bluuebunny/crossref_metadata_2025_split huggingface dataset:
Economic evaluation of telephone-based concussion management for combat-related mild traumatic brain injury
Authors: Richardson John S , Guzauskas Gregory F , Fann Jesse R , Temkin Nancy R , Bush Nigel E , Bell Kathleen R , Gahm Gregory A , Smolenski Derek J , Brockway Jo Ann , Hansen Ryan N 
Published: April 2017

Introduction Mild traumatic brain injury (mTBI) is an unfortunately common repercussion of military service in a combat zone. The CONTACT study tested an individualized telephone support intervention employing problem solving therapy (PST) for mTBI in soldiers recently returned from deployment. We sought to determine the cost effectiveness of this intervention from a military healthcare system perspective. Methods We conducted an intent-to-treat post-hoc analysis by building a decision analytic model that evaluated the choice between using PST or education only (EO). The model included cost-minimization and cost-effectiveness analyses. The incremental cost-effectiveness ratios (ICERs) were calculated as the differences in costs of PST versus EO relative to the differences in the outcomes of participants. Results The PST intervention resulted in an annual per-enrolee cost of $1027 (95% CI: $836 to $1248), while EO costs were $32 (95% CI: $25 to $39), resulting in a net incremental cost of $996 per enrolee (95% CI: $806 to $1,217). The ICERs were $68,658/QALY based on EQ-5D (95% CI: -$463,535 to $596,661) and $49,284/QALY based on SF-6D (95% CI: $26,971 to $159,309). Estimates of treatment costs in a real-world setting were accompanied by substantially lower ICERs that are within accepted thresholds for willingness-to-pay. Discussion Although the intervention had short-term benefits sufficient to yield acceptable ICERs, there was no long-term effect of PST over EO observed in the study. Consequently, we suggest that future studies examine the use of low-cost approaches, such as booster relapse-prevention calls, that may lead to a sustained treatment benefit for this population.
Long-term cost-effectiveness of thrombectomy for acute ischaemic stroke in real life: An analysis based on data from the Swedish Stroke Register (Riksstroke)
Authors: Steen Carlsson Katarina , Andsberg Gunnar , Petersson Jesper , Norrving Bo 
Published: April 2017

Background Randomised controlled trials have demonstrated substantial clinical benefit for thrombectomy in patients with acute ischaemic stroke and proximal anterior circulation arterial occlusion. Aim We investigated the long-term cost-effectiveness of thrombectomy after thrombolysis versus thrombolysis alone using real-world outcome data on need for health care, home help and nursing home care. Methods We used real-life resource use and survival data from the Swedish Stroke Register and pooled outcomes from five randomised controlled trials published in 2015 in a newly constructed Markov cost-effectiveness model with a societal perspective. Data were stratified by age (18–64; 65–74; 75–84 years) and modified Rankin scale at three months for patients with an index ischaemic stroke in 2014 fulfilling inclusion criteria NIHSS ≥ 8 before treatment and treated with thrombolysis ( n = 710). Univariate sensitivity analyses explored robustness of results. A life-time perspective and 3% discount rate were applied. Results Thrombectomy increases the health care cost per patient (+GBP 9000) mainly because of intervention costs, but the reduced burden on the social services (home help services −GBP 13,000; nursing home care −GBP 26,000) implies overall cost savings. The average patient gain was 1.0 quality-adjusted life year (QALY) with higher gains for younger age groups. Thrombectomy was a dominant strategy in the base case and all sensitivity analyses where social services were considered. Conclusion Thrombectomy has a small effect on hospital costs except for the direct intervention cost. However, thrombectomy is highly likely to lead to substantial cost savings in the social service sector, up to four times the increase in health-care costs.
Treatment of Barrow type ‘B’ carotid cavernous fistulas with flow diverter stent (Pipeline)
Authors: Castaño Carlos , Remollo Sebastián , García-Sort Rosa , Domínguez Carlos , Terceño Mikel 
Published: April 2017

