bluuebunny/crossref_metadata_2025_split huggingface dataset:
End-of-life care in a nursing home: Assistant nurses’ perspectives
Authors: Holmberg Bodil , Hellström Ingrid , Österlind Jane 
Published: June 2018

Background: Worldwide, older persons lack access to palliative care. In Sweden, many older persons die in nursing homes where care is provided foremost by assistant nurses. Due to a lack of beds, admission is seldom granted until the older persons have complex care needs and are already in a palliative phase when they move in. Objective: To describe assistant nurses’ perspectives of providing care to older persons at the end of life in a nursing home. Research design: Data were collected in semi-structured individual interviews and analyzed with inductive qualitative content analysis. Participants and research context: Seven assistant nurses from a nursing home in Sweden were randomly selected. Ethical consideration: The research was approved by the local ethics committee. Results: Three main categories emerged; “Death a natural part of life”; “The older person’s well-being”; and “Care in the moment of death”; and seven sub-categories. The assistant nurses described themselves as knowing the older persons well enough to provide good end-of-life care. This was achieved by making small-talk while providing daily care. Relying on experience-based knowledge, they strove to provide end-of-life care built upon respect and engagement with the ambition to strengthen older persons’ dignity, for example, by lowering the tempo of care at the end of life, in spite of organizational restrictions. Discussion: The assistant nurses offered attentive end-of-life care, focusing upon bodily care. The existential needs of the older persons were not foregrounded. Conclusion: To develop their work, and to promote an ethical foundation for such care, assistant nurses might need support and education to be able to offer a care more in line with the aims of palliative care. Furthermore, the organization of care needs to promote, not impede, the realization of this development.
Insulin/IGF-1 enhances intestinal epithelial crypt proliferation through PI3K/Akt, and not ERK signaling in obese humans
Authors: Zhou Weinan , Rowitz Blair M , Dailey Megan J 
Published: June 2018

The intestinal epithelium is continuously regenerated through proliferation and differentiation of stem cells located in the intestinal crypts. Obesity affects this process and results in greater stem cell proliferation and altered tissue growth and function. Obesity-induced high levels of insulin and insulin-like growth factor-1 in the stem cell niche are found to impact proliferation in rodents indicating that insulin and insulin-like growth factor-1 receptors may play a role in modulating intestinal epithelial stem cell proliferation. To determine whether insulin or insulin-like growth factor-1 can induce proliferation in human intestinal epithelial stem cells, and if two downstream insulin and insulin-like growth factor-1 receptor signaling pathways, PI3K/Akt and ERK, are involved, we used primary small intestinal epithelial crypts isolated from obese humans and investigated (1) the effect of insulin or insulin-like growth factor-1 on crypt proliferation, and (2) the effect of insulin and insulin-like growth factor-1 signaling inhibitors on insulin or insulin-like growth factor-1-induced proliferation. We found that insulin and insulin-like growth factor-1 enhanced the proliferation of crypt cells, including intestinal epithelial stem cells. Inhibition of the PI3K/Akt pathway attenuated insulin and insulin-like growth factor-1-induced proliferation, but inhibition of the ERK pathway had no effect. These results suggest that the classical metabolic PI3K pathway and not the canonical proliferation ERK pathway is involved in the insulin/insulin-like growth factor-1-induced increase in crypt proliferation in obese humans, which may contribute to abnormal tissue renewal and function. Impact statement This study investigates if insulin or insulin-like growth factor-1 (IGF-1) induces intestinal epithelial proliferation in humans, and if insulin and IGF-1 receptor signaling is involved in this process in obesity. Although obesity-induced high levels of insulin and IGF-1 in the stem cell niche are found to impact the proliferation of intestinal epithelial stem cells in rodents, we are the first to investigate this effect in humans. We found that insulin and IGF-1 enhanced the proliferation of intestinal crypts (including stem cells and other crypt cells) isolated from obese humans, and PI3K/Akt, and not ERK signaling was involved in insulin or IGF-1-induced proliferation. The imbalance in signaling between PI3K/Akt and ERK pathways may point to a pathway-specific impairment in insulin/IGF-1 receptor signaling. We propose that this may contribute to reciprocal relationships between insulin/IGF-1 receptor resistance and intestinal epithelial proliferation that leads to abnormal tissue renewal and function.
Intravenous thrombolysis for acute ischemic stroke in Greece: the Safe Implementation of Thrombolysis in Stroke registry 15-year experience
Authors: Tsivgoulis Georgios , Kargiotis Odysseas , Rudolf Jobst , Komnos Apostolos , Tavernarakis Antonios , Karapanayiotides Theodoros , Ellul John , Katsanos Aristeidis H. , Giannopoulos Sotirios , Gryllia Maria , Safouris Apostolos , Papamichalis Panagiotis , Vadikolias Konstantinos , Mitsias Panayiotis , Hadjigeorgiou Georgios 
Published: June 2018

