bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimal early active mobilisation protocol after extensor tendon repairs in zones V and VI: A systematic review of literature
Authors: Collocott Shirley JF , Kelly Edel , Ellis Richard F 
Published: September 2017

Introduction Early mobilisation protocols after repair of extensor tendons in zone V and VI provide better outcomes than immobilisation protocols. This systematic review investigated different early active mobilisation protocols used after extensor tendon repair in zone V and VI. The purpose was to determine whether any one early active mobilisation protocol provides superior results. Methods An extensive literature search was conducted to identify articles investigating the outcomes of early active mobilisation protocols after extensor tendon repair in zone V and VI. Databases searched were AMED, Embase, Medline, Cochrane and CINAHL. Studies were included if they involved participants with extensor tendon repairs in zone V and VI in digits 2–5 and described a post-operative rehabilitation protocol which allowed early active metacarpophalangeal joint extension. Study designs included were randomised controlled trials, observational studies, cohort studies and case series. The Structured Effectiveness Quality Evaluation Scale was used to evaluate the methodological quality of the included studies. Results Twelve articles met the inclusion criteria. Two types of early active mobilisation protocols were identified: controlled active motion protocols and relative motion extension splinting protocols. Articles describing relative motion extension splinting protocols were more recent but of lower methodological quality than those describing controlled active motion protocols. Participants treated with controlled active motion and relative motion extension splinting protocols had similar range of motion outcomes, but those in relative motion extension splinting groups returned to work earlier. Discussion The evidence reviewed suggested that relative motion extension splinting protocols may allow an earlier return to function than controlled active motion protocols without a greater risk of complication.
A threshold trajectory was revealed by isolating the effects of hemoglobin rate of rise in anemia of chronic kidney disease
Authors: Fusco Gregory , Hariri Ali , Vallarino Carlos , Singh Ajay , Yu Peter , Wise Lesley 
Published: September 2017

Background: To assess cardiovascular risk among various hemoglobin (Hb) rates of rise (RoR) in chronic kidney disease (CKD) patients with anemia who have initiated therapy with erythropoiesis stimulating agents (ESAs). Methods: Observational cohort of CKD patients initiating ESA therapy from the Centricity® database, 1990–2011. Proportional hazards models tested the hypothesis that a slower Hb RoR (0 < g/dl/month ⩽ 0.125) is associated with a lower cardiovascular (CV) incidence [composite of fatal/nonfatal myocardial infarction (MI) and stroke] compared with faster RoR (0.125 < g/dl/month ⩽ 2.0, and >2.0 g/dl/month). Results: A total of 9220 patients receiving ESAs were followed for an average of 3.1 years. Slow (group B) RoR versus medium (group C′) and fast (group D′) RoR in Hb, throughout all Hb milestones, was associated with lower risk of the composite endpoint [B (slow) versus D′ (fast) [hazard ratio (HR) = 0.20 (0.11, 0.39), p < 0.0001]; B versus C′ (medium) [HR = 0.34 (0.19, 0.62), p = 0.0004], and C′ versus D′ [HR = 0.60 (0.42, 0.85), p = 0.005]]. Within achieved Hb milestones, HRs were: B versus D′ at milestone ⩾ 14.1 g/dl [HR = 0.17 (0.05, 0.56); p = 0.004] and at milestone 12.6−14.0 [HR = 0.18 (0.07, 0.46), p = 0.0004]. Conclusion: Rapid Hb rise is associated with adverse CV outcomes, with markedly lower risk for rates below a threshold trajectory of 0.125 g/dl/month, even with complete correction.
Healthcare expenditure of multiple sclerosis patients in 2013: A nationwide study based on French health administrative databases
Authors: Lefeuvre Delphine , Rudant Jérémie , Foulon Stéphanie , Alla François , Weill Alain 
Published: September 2017

