bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiographic Landmarks for Femoral Tunnel Positioning in Lateral Extra-articular Tenodesis Procedures
Authors: Jaecker Vera , Naendrup Jan-Hendrik , Pfeiffer Thomas R. , Bouillon Bertil , Shafizadeh Sven 
Published: August 2019

Background: Lateral extra-articular tenodesis (LET) is being increasingly performed as an additional procedure in both primary and revision anterior cruciate ligament reconstruction in patients with excessive anterolateral rotatory instability. Consistent guidelines for femoral tunnel placement would aid in intraoperative reproducible graft placement and postoperative evaluation of LET procedures. Purpose: To determine radiographic landmarks of a recently described isometric femoral attachment area in LET procedures with reference to consistent radiographic reference lines. Study Design: Descriptive laboratory study. Methods: Ten fresh-frozen cadaveric knees were dissected. The footprints of the lateral femoral epicondyle (LFE) apex and the deep aspects of the iliotibial tract, with its Kaplan fiber attachments (KFAs) on the distal femur, were marked with a 2.5-mm steel ball. True lateral radiographic images were taken. Mean absolute LFE and KFA distances were measured from the posterior cortex line (anterior-posterior direction) and from the perpendicular line intersecting the contact of the posterior femoral condyle (proximal-distal direction), respectively. Furthermore, positions were measured relative to the femur width. Finally, radiographic descriptions of an isometric femoral attachment area were developed. Results: The mean LFE and KFA positions were found to be 4 ± 4 mm posterior and 4 ± 3 mm anterior to the posterior cortex line, and 6 ± 4 mm distal and 20 ± 5 mm proximal to the perpendicular line intersecting the posterior femoral condyle, respectively. The mean LFE and KFA locations, relative to the femur width, were found at –12% and 11% (anterior-posterior) and –17% and 59% (proximal-distal), respectively. Femoral tunnel placement on or posterior to the femoral cortex line and proximal to the posterior femoral condyle within a 10-mm distance ensures that the tunnel remains safely located in the isometric zone. Conclusion: Radiographic landmarks for an isometric femoral tunnel placement in LET procedures were described. Clinical Relevance: These findings may help to intraoperatively guide surgeons for an accurate, reproducible femoral tunnel placement and to reduce the potential risk of tunnel misplacement, as well as to aid in the postoperative evaluation of LET procedures in patients with residual complaints.
Factors Associated With a Return to Preinjury Level of Sport Performance After Anterior Cruciate Ligament Reconstruction Surgery
Authors: Webster Kate E. , McPherson April L. , Hewett Timothy E. , Feller Julian A. 
Published: August 2019

Background: Many studies have investigated factors that predict a return to sport participation after anterior cruciate ligament (ACL) reconstruction, but it is unclear whether the same factors are associated with a return to preinjury level of sport performance. Purpose: To identify factors that contribute to an athlete’s return to preinjury level of performance after ACL reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: A cohort of 222 patients (132 male, 90 female) who had ACL reconstruction surgery and completed a 12-month postoperative assessment were followed out to a mean 3 years (range, 2-4 years) to determine whether they had returned to their self-reported preinjury levels of sport performance. Rates of return to preinjury performance were calculated. Measures that had been recorded at the 12-month postoperative review—demographic (age, sex), sport activity level (Marx Activity Rating Scale, return to competition sport), knee laxity, limb symmetry (single and triple crossover hop), subjective function/symptoms (International Knee Documentation Committee subjective), and psychological readiness (Anterior Cruciate Ligament Return to Sport After Injury scale)—were compared between patients who returned to their preinjury levels of performance and those who did not. Univariate and multivariate logistic regression models were also used to prospectively determine the association between these measures and return to preinjury level of sport performance. Results: A total of 135 (61%) patients reported that they had returned to their preinjury levels of performance, with return rates similar between males (59%) and females (63%) and between those who had returned to competition at 12 months (62%) and those who had not (60%). There was no significant age difference between patients who returned to their preinjury levels of sport performance and those who did not; however, higher psychological readiness ( P < .0001), greater limb symmetry ( P < .05), higher subjective knee scores ( P = .01), and a higher activity level ( P < .04) were all associated with a return to performance. In the multivariate model, psychological readiness was the only variable that remained a significant predictor (odds ratio = 1.03; 95% CI, 1.01-1.04; P < .0001). Conclusion: A majority of athletes who returned to sport after ACL reconstruction reported that their performance was comparable with preinjury. Having a greater psychological readiness to return during rehabilitation was the most significant predictor of a subsequent return to comparable performance.
Reality, Delays, and Challenges within Pain Prevalence and Treatment in Palliative Care Patients: A Survey of First-Time Patients at the National Cancer Institute in Mexico
Authors: Silvia Allende-Perez , Adriana Peña-Nieves , Laura Garcia-Gonzalez , Edith Monreal-Carrillo , Emma Verastegui-Aviles 
Published: August 2019

