bluuebunny/crossref_metadata_2025_split huggingface dataset:
Family members’ or friends’ involvement in self-care for patients with depressive symptoms and co-morbid chronic conditions
Authors: Sussman Tamara , Mccusker Jane , Yaffe Mark , Belzile Eric , Sewitch Maida , Cole Martin , Strumpf Erin 
Published: March 2016

Objectives To describe the support that patients reported receiving from family or friends (F/F) while participating in a self-care intervention for depressive symptoms; examine associations between patient-reported F/F support and use of self-care materials; and describe F/F perceptions of involvement in a subsample of F/F. Methods One hundred eighty-nine of 223 (85%) patients aged 40+ with chronic physical conditions and co-morbid depressive symptoms participating in a randomized self-care intervention trial, completed structured telephone surveys at three months about the F/F support received. Ten F/F participated in post study qualitative interviews on the support provided. Results 30%, 44%, and 91% of patients reported overall F/F support with self-care, F/F involvement with the self-care intervention and emotional support, respectively. 61% felt positively and 10% felt negatively or conflicted with F/F support. F/F involvement in the self-care intervention was the only variable associated with patient use of self-care materials when examined alongside all F/F support variables (Proportional Odds Ratio = 1.21; 95% C.I. = 1.01, 1.45). F/F perceived less involvement in the self-care intervention than patients. Discussion Patients engaged in a self-care intervention for depressive symptoms use more self-care materials when they perceive F/F involvement in the intervention. Patients and F/F may perceive involvement differently and benefit from discussions about potential F/F roles.
Understanding factors that facilitate the inclusion of pain education in undergraduate curricula: Perspectives from a UK survey
Authors: Carr Eloise CJ , Briggs Emma V , Briggs Michelle , Allcock Nick , Black Pauline , Jones Derek 
Published: March 2016

Background: Studies in Europe, North America and Australasia suggest that one in five adults suffer from pain. There is increasing recognition that pain, particularly chronic pain, represents a global health burden. Many studies, including two national surveys exploring the content of undergraduate curricula for pain education, identify that documented pain education in curricula was limited and fragmentary. Methods: The study design used a questionnaire which included an open text comment box for respondents to add ‘further comments’ as part of larger study previously published. The sample consisted of 19 UK universities that offered 108 undergraduate programmes in the following: dentistry, medicine, midwifery, nursing (adult, child, learning disabilities and mental health branches), occupational therapy (OT), pharmacy, physiotherapy and veterinary science. An inductive content analysis was performed, and the data were managed using NVivo 10 software for data management. Results: A total of 57 participants across seven disciplines (dentistry, medicine, midwifery, nursing, pharmacy, physiotherapy and OT) completed the open text comment box (none were received from veterinary science). Analysis revealed two major themes of successes and challenges. Successes included expansion (extending coverage and/or increased student access), multidimensional curriculum content and diversity of teaching methods. Challenges included difficulties in identifying where pain is taught in the curriculum, biomedical versus biopsychosocial definitions of pain, perceived importance, time, resources and staff knowledge, and finally a diffusion of responsibility for pain education. Conclusion: This study identifies new insights of the factors attributed to successful implementation of pain education in undergraduate education. Many of the challenges previously reported were also identified. This is one of the first studies to identify a broad range of approaches, for pain education, that could be deemed as ‘successful’ across a range of health disciplines.
Medication regimen complexity and readmissions after hospitalization for heart failure, acute myocardial infarction, pneumonia, and chronic obstructive pulmonary disease
Authors: Abou-Karam Nada , Bradford Chad , Lor Kajua B , Barnett Mitchell , Ha Michelle , Rizos Albert 
Published: March 2016

