bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cervical Hip Fracture in Afinnish Population: Incidence and Mortality
Authors: Panula J. , Pihlajamäki H. , Sävelä M. , Jaatinen P. T. , Vahlberg T. , Aarnio P. , Kivelä S.-L. 
Published: January 2017

Background and Aims: Our aim was to describe the incidence of cervical hip fractures and to describe the relationships between selected background variables and mortality at 30 days, 6 months, and 3 years postoperatively. Material and Methods: The basic material consisted of population-based data set of patients aged 65 years or older who had sustained a hip fracture and were treated operatively between 1999 and 2000. Out of these, we identified 266 consecutive patients with cervical hip fracture. Results: The age-adjusted incidence of cervical hip fractures in women was 1.3-fold compared to men. In age-adjusted analysis, occurrence of chronic lung disease, cardiovascular disease or 2–5 comorbidities, male gender, the need for 2-person mobility assistance, and poor ambulation postoperatively were associated with excess mortality at least at one evaluation point. Conclusions: Only chronic lung disease and male gender were independent predictors of increased mortality at each follow-up assessment in multivariate analysis.
Comparison of Standard Anteroposterior Knee and Hip-to-Ankle Radiographs in Determining the Lower Limb and Implant Alignment after Total Knee Arthroplasty
Authors: Skyttä E. T. , Lohman M. , Tallroth K. , Remes V. 
Published: January 2017

Background and Aims: The coronal alignment of the lower limb is important for planning and assessing outcome after total knee arthroplasty. This study compared postoperative estimation of alignment and measurement of angles using both hip-to-ankle radiographs and anteroposterior (AP) knee radiographs in standing position. Patients and Methods: Consecutive standard AP knee and hip-to-ankle radiographs in 83 patients (103 knees) after total knee arthroplasty were analyzed. Results: The tibiofemoral angle measured from both hip-to-ankle and knee radiographs correlated moderately with the mechanical axis (r = 0.646 and r = 0.540, respectively). The correlation between tibiofemoral angles in the two radiographs was excellent (r = 0.860). Furthermore, measurements of tibial and femoral component alignment between the two radiographs correlated highly (r = 0.718 and r = 0.773, respectively). Intra- and interobserver correlations were high in all analyses. Conclusions: The standard AP knee radiograph appears to be a valid alternative to the hip-to-ankle radiograph for determining knee coronal plane alignment in routine follow-up after total knee arthroplasty. However, the hip-to-ankle radiograph alone provides accurate information on weight-bearing mechanical axis in patients with suspected lower limb malalignment.
Neurogenic Bladder in Children: Basic Principles, New Therapeutic Trends
Authors: Guys J. M. , Hery G. , Haddad M. , Borrionne C. 
Published: January 2017

Diagnosis of neurogenic bladder is straightforward in children with myelomeningocele. However, recognition is more difficult in patients with occult dysraphism or central nervous system disorders since clinico-anatomical correlations are poor. Careful clinical examination and urodynamic exploration are mandatory for diagnosis and follow-up. Even if urinary leak is the first symptom, the main goal of the pediatric surgeon must be to preserve the upper urinary tract. The ideal protection strategy consists of ensuring that micturition is voluntary and complete and that the bladder capacity is sufficient with adequate compliance and sphincter outlet resistances. Balancing these functions requires a combination of medical and surgical treatment. A variety of techniques can be used depending on gender and age of the patient and social environment. In most cases, intermittent bladder catheterization is necessary to obtain complete evacuation of the bladder. Bladder capacity can be increased by anticholinergic drugs, injection of botulinum toxin into the bladder, and augmentation cystoplasty. Augmentation of bladder outlet resistances requires endoscopic injection of bulking agents, surgical bladder neck reconstruction and urethral lengthening, bladder neck suspension, and artificial urinary sphincter. In difficult cases, continent cystostomy with closure of the bladder neck can achieve definitive continence. At the beginning endoscopic treatment combining anti reflux procedure, injection of the bladder neck and botulinum toxin can be considered as a “total endoscopic management” and should be our first line. Other techniques are under evaluation. Sacral neuromodulation has given promising results. Artificial tissue engineering will probably be used in the next future. Management of neurogenic bladder is not limited to urological considerations. Orthopedic, digestive, and sexual problems must also be taken into account in order to obtain an “acceptable quality of life”.
Current Controversies in the Surgical Treatment of Esophageal Atresia
Authors: Tovar J. A. , Fragoso A. C. 
Published: January 2017

