bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of dying and quality of end-of-life care of nursing home residents in six countries: An epidemiological study
Authors: Pivodic Lara , Smets Tinne , Van den Noortgate Nele , Onwuteaka-Philipsen Bregje D , Engels Yvonne , Szczerbińska Katarzyna , Finne-Soveri Harriet , Froggatt Katherine , Gambassi Giovanni , Deliens Luc , Van den Block Lieve 
Published: October 2018

Background: Nursing homes are among the most common places of death in many countries. Aim: To determine the quality of dying and end-of-life care of nursing home residents in six European countries. Design: Epidemiological survey in a proportionally stratified random sample of nursing homes. We identified all deaths of residents of the preceding 3-month period. Main outcomes: quality of dying in the last week of life (measured using End-of-Life in Dementia Scales – Comfort Assessment while Dying (EOLD-CAD)); quality of end-of-life care in the last month of life (measured using Quality of Dying in Long-Term Care (QoD-LTC) scale). Higher scores indicate better quality. Setting/participants: Three hundred and twenty-two nursing homes in Belgium, Finland, Italy, the Netherlands, Poland and England. Participants were staff (nurses or care assistants) most involved in each resident’s care. Results: Staff returned questionnaires regarding 1384 (81.6%) of 1696 deceased residents. The End-of-Life in Dementia Scales – Comfort Assessment while Dying mean score (95% confidence interval) (theoretical 14–42) ranged from 29.9 (27.6; 32.2) in Italy to 33.9 (31.5; 36.3) in England. The Quality of Dying in Long-Term Care mean score (95% confidence interval) (theoretical 11–55) ranged from 35.0 (31.8; 38.3) in Italy to 44.1 (40.7; 47.4) in England. A higher End-of-Life in Dementia Scales – Comfort Assessment while Dying score was associated with country ( p = 0.027), older age ( p = 0.012), length of stay ⩾1 year ( p = 0.034), higher functional status ( p < 0.001). A higher Quality of Dying in Long-Term Care score was associated with country ( p < 0.001), older age ( p < 0.001), length of stay ⩾1 year ( p < 0.001), higher functional status ( p = 0.002), absence of dementia ( p = 0.001), death in nursing home ( p = 0.033). Conclusion: The quality of dying and quality of end-of-life care in nursing homes in the countries studied are not optimal. This includes countries with high levels of palliative care development in nursing homes such as Belgium, the Netherlands and England.
Economic evaluation of the randomised, double-blind, placebo-controlled study of subcutaneous ketamine in the management of chronic cancer pain
Authors: McCaffrey Nikki , Flint Thomas , Kaambwa Billingsley , Fazekas Belinda , Rowett Debra , Currow David C , Hardy Janet , Agar Meera R , Quinn Steve , Eckermann Simon 
Published: October 2018

Background: Treating chronic, uncontrolled, cancer pain with subcutaneous ketamine in patients unresponsive to opioids and co-analgesics remains controversial, especially in light of recent evidence demonstrating ketamine does not have net clinical benefit in this setting. Aim: To evaluate the cost-effectiveness of subcutaneous ketamine versus placebo in this patient population. Design and setting: A within-trial cost-effectiveness analysis of the Australian Palliative Care Clinical Studies Collaborative’s randomised, double-blind, placebo-controlled trial of ketamine was conducted from a healthcare provider perspective. Mean costs and outcomes were estimated from participant-level data over 5 days including positive response, health-related quality of life (HrQOL) measured with the Functional Assessment of Chronic Illness Therapy–Palliative Care (FACIT-Pal), ketamine costs, medication usage and in-patient stays. Results: There was no statistically significant difference in responder rates, but higher toxicity and worse HrQOL for ketamine participants (mean change −3.10 (standard error (SE) 1.76), ketamine n = 93; 4.53 (SE 1.38), placebo n = 92). Estimated total mean costs were AU$706 higher per ketamine participant (AU$6608) compared with placebo (AU$5902), attributable to the cost of higher in-patient costs as well as costs of ketamine administration. The results were robust to sensitivity analyses accounting for different medication use costing methods and removal of cost outliers. Conclusion: The findings suggest subcutaneous ketamine in conjunction with opioids and standard adjuvant therapy is neither an effective nor cost-effective treatment for refractory pain in advanced cancer patients.
Intramedullary nail versus locking plate for treatment of proximal humeral fractures: A meta-analysis based on 1384 individuals
Authors: Li Ming , Wang Yanhua , Zhang Yupeng , Yang Ming , Zhang Peixun , Jiang Baoguo 
Published: October 2018