Background: Intravenous thrombolysis (IVT) remains the only approved systemic reperfusion treatment for acute ischemic stroke (AIS), however there are scarce data regarding outcomes and complications of IVT in Greece. We evaluated safety and efficacy outcomes of IVT for AIS in Greece using the Safe Implementation of Thrombolysis in Stroke: International Stroke Thrombolysis Register (SITS-ISTR) dataset. Methods: All AIS patients treated with IVT in Greece between December 2002 and July 2017 and recorded in the SITS-ISTR were evaluated. Demographics, risk factors, baseline stroke severity [defined using National Institutes of Health Stroke Scale (NIHSS)], and onset-to-treatment time (OTT) were recorded. Safety outcomes included symptomatic intracranial hemorrhage (sICH) and 3-month mortality rates. The efficacy outcomes evaluated a reduction in baseline NIHSS score at 2 and 24 h following IVT onset, 3-month favorable functional outcome [FFO; modified Rankin scale (mRS) scores of 0–1] and 3-month functional independence (FI; mRS-scores of 0–2). The safety and efficacy outcomes were assessed comparatively with previously published data from SITS national and international registries. Results: A total of 523 AIS patients were treated with IVT in 12 Greek centers participating in the SITS-ISTR during the study period (mean age 62.4 ± 12.7; 34.6% women; median baseline NIHSS score: 11 points; median OTT: 150 min). The rates of sICH were 1.4%, 2.3%, and 3.8% according to the SIST-MOST, ECASS II, and NINDS criteria respectively. The median reduction in NIHSS score at 2 and 24 h was 3 [interquartile range (IQR): 1–5] and 5 (IQR: 2–8) points respectively. The 3-month FI, FFO and mortality were 66.5%, 55.6% and 7.9%. All safety and efficacy outcomes were comparable with available data from SITS-ISTR in other European countries. Conclusions: Our study underscores the safety and efficacy of IVT for AIS in Greece. Additional action is necessary in order to increase the availability of IVT in the Greek population and to include more centers in the SITS-ISTR.
Occupational performance problems identified by 507 patients: An insight that can guide occupation-based hand therapy
Authors: Poulsen Helle S , Hansen Alice Ø 
Published: June 2018

Introduction Several barriers challenge the use of occupation-based interventions in hand therapy. An outpatient clinical setting can be prepared in such a way as to address the most common occupational performance problems which might promote an occupation-based intervention. To this end, more knowledge is needed about which problems patients with hand-related disorders consider most important. Methods Interviews using the Canadian Occupational Performance Measure (COPM)were conducted with 507 patients. Data were entered into Microsoft Excel in the COPM categories: Self-care, productivity and leisure and analysed using descriptive statistics. Data concerning main problem areas were categorized according to the Taxonomic Code of Occupational Performance (TCOP). The analysis included the number of prioritized occupational performance problems (NPOPP) in each COPM category/subcategory; the NPOPP in each category is relative to gender and age and the most frequent problems. Results The total NPOPP was 2384. Problems within productivity and self-care constituted the largest proportion, respectively, 46% and 40%. Gender or age affected the NPOPP in each category to a limited extend. Problems were expressed at all levels in the TCOP, except the lowest level. The most frequently expressed problem was use of utensils when eating. Conclusion The problems mostly concern productivity and self-care, regardless of gender or age. Patients consider problems at the levels of occupation, activities, tasks and actions to be important and meaningful to address in their intervention. This study provides useful knowledge that can be applied when preparing a setting to address the most common problems, which could lead to the promotion of occupation-based interventions.
Is There a Role for Early Palliative Intervention in Frail Older Patients With a Neck of Femur Fracture?
Authors: Davies Andrew , Tilston Thomas , Walsh Katherine , Kelly Michael 
Published: June 2018