Background and Aims: Esophageal atresia (EA) with or without tracheo-esophageal fistula (TEF) is a rare condition that can be nowadays succesfully treated. The current interest therefore is focused on the management of the difficult cases, on thoracoscopic approach, and on some aspects of the long-term results. Methods: The current strategies for the difficult or impossible anastomoses in pure and long-gap EA, the introduction of thoracoscopic repair and the causes, mechanisms and management of post-operative gastro-esophageal reflux (GER) are reviewed. Results: Methods of esophageal elongation and multi-staged repair of pure and long-gap EA allow anastomosis but with functional results that are often poor. Esophageal replacement with colon or stomach achieves at least similar results and often requires less procedures. Thoracoscopic repair is a promising adjunct, but the difficulties for setting it as a gold-standard are pointed out. GER is a part of the disease and its surgical treatment, that is often required, is burdened by high failure rates. Conclusions: EA with or without TEF can be successfully treated in most cases, but a number of unsolved issues remain and the current approach to difficult cases will certainly evolve in the future.
Research to Practice: A National Consensus Conference
Authors: Metzger Robert A. , Taylor Gloria J. , McGaw Lin J. , Delmonico Francis L. , Prottas Jeffrey M. ,   for the UNOS Research to Practice Steering Committee
Published: January 2017

Purpose To gain consensus on aspects of the process of gaining consent for organ donation that should be mainstream daily practice. Methods A 3-day consensus conference of transplant professionals that provided a forum for research and innovative ideas about gaining consent for organ donation. Four work groups were assembled to address issues of gaining consent from organ and tissue donors: (1) demystifying first-person consent (donor authorization): is it a matter of law?, (2) recovery coordinators: getting from green to great, (3) maximizing the process: old views and new, and (4) donor family support: mother or smother? Results Participants reached a consensus about major consent-related practices, identified areas of practice variance, and defined topics in need of further research. Conclusions The conference participants agreed that (1) the primary role of the organ procurement organization is to recover organs for transplantation from deceased donors and to facilitate distribution of those organs to the appropriate recipients; (2) early referral of potential donors from the hospital to the organ procurement organization is desirable; (3) a score less than 5 on the Glasgow Coma Scale should initiate end-of-life discussions with family members; a procurement coordinator from the organ procurement organization who is physically housed within the hospital is the most successful model for accommodating early referral of potential donors and optimizing family support practices; and (3) a decedent's right to donate should take precedence in the donation process and such designation by the donor before death is irrevocable and does not require the consent or concurrence of any person after the donor's death.
Evaluation of the Electronic Version of the Questionnaire for Lung Transplant Patients
Authors: Dabbs Annette De Vito , Johnson Bruce A. , Wardzinski W. Todd , Iacono Aldo T. , Studer Sean M. 
Published: January 2017

Context Recent modifications to the QLTP (Questionnaire for Lung Transplant Patients), including changing items from dichotomous to multiple dimension scaling, adding psychological symptoms, and converting to an electronic format (e-QLTP), made it necessary to reevaluate its reliability, validity, recipient satisfaction, and feasibility of administering the e-QLTP in the clinical setting. Purpose To report the final modifications, psychometric properties, recipient satisfaction, and feasibility of administering the e-QLTP, a patient report outcome measure of symptoms and activity tolerance. Methods Sixty lung recipients completed the original QLTP and the e-QLTP and rated their satisfaction with the e-version during a routine posttransplant evaluation; 65% (38 of 60) also completed a retest version. Correlations were computed for retest stability, concurrent validity between versions of the QLTP, and construct validity among the subscales of the e-QLTP and forced expiratory volumes in 1 second. Using the After Scenario Questionnaire, participants rated their satisfaction with the ease, amount of time, and support information when completing the e-QLTP. Results The e-QLTP and subscales were internally consistent (α=.73-.90) and stable (intraclass correlations = .47-.93). Significant correlations ( P = .001) were found between the e-QLTP and the original QLTP ( r=0.53–0.56) and between the e-QLTP subscales and forced expiratory volumes in 1 second ( r = 0.51–0.53). The overall mean satisfaction score was 1.27 (± 0.47). Conclusions The e-QLTP is a reliable and valid measure of physical and psychological symptoms after lung transplantation. It is feasible to complete in the clinical setting and recipients are highly satisfied with its use. Its computerized functionality enhances assessment and management of symptoms over time.
Further Exploration: Maturity and Adherence in Adolescent and Young Adult Heart Transplant Recipients
Authors: Lawrence Kathy , Stilley Carol S. , Olshansky Ellen , Bender Ann , Webber Steven A. 
Published: January 2017