Objective The optimal surgical intervention on the treatment for proximal humeral fractures (PHFs) remains uncertain. The aim of this study was to evaluate clinical outcomes following fixation of PHFs by intramedullary nails or locking plates Methods The Cochrane Library, PubMed, EMBASE, China Knowledge Resource Integrated (CNKI), Chongqing VIP and Wanfang databases were systematically searched for studies published between January 01, 1996 and December 31, 2016 that investigated intramedullary nail vs. locking plate in the surgical treatment of PHFs. A meta-analysis examined incision length, blood loss, operation time, fracture healing time, Constant scores and post-operative complications. The methodological and evidence quality were also assessed by MINORS and GRADE system. Results From the original 1024 references, 20 studies involving 1384 patients met the eligibility criteria. Analyses showed that intramedullary nails were superior to locking plates in incision length, peri-operative bleeding time, operation time and fracture healing time. However, there were no differences between treatments in Constant score or post-operative complications. Conclusion Although the evidence quality was poor, the results suggest that compared with locking plates, intramedullary nails may be a better choice for the repair of PHFs.
Characteristics of wooden intraocular foreign body by magnetic resonance imaging in rabbits
Authors: Wen Baohong , Cheng Jingliang , Zhang Huixia , Zhang Yong , Zhang Xiaonan , Yan Chenyu , Zhang Fengguang 
Published: October 2018

Objective Intraocular foreign body (IOFB), a frequent cause of ocular trauma, causes serious damage to the eyes. This study was designed to elaborate and compare the characteristics of different magnetic resonance imaging (MRI) sequences in detecting wooden IOFBs in rabbits. Methods The right vitreous of 24 healthy rabbits was randomly implanted with diverse wooden foreign bodies (diameter φ = 0.2 mm). The T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), proton density-weighted imaging (PDWI), and susceptibility-weighted imaging (SWI) sequences were applied individually 2 weeks after the implantation. Results IOFBs were detected as linear low signals on T1WI, T2WI, PDWI, and SWI (SWI image). The detectable rates of poplar wood with a length of 0.5 mm were 0%, 50%, 0%, and 67% for T1WI, T2WI, PDWI, and SWI, respectively. SWI and T2WI sequences exhibited higher sensitivity than T1WI and PDWI. The detectable rates of the first three SWI sequences (magnitude, phase, and SWI) were all 67%, which was higher than that of the minimum intensity projection sequence (33%). Conclusion MRI is practicable in the diagnosis of wooden IOFBs. SWI and T2WI are optimal for the integrated diagnosis of wooden IOFBs and could be used for diagnosis and immediate treatment.
Treatment outcomes and therapeutic evaluations of patients with left ventricular aneurysm
Authors: Sui Yonggang , Teng Siyong , Qian Jie , Zhao Zhenyan , Zhang Qian , Wu Yongjian 
Published: October 2018

Objective This study was performed to analyze and compare the efficacy of three treatment methods for left ventricular aneurysm (LVA): coronary artery bypass grafting (CABG) combined with left ventricular resection, drug treatment, and percutaneous coronary intervention (PCI). Methods In total, 183 patients with LVA from Fuwai Hospital were divided into three groups according to the treatment method: 51 patients underwent left ventricular resection combined with CABG (CABG-resection group), 65 underwent drug treatment (drug group), and 67 underwent PCI (PCI group). The clinical characteristics and survival rates of the patients were compared among the three groups. Results The patients’ basic data and medical history were analyzed. The postoperative left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) were significantly higher than those before surgery, indicating that the left ventricular function markedly improved after the operation. Conclusion Surgery is recommended as the first treatment option for LVA, and conservative therapy can be considered for selected patients. Although the difference was not statistically significant, CABG with left ventricular resection was associated with a better LVEF and LVEDD and higher survival and non-recurrence rates than PCI or drug treatment.
Beraprost sodium versus clopidogrel for preventing vascular thromboembolic events of arteriovenous fistula in uraemic patients: a retrospective study with a mean 3-year follow-up
Authors: Wan Ziming , Zhu Ying , Yang Ruikun , Zhang Yongjian , Yang Chen , Cao Lei , Yan Wenjing , Wang Qi , Li Ning , Zhao Mingdong , Gui Keke , Xiong Min 
Published: October 2018