Background Little is known about expenditure items of multiple sclerosis (MS) patients over recent years in France. Objective To describe healthcare expenditure among MS patients and identify the main expenditure drivers. Methods All healthcare expenditure reimbursed by French National Health Insurance to MS patients in 2013 was described on the basis of nationwide health administrative databases (SNIIRAM/PMSI). Expenditure was described globally and according to age and sex. Results The average expenditure among the 90,288 MS patients included was €11,900 per patient. Pharmacy and hospitalisation accounted for 47% and 23% of healthcare expenditure, respectively (38% and 22% of MS patients were treated with disease-modifying therapies and hospitalised overnight or longer, respectively). Average expenditure did not differ according to age. However, pharmacy expenditure decreased with age (from 71% between the ages of 20 and 29 years to 18% between the ages of 70 and 79 years), whereas hospitalisation expenditure increased with age (from 15% to 35%). Paramedical fees accounted for 2% of expenditure between the ages of 20 and 29 years and 24% between the ages of 70 and 79 years. Conclusion Overall, pharmacy expenditure was the main expenditure item, which decreased with increasing age, while hospitalisation and paramedical expenditure increased with increasing age.
Clinical Progress in the Management of Tetralogy of Fallot in the Dominican Republic: A Case Series
Authors: Perez María T. , Vázquez Marietta , Canarie Michael F. , Toribio Janet , León-Wyss Juan 
Published: September 2017

Background: Definitive surgical interventions for Dominican children with congenital heart disease, like those of other low- and middle-income countries, have been historically limited. Methods: We undertook review of a case series focusing on the surgical correction of complex forms of tetralogy of Fallot at a single center, CEDIMAT Centro Cardiovascular, in the Dominican Republic, over a 30-month period. Results: According to our criteria, 43 cases were determined to be complex tetralogy of Fallot repairs from the two-year period. Besides tetralogy of Fallot, the cohort had an additional 55 anatomic anomalies that had to be addressed at the time of surgery. Median age at the time of surgery was notably 30 months, and an average of 42 months elapsed from the time of diagnosis to the time of surgery for this group. Only 33% of the cases reviewed had no hypercyanotic crises before repair. Median time to extubation for this group of patients was one day, with a three-day median length of stay in the intensive care setting. Conclusions: Our study importantly captures the present experience of a surgical congenital heart program that has recently transitioned from a traditional “mission model” to a now self-sustaining local practice. Both the number and the complexity of the lesions corrected in this caseload represent an advance from the level of care previously provided to children in the Dominican Republic.
Risk Factors For Unfavorable Outcomes After Bidirectional Cavopulmonary Anastomosis
Authors: Nichay Nataliya R. , Gorbatykh Yuriy N. , Kornilov Igor A. , Soynov Ilya A. , Kulyabin Yuriy Y. , Gorbatykh Artem V. , Ivantsov Sergey M. , Bogachev-Prokophiev Alexander V. , Karaskov Alexander M. 
Published: September 2017

Background: Bidirectional cavopulmonary anastomosis (BCPA) is an important preliminary step toward the Fontan procedure; thus, understanding of risk factors for morbidity and mortality after BCPA may ultimately promote improved rates of success with Fontan completion and general survival. This study evaluated survival and predictors of unfavorable outcomes in patients after BCPA. Methods: Clinical data of 157 patients who underwent BCPA from 2003 to 2015 at a single center were retrospectively analyzed. Results: Three-year and nine-year survival after BCPA were 87.1% ± 2.8% and 85.8% ± 2.9%, respectively. Freedom from unfavorable outcomes (mortality, BCPA takedown, nonsuitability for Fontan procedure) was 83.8% ± 3.1% at three years and 73.5% ± 4.8% at nine years. Multivariate proportional hazards regression analysis revealed that total anomalous pulmonary venous connection (TAPVC; hazard ratio [HR]: 3.74, 95% confidence interval [CI]: 1.35-10.36; P = .01) and increased mean pressure in BCPA circuit (HR: 1.17, 95% CI: 1.02-1.34; P = .03) were independent risk factors for unfavorable outcomes. Postoperative mean pressure in BCPA circuit in patients with poor outcomes was median 16 mm Hg (interquartile range [IQR]: 14-18 mm Hg) versus median 14 mm Hg (IQR: 12-15.5 mm Hg) in patients with favorable outcomes ( P < .01). Preoperative (HR: 1.87, 95% CI: 1.20-2.91; P < .01) and postoperative atrioventricular valve regurgitation (AVVR; HR: 2.22, 95% CI: 1.24-3.94; P < .01) were also associated with unfavorable outcome in univariate Cox regression. Conclusions: Elevated mean pressure in the BCPA circuit is the main predictor of unfavorable outcome; therefore, thorough preoperative examination and careful patient selection are critical points for successful intermediate-stage and later Fontan completion. Total anomalous pulmonary venous connection and insufficient correction of AVVR worsen the prognosis in this patient group.
Correlation Between Changes in Visual Analog Scale and Patient-Reported Outcome Scores and Patient Satisfaction After Hip Arthroscopic Surgery
Authors: Chandrasekaran Sivashankar , Gui Chengcheng , Walsh John P. , Lodhia Parth , Suarez-Ahedo Carlos , Domb Benjamin G. 
Published: September 2017

