bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomized Study of Postcesarean Analgesia With Intrathecal Morphine Alone or Combined With Clonidine
Authors: Carvalho F.A. , Tenório S.B. , Shiohara F.T. , Maia L.R. , Mota A. 
Published: February 2017

(J Clin Anesth. 2016;33:395–402)
Intrathecal morphine provides long-lasting pain relief after cesarean deliveries but can be difficult to dose properly (range is 25 to 500 μg). It is possible that the concomitant use of clonidine, an alpha-2-adrenoceptor agonist, with morphine may help to improve the quality of analgesia and reduce opioid consumption and side effects. Therefore, the authors of the present study compared the efficacy of 50 μg intrathecal morphine combined with 75 μg clonidine to the efficacy of 50 μg or 100 μg intrathecal morphine alone for postcesarean analgesia.
The Validity and Reliability of the Turkish Version of the Neonatal Skin Risk Assessment Scale
Authors: Sari Çiğdem , Altay Naime 
Published: February 2017

ABSTRACT

PURPOSE:
The study created a Turkish translation of the Neonatal Skin Risk Assessment Scale (NSRAS) that was developed by Huffines and Longsdon in 1997. Study authors used a cross-sectional survey design in order to determine the validity and reliability of the Turkish translation.

SUBJECTS AND SETTING:
The study was conducted at the neonatal intensive care unit of a university hospital in Ankara between March 15 and June 30, 2014. The research sample included 130 neonatal assessments from 17 patients.

METHODS:
Data were collected by questionnaire regarding the characteristics of the participating neonates, 7 nurse observers, and the NSRAS and its subarticles. After translation and back-translation were performed to assess language validity of the scale, necessary corrections were made in line with expert suggestions, and content validity was ensured. Internal consistency of the scale was assessed by its homogeneity, Cronbach’s α, and subarticle–general scale grade correlation.

RESULTS:
Cronbach’s α for the scale overall was .88, and Cronbach’s α values for the subarticles were between .83 and .90. Results showed a positive relationship among all the subarticles and the overall NSRAS scale grade (P < .01) with correlation values between 0.333 and 0.721. Explanatory and predicative factor analysis was applied for structural validity. Kaiser-Meyer-Olkin analysis was applied for sample sufficiency, and Bartlett test analysis was applied in order to assess the factor analysis of the sample. The Kaiser-Meyer-Olkin coefficient was 0.73, and the χ
2
value found according to the Bartlett test was statistically significant at an advanced level (P < .05). In the 6 subarticles of the scale and in the general scale total grade, a high, positive, and significant relationship among the grades given by the researcher and the nurse observers was found (P < .05).

CONCLUSION:
The Turkish NSRAS is reliable and valid.
Leveraging Telemedicine Infrastructure to Monitor Quality of Operating Room to Intensive Care Unit Handoffs
Authors: Barry Mark E. , Hochman Beth R. , Lane-Fall Meghan B. , Zappile Denise , Holena Daniel N. , Smith Brian P. , Kaplan Lewis J. , Huffenberger Ann , Reilly Patrick M. , Pascual Jose L. 
Published: February 2017

Purpose
To analyze in-room video recordings of operating room (OR) to intensive care unit (ICU) handoffs to determine tempo and quality of team interactions on nights and weekends compared with weekdays, and to demonstrate how existing telemedicine technology can be used to evaluate handoffs.

Method
This prospective observational study of OR-to-ICU bedside handoffs was conducted in the surgical ICU of the Hospital of the University of Pennsylvania in July 2014–January 2015. Handoff video recordings were obtained for quality improvement purposes using existing telemedicine cameras. Evaluators used adapted validated in-person assessment measures to analyze basic characteristics and quality measures (timing, report types, report duration, presence of physical exam, teamwork skills, engagement, report delivery skills, listening skills, interruptions, unprofessional comments or actions).

Results
Sixteen weekday and 16 night and weekend handoffs were compared. There were no significant differences in basic characteristics. Most quality measures were similar on weekdays compared with nights and weekends. Surgeons demonstrated better report delivery skills and engagement on nights and weekends (P = .002 and P = .04, respectively), whereas OR anesthesiologists’ scores were similar during both time frames.