Objective This study aimed to evaluate the efﬁcacy of beraprost sodium (BPS) or clopidogrel (CL) using vascular thromboembolic events (VTEs) of arteriovenous fistula as a primary endpoint in patients with end-stage renal disease (ESRD) undergoing arteriovenous fistula surgery. Methods We performed a multicentre, retrospective cohort study from August 2012 to August 2016. We studied patients with ESRD who underwent arteriovenous fistula surgery and received peroral administration of 40 µg BPS, three times per day, for 1 month, or 75 mg CL (initial dose of 300 mg), one time per day, for 1 month. The time to first on-study VTE was the primary endpoint. Results The BPS-treated cohort had a significantly delayed time to first VTE compared with the CL-treated cohort (hazard ratio 0.33, 95% confidence interval 0.18–0.56). An increased incidence of VTEs was detected in the 1-month follow-up, with rates of 2.4% and 8.7% for BPS and CL, respectively. This difference persisted over time, with rates of 8.0% and 18.1% at the final follow-up, respectively. Conclusion CL-treated patients with ESRD have a greater risk of VTEs compared with BPS-treated patients. CL-treated patients also tend to experience a VTE within the first month after cessation of oral administration.
Current Concepts in the Operative Management of Acromioclavicular Dislocations: A Systematic Review and Meta-analysis of Operative Techniques
Authors: Gowd Anirudh K. , Liu Joseph N. , Cabarcas Brandon C. , Cvetanovich Gregory L. , Garcia Grant H. , Manderle Brandon J. , Verma Nikhil N. 
Published: October 2018

Background: Acromioclavicular (AC) instability is a frequent injury affecting young and athletic populations. Symptomatic, high-grade dislocations may be managed by a myriad of operative techniques that utilize different grafts to achieve reduction. Comparative data are lacking on the ability of these techniques to achieve excellent patient outcomes and stable AC reduction and to minimize complications. Purpose: To systematically review the outcomes and complications of different techniques of AC joint reconstruction. Study Design: Systematic review and meta-analysis. Methods: The MEDLINE, Scopus, Embase, and Cochrane Library databases were accessed to perform a systematic review of the scientific literature from 2000 to 2018 using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following keywords: “acromioclavicular” and “reconstruction.” Included articles were evaluated for loss of reduction, complication rate, revision rate, and change in coracoclavicular distance. Articles were stratified by graft and surgical material used: suture only, Endobutton with suture, TightRope, GraftRope, synthetic artificial ligament, tendon graft, and Weaver-Dunn coracoacromial ligament transfer. These outcomes were pooled using a random-effects model and stratified by surgical technique and arthroscopic versus open reconstruction. Results: Fifty-eight articles were included in the analysis, with 63 homogeneous populations composed of 1704 patients. The mean age was 37.1 years (range, 15-80 years) with a mean follow-up of 34.3 months (range, 1.5-186 months). The overall failure rate was 20.8% (95% CI, 16.9%-25.2%). The overall pooled complication rate was 14.2% (95% CI, 10.5%-18.8%). The most common complications were infection (6.3% [95% CI, 4.7%-8.2%]), fracture to the coracoid or distal clavicle (5.7% [95% CI, 4.3%-7.6%]), and hardware/button failure (4.2% [95% CI, 3.1%-5.8%]). There were no differences between arthroscopic and open techniques in regard to loss of reduction ( P = .858), overall complication rate ( P = .774), and revision rate ( P = .390). Open surgery had a greater rate of clavicular/coracoid fractures than arthroscopic surgery ( P = .048). Heterogeneity, best assessed from the pooled loss of reduction, was measured as I2 = 64.0%. Conclusion: Open and arthroscopic AC joint reconstruction techniques have no differences in loss of reduction, the complication rate, and the revision rate based on the available literature. Complications are significant, and profiles vary between surgical techniques, which should be evaluated in the decision making of selecting the technique.
Chronic Comorbid Illnesses Predict the Clinical Course of 866 Patients Requiring Prolonged Mechanical Ventilation in a Long-Term, Acute-Care Hospital
Authors: Frengley J. Dermot , Sansone Giorgio R. , Kaner Robert J. 
Published: October 2018