Background: Improvements in pain, function, and patient satisfaction are used to evaluate the outcomes of hip arthroscopic surgery. Purpose: To identify correlations between the visual analog scale (VAS) score for pain and patient satisfaction with 4 commonly used patient-reported outcome (PRO) scores to determine to what extent changes in these 2 parameters are reflected in each of the PRO scores. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Patients undergoing hip arthroscopic surgery between February 2008 and February 2013 were assessed prospectively before surgery, at 3 months, and annually thereafter with the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–sports-specific subscale (HOS-SSS), and Hip Outcome Score–activities of daily living (HOS-ADL). Patients were also assessed using a 10-point VAS for pain and queried for satisfaction at the same time points (“0” indicated no pain, and “10” indicated complete satisfaction with surgery). The VAS score and patient satisfaction were correlated with changes in the 4 PRO scores. Results: During the study period, 1417 patients underwent hip arthroscopic surgery, of whom 1137 patients had 2-year postoperative PRO scores after primary surgery. There was a significant improvement in all PRO scores at 2-year follow-up. The mean improvements in mHHS, NAHS, HOS-ADL, and HOS-SSS scores were 16.7, 21.6, 19.7, and 22.7 points, respectively. The mean improvement in the VAS score was 2.9 points. Mean patient satisfaction at 2-year follow-up was 7.74 (of 10). There was a statistically significant correlation between the VAS and patient satisfaction scores and changes in each of the 4 PRO scores. The strength of the correlation was moderate. Conclusion: This study demonstrated a moderate correlation between the VAS and patient satisfaction outcomes and changes in 4 commonly used PRO scores in hip arthroscopic surgery (mHHS, HOS-ADL, HOS-SSS, and NAHS). In addition to several PRO instruments, a VAS for pain and patient satisfaction may add to the overall assessment of the efficacy of hip arthroscopic surgery.
Clinical Use of Precision Oncology Decision Support
Authors: Johnson Amber , Khotskaya Yekaterina B. , Brusco Lauren , Zeng Jia , Holla Vijaykumar , Bailey Ann M. , Litzenburger Beate C. , Sánchez Nora S. , Abu Shufean Md , Piha-Paul Sarina , Subbiah Vivek , Hong David , Routbort Mark , Broaddus Russell , Shaw Kenna R. Mills , Mills Gordon B. , Mendelsohn John , Meric-Bernstam Funda 
Published: September 2017

Purpose Precision oncology is hindered by the lack of decision support for determining the functional and therapeutic significance of genomic alterations in tumors and relevant clinically available options. To bridge this knowledge gap, we established a Precision Oncology Decision Support team that provides annotations at the alteration level and subsequently determined whether clinical decision making was influenced. Methods Genomic alterations were annotated to determine actionability on the basis of a variant’s known or potential functional and/or therapeutic significance. The medical records of a subset of patients annotated in 2015 were manually reviewed to assess trial enrollment. A Web-based survey was implemented to capture the reasons genotype-matched therapies were not pursued. Results The Precision Oncology Decision Support team processed 1,669 requests for annotation of 4,084 alterations (2,254 unique) across 49 tumor types for 1,197 patients. A total of 2,444 annotations for 669 patients included an actionable variant call: 32.5% actionable, 9.4% potentially actionable, 29.7% unknown, and 28.4% nonactionable. Sixty-six percent of patients had at least one actionable/potentially actionable alteration, and 20.6% of patients (110 of 535) annotated enrolled in a genotype-matched trial. Trial enrollment was significantly higher for patients with actionable/potentially actionable alterations (92 of 333; 27.6%) than for those with unknown (16 of 136; 11.8%) and nonactionable (2 of 66; 3%) alterations ( P < .001). Actionable alterations in PTEN, PIK3CA, and ERBB2 most frequently led to enrollment in genotype-matched trials. Clinicians cited a variety of reasons that patients with actionable alterations did not enroll in trials. Conclusion Over half of alterations annotated were of unknown significance or nonactionable. Physicians were more likely to enroll a patient in a genotype-matched trial when an annotation supported actionability. Future studies are needed to demonstrate the impact of decision support on trial enrollment and oncologic outcomes.
Reduced Frequency of Biological and Increased Frequency of Adopted Children in Males With 21-Hydroxylase Deficiency: A Swedish Population-Based National Cohort Study
Authors: Falhammar Henrik , Frisén Louise , Norrby Christina , Almqvist Catarina , Hirschberg Angelica Linden , Nordenskjöld Agneta , Nordenström Anna 
Published: September 2017

