 questionnaires were analysed. Of these, 78.1% (100/128) reported the use of fluoroscopy, 17.2% (22/128) use of ultrasound monitoring, 78.9% (101/128) use of air and 17.9% (23/128) use of normal saline. A total of 78.9% (101/128) reported a success rate of 90%, 25.8% (33/128) reported that a paediatric surgeon managed the reduction, 18.8% (24/128) that a radiologist managed the reduction and 44.5% (57/128) that a paediatric surgeon and radiologist jointly managed the reduction. Conclusions There is large variation in the techniques of enema reduction of intussusception in China. Fluoroscopy-guided air enema reduction is mainly used. Enema reduction of uncomplicated cases of paediatric intussusception in China lacks standardization of equipment and personnel involvement.
Improvement in Functional Outcome Scores Despite Persistent Pain With 1 Year of Nonsurgical Management for Acetabular Labral Tears With or Without Femoroacetabular Impingement
Authors: Quinlan Noah J. , Alpaugh Kyle , Upadhyaya Shivam , Conaway William K. , Martin Scott D. 
Published: December 2018

Background: Acetabular labral tears are increasingly recognized as a source of hip pain in a younger active population. Given the significant focus on surgical intervention, there has been limited investigation on the nonsurgical management and natural history of such injuries. Hypothesis: Patients undergoing nonsurgical treatment for symptomatic acetabular labral tears experience functional improvement based on patient-reported outcome measures over the course of 1 year. Study Design: Case series; Level of evidence, 4. Methods: Seventy-one patients were identified who had acetabular labral injuries confirmed by magnetic resonance imaging or arthrography, received a minimum of 1 year of nonsurgical treatment, and completed baseline functional outcome questionnaires: modified Harris Hip Score (mHHS), Hip Outcome Score (HOS)–Activities of Daily Living, HOS-Sports, and iHOT-33 (International Hip Outcome Tool–33). Of these, 52 (73.2%) completed the minimum 1-year follow-up questionnaires. Chart review was conducted to obtain demographic information. Statistical significance ( P < .05) was determined by paired t test, independent samples t test, and chi-square test. Results: Twenty-two male and 30 female patients completed 1-year follow-up questionnaires. Mean ± SD follow-up time was 16.2 ± 3.1 months. The cohort had a mean age of 38.9 ± 9.3 years. Baseline radiographs demonstrated minimal arthritis (Tönnis grades 0-2). Mean alpha angle differed significantly between men and women at 52.9°± 8.6° and 46.3°± 8.5°, respectively. At 1-year follow-up, patients experienced a significant improvement in all 4 functional outcome measures (mHHS: 72.6 vs 81.8, HOS–Activities of Daily Living: 78.6 vs 86.4, HOS-Sports: 56.0 vs 71.1, iHOT-33: 47.5 vs 67.9). Patients with and without femoroacetabular impingement demonstrated a significant improvement in the mHHS. However, 48.1% reported no improvement in their pain; 69.2% were limited in their activities; and 40.4% were still considering surgery. Overall, 71.2% were satisfied with nonsurgical treatment. Conclusion: Patients with symptomatic labral tears can experience functional improvement after a minimum 1 year of nonsurgical treatment in the presence and absence of femoroacetabular impingement. However, many report residual pain, alteration of their activities, and interest in surgery. This information is important when patients are counseled in the treatment options for this injury. Identifying the population that responds best to nonsurgical management and comparing outcomes with those undergoing surgical management should be the focus of future research. Longer-term follow-up may be necessary to reevaluate pain, function, and return to activities.
Long-term results of a diffractive trifocal intraocular lens: Visual, aberrometric and patient satisfaction results
Authors: Oliveira Renan F , Vargas Veronica , Plaza-Puche Ana Belén , Alió Jorge L 
Published: December 2018

Purpose: To evaluate the long-term objective and subjective results of a trifocal intraocular lens. Methods: Prospective observational study enrolling 24 eyes that underwent uneventful microincisional cataract surgery with bilateral implantation of a diffractive trifocal intraocular lens (FineVision Micro F, PhysIOL, Belgium). After a mean follow-up period of 60 ± 2 months, patients answered the 10-item Near Activity Vision Questionnaire (NAVQ-10) and were assessed for uncorrected and corrected distance, intermediate and near visual acuity, defocus curve, light-distortion analysis, and total ocular aberrometry with a pyramidal wavefront sensor (Osiris, CSO, Italy). Results: There was significant improvement of uncorrected visual acuity at all distances in all eyes (p < 0.01). The distorsion index and best-fit circle radius were significantly lower in binocular conditions (p = 0.02). Mean Rasch score at NAVQ-10 was 16.29 ± 11.57. Patients reported to be completely, very, and moderately satisfied with their uncorrected near vision in 67%, 25%, and 8% of cases, respectively. We found no significant correlation between patient satisfaction scores at near vision satisfaction questionnaire and other variables such as light-distortion analysis or wavefront aberrometry parameters. Conclusion: The studied diffractive trifocal intraocular lens provides good and stable long-term results for distance, intermediate, and near vision, with high levels of patient satisfaction at long-term follow-up. The intraocular lens’ light-distortion effect is less disturbing in binocular conditions and may have its perception down-modulated by neuroadaptation over time.
Spectral-domain optical coherence tomography foveal morphology as a prognostic factor for vision performance in congenital aniridia
Authors: Casas-Llera Pilar , Siverio Ana , Esquivel Gemma , Bautista Cristina , Alió Jorge L 
Published: December 2018

