bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Clubfoot Relapses With the Ponseti Method: Results of a Survey of the POSNA Members
Authors: Hosseinzadeh Pooya , Kiebzak Gary M. , Dolan Lori , Zionts Lewis E. , Morcuende Jose 
Published: February 2017

Background:
Despite the high rate of initial success using the Ponseti method to manage idiopathic clubfoot deformity, relapse continues to be a problem. We surveyed the Pediatric Orthopedic Society of North America (POSNA) members about their experience with relapsed deformity following the initial correction of clubfeet.

Methods:
We created a survey to focus on the management of clubfeet after initial correction of deformity. The survey included questions on postcorrective bracing, clinical findings used to identify relapse, the observed frequency of relapsed deformity, and how relapses are managed. The questionnaire was approved by the POSNA Evidence Based Committee and was sent electronically to all POSNA members.

Results:
We received responses from 321 members (26%). Of those, 94% were fellowship trained in pediatric orthopaedics. The Ponseti method was used by 98% of respondents. The Mitchell-Ponseti orthosis was most commonly used (51%), followed by the Denis-Browne brace (25%). The duration of bracing used varied among members with 23% recommending only 2 years, 33% recommending 3 years, and 34% recommending 4 years. A tight heel cord was felt to be the first sign of relapse by 59% of respondents, and dynamic supination by 30%. The rate of relapse was observed to be <10% by 22% of the respondents, 10% to 20% by 52%, and 20% to 40% by 25%. Manipulation and cast treatment alone (55%) and cast treatment with tenotomy (23%) were reported as the 2 most common initial treatment approaches for a relapsed deformity. Cast treatment to correct relapsed deformity before tibialis anterior tendon transfer was reported by 62% of respondents. Heel cord tenotomy (75%) and posterior capsular release (43%) were the 2 most common procedures used in addition to tibialis anterior tendon transfer for the treatment of clubfoot relapse.

Conclusion:
This study highlights the wide variation with which clubfoot relapses are evaluated and treated among the POSNA membership with differences in the recommended duration of bracing, identification of relapses, and their management. These wide differences highlight the need for future research and educational programs to inform and standardize the management of clubfoot using the Ponseti Method.

Level of Evidence:
Not applicable.
Description and Results of a Fully Arthroscopic Anatomic Broström Repair and Gould Modification
Authors: Perera Anthony M.N. , Molloy Andrew , Guillo Stephane 
Published: February 2017

Ankle instability is a common sequelae of a lateral ankle sprain. Surgery for this condition must address any intra-articular pathology as well as repairing the ligaments. The former is generally done arthroscopically and the advantages of this approach are well documented. However, once this is competed the second stage of ligament repair is traditionally done in an open manner. There is increasing interest in the role of arthroscopic ligament repair though to date most techniques have repaired only the anterior talofibular ligament and then performed a percutaneous retinacular advancement. The only technique that addresses the calcaneofibular ligament (CFL) does so from an accessory portal just anterior to the tip of the fibula though in practice it can be difficult to see the CFL from this portal. We have developed the technique of lateral ankle endoscopy, performed through the bed of the peroneus brevis tendon. This technique gives direct and clear visualization of the CFL, anterior talofibular ligament, and also the extensor retinaculum, which then allows direct, anatomic tightening. The stabilization is performed with bone anchors onto the fibula. We present the results in 15 consecutive cases performed with this entirely arthroscopic technique. We believe that this technique gives better visualization of the structures than an open technique and that as a result a more anatomic reconstruction can be performed.Level of Evidence:Diagnostic Level 5. See Instructions for Authors for a complete description of levels of evidence.
Two Models to Conduct Nonphysician-led Exercise Stress Testing in Low to Intermediate Risk Patients
Authors: Scott Adam , Whitman Mark , McDonald Alice , Webster Meghan , Jenkins Carly 
Published: February 2017

Background:
Exercise stress testing (EST) is a noninvasive procedure that aids the diagnosis and prognosis of a range of cardiac pathologies. Reduced access is recognized as a limiting factor in enabling early access to treatment or safe and appropriate discharge. Increased accessibility can be achieved by utilizing nonphysician health practitioners to supervise tests. To implement nonphysician-led EST in clinical environments, there is a need for the development and administration of feasible and effective models.

Objective:
Via inpatient and outpatient referral, this article aims to present 2 standardized models of care for patients requiring EST for diagnostic and prognostic evaluation of numerous pathologies.