Background Carotid cavernous fistulas (CCFs) Barrow type ‘B’ are dural shunts between the meningeal branches of the internal carotid artery and the cavernous sinus. The symptoms include vision deterioration, ophthalmoplegia with diplopia, exophthalmos, conjunctival injection, chemosis, ocular bruit, seizures, or neurological deficit. Endovascular treatment remains the gold standard for treatment through the transvenous or transarterial routes. The transvenous approaches have been proved to be the first option. Endovascular access through the superior ophthalmic vein (SOV) or inferior petrosal sinus have been widely used. The problem arises when there is no vascular access. For these cases, different approaches have been described, such as: direct access to the SOV; combining direct access to the SOV along with blind probing of the proximal occluded SOV; and a direct puncture of the cavernous sinus. But these techniques are very aggressive and can cause serious complications. As a result of the above, we describe a new alternative technique, which is effective and less invasive for the treatment of these special cases. Case reports We report two cases of Barrow type ‘B’ CCFs that did not have vascular access (neither arterial nor venous) to embolise fistulas with coils or glue, and which were successfully resolved with a flow diverter (Pipeline) stent in the internal carotid artery. To our knowledge, this treatment has not previously been described for this pathology. Conclusions The placement of a flow diverter stent in the internal carotid artery is an effective alternative technique in those cases of Barrow type ‘B’ CCFs that have no vascular access (neither venous nor arterial).
Return to Play After Revision Anterior Cruciate Ligament Reconstruction in National Football League Players
Authors: Okoroha Kelechi R. , Kadri Omar , Keller Robert A. , Marshall Nathan , Cizmic Zlatan , Moutzouros Vasilios 
Published: April 2017

Background: National Football League (NFL) players who undergo anterior cruciate ligament (ACL) reconstruction have been shown to have a lower return to play (RTP) than previously expected. However, RTP in the NFL after revision ACL reconstruction (RACLR) is not well defined. Purpose/Hypothesis: The purpose of this study is to determine the RTP of NFL players after RACLR and evaluate factors that predict RTP. Our hypothesis was that more experienced and established players would be more likely to RTP after RACLR. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 24 NFL players who underwent RACLR between 2007 and 2014 were reviewed and evaluated. Return to NFL play, time to return, seasons and games played prior to and after revision surgery, draft status, and demographic data were collected. Overall RTP was determined, and players who did RTP were compared with those unable to RTP. Data were also compared with control players matched for age, position, size, and experience. Results: After RACLR, 79% (19/24) of NFL players returned to NFL regular-season play at an average of 12.6 months. All players who were drafted in the first 4 rounds, played in at least 55 games, or played 4 seasons of NFL play prior to injury were able to RTP. Players drafted in the first 4 rounds of the NFL draft were more likely to RTP than those who were not (odds ratio, 0.1; 95% CI, 0.01-1.00; P = .05). Those who returned to NFL play played in significantly less games and seasons after their injury than before ( P = .01 and P = .01, respectively). However, these values did not differ when compared with matched controls ( P = .67 and P = .33). Conclusion: NFL players who RTP after RACLR do so at a similar rate but prolonged time period compared with after primary ACL reconstruction. Athletes who were drafted in earlier rounds were more likely to RTP than those who were not. Additionally, player experience prior to injury is an important factor when predicting RTP after RACLR.
Proliferative Vitreoretinopathy (PVR) Update: Current Surgical Techniques and Emerging Medical Management
Authors: Kuriakose Robin K. , Xu Kunyong , Chin Eric K. , Almeida David R. P. 
Published: April 2017

Purpose: To provide an update on current surgical techniques and emerging medical management in proliferative vitreoretinopathy (PVR). Methods: A literature search was conducted on studies in the past decade with the inclusion of historical, landmark studies. Results: Proliferative vitreoretinopathy remains the primary obstacle to successful retinal detachment (RD) surgery, despite increasing knowledge on its pathophysiology and efforts to reduce its occurrence. A number of recent visualization and surgical advancements, including smaller gauge vitrectomies, have shown promising results. Likely, effective PVR prevention and treatment may rest on a multimodal approach, with particular attention toward adjunct pharmacological use. There is a growing body of literature on effective anti-inflammatory, antineoplastic/proliferative, antigrowth factor, and antioxidant adjunct therapy. Nonetheless, a number of preoperative and perioperative risk factors must be assessed before considering any surgical or medical management. Newer preoperative risk factor findings, such as smoking, highlight the need for a broad consideration during patient counseling. Discussion: Most studies in this field are retrospective in design, and the number of randomized control trials is limited, owing to the uncommon nature and complicated clinical profiles of patients with PVR RDs. Prospective studies should consider including combination drug formulations as a part of its intervention. Surgical techniques that may mitigate the inflammatory response by reducing ocular trauma should also continue to be investigated.
How I treat central venous access device–related upper extremity deep vein thrombosis
Authors: Rajasekhar Anita , Streiff Michael B. 
Published: April 2017