Objectives: Readmission rate is increasingly being viewed as a key indicator of health system performance. Medication regimen complexity index scores may be predictive of readmissions; however, few studies have examined this potential association. The primary objective of this study was to determine whether medication regimen complexity index is associated with all-cause 30-day readmission after admission for heart failure, acute myocardial infarction, pneumonia, or chronic obstructive pulmonary disease. Methods: This study was an institutional review board–approved, multi-center, case–control study. Patients admitted with a primary diagnosis of heart failure, acute myocardial infarction, pneumonia, or chronic obstructive pulmonary disease were randomly selected for inclusion. Patients were excluded if they discharged against medical advice or expired during their index visit. Block randomization was utilized for equal representation of index diagnosis and site. Discharge medication regimen complexity index scores were compared between subjects with readmission versus those without. Medication regimen complexity index score was then used as a predictor in logistic regression modeling for readmission. Results: Seven hundred and fifty-six patients were randomly selected for inclusion, and 101 (13.4%) readmitted within 30 days. The readmission group had higher medication regimen complexity index scores than the no-readmission group ( p < 0.01). However, after controlling for demographics, disease state, length of stay, site, and medication count, medication regimen complexity index was no longer a significant predictor of readmission (odds ratio 0.99, 95% confidence interval 0.97–1.01) or revisit (odds ratio 0.99, 95% confidence interval 0.98–1.02). Conclusion: There is little evidence to support the use of medication regimen complexity index in readmission prediction when other measures are available. Medication regimen complexity index may lack sufficient sensitivity to capture an effect of medication regimen complexity on all-cause readmission.
Sphingosine kinase 1 inhibition improves lipopolysaccharide/D‐galactosamine‐induced acute liver failure by inhibiting mitogen‐activated protein kinases pathway
Authors: Tian Tao , Tian Weiliang , Yang Fan , Zhao Risheng , Huang Qian , Zhao Yunzhao 
Published: March 2016

BackgroundSphingosine kinase 1 (SphK1)/sphingosine‐1‐phosphate (S1P)/sphingosine‐1‐phosphate receptors (S1PRs) signaling plays a key role in inflammatory responses. Lei et al. showed that SphK1 inhibition presented a hepatoprotective effect on acute liver damage via decreasing hepatic high‐mobility group box 1 (HMGB1) cytoplasmic translocation.ObjectiveWe aim to determine whether SphK1 or S1PRs inhibition improves lipopolysaccharide (LPS)/D‐galactosamine (GalN)‐induced acute liver failure by inhibiting the mitogen‐activated protein kinases (MAPKs) pathway.MethodsA mouse model of acute liver failure was induced by LPS/GalN. Male C57BL/6J mice (6–8 weeks) were randomly distributed into five groups: control group, LPS/GalN group, SphK1 inhibition group (LPS/GalN+SKI‐5c), S1PR1 inhibition group (LPS/GalN+W146), and S1PR3 inhibition group (LPS/GalN+CAY10444).ResultsWe confirmed the findings of Lei et al. that hepatic SphK1 expression was upregulated; serum transaminase activity (AST, ALT), as well as serum TNF‐α and IL‐6, were decreased by SphK1 inhibition. We further showed that the expression of S1PR1 and S1PR3 was augmented in response to LPS/GalN. SphK1 inhibition improves hepatic hemorrhage, and the activities of hepatic caspase‐3 and myeloperoxidase (MPO). Furthermore, the activation of the MAPKs family (JNK, ERK and p38) was suppressed by SphK1 inhibition. However, S1PR1 or S1PR3 inhibition did not protect the mouse against liver damage, though S1PR1 or S1PR3 inhibition reduced serum TNF‐α and IL‐6, and partially attenuated the phosphorylation of the MAPKs signaling.ConclusionsSphK1 inhibition improves LPS/GalN‐induced liver injury by inhibiting activation of MAPKs signaling.
Radiographic Osteoarthritis, Clinical Outcomes and Re-Injury 20 Years after ACL Reconstruction
Authors: Pinczewski Leo , Salmon Lucy , Thompson Simon , Waller Alison , Linklater James , Roe Justin 
Published: March 2016