Method:
An inpatient and outpatient model was implemented at the Royal Brisbane and Women’s Hospital and Logan Hospital in Queensland, Australia between July 2013 and December 2015. Tests were performed by 2 cardiac scientists employed by each hospital. All tests were immediately reported by a cardiology advanced trainee registrar or consultant cardiologist.

Results:
A total of 2095 tests were performed via the 2 models. Overall, 73 had a positive result (3.5%), 120 equivocal (5.7%), 129 inconclusive/submaximal (6.2%), and 1773 negative (85.2%). After further testing, 38 of the patients with positive and equivocal results were diagnosed with flow-limiting coronary artery disease. The remaining patients were resolved as negative through further diagnostic testing or lost to follow up.

Conclusions:
After implementation of the 2 models, patient flow was improved for earlier discharge, reduced waiting times, or timely identification of possible cardiac pathologies, thereby optimizing patient care.
Preoperative Hemoglobin A1c and the Occurrence of Atrial Fibrillation Following On-pump Coronary Artery Bypass Surgery in Type-2 Diabetic Patients
Authors: Abbaszadeh Shahin , Shafiee Akbar , Bina Payvand , Jalali Arash , Sadeghian Saeed , Karimi Abbasali 
Published: February 2017

Background:
We investigated the association of the preoperative hemoglobin A1c (HbA1c) with occurrence of postoperative atrial fibrillation (POAF) in type-2 diabetic patients who underwent isolated coronary artery bypass grafting.

Methods:
We prospectively studied 708 type-2 diabetes patients [433 men ([61.2%)], candidate for isolated coronary artery bypass grafting. Biochemistry profile was measured on the day of operation. All patients were telemonitored for 72 hours after operation for the occurrence of atrial fibrillation. The role of HbA1c as a predictor for the occurrence of atrial fibrillation was then evaluated.

Results:
A total of 109 (15.3%) patients developed POAF. Patients in the atrial fibrillation group tended to be older, with prolonged longer diabetes, and have renal failure, chronic obstructive pulmonary disease, and hypertension. In the univariable and multivariable regression model, HbA1c was not a predictor for POAF.

Conclusions:
Serum level of HbA1c could not be used as a predictor for the development of POAF.
Noninvasive Bioelectrical Impedance for Predicting Clinical Outcomes in Outpatients With Heart Failure
Authors: Lyons Kristin J. , Bischoff Michelle K. , Fonarow Gregg C. , Horwich Tamara B. 
Published: February 2017

Background:
Noninvasive bioelectrical impedance analysis (BIA) has shown promise in acute heart failure (HF) management. To our knowledge, its use in predicting outcomes in outpatients with chronic HF patients has not been well described.

Methods and Results:
BIA assessment of edema index was performed in 359 outpatients with HF using the InBody 520 scale. Edema index was calculated by dividing extracellular by total body water. Patients were stratified into those with low (≤0.39) and high (>0.39) edema indices. The outcome of interest was death, urgent transplant, or ventricular assist device over 2-year follow up. Patients with a high edema index were older, had higher B-type natriuretic peptide values and New York Heart Association Class. Patients with a high edema index had poorer outcomes (unadjusted hazard ratio 1.90, 95% confidence intervals 1.05–3.56). However, in multivariate analyses, a high edema index was not an independent predictor of outcomes (adjusted hazard ratio 1.21, 95% confidence interval 0.51–2.90).

Conclusions:
A high edema index using a bioimpedance scale in a HF clinic correlated with patient outcomes in unadjusted analyses, but was not a predictor of outcomes once other measures of HF severity are accounted for. As a noninvasive measure of volume status, use of BIA in a HF clinic may be beneficial in determining patient prognosis and treatment when other outcome predictors are not immediately available.
A Prospective Analysis of Olfactory Impairment Recovery After Severe Traumatic Brain Injury
Authors: Drummond Melanie , Douglas Jacinta , Olver John 
Published: February 2017

Objective:
To investigate the natural progression of olfactory impairment (OI) in individuals with traumatic brain injury (TBI) at 6 months postinjury.

Participants:
Forty-seven adults (mean age = 43.1 years, SD = 18.2), with predominantly severe TBI (mean posttraumatic amnesia [PTA] duration = 25.5 days, SD = 22.8).

Design:
Consecutive admission longitudinal study.

Main Measures:
Participants were evaluated using the University of Pennsylvania Smell Identification Test (UPSIT) at resolution of PTA and at 6 months post–initial injury. Each participant was also interviewed to explore his or her experience of having an OI. Standard multiple regression was used to assess the ability of age, PTA duration, presence of facial fractures, and initial UPSIT score to predict olfactory performance at 6 months.