AbstractCentral venous access device (CVAD)-related thrombosis (CRT) is a common complication among patients requiring central venous access as part of their medical care. Complications of CRT include pulmonary embolism, recurrent deep venous thrombosis, loss of central venous access, and postthrombotic syndrome. Patient-, device-, and treatment-related factors can influence the risk of CRT. Despite numerous randomized controlled trials, the clinical benefit of pharmacologic thromboprophylaxis for the prevention of CRT remains to be established. Therefore, minimizing patient exposure to known risk factors is the best available approach to prevent CRT. Venous duplex is recommended for the diagnosis of CRT. Anticoagulation for at least 3 months or the duration of the indwelling CVAD is recommended for treatment of CRT. Thrombolysis should be considered for patients at low risk for bleeding who have limb-threatening thrombosis or whose symptoms fail to resolve with adequate anticoagulation. CVAD removal should be consider for patients with bacteremia, persistent symptoms despite anticoagulation, and if the CVAD is no longer needed. Superior vena cava filters should be avoided. Prospective studies are needed to define the optimal management of patients with or at risk for CRT.
Lung function and disease severity in cystic fibrosis patients heterozygous forp.Arg117His
Authors: Shteinberg Michal , Downey Damian G. , Beattie Diane , McCaughan John , Reid Alastair , Stein Nili , Elborn J. Stuart 
Published: April 2017

Expression ofp.Arg117Hiscystic fibrosis (CF) transmembrane conductance regulator is influenced by a polythymidine (poly-T) tract and a thymidine–guanine (TG) repeat on intron 9, which vary in length and affect exon 10 skipping.We compared clinical characteristics and the rate of progression of lung disease of CF patients carrying thep.Arg117Hismutation with different intron 9 varying sequences (poly-T) and mutation classesin trans.Data were collected from patients in Northern Ireland, UK, including diagnostic features, sweat chloride, nutritional status, sputum microbiology, CF-related complications and lung function. Poly-T and TG repeats were determined by PCR. Forced expiratory volume in 1 s (FEV1) decline was determined from linear regression of FEV1measurements of patients over time.We identified 62 patients withp.Arg117His, 55 with a class I/II mutationin transand six withp.Arg117His/p.Gly551Asp. 42 patients had 5T and 13 had 7T. All patients had 12 TG repeats. Patients withp.Arg117His-5T had greater lung function decline, sweat chloride concentrations, pancreatic insufficiency and prevalence ofPseudomonas aeruginosainfection compared with patients withp.Arg117His-7T.Lung function decline and disease severity inp.Arg117Hisis determined by the poly-T tract length and identity of the mutationin trans.Patients withp.Arg117His-5T and a second class I/II mutation have a severity similar top.Phe508delhomozygous patients, although lung function decline is delayed to an older age. There may be linkage disequilibrium betweenp.Arg117Hisand 12 TG repeats.
An observational study of 110 elderly lithium-treated patients followed up for 6 years with particular reference to renal function
Authors: Bocchetta Alberto , Cabras Francesca , Pinna Martina , Poddighe Antonio , Sardu Claudia , Ardau Raffaella , Chillotti Caterina , Del Zompo Maria 
Published: April 2017

Abstract
Background
Recent observational studies have focused on lithium treatment in the elderly, with particular reference to safety in terms of thyroid and renal functions. The purpose of this study was to compare the clinical characteristics of patients starting lithium treatment before (N = 79) or after (N = 31) the age of 65 years. Patients were followed up for 6 years with focus on renal function and prescription of levothyroxine and methimazole.

Results
At baseline, median lithium serum concentration was 0.55 mmol/l. The estimated glomerular filtration rate was lower than 60 ml/min/1.73 m2 in 43 (39%) patients. In a multiple regression analysis controlling for age and gender, we found a significant effect of duration of lithium treatment on estimated glomerular filtration rate (−0.85 ml/min/1.73 m2 per year of prior exposure). The annual decline during follow-up was 2.3 ml/min/1.73 m2. Two patients were prescribed levothyroxine, and two were prescribed methimazole for the first time during follow-up.