Background: Cancer is a major burden of disease and a public health problem, as it is one of the main causes of morbidity and mortality worldwide. It is estimated that 25% of cancer patients die without receiving proper pain management. Objective: To acknowledge the epidemiological profile of first-time patients at the palliative care service of a referral center, along with the pharmaceutical treatment and social and familiar implications of the treatment costs in first-time patients. Methods: A survey including 28 questions was conducted including 490 first-time patients at the National Cancer Institute in Mexico City. Results: Median age was 53 years; 63.3% (n = 310) were females; 72% were married or single (50.5% and 21.2%, respectively). The most frequent diagnoses were gastrointestinal tumors, followed by urological, and skin/soft tissue carcinomas (19.8%, 12.5%, and 12%, respectively). Pain prevalence was 50.4% among the cohort. From the subgroup of participants with pain, 26.7% presented an intensity ≥7. Conclusions: As most patients in our study presented pain, there is a need of strengthening public policy about opioid treatments.
Trade, Industrial Dissimilarity, FDI and Business Cycle Co-movements: EC3SLS Evidence from Eurozone Economies
Authors: Kunroo Mohd Hussain 
Published: August 2019

This article uses simultaneous equations error component three-stage least squares (EC3SLS) panel data technique to find the direct and indirect impacts of trade, industrial dissimilarity and FDI on the business cycle synchronisation of Eurozone economies. The period of analysis is 1990–2009. These are the major findings: (a) trade, industrial dissimilarity and FDI have both direct and indirect effects on the business cycle synchronisation of sample economies; (b) EC3SLS estimates show that closer trade ties among these Eurozone countries have led to more synchronised business cycle co-movements, because common disturbances are more prevalent and intra-industry trade dominates; (c) the bilateral FDI flows have served as a source of destabilisation rather than a source of synchronisation; (d) industry-specific shocks have almost lost their importance both in terms of generating more trade and in terms of raising the output correlation of sample countries; (e) trade intensity and FDI flows are positively and significantly correlated, thereby suggesting that more FDI encourages more trade and vice-versa; (f) trade shows a negative relationship with industrial dissimilarity, which implies that bilateral trade in these countries promotes similar industrial structures; and finally, (g) these economies characterise intra-industry trade patterns, as expected in the case of these highly integrated Eurozone economies. Although the results show the presence of intra-industry trade types, these economies have diversified their production processes at the higher income levels. JEL: E32, F02, F10, F11, F15, C33
Mindfulness Training Supports Quality of Life and Advance Care Planning in Adults With Metastatic Cancer and Their Caregivers: Results of a Pilot Study
Authors: Johns Shelley A. , Beck-Coon Kathleen , Stutz Patrick V. , Talib Tasneem L. , Chinh Kelly , Cottingham Ann H. , Schmidt Karen , Shields Cleveland , Stout Madison E. , Stump Timothy E. , Monahan Patrick O. , Torke Alexia M. , Helft Paul R. 
Published: August 2019