Context Pediatric transplant clinicians note high rates of nonadherence with medications, appointment keeping, and laboratory tests and high rates of engagement in high-risk behaviors among older adolescents and young adult recipients. The caregivers also report symptoms of identity confusion, social immaturity, and failure to appreciate consequences of risky behavior among recipients. Objective To build on an earlier study that identified developmental characteristics that distinguish poor from good adherers. Design Qualitative methods were used to explore key themes identified in the first study with heart transplant recipients and their significant others. Results This research confirmed the themes of developmental maturity suggested by the first study: good adherers were able to integrate the transplant into sense of self, become independent adults, and achieve normalcy; poor adherers continued to “push away” the transplant experience and worried that they would never be normal. The good adherers, their parents, and friends had views of relationships that were congruent, acknowledging difficulties, discussing them, and moving toward mutual satisfaction. The poor adherers, their parents, and friends expressed incongruent views of the relationships, avoiding discussion of problems and idealizing relationships. Discussion Strategies for clinicians, family, and friends to increase maturity and independence among older adolescent and young adult heart transplant recipients are described.
Designing an Educational Strategy for Increasing Organ Donor Registration among Older Adults
Authors: Downing Kimberly , Jones Linda L. 
Published: January 2017

Context Older adults (50–70 years of age) have lower organ donor registration rates than younger adults. Despite recent increases in organ donation registration of adults 18 to 49 years of age, the increase in older adult registrations is less. Objective To use research results from surveys and focus groups to inform an educational strategy and design for the older adult population. Design Pooled survey data from 3 statewide random-digit dial telephone interview surveys of 6230 adults, including 2631 respondents age 50 or older, were used to identify barriers to organ donor registration and information needs of older adults compared with younger adults. Two focus groups with older adults were used to further identify barriers and to pilot test messages for an educational strategy for older adults. Setting and Participants Surveys were conducted with adults in Ohio. Focus groups were conducted in 2 major cities in Ohio with older adults, 50 to 70 years of age. Results Survey results indicate that older adults and younger adults differ on several factors regarding their beliefs, attitudes, and behavior concerning organ donation. Although older adults express positive attitudes toward donation, they often “opt out” from registering to be organ donors for age and health reasons. Focus groups show similar barriers to organ donor registration and indicate that brochures are a preferred way to educate older adults about organ donation. Conclusion Using research results to identify barriers and information needs of specific demographic groups is very important in designing a targeted educational strategy. An educational campaign addressing the concerns and information needs of this age group could increase organ donor registration.
Constantly Responsible, Constantly Worried, Constantly Blessed: Parenting after Pediatric Heart Transplant
Authors: Green Angela , Meaux Julie , Huett Amy , Ainley Kathy 
Published: January 2017

Context Very little research has focused on the long-term caregiving demands associated with parenting a child after a transplant or on the parents' perceptions of those demands. Purpose To describe parents' experiences parenting a school-aged child after heart transplant. Design Focused ethnography. Participants and Setting Eleven parents of children who had undergone heart transplant 2 or more years before the study were recruited from a large children's hospital. Data Collection and Analysis Parents were interviewed in a private location of their choice. Verbatim interview transcripts were analyzed by using content analysis and constant comparison. Results The parents described their experiences in positive terms, yet acknowledged hardships. Key themes included (1) constantly responsible, (2) constantly worried, (3) constantly blessed, and (4) coping with life. The identified themes provide direction for interventions to help parents cope with the experience of parenting a child after heart transplant.
Quality of Life in Caregivers Providing Care for Lung Transplant Candidates
Authors: Lefaiver Cheryl A. , Keough Vicki A. , Letizia Marijo , Lanuza Dorothy M. 
Published: January 2017

Context Caregivers are essential members of the health care team who provide care, valued at more than $250 billion each year, to millions of persons who require assistance with health and daily care. Patients with respiratory diseases who are waiting for a lung transplant are required to have an identified caregiver. The caregivers are rarely studied. Objective To explore the relationships among the health status of caregivers of lung transplant candidates, caregivers' reaction to caregiving, and caregivers' perceived quality of life. Design This descriptive study examined the quality of life of lung transplant caregivers from a multidimensional perspective. Setting and Participants Twenty-nine dyads of lung transplant candidates and their caregivers were recruited from a Midwestern medical center. Measures Data were collected by self-report: caregivers completed the Quality of Life Index, SF-12 health survey, Profile of Mood States-Short Form, and the Caregiver Reaction Assessment. Results Caregivers reported favorable levels of quality of life, physical health, and mood during the pretransplant waiting phase. However, problem areas for caregivers during this time included fatigue, depression, and the financial impact of the transplant. Data analyses indicated that depression, caregiver general health, impact on finances, and lack of family support had the greatest effect on caregivers' quality of life. Nurses are urged to recognize the role of caregivers in the transplant process, ask about and listen to caregivers' needs, and include caregivers in the plan of care.
Experience With a New Process—Condition T—for Uncontrolled Donation After Circulatory Determination of Death in a University Emergency Department
Authors: DeVita Michael A. , Callaway Clifton W. , Pacella Charissa , Brooks Maria Mori , Lutz John , Stuart Susan 
Published: January 2017