Objective: This prospective longitudinal study compares the outcome of isolated endoscopic ACL reconstruction utilizing 4-strand hamstring tendon (HT) and patellar tendon (PT) autograft over a 20-year period. Method: Observational Series. 90 consecutive patients with isolated ACL rupture were reconstructed with a PT autograft and 90 patients received HT autograft, with an identical surgical technique. Patients were assessed at 2, 5, 7, 10, 15 and 20 years. Assessment included the IKDC Knee Ligament Evaluation including radiographic evaluation, KT1000, Lysholm Knee Score, kneeling pain, and clinical outcomes. Results: Subjects who received the PT graft had significantly worse outcomes compared to those who received the HT graft at 20 years for the variables of radiologically detectable osteoarthritis (59% v 39%, p=0.01), kneeling pain (38% v 20%, p=0.02), and incidence of contralateral ACL injury (30% v 14%, p=0.04). There was no significant difference between the HT and PT groups in overall IKDC grade (p=0.23), or IKDC subjective score (p=0.18). Subgroup gender differences were identified. The female PT group had significantly lower mean IKDC subjective scores (p=0.05), and more difficulty with kneeling (p=0.04) compared to the other subgroups. ACL graft rupture occurred in 18% of HT and 10% of the PT (p=0.13), and was associated with males (Hazard Ratio(HR)=3.9, p=0.007), age <18 years (HR=4.6, p=0.003), and non ideal radiological tunnel placement (HR=3.6, p=0.02). Contralateral ACL injury was associated with age <18 years (HR=3.4, p=0.001), and the PT graft (HR=2.2, p=0.02). Conclusion: At 20 years both HT and PT autografts continue to provide good subjective outcomes and objective stability. However, ACL reconstruction using the PT graft is associated with persisting kneeling pain and radiological osteoarthritis, compared to the HT graft. Risk factors for ACL graft rupture include males, young age, and those with tunnel malposition. This information may help in the counseling of patients undergoing this procedure and stratifying their individual risk of re-injury.
Anterior Cruciate Ligament Reconstruction of the Knee Using Double Bundle Hamstring Autograft - Is the Remnant Preservation Technique Superior to the Standard Procedure in Terms of Long-Term Graft Failure Rate, the Need for Revision Operation, and Associated Clinical Dysfunction?
Authors: Annear Peter , Rohr E 
Published: March 2016

Background: Anterior cruciate remnant preservation may be beneficial in Anterior Cruciate Ligament Reconstruction (ACLR). Gohil, Annear & Breidahl (Sept, 2007) used a grade 1 randomised controlled trial to compare the two methods and at short term follow-up, the minimal debridement technique demonstrated earlier revascularisation within the ACL graft at 2 months, and suggested improved strength at 6 months based on radiological imaging. Unfortunately, this did not translate through to clinical benefits in the early 12 month post operative period. Zhang, L et al. (May, 2013) and Naylor, AJ et al. (2013) reiterated that remnant preservation may improve graft revascularization and knee proprioception. Takazawa Y et al. (Sept, 2013) demonstrated that minimal debridement may facilitate recovery of function and decreased graft rupture at two years post primary reconstruction. However, studies have yet to show consistent significant clinical advantages and follow-up has only been analysed over 1-2 years. Purpose: This current study reported results over a long-term follow-up of 10 years post operation for the same participants from the Gohil, Annear & Breidahl (2007) study. Study Design: The review was based on level 1 randomised controlled trial chart review. Methods: All 49 participants (25 standard – group 1, and 24 remnant preserving group – group 2) from the previous study have been included for investigation. The chart review recorded demographic data, graft rupture, re-operation rates, and associated clinical failures of the ACLR. The review presents comparative data between the two groups. Results: At 10 year follow-up, the remnant retention ACLR group only had better outcomes for ipsilateral graft rupture (2 patients versus 3 patients). Standard ACLR group had improved outcomes for contralateral graft rupture (2 versus 3), ipsilateral other knee post operative surgery (5 versus 10), ipsilateral knee post operative complaints (7 versus 12), and other non-knee post operative issues (3 versus 4). Non of the differences were statistically significant. Conclusion: Overall our results suggested no statistically significant difference between the remnant retaining and standard technique for ACLR in these 49 subjects using chart review endpoints of graft revision and knee reoperation rates. The review is limited by a small study group and a chart only review. A larger study group with long term clinical outcome measures may offer more definitive conclusions as to the advantages of remnant sparing ACLR. In this 10 year follow-up post ACL reconstruction there has been no distinct advantage identified for either procedure.
The Diameter of Single Bundle, Hamstring Autograft Does Not Significantly Influence Re-rupture or Clinical Outcomes After Anterior Cruciate Ligament Reconstruction at 7 Years
Authors: MacDessi Samuel , Wernecke Gregory , Seeto Bradley , Chen Darren 
Published: March 2016