Objective: To determine whether burdens of chronic comorbid illnesses can predict the clinical course of prolonged mechanical ventilation (PMV)patients in a long-term, acute-care hospital (LTACH). Methods: Retrospective study of 866 consecutive PMV patients whose burdens of chronic comorbid illnesses were quantified using the Cumulative Illness Rating Scale (CIRS). Based on increasing CIRS scores, 6 groups were formed and compared: group A (≤25; n = 97), group B (26-28; n = 105), group C (29-31; n = 181), group D (32-34; n = 208), group E (35-37; n = 173), and group F (>37; n = 102). Results: As CIRS scores increased from group A to group F, rates of weaning success, home discharges, and LTACH survival declined progressively from 74% to 17%, 48% to 0%, and 79% to 21%, respectively (all P < .001). Negative correlations between the mean score of each CIRS group and correspondent outcomes also supported patients’ group allocation and an accurate prediction of their clinical course (all P < .01). Long-term survival progressively declined from a median survival time of 38.9 months in group A to 3.2 months in group F ( P < .001). Compared to group A, risk of death was 75% greater in group F ( P = .03). Noteworthy, PMV patients with CIRS score <25 showed greater ability to recover and a low likelihood of becoming chronically critically ill. Diagnostic accuracy of CIRS to predict likelihood of weaning success, home discharges, both LTACH and long-term survival was good (area under the curves ≥0.71; all P <.001). Conclusions: The burden of chronic comorbid illnesses was a strong prognostic indicator of the clinical course of PMV patients. Patients with lower CIRS values showed greater ability to recover and were less likely to become chronically critically ill. Thus, CIRS can be used to help guide clinicians caring for PMV patients in transfer decisions to and from postacute care setting.
Impact of Intensive Care Unit Discharge Delays on Patient Outcomes: A Retrospective Cohort Study
Authors: Bose Somnath , Johnson Alistair E. W. , Moskowitz Ari , Celi Leo Anthony , Raffa Jesse D. 
Published: October 2018

Objective: Patients often overstay in intensive care units (ICU) after they are deemed discharge ready. The objective of this study was to examine the impact of such discharge delays (DD) on subsequent in-hospital morbidity and mortality. Design: Retrospective cohort study. Setting: Single tertiary academic medical center. Patients: Adult patients admitted to the medical ICU between 2005 and 2011. Interventions: For all patients, DD (ie, time between request for a ward bed and time of ICU discharge) was calculated. Discharge delays was dichotomized as long (≥24 hours) or short (<24 hours). Multivariable linear and logistic regressions were used to assess the association between dichotomized DD and post-ICU clinical outcomes. Results: Overall, 9673 discharges were included of which 10.4% patients had long DDs. In the fully adjusted model, a long delay was not associated with increased odds of death (adjusted odds ratio [aOR]: 0.99, 95% confidence interval [CI]: 0.74-1.31, P = .95) but was associated with a shorter log plus one of post-ICU discharge length of stay (LOS; regression coefficient: −0.13, 95% CI: −0.17 to −0.08, P < .001). Longer DD was not associated with more hospital-free days (HFD: a composite of post-ICU LOS and in-hospital mortality). Shorter DDs were associated with shorter LOS when LOS was measured from the time of ward bed request as opposed to the time of ICU discharge. Conclusions: In this study, long DD was associated with a slight decrease in post-ICU LOS but longer LOS when measured from the point of ward bed request, suggesting a potential role for more aggressive discharge planning in the ICU for patients with long DDs. There was no association between long DD and subsequent mortality or HFD.
Output Gap, Money Growth and Interest Rate in Japan: Evidence from Wavelet Analysis
Authors: Tiwari Aviral Kumar , Olayeni Olaolu Richard , Sherafatian-Jahromi Reza , Adejonwo Olofin Sodik 
Published: October 2018