Background: Emotional distress often causes patients with cancer and their family caregivers (FCGs) to avoid end-of-life discussions and advance care planning (ACP), which may undermine quality of life (QoL). Most ACP interventions fail to address emotional barriers that impede timely ACP. Aim: We assessed feasibility, acceptability, and preliminary effects of a mindfulness-based intervention to facilitate ACP for adults with advanced-stage cancer and their FCGs. Design: A single-arm pilot was conducted to assess the impact of a 6-week group mindfulness intervention on ACP behaviors (patients only), QoL, family communication, avoidant coping, distress, and other outcomes from baseline (T1) to post-intervention (T2) and 1 month later (T3). Participants: Eligible patients had advanced-stage solid malignancies, limited ACP engagement, and an FCG willing to participate. Thirteen dyads (N = 26 participants) enrolled at an academic cancer center in the United States. Results: Of eligible patients, 59.1% enrolled. Attendance (70.8% across 6 sessions) and retention (84.6% for patients; 92.3% for FCGs) through T3 were acceptable. Over 90% of completers reported high intervention satisfaction. From T1 to T3, patient engagement more than doubled in each of 3 ACP behaviors assessed. Patients reported large significant decreases in distress at T2 and T3. Family caregivers reported large significant improvements in QoL and family communication at T2 and T3. Both patients and FCGs reported notable reductions in sleep disturbance and avoidant coping at T3. Conclusions: The mindfulness intervention was feasible and acceptable and supported improvements in ACP and associated outcomes for patients and FCGs. A randomized trial of mindfulness training for ACP is warranted. The study is registered at ClinicalTrials.gov with identifier NCT02367508 ( https://clinicaltrials.gov/ct2/show/NCT02367508 ).
Referral Characteristics of Palliative Care Service in Patients With Advanced Non-Small Cell Lung Cancer in a Tertiary Cancer Center
Authors: Gu Xiaoli , Chen Menglei , Liu Minghui , Zhang Zhe , Zhao Weiwei , Cheng Wenwu 
Published: August 2019

Background: The American Society of Clinical Oncology recently recommends patients with metastatic non-small cell lung cancer (NSCLC) should be offered palliative care services earlier. We sought to investigate the timing of palliative care referral of Chinese patients with NSCLC in our center. Method: Retrospective medical data including demographic characteristics and referral information were collected for analysis. Overall survival (OS) was calculated as the time since cancer diagnosis till patient’s death. The time interval from palliative care (PC) referral to a patient’s death (PC-D) was calculated. The PC-D/OS ratio was calculated to illustrate the comparison of the duration of PC in the overall length of disease. Results: The mean age of 155 patients with advanced NSCLC was 62.83 years. Before referral to PC, 128 patients received anticancer treatment including surgeon (46.5%). Sixty-three (40.6%) patients died in palliative care unit. The median OS of 144 patients with end cutoff was 19 months (mean = 31.49, 95% confidence interval [CI] = 25.86-37.12). The median PC-D was 41 days (mean = 73.84, 95% CI = 60.37-87.40). The mean interval of PC-D/OS of 144 patients with definitely death time was 0.22 (SD: 0.27, 95% CI: 0.17-0.26). The median interval was 0.089. More than half of patients (n = 75, 51.8%) underwent PC less than 1% time (PC-D/OS < 0.1) of their whole disease course. Patients who were indigenous to Shanghai ( P = .013) and who had brain metastasis ( P = .072) had the potential longer PC-D/OS ratio. A high proportion of patients reported loss of appetite (92.8%) and fatigue (91.4%) at the initial of referral to PC. Conclusion: This retrospective study, in a population of patients with advanced NSCLC, gave detailed information about PC services in a tertiary cancer center.
Risk and Protective Factors for Psychological Distress in Families Following a Diagnosis of Cleft Lip and/or Palate
Authors: Stock Nicola Marie , Costa Bruna , White Paul , Rumsey Nichola 
Published: August 2019