Background: Patients with congenital aniridia usually have some degree of foveal hypoplasia, thus representing a limiting factor in the final visual acuity achieved by these patients. The purpose of this study was to analyze whether the foveal morphology assessed by spectral-domain optical coherence tomography may serve as a prognostic indicator for best-corrected visual acuity in congenital aniridia patients. Methods: Observational two-center study performed between January 2012 and March 2017 in the pediatric ophthalmology department at Vissum Alicante and Vissum Madrid, Spain. A total of 31 eyes from 19 patients with congenital aniridia were included. After a complete ophthalmological examination, a high-resolution spectral-domain optical coherence tomography with a three-dimensional scan program macular protocol was used. A morphological grading system of foveal hypoplasia was used varying from grade 1 in which there is a presence of a shallow foveal pit, extrusion of inner retinal layers, outer nuclear layer widening, and a presence of outer segment lengthening to grade 4 in which none of these processes occur. Results: No correlation between central, mid-peripheral, and peripheral macular thickness and logMAR best-corrected visual acuity was found. The presence of outer segment lengthening was associated with better best-corrected visual acuity with a median best-corrected visual acuity, 0.30 logMAR, whereas the absence of this morphologic feature was associated with poorer VA with a median best-corrected visual acuity of 0.61 logMAR (p < 0.001). Conclusion: Foveal hypoplasia morphology can predict the best-corrected visual acuity. Specifically, the morphologic optical coherence tomography feature that is related to a better best-corrected visual acuity in congenital aniridia patients is the presence of outer segment lengthening.
Psoriasis and Atopic Dermatitis “Resistant” to Topical Treatment Responds Rapidly to Topical Desoximetasone Spray
Authors: Hogue Latrice , Cardwell Leah A. , Roach Catherine , Felix Kayla H. , Oussedik Elias , Richardson Irma , Feldman Steven R. 
Published: December 2018

Purpose: Topical corticosteroids (TS) are a treatment for atopic dermatitis (AD) and psoriasis (Ps). We assessed whether use of a TS under conditions designed to enhance adherence would be effective in patients who “failed” TS in the outpatient setting. Methods: Individuals with treatment-resistant Ps or AD were recruited (AD, n = 12; Ps, n = 12). Six participants were randomized to each of 2 groups of desoximetasone 0.25% spray alone (n = 6) or desoximetasone spray plus twice-daily phone call reminders to use the medication. Disease severity was assessed. Results: In treatment-resistant Ps patients, desoximetasone spray, with reminders, resulted in statistically significant improvement in all outcome measures. In treatment-resistant AD patients, there was statistically significant improvement in some assessments. Despite the very small sample size and short evaluation time, statistically significant changes were detected in this cohort. This is evidence of the large effect size of TS for Ps and AD when the treatment is used. Conclusions: Patients with “treatment-resistant” Ps and AD generally responded well to the use of desoximetasone spray in the trial setting. This may be due to better adherence in the study environment or patients’ preference for the spray vehicle. Patient reminders contributed to improved clinical outcomes in Ps and AD patients with “treatment-resistant” disease.
Gender difference of symptoms of acute coronary syndrome among Chinese patients: a cross-sectional study
Authors: An Libin , Li Wentao , Shi Hongling , Zhou Xiaohua , Liu Xin , Wang Huina , Liu Ju , Fan Shuqin 
Published: December 2018