Conclusions
This study presents a novel approach of assessing handoff quality in OR-to-ICU handoffs using an existing telemedicine infrastructure. Using this approach, quality measures of night and weekend handoffs were found to be no worse—and sometimes better—than those during weekdays. Video analysis may emerge as an ideal unobtrusive quality improvement methodology to monitor handoffs and improve education and compliance with institutional handoff policies.
Engaging Learners to Advance Medical Education
Authors: Burk-Rafel Jesse , Jones R. Logan , Farlow Janice L. 
Published: February 2017

Learners are a pillar of academic medicine, yet their voice is seldom heard in national and international scholarly conversations on medical education. However, learners are eager to contribute: in response to a recent open call from Academic Medicine, medical students and residents representing 98 institutions across 11 countries submitted 224 Letters to the Editor on wide-ranging topics. In this Invited Commentary, the authors—three medical students serving in national leadership roles—contextualize several themes discussed in these learner-authored letters.
The authors first explore the unique voice learners contribute to educational innovation, highlighting the value learners add to curricular and systemic educational reform efforts. They then turn to the broader implications of the many submitted letters addressing the culture and humanism of medicine, proposing that learners can be powerful catalysts and partners in cultural change. Despite these benefits, the authors note that learners are largely untapped change agents who are particularly underrepresented in medical education scholarship, finding that students were just 2.8% (39/1,396) of authors and 3.5% (12/340) of first authors among all print publications in Academic Medicine in 2016. The authors conclude by offering tangible steps for the academic medical community to engage learners in leadership, advocacy, and scholarship.
Treatment of lupus nephritis: current paradigms and emerging strategies
Authors: Dall’Era Maria 
Published: February 2017

Purpose of review
Lupus nephritis is the most common organ-threatening manifestation of lupus and continues to result in end-stage renal disease. This review describes the contemporary treatment of lupus nephritis as well as emerging therapeutic strategies.

Recent findings
Lupus nephritis management consists of an initial (induction) phase and a maintenance (extended) phase in which steroids are used in combination with another immunosuppressive medication. Current treatments are incompletely effective and associated with substantial toxicity. Despite disappointing results of several recent trials, novel therapies targeting diverse immunologic pathways are being actively studied in lupus nephritis. Two promising strategies include the use of B-cell depletion therapy and multitarget therapy with calcineurin inhibitors. In parallel with the conduct of these trials, there are ongoing efforts to improve trial design. Two recent studies of outcome measures reported that a level of proteinuria of less than 0.7–0.8 g at 12 months is most predictive of good long-term renal outcome, and that the inclusion of urine red blood cells worsens the predictive value of proteinuria alone.

Summary
Improved understanding of lupus nephritis pathogenesis, development of novel therapies, and optimization of clinical trial design are leading the path forward for successful drug development in lupus nephritis. The ultimate goal of these efforts is to treat our patients in a more strategic, personalized manner that improves long-term outcomes.
Percutaneous or Open Reduction of Closed Tibial Shaft Fractures During Intramedullary Nailing Does Not Increase Wound Complications, Infection or Nonunion Rates
Authors: Auston Darryl A. , Meiss Jordan , Serrano Rafael , Sellers Thomas , Carlson Gregory , Hoggard Timothy , Beebe Michael , Quade Jonathan , Watson David , Simpson Robert Bruce , Kistler Brian , Shah Anjan , Sanders Roy , Mir Hassan R. 
Published: February 2017

Objective:
To compare the incidence of complications (wound, infection, and nonunion) among those patients treated with closed, percutaneous, and open intramedullary nailing for closed tibial shaft fractures.

Design:
Retrospective review.

Setting:
Multiple trauma centers.

Patients:
Skeletally mature patients with closed tibia fractures amenable to treatment with an intramedullary device.

Intervention:
Intramedullary fixation with closed, percutaneous, or open reduction.

Main Outcome Measurements:
Superficial wound complication, deep infection, nonunion.