Objectives: Despite the potential psychological impact of a diagnosis of cleft lip and/or palate (CL/P) on parents, few large-scale studies currently exist. Utilizing data extracted from The Cleft Collective Birth Cohort Study, the current study aimed to examine the psychological impact of the diagnosis on parent and family functioning and to identify risk and/or protective factors contributing to parental adjustment in order to inform future psychological intervention. Methods: Parent-reported questionnaire data were extracted for 1163 parents (644 mothers and 519 fathers). Outcome measures included the PedsQL-Family Impact Module, the Perceived Stress Scale, the Hospital Anxiety and Depression Scale, and a condition-specific tool designed by the Psychology Clinical Excellence Network. Results: Overall, findings suggest that parents adjust well to the diagnosis. Factors found to be protective against psychological distress for both mothers and fathers included a positive life orientation, satisfaction with health care, and relationship satisfaction. Close friendships were also protective against depression in mothers. Risk factors for mothers included the presence of a prior mental health condition, and stressful life events during pregnancy. Risk factors for fathers included being older at the time of conception, and recently being absent from work. Conclusions: Findings suggest a need for appropriate psychological screening of both parents following a diagnosis of CL/P and emphasize the importance of coordinated multidisciplinary care for psychological health. Preventative models of intervention to strengthen familial relationships and build resilience require further investigation.
Degenerative changes of the hip following in situ fixation for slipped capital femoral epiphysis: a minimum 18-year follow-up study
Authors: Ghijselings Stijn , Touquet Jeroen , Himpe Nicolas , Simon Jean-Pierre , Corten Kristoff , Moens Pierre 
Published: August 2019

Introduction: In situ fixation (ISF) is currently still the ‘gold standard’ treatment for slipped capital femoral epiphysis (SCFE) and has shown acceptable results at mid-term follow-up. This study aims to evaluate functional, clinical and radiographic long-term outcomes after this procedure. Methods: We reviewed 64 SCFE patients (76 SCFE hips) treated with ISF between 1983 and 1998. 82.9% were stable hips and 17.1% unstable according to Loder’s definition. Initial radiographs demonstrated a mild slip in 50%, moderate in 41.3% and severe in 8.7% based on the Southwick angle. Long-term outcomes were assessed using the modified Harris Hip Score (mHHS), University of California at Los Angeles (UCLA) and Tegner activity scores, visual analogue scale (VAS) pain, VAS function, flexion-adduction-internal rotation (FADIR) test, extent of internal-rotation at 90° of hip flexion and Tönnis classification for hip osteoarthritis (OA). Results: 10 (15.6%) SCFE hips were converted to a total hip replacement (THR) after a mean of 16 years. 38 (59.4%) patients underwent a clinical and radiographic examination after a mean follow-up of 23 (range 18–33) years. 12 (18.8%) patients were lost to follow-up. 74% of SCFE hips demonstrated degenerative change on radiography or were converted to THR (Tönnis 1: 33.3%, 2: 18.5%, 3 or THR: 22.2%). There were 3 cases of avascular necrosis (AVN) all in unstable hips. Mean mHHS was 86.8/100, UCLA activity score 7.5/10, Tegner activity score 3.8/10, VAS pain 1.7/10 and VAS function 1.5/10. 20% of SCFE hips were found to have a positive FADIR-test and a limited internal-rotation of 19.7° versus 36.1° ( p < 0.001) in contralateral normal hips. Discussion: This long-term follow-up study of ISF for SCFE shows that although complication rates in terms of AVN are low, a high number of patients become symptomatic and have a limited function. Degenerative changes are common with 22.2% of hips developing end-stage hip OA (Tönnis 3 or THR). It is important that patients and parents are informed about these risks.
An Innovative Three-Step Method for Identifying Exemplars
Authors: Etz Rebecca S. , Gonzalez Martha M. , Crabtree Benjamin F. , Reves Sarah R. , Stange Kurt C. 
Published: August 2019