Results:
Thirty-five participants (74%) continued to demonstrate OI at 6 months. Thirty-two participants (68%) showed some improvement, but only 12 of these individuals achieved scores within the normal range. The remaining 15 participants either produced a poorer performance (23%) or demonstrated no change (9%). Initial UPSIT score uniquely accounted for 73.5% of the variance in UPSIT performance at 6 months.

Conclusions:
Olfactory impairment persists in a substantial proportion of adults who experience it post-TBI and has the potential to impact a broad spectrum of everyday activities.
The Relations of Cognitive, Behavioral, and Physical Activity Variables to Depression Severity in Traumatic Brain Injury: Reanalysis of Data From a Randomized Controlled Trial
Authors: Bombardier Charles H. , Fann Jesse R. , Ludman Evette J. , Vannoy Steven D. , Dyer Joshua R. , Barber Jason K. , Temkin Nancy R. 
Published: February 2017

Objective:To explore the relations of cognitive, behavioral, and physical activity variables to depression severity among people with traumatic brain injury (TBI) undergoing a depression treatment trial.Setting:Community.Participants:Adults (N= 88) who sustained complicated mild to severe TBI within the past 10 years, met criteria for major depressive disorder, and completed study measures.Design:Randomized controlled trial.Methods:Participants were randomized to cognitive-behavioral therapy (n= 58) or usual care (n= 42). Outcomes were measured at baseline and 16 weeks. We combined the groups and used regressions to explore the relations among theoretical variables and depression outcomes.Main Measures:Depression severity was measured with the Hamilton Depression Rating Scale and Symptom Checklist-20. Theory-based measures were the Dysfunctional Attitudes Scale (DAS), Automatic Thoughts Questionnaire (ATQ), Environmental Rewards Observation Scale (EROS), and the International Physical Activity Questionnaire (IPAQ).Results:Compared with non-TBI norms, baseline DAS and ATQ scores were high and EROS and IPAQ scores were low. All outcomes improved from baseline to 16 weeks except the DAS. The ATQ was an independent predictor of baseline depression. An increase in EROS scores was correlated with decreased depression.Conclusions:Increasing participation in meaningful roles and pleasant activities may be a promising approach to treating depression after TBI.
Cross-Validation of a Classification System for Persons With Traumatic Brain Injury in the Posthospital Period
Authors: Sherer Mark , Ponsford Jennie , Hicks Amelia , Leon-Novelo Luis , Ngan Esther , Sander Angelle M. 
Published: February 2017

Objective:
To (1) identify groupings of persons with traumatic brain injury (TBI) in the posthospital period in a cohort recruited in Australia; (2) compare groupings from the Australian cohort to groupings previously developed for a US cohort.

Setting:
Rehabilitation centers in the US and Australia.

Participants:
A total of 170 persons with TBI from Australia and 504 persons with TBI from the United States. Participants were aged 18 to 64 years, greater than 6 months postinjury, had capacity to give consent, and had definitive contemporaneous medical evidence of TBI.

Design:
Observational study.

Main Measures:
Cognitive tests—Wechsler Letter-Number Sequencing and Coding, Rey Auditory Verbal Learning Test, Trail Making Test, Verbal Fluency. Questionnaires—9 scales from the Traumatic Brain Injury Quality-of-Life system; Neurobehavioral Symptom Inventory; Economic Quality of Life, Family Assessment Device—General Functioning. Performance validity—Word Memory Test.

Results:
Agreement in classification for the 2 samples was only moderate with 63.5% correctly classified and Cohen's κ = 0.53. A post hoc analysis placing all persons showing poor performance validity in the same group improved classification to 73% and Cohen's κ = 0.65 indicating substantial agreement.

Conclusion:
Results provided support for the patient groups developed for the US sample and indicate that these groupings largely replicated in a new cohort.
Bedside Ultrasound to Facilitate Early Diagnosis and Ease of Follow-Up in Neurogenic Heterotopic Ossification: A Pilot Study From the Intensive Care Unit
Authors: Stefanidis Konstantinos , Brindley Peter , Ramnarine Raymond , Blaivas Michael , Daneshi Mohammad , Sidhu Paul S. , Alharthy Abdoulrahman , Karakitsos Dimitrios 
Published: February 2017

Objective:
To explore the potential role of ultrasound (US) as a bedside tool in intensive care unit patients with presumed neurogenic heterotopic ossification (NHO).