Abstract

Context
Fertility in males with 21-hydroxylase deficiency (21OHD) is unclear.

Objective
Study fertility outcome in males with congenital adrenal hyperplasia.

Design, Setting, and Participants
Males ≥15 years old with 21OHD (n = 221) were compared with controls matched for sex and year and place of birth (n = 22,024). Data were derived by linking national population-based registers. Subgroup analyses were performed regarding phenotype [salt-wasting (SW), simple virilizing (SV), and nonclassic (NC)] and CYP21A2 genotype (null, I2 splice, I172N, and P30L) and stratified by the introduction of neonatal screening.

Main Outcome Measures
Number of biological and adopted children.

Results
Males with 21OHD were less likely to be fathers of biological children [odds ratio (OR), 0.5; 95% confidence interval (CI), 0.4 to 0.7; after adjusting for socioeconomic characteristics: OR, 0.4; 95% CI, 0.2 to 0.5]. This was true for SW, SV, I2 splice, and I172N, but not for NC, null, and P30L groups (all adjusted). Among patients born before the neonatal screening introduction, fewer were fathers (adjusted OR, 0.3; 95% CI, 0.2 to 0.5), but this normalized in those born afterward. Adoption was more common in the 21OHD males (OR, 2.9; 95% CI, 1.0 to 7.9) and the SV and I172N subgroups. Age at becoming a father, marriage, region of residence, and education were similar, but fewer patients had high incomes. NC and I172N groups had, however, higher academic degrees and NC patients were more often married, whereas SW and I2 splice patients were more often divorced.

Conclusions
21OHD was associated with a reduced frequency of biological children and an increased frequency of adopted children, suggesting impaired fertility, although some subgroups had normal fertility.
Wrist Pain in Gymnasts: A Review of Common Overuse Wrist Pathology in the Gymnastics Athlete
Authors: Benjamin Holly J. , Engel Sean C. , Chudzik Debra 
Published: September 2017

Abstract
Injury rates among gymnasts are among the highest of any sport at the high school and collegiate level per athletic exposure. The wrist has increased injury risk due to repetitive physical stresses predisposing it to acute injury, overuse, and degenerative damage. This article will review the most common overuse wrist injuries seen in gymnasts. Prompt evaluation and management is necessary to avoid the negative sequelae that can often accompany these injuries. Little is known about effective sport-specific injury prevention strategies, but general guidelines for overuse injury prevention including limiting excessive loading of the wrist, maintaining wrist joint flexibility, an emphasis on proper technique, and incorporating wrist and general core strengthening seem beneficial. General return to play principles are similar for all gymnast-related wrist injuries, including resolution of pain, restoration of normal wrist joint function, completion of a progressive rehabilitation program, and use of proper technique.
Competitive Diving Principles and Injuries
Authors: Jones Nathaniel S. 
Published: September 2017

Abstract
Competitive diving is a sport that has evolved over time to become an admired present-day aquatic sport, especially in the Olympic setting. Despite its popularity, sparse research has been written as it applies to our understanding of competitive diving injuries. This article attempts to discuss common principles of competitive diving as they relate to the sport, especially as it relates to the extreme physical forces encountered by the diver and also the repetitive nature of diving. Next, these principles will be applied in the context of musculoskeletal and medical diving specific injuries.
Care of Water Polo Players
Authors: Stromberg Jennifer D. 
Published: September 2017