This article investigated the relationship between output, money and interest rate, using wavelet tools for the period 1972–2017. Application of such tools is helpful in answering particularly two questions: first, what the strength and direction of the causal relationships between money, output and interest rate is, and second, whether the relationship is cyclical or anti-cyclical in nature. Findings from this article show that output and money are highly coherent in low, middle and high frequencies, and coherence increases while controlling for interest rate, with money growth as the leading variable most of the time across frequencies. Output and interest rate are equally highly coherent, mostly at high frequency and some bits of middle frequency; coherence increases with the control for money, and interest rate often times leads the relationship. Also, money and interest rate are coherent at low, middle and high frequencies with interest rate leading the relationship, and controlling the effect of output increases the coherence at some times and decreases at other times. There are observable evidences of both cyclical and anti-cyclical relationships among the variables. Policy decisions should be cautious of shortrun moves in order not to trigger undesired long-run outcomes since no difference is observed in the direction of causation over time–frequency. JEL: C49, E43, E52
Mathematical method for analysis of the asymmetric retinal vascular networks
Authors: Zhu Zhipeng , He Chao , Zhang Yingli , Yue Xiangji , Ba Dechun 
Published: October 2018

Purpose: The purpose of this study was to quantitatively investigate the haemodynamics and oxygen transmission of the retina. Methods: Considering the effect of Fåhraeus-Lindqvist effect on the apparent viscosity of blood and the actual haematocrit in blood vessels, this study used the currently known retinal parameters (e.g. blood flow obtained by Doppler Fourier domain optical coherence tomography, FD-OCT for short) to construct a retinal blood circulation model consisting of an asymmetric vascular network system. Results: The blood flow velocity and the vascular diameter in the retinal blood vessels satisfied the exponential relationship. The wall shear stress was related to the release of nitric oxide synthase and endothelin-1 by endothelial cells and played an important role in retinal blood flow regulation. In the retinal arteries, the oxygen tension ranged from 98 to 65 mmHg, and the oxygen saturation ranged from 97.3% to 92.2%. In the retinal veins, the oxygen tension was approximately 41.8 mmHg, and the oxygen saturation ranged from 79.2% to 77.3%. The difference in oxygen content of the arteriovenous network was 5.4 (ml O2/dl blood), and the oxygen extraction of the superior temporal arteriovenous network was 86 (μl/min*ml O2/dl blood). Conclusion: Compared with previous relevant experimental data, the numerical model established in this article demonstrates reliability. It also helps advance our understanding of the retinal pathological processes related to hemodynamics and metabolism.
Lacrimal sac lymphoma: A series of Japanese patients
Authors: Sabundayo Maria Suzanne , Takahashi Yasuhiro , Kakizaki Hirohiko 
Published: October 2018

Purpose: To present cases of primary lacrimal sac lymphoma in a Japanese population. Methods: In this retrospective case series, five cases (two males and three females; mean age: 49.8 years; age range: 38–62 years) were included. Clinical features, diagnostic findings, and treatment outcomes were collected and reviewed. Results: Most patients presented with a swelling or mass in the medial canthal area. Only one patient presented with epiphora, while another patient also complained of pain which was due to inflammation. Imaging studies revealed a lacrimal sac mass with involvement of the nasolacrimal duct and variable involvement of the nasal cavity. Histopathological findings revealed three cases of diffuse large B-cell lymphoma, one case of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue, and one case of follicular lymphoma. Four cases were treated with a combination of chemotherapy and immunotherapy, with one case necessitating additional radiotherapy. One case was treated with immunotherapy alone. The mean follow-up was 23 (range: 3–50) months. Four cases showed complete remission, while the remaining patient is still ongoing treatment. Conclusion: Diffuse large B-cell lymphoma is the most common type of lacrimal sac lymphoma in this series. Lacrimal sac tumors should be ruled out in the presence of epiphora, dacryocystitis, or a mass in the medial canthus, even in the absence of pain or bleeding. Combined chemotherapy and immunotherapy is an effective treatment for these cases.