Background: In the United States, organ donation after circulatory death (DCD) determination is increasing among those who are removed from life-sustaining therapy but is rare when death is unexpected. We created a program for uncontrolled DCD (uDCD). Methods: A comprehensive program was created to train personnel to identify and respond quickly to potential donors after unexpected death. The process termed Condition T was implemented in the emergency department (ED) of 2 academic medical centers. All ED deaths were screened for uDCD potential. Eligible donors included patients with preexisting donor designation who received cardiopulmonary resuscitation, failed to respond, and were pronounced dead. Results: Over 350 nurses, physicians, perfusionists, organ procurement personnel, and administrators were trained. From February 2009 to June 2010, a total of 18 patients were potential Condition T candidates. Six Condition T responses were triggered. Three donors underwent cannulation, and 4 organs were recovered (3 kidney and 1 liver) from 2 donors. Time from Condition T trigger to perfusion with organ preservation solution ranged from 14 to 22.3 minutes. Perfusion duration was 197 and 221 minutes. No recovered organs were transplanted because biopsies showed prolonged warm ischemia. Conclusions: It is feasible to create a process to rapidly intervene in the ED for uDCD. However, no organ transplants resulted. The utility and sustainability of an uDCD program in this particular setting are questionable.
A Prospective Study of Depression and Weight Change After Kidney Transplant
Authors: Stanfill Ansley , Hathaway Donna , Bloodworth Robin , Cashion Ann 
Published: January 2017

Context: Kidney transplant recipients have great risk for gaining significant weight (upward of 10 kg) in the first year posttransplant. Clinical depression can occur in response to life situations and is associated with weight gain. Objective: To explore the association between demographic characteristics, weight change, and depression posttransplantation. Design: Secondary data analysis on longitudinal data collected for a larger observational study. Demographic characteristics, weight, and Center for Epidemiologic Studies Depression Scale (CES-D) data were obtained at baseline (BL) (time of transplantation), 6, and 12 months posttransplant. The CES-D scores were compared among time points using means, standard deviations, correlations, t tests, and chi-square as well as by multiple regression modeling. Setting: Regional transplant center in the mid-south United States. Participants: Forty-seven kidney transplant recipients (55% female, 57% African American, mean age 52.5 years). Weight change ranged from −18.1 to +24.8 kg. Results: In all, 62% reported baseline CES-D scores indicative of depression, with lower scores indicating less psychological distress at 6 and 12 months (47% and 49%, respectively). We found no significant differences among CES-D scores at any time point. Regression models found age, race, gender, and weight change to be predictive of CES-D scores at 6 months ( P = .04, R2 = .137). Age was the most influential ( P = .008), with older individuals more likely to obtain higher CES-D scores. Since the experience of depression is common at transplant and during the first year, it is important that transplant recipients be evaluated for depression early in the recovery period.
Integration of Clinical Examination, Self-Report, and Hair Ethyl Glucuronide Analysis for Evaluation of Patients With Alcoholic Liver Disease Prior to Liver Transplantation
Authors: Beckmann Mingo , Paslakis Georgios , Böttcher Michael , Helander Anders , Erim Yesim 
Published: January 2017

Context: A large proportion of liver transplants (LTXs) are performed due to alcoholic liver disease (ALD) in the final stage of organ insufficiency. In order to list patients for LTX, transplant centers commonly require 6 months abstinence from alcohol. However, significant differences have been reported between alcohol intake as indicated by self-report and biochemical markers of alcohol. Objective: In the present study, the usefulness of ethyl glucuronide analysis in hair (hETG) was examined during the evaluation procedure before listing patients with ALD for an LTX. Design: Cross-sectional survey. Setting: Psychosomatic evaluation. Patients: Seventy patients with ALD prior to listing for an LTX. Interventions: According to clinical assessment before listing patients with ALD (n = 233) for an LTX, hETG analysis was only performed in the patients who were assumed to deny or underreport their alcohol consumption (n = 70). Main Outcome Measures: The analysis of hETG by liquid chromatography–mass spectrometry, clinical interview. Results: By hETG analyses, 27 (38.6%) of the 70 patients tested positive for ongoing alcohol consumption. Conclusions: Selective use of hETG based on the clinical interview rather than widespread screening is a possible way to detect excessive alcohol consumption in patients with ALD in the transplant setting. The primary evaluation of a patient’s situation in its entirety should remain the superordinate standard procedure. An interdisciplinary approach to transplant candidates with an ALD is asked for.