Results:
A total of 317 tibial shaft fractures in 315 patients were included in the study. Two-hundred fractures in 198 patients were treated with closed reduction, 61 fractures in 61 patients were treated with percutaneous reduction, and 56 fractures in 56 patients were treated with formal open reduction. The superficial wound complication rate was 1% (2/200) for the closed group, 1.6% (1/61) for the percutaneous group, and 3.6% (2/56) for the open group with no statistical difference between the groups (P = 0.179). The deep infection rate was 2% (4/200) for the closed group, 1.6% (1/61) for the percutaneous group, and 7.1% (4/56) for the open group with no significant difference between the groups (P = 0.133). Nonunion rate was 5.0% (10/200) for the closed group, 4.9% (3/61) for the percutaneous group, and 7.1% (4/56) for the open group, with no statistical difference between the groups (P = 0.492).

Conclusions:
This is the largest reported series of closed tibial shaft fractures nailed with percutaneous and open reduction. Percutaneous or open reduction did not result in increased wound complications, infection, or nonunion rates. Carefully performed percutaneous or open approaches can be safely used in obtaining reduction of difficult tibial shaft fractures treated with intramedullary devices.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Spanish Translation, Cross-Cultural Adaptation, and Validation of the American Academy of Orthopaedic Surgeons Foot and Ankle Outcomes Questionnaire in Mexican-Americans With Traumatic Foot and Ankle Injuries
Authors: Zelle Boris A. , Francisco Ben S. , Bossmann James P. , Fajardo Roberto J. , Bhandari Mohit 
Published: February 2017

Background:
Hispanics represent the largest minority group within the US population accounting for an estimated 55.4 million individuals. Enrolling Hispanics into clinical outcome studies is important in order for study populations to be externally valid and representative of the US population. Inclusion of Mexican-Americans in clinical studies is frequently limited by the lack of validated outcome measures. The goal of this study was to validate a Spanish version of the American Academy of Orthopaedic Surgeons Foot and Ankle Outcomes Questionnaire (AAOS-FAOQ) in Mexican-Americans with traumatic foot and ankle injuries.

Methods:
The translation and cross-cultural adaptation procedure was performed by a committee of bilingual speakers using the following steps: (1) forward translation and adaptation, (2) synthesis, (3) back translation, (4) committee review, and (5) pilot testing. The validation was performed in 100 Mexican-Americans with traumatic foot and ankle injuries.

Results:
A total of 41 females and 59 males were enrolled in this study. The mean age was 42.98 years (range 18–88). The Spanish version of the Global Foot and Ankle Scale of the AAOS-FAOQ showed statistically significant correlations with all 8 subscales of the Spanish SF-36 as well as the Physical Component Summary scale and the Mental Component Summary scale (P < 0.05). The Global Foot and Ankle scale of the Spanish AAOS-FAOQ demonstrated a test–retest reliability of 0.68.

Conclusion:
We provide a Spanish translation and cross-cultural adaptation of the AAOS-FAOQ. The instrument demonstrates appropriate psychometric properties in Mexican-Americans with traumatic foot and ankle injuries.
Is This Autograft Worth It?: The Blood Loss and Transfusion Rates Associated With Reamer Irrigator Aspirator Bone Graft Harvest
Authors: Marchand Lucas S. , Rothberg David L. , Kubiak Erik N. , Higgins Thomas F. 
Published: February 2017

Objectives:
To investigate the blood loss and transfusion rate associated with the use of reamer irrigator aspirator (RIA).

Design:
Retrospective review.

Setting:
Academic Level-I trauma hospital.

Patients:
One hundred eight patients requiring bone graft harvest for surgical reconstruction of nonunion or failed arthrodesis.

Intervention:
Bone graft harvest preformed via RIA or iliac crest bone graft (ICBG).

Main Outcome Measure:
Blood loss as measured by a change in preoperative and postoperative hematocrit (Hct). In addition, postoperative transfusion reported intraoperative blood loss, volume of graft harvested, and major complications.