Background: The incidence of acute coronary syndrome is increasing in China. Objective: To investigate gender differences in Chinese patients’ acute coronary syndrome symptoms, attribution of symptoms and reasons for seeking medical service. Methods: This was a cross-sectional, multicentre study. Acute coronary syndrome patients were recruited from five university hospitals located in four cities, between June 2013 and February 2014. Data were collected using the McSweeney acute and prodromal myocardial infarction symptom survey. Results: A total of 806 patients with acute coronary syndrome (323 men, 483 women) participated in the study. Adjusted (diabetes, smoking, age) logistic regression models revealed that women were significantly more likely to have pain or discomfort in the: central high chest; back, between, or under the shoulder blades; neck or throat; or arms relative to men. Women were also more likely to have unusual fatigue, weakness, shortness of breath or difficulty breathing, or dizziness relative to men. Conversely, women were significantly less likely to have generalised chest pain relative to men. Gender difference in the attribution of symptoms was largely driven by women’s attribution to having a heart attack more frequently than men. Finally, women were more often told by a friend to seek medical help or they knew their symptoms were different, while men more frequently sought medical help because their symptoms did not go away. Conclusions: There were gender differences in pain, discomfort and other symptoms. Both potential patients and healthcare providers need to be more aware of potential gender differences in acute coronary syndrome symptoms and decisions to seek care to ensure quick access.
Functional results of wrist arthrodesis versus arthroplasty with proximal fibula following giant cell tumour excision of the distal radius
Authors: Qu Huayi , Guo Wei , Li Dasen , Yang Yi , Wei Ran , Xu Jie 
Published: December 2018

Twenty-one patients underwent excision of a Campanacci grade III giant cell tumour of the distal radius and had reconstruction using a proximal fibula autograft. We compared the functional results of wrist arthrodesis versus arthroplasty. All 21 patients healed in an average of 8 months, and all have remained disease free. The Musculoskeletal Tumor Society 93, the Disabilities of the Arm, Shoulder, and Hand scores and the grip strength of the operated wrist compared with the contralateral wrist were 93%, 7, and 71% for the arthrodesis group and 83%, 17, and 40% for the arthroplasty group. Arthrodesis of the reconstructed radiocarpal joint provided better grip strength and functional outcomes than arthroplasty. Level of evidence: III
Secondary use of electronic health records: Availability aspects in two Nordic countries
Authors: Vikström Antti , Moen Hans , Moosavi Sanaz Rahimi , Salakoski Tapio , Salanterä Sanna 
Published: December 2018

Background: The potential for the secondary use of electronic health records (EHRs) is underused due to restrictions in national legislation. For privacy purposes, legislative restrictions limit the availability and content of EHR data provided to secondary users. These limitations do not encourage healthcare organisations to develop procedures to promote the secondary use of EHRs. Objective: The objective of this study is to identify factors that restrict the secondary use of unstructured EHRs in academic research in Finland and Sweden. Method: A study was conducted to identify these availability-restricting issues that pertain to the academic secondary use of unstructured EHRs. Using semi-structured interviews, 14 domain experts in science, hospital management and business were interviewed to evaluate the efficiency of procedures and technologies that are implemented in secondary use processes. Results: The results demonstrate three aspects that restrict the availability of unstructured EHRs for secondary purposes: (i) the management and (ii) privacy preservation of such data as well as (iii) potential secondary users. Conclusion: Based on these categories, two approaches for the secondary use of unstructured EHRs are identified: the protected processing environment and altered data. Implications: The protected processing environment ensures patient privacy by providing unstructured EHRs for exclusive user groups that have preferred use intentions. Compared to the use of such processing environments, data alteration enables the secondary use of unstructured EHRs for a larger user group with various use intentions but that yield less valuable content.
Strength Measurement After Achilles Tendon Repair
Authors: Bäcker Henrik C. , Yenchak Adrian J. , Trofa David P. , Vosseller J. Turner 
Published: December 2018

The goal of treatment after Achilles tendon rupture (ATR) is to restore appropriate tension to the tendon, so that normal baseline strength and functional soft-tissue length can be achieved. The assessment of plantarflexion strength has shown widespread variability. The purpose of this study is to document variations in strength assessment after the treatment of ATR in the literature. A comprehensive literature review was performed. In total, 2758 articles were found on Achilles tendon rupture and Achilles tendon strength measurement. The full text of articles including strength as a functional outcome measurement in the abstract were assessed. All objective strength measurements performed were reviewed and recorded for comparison. One-hundred articles were included in our study. In 78 articles, a dynamometer was used to measure strength, whereas in 22 articles, an endurance test (n=14) or formal gait assessment (n=8) was applied. When a dynamometer was used, there was wide variability in the various methods used including the incorporation of both isokinetic (n = 65) and isometric (n = 29) exercises utilizing varying degrees of knee flexion and patient testing position. Furthermore, the number of measurements at certain angular velocities varied. This study illustrates that no general consensus exists regarding an optimal method for measuring strength after ATR. The variability creates difficulty and challenges medical professionals’ ability to formulate consistent conclusions when determining functional performance outcomes. A more uniform way of measuring strength after ATR may allow for better comparisons between studies in the literature, potentially leading to a better understanding of strength. Levels of Evidence: Therapeutic, Level II