Background: Patients with a neck of femur fracture have a high mortality rate. National outcomes have improved significantly as the management of this patient group is prioritized. In 2016, however, 4398 (6.7%) patients died within 30 days of admission. Objective: To investigate whether palliative care could be integrated early in the care plan for high-risk patients. Methods: All cases of inpatient mortality following neck of femur fracture at North Bristol Major Trauma Centre over a 24-month period were reviewed. A comprehensive assessment of care was performed from the emergency department until death. All investigations, interventions, and management decisions were recorded. A consensus decision regarding expected mortality was made for each case at a multidisciplinary meeting which included surgical, orthogeriatric, nursing, and anesthetic team input. Results: A total of 1033 patients were admitted following a neck of femur fracture. There were 74 inpatient deaths, and 82% were considered predictable at our multidisciplinary meeting. The mean length of stay was 18 days (range: 0-85, median 14). In 42% of cases, mortality was considered predictable on admission, and 40% were considered predictable following acute deterioration. These patients received on average 28 blood tests (range: 4-114) and 6.8 X-rays and computed tomographies (range: 2-20). Of this, 66% received end-of-life care; mean duration 2.3 days (range: 0-17). Conclusions: Mortality rates remain high in a subset of patients. This study demonstrates that intensive investigation and medical management frequently continues until death, including in patients with predictably poor outcomes. Early palliative care input has been integrated successfully into patient management in other specialties. We demonstrate that it is feasible to identify patients with hip fracture who may benefit from this expertise.
Is Edema at the Posterior Medial Tibial Plateau Indicative of a Ramp Lesion? An Examination of 307 Patients With Anterior Cruciate Ligament Reconstruction and Medial Meniscal Tears
Authors: Kumar Neil S. , Spencer Tiahna , Cote Mark P. , Arciero Robert A. , Edgar Cory 
Published: June 2018

Background: Medial meniscal tears are commonly seen during anterior cruciate ligament reconstruction (ACLR). A subset of these injuries includes posterior meniscocapsular junction or “ramp” tears. One criterion that may correlate with a ramp lesion is the presence of posterior medial tibial plateau (PMTP) edema. Purpose: To compare patients with ramp lesions to patients with nonramp (meniscal body) medial meniscal tears and correlate PMTP edema on preoperative magnetic resonance imaging (MRI) to the incidence of ramp tears. Study Design: Case-control study; Level of evidence, 3. Methods: From 2006 to 2016, a total of 852 patients underwent ACLR and had operative reports available for review. Age, sex, laterality, mechanism of injury (contact/noncontact), sport, revision procedure, multiligament injury, time to MRI, and time to surgery were recorded. Preoperative MRI scans were reviewed for PMTP edema using axial, coronal, and sagittal T2 and proton-density sequences. Differences between groups were analyzed using a 2-sample t test and chi-square test. Univariate and multivariate logistic regression models examined correlations with tear type. Results: Overall, 307 patients had medial meniscal tears identified during ACLR (127 ramp lesions, 180 meniscal body lesions). The ramp group was 7.5 years younger than the meniscal body group ( P < .01). The groups were not different regarding sex, contact injury, revision surgery, laterality, or multiligament injury. Patients with delayed ACLR were significantly more likely to have a meniscal body tear than a ramp lesion (odds ratio, 3.3 [95% CI, 1.9-5.6]; P < .01). The sensitivity of PMTP edema for a ramp tear was 66.3%, and 54.5% of patients with ACLR and a medial meniscal tear had PMTP edema. Patients with PMTP edema were significantly more likely to have a ramp tear than a meniscal body tear (odds ratio, 2.1 [95% CI, 1.1-4.1]; P < .03). Conclusion: The overall incidence of ramp tears in patients undergoing ACLR was 14.9%, and these tears were more prevalent in younger patients. Meniscal body tears were significantly more likely than ramp tears with delayed ACLR. In patients undergoing ACLR with an associated medial meniscal tear, the presence of PMTP edema demonstrated significantly greater odds for ramp lesions compared with meniscal body tears.
Efficacy and Tolerability of a Dietary Supplement Containing Collagen, Hyaluronic Acid, Chondroitin Sulfate and Plasma Proteins in the Recovery After Anterior Cruciate Ligament Reconstruction
Authors: López Vidriero E , Olivé Vilas R , López Capapé D , Alonso Rodríguez J , Varela Sende L , López Vidriero R , Ramoneda Salas J 
Published: June 2018