Abstract
Water polo is a team sport that combines swimming with overhead throwing and wrestling. This places water polo players at risk for a unique group of illnesses and injuries. In addition to the medical problems and injuries seen in competitive swimmers, water polo players are at risk for a variety of traumatic injuries, including concussions, eye injuries, tympanic membrane perforation, fractures, dislocations, and lacerations. Repetitive overhead throwing also places these athletes at risk for related injuries, such as shoulder problems, including rotator cuff strain and impingement, and elbow problems, such as ulnar collateral ligament injuries, posteromedial impingement, and osteochondritis dissecans of the radial capitellum. This article serves as an overview of these illnesses and injuries, as well as how the aquatic environment affects pathogenesis, treatment, and return to play.
Patterns and Appropriateness of Thrombophilia Testing in an Academic Medical Center
Authors: Cox Nicholas , Johnson Stacy A. , Vazquez Sara , Fleming Ryan P. , Rondina Matthew T. , Kaplan David , Chauv Stephanie , Fontaine Gabriel V. , Stevens Scott M. , Woller Scott , Witt Daniel M. 
Published: September 2017

BACKGROUNDClinical guidelines recommend against routine use of thrombophilia testing in patients with acute thromboembolism. Thrombophilia testing rarely changes acute management of a thrombotic event.OBJECTIVETo determine appropriateness of thrombophilia testing in a teaching hospital.DESIGNRetrospective cohort study.SETTINGOne academic medical center in Utah.PARTICIPANTSAll patients who received thrombophilia testing between July 1, 2014, and December 31, 2014.MAIN MEASUREMENTSProportion of thrombophilia tests occurring in situations associated with minimal clinical utility, defined as tests meeting at least 1 of the following criteria: discharged before results available; test type not recommended; testing in situations associated with decreased accuracy; duplicate testing; and testing following a provoked thrombotic event.RESULTSOverall, 163 patients received a total of 1451 thrombophilia tests for stroke (50% of tests; 35% of patients), venous thromboembolism (21% of tests; 21% of patients), and pregnancy‐related conditions (15% of tests; 25% of patients). Of the 39 different test types performed, the most common were cardiolipin IgG and IgM antibodies (9% each), lupus anticoagulant (9%), and β2‐glycoprotein 1 IgG and IgM antibodies (8% each). In total, 911 tests (63%) were performed in situations associated with minimal clinical utility, with 126 patients (77%) receiving at least one such test. Only 2 patients (1%) had clear documentation of being offered genetic consultation.CONCLUSIONSThrombophilia testing in this single‐center study was often associated with minimal clinical utility. Strategies to improve testing practices (eg, hematology specialty consult prior to inpatient testing, improved order panels) might help minimize inappropriate testing and promote value‐driven care.
The Weekend Effect in Hospitalized Patients: A Meta‐Analysis
Authors: Pauls Lynn A. , Johnson‐Paben Rebecca , McGready John , Murphy Jamie D. , Pronovost Peter J. , Wu Christopher L. 
Published: September 2017

BACKGROUNDThe presence of a “weekend effect” (increased mortality rate during Saturday and/or Sunday admissions) for hospitalized inpatients is uncertain.PURPOSEWe performed a systematic review to examine the presence of a weekend effect on hospital inpatient mortality.DATA SOURCESPubMed, EMBASE, SCOPUS, and Cochrane databases (January 1966–April 2013) were utilized for our search.STUDY SELECTIONWe examined the mortality rate for hospital inpatients admitted during the weekend compared with those admitted during the workweek. To be included, the study had to provide discrete mortality data around the weekends (including holidays) versus weekdays, include patients who were admitted as inpatients over the weekend, and be published in English.DATA EXTRACTIONThe primary outcome was all‐cause weekend versus weekday mortality with subgroup analysis by personnel staffing levels, rates and times to procedures rates and delays, or illness severity.DATA SYNTHESISA total of 97 studies (N = 51,114,109 patients) were examined. Patients admitted on the weekends had a significantly higher overall mortality (relative risk, 1.19; 95% confidence interval, 1.14‐1.23). With regard to the subgroup analyses, patients admitted on the weekends consistently had higher mortality than those admitted during the week, regardless of the levels of weekend/weekday differences in staffing, procedure rates and delays, and illness severity.CONCLUSIONSHospital inpatients admitted during weekends may have a higher mortality rate compared with inpatients admitted during the weekdays.