Objectives: Increased graft diameters in ACL reconstruction have recently gained popularity as several studies have suggested that this may reduce graft failure rate in young patients, especially those with graft diameters less than 8mm. The purpose of this study was to review the revision rates and outcomes following ACL reconstruction in relation to graft diameter and determine whether increasing graft diameter reduces failure risk. Methods: A retrospective analysis of 786 consecutive ACL reconstructions from January 2007 to August 2015 was undertaken. Only cases where a single bundle hamstring autograft reconstruction were included. The surgical technique involved suspensory femoral fixation, tibial screw fixation or cortical button fixation, and a transportal femoral drilling technique. Patients were excluded if there were associated fractures, multiple ligament injuries and previous surgery to the knee. A research database with prospectively recorded data was used for the analysis. The primary outcome measure was graft revision with secondary endpoints being KOOS, IKDC and Tegner Activity Score. Results: 786 consecutive cases were identified with 76 lost to follow up for outcome scores at 2 years. The overall graft revision rate was 5.98% at 7 years. There was no significant difference between responders and non-responders with regards to age, gender and BMI. Mean graft diameter for the males was 7.99mm and 7.56mm for females (p<0.0001). Graft diameter did not correlate with revision when controlled for age, gender, concurrent meniscal pathology and Tegner activity score (N=348). Only grafts <7mm in diameter had a trend towards higher revision rate (5.6 versus 13.5%) but this did not reach significance (p= 0.063). No difference in functional outcomes between small and large grafts was noted. Age < 20 had a significant impact on revision risk (12.3% revision rate < 20, 4.2% > 20 years old). There was no significant difference in rupture rates at any dichotomous graft size for those under 20. Conclusion: In this series, graft diameter did not correlate with ACL graft revision for failure. The increasingly popular concept that large diameter grafts offer a protective benefit to revision risk was not found. This study once again highlights that age remains a major determinant of graft failure and factors that can reduce risk in this age group need to be addressed.
Total Knee Replacement with an Oxidised Zirconium Femoral Component
Authors: Roe Justin , Ahmed Isaac , Salmon Lucy , Watanabe Hiroki , Pinczewski Leo 
Published: March 2016

Objectives: Oxidized zirconium was introduced as a material for femoral components in total knee replacement (TKR) to reduce polyethylene wear. However the long term survival of this prosthesis is not known. Methods: A series of 303 consecutive oxidised zirconium TKR were performed over a 3 year period and prospectively included in a database. Subjects were assessed preoperatively and 10 years after TKR. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index, Knee Injury and Osteoarthritis Outcome Score (KOOS), radiographic evaluation and a patient satisfaction. Results: A total of 303 consecutive TKRs were performed in 278 patients with a mean age of 68 years (range 45 to 89 years). The ten year survival rate from the Kaplan–Meier predicted survivorship was 97% (95% CI 94 - 99) with revision for any reason as the endpoint. There were no revisions for loosening, osteolysis or implant failure. There was a significant improvement in all components of the WOMAC score at final follow up (p<0.001). The mean individual components of the KOOS score for symptoms (82.4 points), pain (87.5 points), activities of daily life (84.9 points) and quality of life (71.4 points) were all at higher end of the scale. Conclusion: The oxidized zirconium TKR is associated with favourable survival rates and excellent functional outcomes at ten years.
Objective Measure of Activity Level After Total Knee Arthoplasty with The Use of the ‘Fitbit’ Device
Authors: Roe Justin , Salmon Lucy , Twiggs Joshua 
Published: March 2016