Introduction: Arthroscopic reconstruction of the anterior cruciate ligament (ACL) is common in patients with ACL injuries. To enhance recovery after surgery, various nutritional supplements have been proposed as adjuvant treatments to physical therapy. Objectives: Efficacy and tolerability of a nutritional supplement containing hydrolyzed collagen, a complex of HA and CS (HC-15), and a plasma protein concentrate as adjuvant treatment to physical therapy in healing augmentation after ACL reconstruction. Methods: Prospective, multicenter, randomized, open-label trial including patients who underwent arthroscopic ACL reconstruction after injury. 80 patients were randomized into two groups to receive physical therapy only (control group) or combined with a nutritional supplement (composed of hydrolyzed collagen, a complex of hyaluronic acid and chondroitin sulfate, and plasma proteins) (Progen group). Efficacy assessments included a pain VAS score and the International Knee Documentation Committee (IKDC) index. Indirect measures of efficacy included analgesic consumption, the number of days to return to pre-injury activities, the number of rehabilitation sessions needed, and MRI graft maturation. The perceived efficacy and tolerability were assessed by patients and physicians. Results: At baseline, the demographic and clinical characteristics of both groups showed no significant differences. Both interventions showed efficacy in reducing the VAS and IKDC scores, with no significant differences between groups. Compared with patients in the control group, those in the Progen group required fewer rehabilitation sessions (mean [SD] of 48.4 [11.3] sessions vs. 38.0 [9.3] sessions; p < 0.001), thus returning earlier to their pre-injury activities. At the end of the follow-up, analgesic consumption was lower in the Progen group (8.6% of patients vs. 50.0%). According to the MRI findings, 61.8% and 38.2% of patients showed a high or complete maturation of the graft in the Progen and control groups, respectively. No serious adverse events were recorded. Both physicians and patients showed a trend towards a better perceived efficacy and tolerability in the Progen group. Conclusion: Adjuvant oral supplementation may increase the efficacy of physical therapy by shortening the time needed to return to pre-injury activity and the analgesic consumption. Also, MRI assessment revealed that more patients in the Progen group experienced a high or complete maturation of the graft, in line with the consistent trend observed in indirect measures of efficacy and patients’ quality of life at three months of treatment.
Proposal of a rehabilitation protocol for a Type II Mason radius head fracture following surgical intervention OSTEOSYNTHESIS with cannulated screws in an elite triathlete. Case study
Authors: Ibañez Martin LI , Ogando Berea H 
Published: June 2018

A 33-year-old man suffers a radius head fracture after a bicycle fall. Surgically operation with OSTEOSYNTHESIS with two cannulated screws was performed. These fractures, can be a complication in this sport for the technical gesture necessary for the practice of swimming, which needs the recovery of the strength and the complete articular range. Objectives: The objective of the present work is make a proposal of a rehabilitation program focused on the recovery of joint range, strength and adaptation work to swimming. Methods: A systematic review of the scientific literature of the databases of Medline, PubMed, Scopus, PEDRO and SPORTDiscus was carried out. Results: It was designed a rehabilitation protocol specialized in elbow joint mobilization in flexo-extension and prono-supination, joint and soft-tissue manual therapy, electrotherapy and analgesic measures, muscular strengthening work (isometric, concentric and eccentric) and proprioceptive work In different joint ranges. Spine and shoulders: Manual joint and soft tissue therapy in cervical-dorsal spine, scapular and glenohumeral articulations, strengthening of the external rotator shoulder and scapular stabilizers muscles and flexibilization of the dorsal spine. Integration in technical movements: in water (Swimming technique and swimming simulation), functional work (with elastic bands), integration of the elbow movements in the lumbopelvic stabilization work and functional movements (ball launches and receptions). The program was evaluated by goniometric measurement, recordings of the technical gesture and comparative evaluation of the strength. Conclusion: The triathlete recovered the ROM and strength necessary to make the gesture of swimming correctly as well as the return to the competition of high level, reason why the protocol proposed can be useful.Limitation of the work: lack of research on this topic (which limits its justification).
Femoral neck stress fracture in a young female recruit: case report
Authors: Fonte Hélder , Rodrigues-Pinto Ricardo 
Published: June 2018