Results:
The average Hct drop was found to be 13.7 (4.1–27.4) in the RIA cohort of 61 patients and 7.36 (1.2–14.5) in the ICBG cohort of 47 patients (P = 0.013). Operative reports documented an average estimated blood loss of 674 mL (100–2000 mL) in the RIA cohort compared with 255 mL (50–1000 mL) in the ICBG cohort (P < 0.001). Twenty-seven patients (44%) required blood transfusion after RIA, whereas 10 patients (21%) required blood transfusion after ICBG (odds ratio 5.32, 95% confidence interval 2.2–6.3, P < 0.001). RIA procedures collected an average 53 mL (20–100 mL) of bone graft compared with 27 mL (15–50 mL) with ICBG. There was no significant difference between groups regarding age, sex, medical comorbidities, or postoperative major complications.

Conclusions:
This series demonstrated that 44% of patients undergoing RIA bone graft harvest required transfusion, with a mean Hct drop of 13.7 across all subjects, which is significantly greater than that associated with ICBG.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Outcomes of Hemiarthroplasty and Total Hip Arthroplasty for Femoral Neck Fracture: A Medicare Cohort Study
Authors: Wang Zhong , Bhattacharyya Timothy 
Published: February 2017

Objectives:
For patients with femoral neck fractures, total hip arthroplasty (THA) demonstrates superior outcomes compared with hemiarthroplasty. However, hemiarthroplasty remains a common treatment for femoral neck fractures and the conversion rates are unknown. We compared the results of the 2 procedures using a Medicare database.

Methods:
We assembled a cohort of 70,242 patients 65 to 90 years of age with an ICD9 diagnosis and matching Current Procedure Terminology code for femoral neck fracture between 2008 and 2012. Patients were followed forward for 2 years minimum. Incidences of dislocation and mortality were measured. Reoperation for revision of THA or conversion of hemiarthroplasty to THA was assessed by Current Procedure Terminology code. Groups were compared through proportional hazard models controlling for age, race, sex, and comorbidity index.

Results:
Hemiarthroplasty represented 95% of the patients treated using arthroplasty for femoral neck fracture. The proportional hazard of reoperation and dislocation were significantly lower for hemiarthroplasty than THA (P < 0.0001 for both). At 2 years, fewer than 2% of hemiarthroplasty patients underwent conversion to total hip replacement. Patients treated with THA were more likely to be alive for 2 years (adjusted hazard ratio = 1.67, 95% confidence interval: 1.59–1.92).

Conclusion:
Patients treated with hemiarthroplasty after femoral neck fractures had significantly lower proportional hazard of reoperation than those treated with THA. THA may be associated with lower mortality.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Open Tibia Shaft Fractures and Soft-Tissue Coverage: The Effects of Management by an Orthopaedic Microsurgical Team
Authors: VandenBerg James , Osei Daniel , Boyer Martin I. , Gardner Michael J. , Ricci William M. , Spraggs-Hughes Amanda , McAndrew Christopher M. 
Published: February 2017

Objectives:
To compare the timing of soft-tissue (flap) coverage and occurrence of complications before and after the establishment of an integrated orthopaedic trauma/microsurgical team.

Design:
Retrospective cohort study.

Setting:
A single level 1 trauma center.

Patients:
Twenty-eight subjects (13 pre- and 15 post-integration) with open tibia shaft fractures (OTA/AO 42A, 42B, and 42C) treated with flap coverage between January 2009 and March 2015.

Intervention:
Flap coverage for open tibia shaft fractures treated before (“preintegration”) and after (“postintegration”) implementation of an integrated orthopaedic trauma/microsurgical team.

Main Outcome Measure:
Time from index injury to flap coverage.

Results:
The unadjusted median time to coverage was 7 days (95% confidence interval, 5.9–8.1) preintegration, and 6 days (95% confidence interval, 4.6–7.4) postintegration (P = 0.48). For preintegration, 9 (69%) of the patients experienced complications, compared with 7 (47%) postintegration (P = 0.23).

Conclusions:
After formation of an integrated orthopaedic trauma/microsurgery team, we observed a 1-day decrease in median days to coverage from index injury. Complications overall were lowered in the postintegration group, although statistically insignificant.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Renal cystic disease and associated ciliopathies
Authors: Kagan Karl O. , Dufke Andreas , Gembruch Ulrich 
Published: February 2017

Purpose of review
To review disorders that are associated with renal cystic disease during prenatal life and to highlight the strong association between renal cystic disease and ciliopathies.