Objectives: The commercial release of non invasive, light weight, low cost accelerometers has great potential to more accurately assess activity level before and after knee arthroplasty from a small light weight wrist strap. These devices have been shown to be valid and reliable assessment tools for activity levels in normal subjects. This study examines activity levels before and after knee arthroplasty using a modern commercially available accelerometer known as a “FitBit”. Methods: Observational Series. Subjects undergoing knee arthroplasty under the care of the senior surgeon were invited to participate and wear the accelerometer for 5-7 days at 4 times periods: before surgery, day 1-3, 6 weeks and 12 month after arthroplasty. Preoperatively and at 12 months after TKR subjects completed the Knee injury and Osteoarthritis Outcome Score (KOOS), WOMAC Assessment, and British Orthopaedic Association Patient Satisfaction Scale. Results: 54 subjects were recruited to the study over a 12 month period. Prior to total knee arthroplasty, the mean number of recorded steps per day was 6600. Post arthroplasty the mean number of steps per day was 1200 in the first 3 days, 5700 at 6 weeks and 7200 at 1 year. Preoperative activity level was significantly correlated with preoperative Pain Score (p=0.003). Activity level within the first 3 days after surgery was correlated with 6 weeks activity level (0.473, p=0.004), and 1 year activity level (0.593, p=0.02), but not 1 year KOOS scores. Conclusion: Modern accelerometers present a novel way to objectively measure activity level before and after knee arthroplasty. Preoperative activity level is significantly associated with post operative activity level. One year after knee arthroplasty the mean number of steps per day is 7200, and 50% of subjects taking more than 7000 steps per day, which is the recommended daily average for those age 65+ years.
Use of Supercritical Sterilized Bone Allograft in Two Stage Revision ACL Reconstruction
Authors: Roe Justin , Rutten Sjoerd , Bonnar Fiona , Salmon Lucy , Pinczewski Leo 
Published: March 2016

Objectives: Revision ACL-reconstruction can be compromised by bone loss as result of tunnel widening or poorly placed tunnels. Two-stage revision ACL consist of initial removal of the old fixation hardware and remaining ACL-graft tissue, followed by bone grafting of the tunnels. After a period of graft incorporation and bone remodeling, an ACL-reconstruction is performed. Our primary aim is to examine the use of supercritical carbon dioxide sterilized bone allograft for tunnel grafting in order to determine the bone quality, graft incorporation and remodeling, by using histology and histomorphometric analysis. Secondarily, we aimed to determine whether the histological findings correlate with the timing of the second stage revision procedure. Methods: Case Series. 12 subjects underwent 2-stage revision ACL reconstruction. Femoral and tibial tunnels were bone grafted with supercritical carbon dioxide sterilized bone allograft (Australian Biotechnologies). Mean time from bone grafting to 2nd stage was 8.8 months (range, 5.6 to 21.3 months). Bone biopsies were taken at the time of the 2nd surgery and decalcified and embedded in paraffin. Sections were hematoxylin and eosin stained for microscopic analysis. Results: The graft material was easily identified by its necrotic appearance with empty osteocytes lacunes within the lamellar trabecular bone. In all tissue samples predominately lamellar host bone apposition was seen on the surface of graft fragments known as creeping substitution. Separate bone graft fragments were bridged by newly formed woven bone. In the histological sections of 2 subjects some small islands of chondral cell differentiation were seen, which may relate to endochondral ossification. Active bone remodeling and resorption through combined osteoclastic and osteoblastic activity was present in 2 subjects (7.0 and 6.3 months post grafting), suggesting more advanced phases of graft incorporation. Mean bone volume was 68% over tissue volume (range 33-92%), and graft volume over bone volume was 41% (range 19-70%). Subgroup analysis for graft volume to time of second stage could not demonstrate a difference in 6 to 9 months (mean 44%, range 19-70 %) and >10 months (mean 34%, range 19-48%). Conclusion: The osteoconductive supercritical sterilized bone allograft acted as an effective structural framework, allowing for successful graft incorporation through creeping substitution. Although cancellous grafts may remodel completely with time, the initial bone apposition on and bridging of graft fragments provides early mechanical strengths to facilitate 2-stage revision ACL reconstruction. Bone volume and graft volume varied among subjects, but no beneficial effect was demonstrated for graft incorporation and bone remodeling in delaying the 2nd stage procedure for more than 6 months.