Introduction Stress fractures of the femoral neck are rare, representing 5% of all stress fractures, and most prevalent among runners and military recruits. Women seem to be at higher risk. Most of these fractures are undisplaced. Early diagnosis with appropriate imaging in patients with a history of groin pain during training might be crucial in detecting the fractures at early stages. The goal of this paper is to report a case of femoral neck stress fracture in a young female recruit and to highlight the importance of early suspicion of this kind of lesions in military and athlete populations, especially in females, providing the right treatment and avoiding possible complications. Materials and Methods A 27-year-old female, who was enrolled in military recruit, reported left groin pain after a strenuous running exercise. After one week taking NSAIDs and without relief, she presented at medical facility. Left hip active and passive range of motion was painful.The patient reported history of amenorrhea that had started a few weeks after the onset of the recruit. An X-Ray was performed, and interpreted as normal, but MRI and CT scans revealed a nondisplaced compression-type femoral neck fracture with fatigue line <50% width. Results Female athlete triad was not present. The patient was advised to a six-week period of non-weightbearing, using crutches and restriction from physical activity. The follow-up imaging study revealed union of the femoral neck fracture. At three months, she started light impact activities and seven months after she had no pain and no daily-life limitations. Conclusion Stress fractures have been described extensively in the runner as well as military recruit population.They typically involve the lower extremity. Although relatively rare, unrecognized or untreated stress fractures of the femoral neck carry amuch higher morbidity rate than other stress fractures. If X-ray is inconclusive, MRI can be useful. Treatment depends on the location and the type of fracture. It is important to keep in mind when evaluating soldiers and athletes who present with activity-related pain that stress fractures are not uncommon and should be given significant consideration.
Is suture cut-out damage reduced by the use of tape instead of thread in transtibial posterior root repair? Influence on the biomechanical properties of the meniscus-suture complex in a porcine model
Authors: Espejo-Reina A , Lombardo Torre M , Pérez de la Blanca A , Ezquerro-Juanco F , Prado-Novoa M , Dalla Rosa-Nogales J , Espejo-Reina MJ , Espejo-Baena A 
Published: June 2018

Objectives: To assess the influence of suture shape, tape or thread, in the development of suture cut-out damage by modifying the contact area at the tissue-suture interface in transtibial repair of the posterior meniscal root, and to analyze its relation with the initial biomechanical properties of the meniscus-suture complex. Methods: Twenty medial porcine menisci were randomized in two groups depending on the suture shape: thread or tape. The sutured menisci were first subjected to 1000 cycles of [10,30]N load at 0.5 Hz; stiffness, residual displacement and displacement at 30 N were computed. Following this, load-to-failure testing was conducted at 0.5mm/s and stiffness, ultimate failure load and displacement were determined. During tests, the tissue-suture interface was recorded using a high-resolution camera. Results: In cyclic tests, cut-out progression at suture insertion points was not observed for any specimen of either group and no differences were found between groups for any parameter. In load-to-failure test, all specimens failed by suture cut-out and suture tape had a greater ultimate load (221.61(sd=43.77)N vs 291.58(sd=78.98)N, p=0.03) with no other differences. Conclusions: In a porcine model simulating a repaired posterior meniscal root, there is no evidence of suture cut-out progression using thread or tape of the same material until high loading levels close to the ultimate load. Accordingly, the larger meniscus-suture contact area of tape compared to thread does not reduce displacements under cyclic loads representative of current rehabilitation protocols in the early postoperative period but increases resistance to tissue cut-through during load-to-failure, producing a higher ultimate load.