Purpose: To improve practices in rapidly changing environments, it is helpful to learn from relevant innovators. This article describes a well-defined and adaptable method for discovering innovative cases that inform best practices or positive/negative deviant research. Methods: As part of a national study of innovation in primary care settings, we developed a three-step method for identifying exemplar practices and applied that method to finding a sample of relevant innovators for in-depth case studies from which to draw transportable lessons about improving primary care practice. Results: Relevant, information-rich cases are uncovered using cycles of identification, sampling, and assessment. This cycle is repeated at each step of the defined three-step method. Step 1, a scan of the published literature, assesses both the state-of-the-art and the baseline characteristics of relevant cases; Step 2, a scan of practice settings, draws upon the expert knowledge of key informants to identify additional potentially relevant cases; and Step 3, sample refinement, evaluates potential cases for eligibility, purposeful diversity, and information-rich expressions of defined key domains. Using this three-step method, we identified a national cohort of primary care practice innovators. We found the method to be feasible, practical, and highly successful at identifying information-rich practices from which to draw transportable lessons about practice innovation. Conclusions: The three-step method outlines an effective sampling strategy for identifying innovation exemplars and information-rich cases that exceed measures of central tendency. By leveraging the collective knowledge of innovators, this method can support dynamic research and foster rapid cycle learning.
miR-142-3p as a novel biomarker for predicting poor prognosis in renal cell carcinoma patients after surgery
Authors: Peng Xiqi , Pan Xiang , Liu Kaihao , Zhang Chunduo , Zhao Liwen , Li Hang , Guan Xin , Xu Weijie , Xu Jinling , Zhang Fangting , Lai Yongqing 
Published: August 2019

Background: miR-142-3p has proved to be involved in tumorigenesis and the development of renal cell carcinoma. The present study aimed to explore the prognostic value of miR-142-3p. Methods: Total RNA was extracted from renal cell carcinoma specimens and the expression level of miR-142-3p was measured. Pearson Chi-square test, Kaplan–Meier analysis, as well as univariate and multivariate regression analysis were performed to determine the correlation between miR-142-3p and the prognosis of renal cell carcinoma patients. Receiver operating characteristic curves were constructed to evaluate the predictive efficiency of miR-142-3p for the prognosis of renal cell carcinoma patients. Data from The Cancer Genome Atlas (TCGA) were utilized to validate our findings. Results: Our results demonstrated that upregulation of miR-142-3p was correlated with shorter overall survival (P=0.002) and was, in the meantime, an independent prognostic factor for renal cell carcinoma patients (P=0.002). The receiver operating characteristic curve combining miR-142-3p expression with tumor stage showed an area under the curve of 0.633 (95% confidence interval 0.563, 0.702). The result of TCGA data was consistent with our findings. Conclusions: Our results suggest miR-142-3p expression is correlated with poor prognosis of renal cell carcinoma patients and may serve as a prognostic biomarker in the future.
Benefit of Digital Tools Used for Integrated Personalized Diabetes Management: Results From the PDM-ProValue Study Program
Authors: Heinemann Lutz , Schramm Wendelin , Koenig Helena , Moritz Annette , Vesper Iris , Weissmann Joerg , Kulzer Bernhard 
Published: August 2019

Background: Integrated personalized diabetes management (iPDM) is a digitally supported therapeutic concept to improve patient-physician interaction to overcome the aspects of clinical inertia. Integrated personalized diabetes management can support decision making and improve therapeutic outcomes of suboptimally controlled persons with insulin-treated type 2 diabetes (T2D). In this paper, we report the results of an analysis of the PDM-ProValue study program on the effectiveness and perceived benefit of this approach, with a focus on how physicians used and assessed the digital tools provided for the iPDM process. Materials and Methods: The study program included two 12-month, prospective, controlled, cluster-randomized multicenter trials. A total of 101 practices participated with 907 patients. Practices were cluster-randomized to an intervention group and a control group. Digital tools for data visualization and analysis applied were used. HCP were asked to assess the use, relevance, and usefulness of the tools. Results: A clear preference was stated for the visual overview over more statistically complex analyses. A total of 83% of the participants rated a high relevance of the “daily profile,” 81% of the “total profile,” and 68% the “risk illustrated by traffic light symbols” for the therapy decision. The overall iPDM process was very favorably rated with respect to structuredness and potential for personalized treatment and well accepted among health care professionals (HCP). Conclusions: Embedding digital tools in a structured process (iPDM) were proved to provide a benefit for insulin-treated T2D patients and their physicians. These results offer insight for further development and improvement of the tools and add information on how to overcome clinical inertia.