Setting:
Tertiary university teaching hospitals.

Participants:
Critical care patients with acquired brain injury.

Design:
A multicenter prospective study of critical care patients with possible NHO.

Main Measures:
Following a screening clinical examination, the major joints were evaluated with US, serum laboratory work, and x-ray.

Results:
A total of 310 patients had decreased range of motion by clinical screen and all received US interrogation. Sonographic signs of NHO were identified in 21 of the 310 patients (6.8%), of which 17/21 (81.0%) showed hyperemia; 9/21 (42.8%) showed the reverse zone phenomenon, and 4/21 patients (19.0%) showed the prezone phenomenon. All 21 patients progressed to the zone phenomenon within 15 weeks. Laboratory parameters were not significantly correlated with US (r = 0.11, r = 0.13; P > .05, respectively), whereas x-rays were associated with a mean diagnostic delay of 2 ± 0.5 weeks (P < .05) compared with US. All 21 sonographic NHO patients survived to intensive care unit discharge. Twelve months after admission, 3/21 had died; 6/21 still had abnormalities by x-ray, US, and clinical examination; and 12/21 had resolution by x-ray, US, and clinical examination.

Conclusion:
Our pilot study suggests potential benefits for bedside US in NHO, especially when compared with x-ray or laboratory investigations. These include the possibility of earlier diagnosis, consideration of therapy before ossification, and ease of follow-up. Our study also provides insights into the morphologic, sonographic, radiologic, and clinical course of NHO.
Ecological Assessment of Everyday Executive Functioning at Home and at School Following Childhood Traumatic Brain Injury Using the BRIEF Questionnaire
Authors: Chevignard Mathilde , Kerrouche Bernadette , Krasny-Pacini Agata , Mariller Aude , Pineau-Chardon Emmanuelle , Notteghem Pauline , Prodhomme Julie , Le Gall Didier , Roulin Jean-Luc , Fournet Nathalie , Roy Arnaud 
Published: February 2017

Objectives:
To describe dysexecutive symptoms in children with traumatic brain injury (TBI) using the Behavior Rating Inventory of Executive Function (BRIEF); to compare parent- and teacher-ratings, to analyze the differential impairment in the BRIEF subscales, and factors influencing outcome.

Participants:
Children aged 5 to 18 years 11 months, referred to a rehabilitation department following TBI.

Outcome Measures:
Parent- and teacher reports of the BRIEF.

Results:
A total of 194 patients participated in the study: mild (n = 13), moderate (n = 12), severe (n = 169); mean 4.92 (standard deviation = 3.94) years post-injury. According to parent ratings (n = 193), all BRIEF subscales and indices were significantly elevated (23.8%–48% in the clinical range). The Working Memory subscale score was significantly higher than all other subscales. Results of teacher ratings (n = 28) indicated similar significantly elevated scores in all subscales (39.3%–57.2% in the clinical range). No significant difference was found between parent and teacher ratings, which were significantly correlated. Regression analyses indicated that, in children with severe TBI, parental BRIEF overall and metacognition indices were significantly predicted by younger age at injury and older age at assessment, whereas no significant predictor of behavioral regulation index was identified.

Discussion and Conclusion:
This study highlights significant executive dysfunction in everyday life several years after childhood TBI, evident in home and school environments.
Rehospitalization in the First Year Following Veteran and Service Member TBI: A VA TBI Model Systems Study
Authors: Tran Johanna , Hammond Flora , Dams-O'Connor Kristen , Tang Xinyu , Eapen Blessen , McCarthy Marissa , Nakase-Richardson Risa 
Published: February 2017

Objective:
To determine the incidence and causes of rehospitalization following military or Veteran traumatic brain injury (TBI).

Setting:
Department of Veterans Affairs (VA) Veterans Health Administration Polytrauma Rehabilitation Centers (VHA PRCs).

Participants:
Consecutive sample of VHA TBI Model System participants (N = 401).

Design:
Prospective observational cohort study.

Main Measures:
Number and type of rehospitalizations in first year post-TBI.

Results:
Forty-one percent of 401 participants were rehospitalized. Rehospitalization status was associated with greater injury severity and receipt of TBI while active duty. Of those rehospitalized, 30% had 2 or more readmissions. Participants experiencing multiple rehospitalizations (2+) were more likely to have sustained their TBI during deployment than those with none or single rehospitalization. This group also sustained more severe injuries and spent more time in VA PRC inpatient rehabilitation. Common reasons for rehospitalization included inpatient rehabilitation (33%), unspecified (26%), orthopedic (10%), seizures (8%), infection (8%), and psychiatric (7%).