Recent findings
There are numerous causative genes for ciliopathies that can present with cystic kidney disease. In the group of single gene ciliopathies, autosomal dominant polycystic kidney disease is by far the most prevalent one. Other examples are autosomal recessive polycystic kidney disease, nephronophthisis, Bardet–Biedl syndrome, Meckel–Gruber syndrome, Joubert syndrome and related disorders as well as X-linked orofaciodigital syndrome type 1, respectively. The prevalence of these inherited disorders sums up to about in 1 : 2000 people. These disorders with their hepatorenal fibrocystic character should be classified as multisystem diseases.

Summary
Understanding of the origin of renal cystic disease and associated disorders is important to make the appropriate prenatal diagnosis and for counseling affected parents. In the future, understanding of the pathophysiology may help to develop new treatment strategies.
Invasive therapies for primary post-partum haemorrhage as missed opportunities for medical prevention
Authors: Kayem Gilles , Deneux-Tharaux Catherine 
Published: February 2017

Purpose of review
Examine the available results from population-based studies to test the hypothesis that differences between countries in medical practices for the management of labour, delivery and early bleeding may lead to a differential risk of post-partum haemorrhage (PPH)-related maternal morbidity and in the need for PPH-related invasive therapies.

Recent findings
International comparison of ratios of maternal mortality due to PPH shows significant differences between developed countries. Direct international comparisons of PPH rates to investigate these differences are difficult because PPH definition is not homogeneous. One widely used proxy for severe PPH is the use of secondary invasive procedures for PPH treatment. Comparative analysis of results from population-based studies shows wide variations in the rates of invasive therapies for PPH across countries and suggests that high rates of such therapies may be explained partly by variations in practices for the management of first and third stages of labour and in the noninvasive steps of PPH treatment.

Summary
Invasive therapies for PPH may be considered markers of missed opportunities for primary or secondary prevention of PPH. Management of first and third stages of labour as well as the early steps of PPH treatment are important keys to prevent severe maternal complications of PPH and the need for invasive therapies.
EVALUATION OF FULL-FIELD ELECTRORETINOGRAM REDUCTIONS AFTER OCRIPLASMIN TREATMENT
Authors: Birch David G. , Benz Matthew S. , Miller Daniel M. , Antoszyk Andrew N. , Markoff Joseph , Kozma Petra , Meunier Esmeralda , Sergott Robert C. ,   for the OASIS Study Team
Published: February 2017

Purpose:
To explore a possible association between full-field electroretinograms with vitreomacular adhesion resolution and best-corrected visual acuity as part of the prospective, randomized, double-masked, sham-controlled Ocriplasmin for Treatment for Symptomatic Vitreomacular Adhesion Including Macular Hole (OASIS) trial studying ocriplasmin.

Methods:
The ERG substudy enrolled 62 of 220 OASIS subjects (randomized 2:1) and analyzed full-field electroretinograms and their association with both vitreomacular adhesion resolution and best-corrected visual acuity from baseline through Month 24. Electroretinogram reductions were defined as acute full-field electroretinogram reductions in amplitude of ≥40% from baseline occurring at postinjection Day 7 or Day 28.

Results:
In the ocriplasmin group, 16/40 (40%) subjects developed ERG reductions, compared to 1/21 (4.8%) in the sham group; 13/16 (81.3%) and 1/1 (100%) resolved by study end, respectively. A total of 11/16 (68.8%) ocriplasmin-treated subjects with ERG reductions achieved vitreomacular adhesion resolution, compared to those without (9/24, 37.5%). The ocriplasmin-treated subjects with ERG reductions also gained more letters on average (11.3 vs. 9.3 letters) from baseline and had a difference of 6.7 letters in mean best-corrected visual acuity by study end compared to those without ERG reductions.

Conclusion:
Ocriplasmin-treated subjects with ERG reductions had a higher rate of vitreomacular adhesion resolution and showed better visual improvement than their counterparts without ERG reductions or sham subjects by study end.