Conclusion:
This is the first study examining military and Veteran rehospitalization following TBI requiring inpatient rehabilitation at a VA PRC. Findings indicate frequent rehospitalizations in the first year postinjury, suggesting the need for preventive models of health maintenance following inpatient rehabilitation discharge. Greater surveillance of those with deployment-related TBI or active duty at the time of injury and greater TBI severity may be warranted.
ASSOCIATION OF DRUSEN VOLUME WITH CHOROIDAL PARAMETERS IN NONNEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Balasubramanian Siva , Lei Jianqin , Nittala Muneeswar G. , Velaga Swetha B. , Haines Jonathan , Pericak-Vance Margaret A. , Stambolian Dwight , Sadda SriniVas R. 
Published: February 2017

Purpose:
The choroid is thought to be relevant to the pathogenesis of nonneovascular age-related macular degeneration, but its role has not yet been fully defined. In this study, we evaluate the relationship between the extent of macular drusen and specific choroidal parameters, including thickness and intensity.

Methods:
Spectral domain optical coherence tomography images were collected from two distinct, independent cohorts with nonneovascular age-related macular degeneration: Amish (53 eyes of 34 subjects) and non-Amish (40 eyes from 26 subjects). All spectral domain optical coherence tomography scans were obtained using the Cirrus HD-OCT with a 512 × 128 macular cube (6 × 6 mm) protocol. The Cirrus advanced retinal pigment epithelium analysis tool was used to automatically compute drusen volume within 3 mm (DV3) and 5 mm (DV5) circles centered on the fovea. The inner and outer borders of the choroid were manually segmented, and the mean choroidal thickness and choroidal intensity (i.e., brightness) were calculated. The choroidal intensity was normalized against the vitreous and nerve fiber layer reflectivity. The correlation between DV and these choroidal parameters was assessed using Pearson and linear regression analysis.

Results:
A significant positive correlation was observed between normalized choroidal intensity and DV5 in the Amish (r = 0.42, P = 0.002) and non-Amish (r = 0.33, P = 0.03) cohorts. Also, DV3 showed a significant positive correlation with normalized choroidal intensity in both the groups (Amish: r = 0.30, P = 0.02; non-Amish: r = 0.32, P = 0.04). Choroidal thickness was negatively correlated with normalized choroidal intensity in both Amish (r = −0.71, P = 0.001) and non-Amish (r = −0.43, P = 0.01) groups. Normalized choroidal intensity was the most significant constant predictor of DV in both the Amish and non-Amish groups.

Conclusion:
Choroidal intensity, but not choroidal thickness, seems to be associated with drusen volume in Amish and non-Amish populations. These observations suggest that choroidal parameters beyond thickness warrant further study in the setting of age-related macular degeneration.
RISK FOR LOW VISUAL ACUITY AFTER 1 AND 2 YEARS OF TREATMENT WITH RANIBIZUMAB OR BEVACIZUMAB FOR PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Westborg Inger , Albrecht Susanne , Rosso Aldana 
Published: February 2017

Purpose:
To investigate how patients with neovascular age-related macular degeneration treated with ranibizumab or bevacizumab respond to treatment in daily clinical practice.

Methods:
Data from the Swedish Macula Register on the treatment received by 3,912 patients during 2011 to 2014 is reported. Patients' characteristics at the first visit, visual acuity, number of injections, and reason for terminating the treatment if applicable are discussed. Furthermore, the risk of having poor vision (visual acuity under 60 Early Treatment Diabetes Retinopathy Study letters or approximately 20/60 Snellen) is calculated for the treated eye after 1 year and 2 years.

Results:
The treatment outcome depends on the visual acuity at the first visit. For patients with visual acuity more than 60 letters, the risk of having a visual acuity lower than 60 letters after 1 year or 2 years of treatment is approximately 20%. However, for patients with low visual acuity at diagnosis (fewer than 60 letters), the risk is approximately 60%. The risk of having a visual acuity lower than 60 letters does not depend on the choice of treatment drug.

Conclusion:
Treatment with anti-vascular endothelial growth factor intravitreal injections mainly maintains the visual acuity level, and only approximately 20% and 40% of the patients required vision rehabilitation after 1 year and 2 years, respectively.