Conclusions
Median lithium serum concentration in this cohort of elderly patients with mainly bipolar disorders was lower than the therapeutic range indicated for younger adults. The decline in glomerular filtration rate may be accelerated by long-term lithium use. Thyroid and renal functions continue to require close monitoring throughout the course of lithium treatment.
Trial registration NP/2013/3836. Registered 24 June 2013
Continuous Ropivacaine Subfascial Wound Infusion Compared With Intrathecal Morphine for Postcesarean Analgesia: A Prospective, Randomized Controlled, Double-Blind Study
Authors: Lalmand Manon , Wilwerth Madeleine , Fils Jean-François , Van der Linden Philippe 
Published: April 2017

BACKGROUND:
After cesarean delivery, postoperative pain management allows early rehabilitation and helps prevent postpartum depression and chronic pain. Our present prospective, randomized controlled, double-blind study assessed the duration and effect of intrathecal analgesia and continuous ropivacaine wound infiltration versus a control group after cesarean delivery. The primary outcome was analgesia duration, defined as time to first morphine request. Secondary outcomes were cumulative postoperative morphine consumption, number of patients who did not require IV morphine, incidence of adverse effects, and time to first ambulation.

METHODS:
A total of 192 full-term parturients undergoing elective cesarean delivery were randomly allocated into 3 groups (control, morphine, and catheter). All patients received spinal anesthesia with 10 mg bupivacaine 0.5% hyperbaric bupivacaine (2 mL) + 5 μg of sufentanil (1 mL) and a multiholed catheter inserted into the wound. In the control group, NaCl 0.9% was administered intrathecally (0.1 mL) and through the catheter. The morphine group received 100 μg morphine (0.1 mL) intrathecally and NaCl 0.9% infused through the wound catheter. The catheter group received 0.1 mL NaCl 0.9% intrathecally and ropivacaine 0.2% infused in the catheter. Each patient received a 15-mL bolus of the dedicated solution through the catheter, which was connected to an elastomeric pump infusor delivering the same solution at a rate of 10 mL/h for 30 hours. All patients also received multimodal analgesia including acetaminophen and diclofenac. Analgesia duration was defined as the time from spinal injection (T0) to first IV morphine requirement (T1) administered via a patient-controlled IV analgesia pump. Statistical data analyses included use of the Kruskal-Wallis rank-sum test followed by the post hoc Tukey test and χ2 test.

RESULTS:
The duration of postoperative analgesia was increased with intrathecal morphine (380 minutes; 215–1527) and ropivacaine wound infusion (351 minutes; 227–594) compared with the control (247 minutes; 182–338) with effect sizes of 0.171 (0.043–0.293) for morphine versus control and 0.164 (0.052–0.271) for catheter versus control. There was no difference between the morphine group and catheter group (effect size, 0.007; −0.118 to 0.132). Cumulative postoperative morphine consumption was also significantly lower in the morphine group and catheter group compared with the control group. The incidence of adverse effects did not differ between groups.

CONCLUSIONS:
After elective cesarean delivery, 100 μg intrathecal morphine and ropivacaine wound infusion both increased the duration and effect of postcesarean analgesia without increased incidence of side effects.
Physician-Directed Versus Computerized Closed-Loop Control of Blood Pressure Using Phenylephrine in a Swine Model
Authors: Marques Nicole Ribeiro , Whitehead William E. , Kallu Upendar R. , Kinsky Michael P. , Funston Joe S. , Wassar Taoufik , Khan Muzna N. , Milosch Mindy , Jupiter Daniel , Grigoriadis Karolos , Kramer George C. 
Published: April 2017

BACKGROUND:
Vasopressors provide a rapid and effective approach to correct hypotension in the perioperative setting. Our group developed a closed-loop control (CLC) system that titrates phenylephrine (PHP) based on the mean arterial pressure (MAP) during general anesthesia. As a means of evaluating system competence, we compared the performance of the automated CLC with physicians. We hypothesized that our CLC algorithm more effectively maintains blood pressure at a specified target with less blood pressure variability and reduces the dose of PHP required.

METHODS:
In a crossover study design, 6 swine under general anesthesia were subjected to a normovolemic hypotensive challenge induced by sodium nitroprusside. The physicians (MD) manually changed the PHP infusion rate, and the CLC system performed this task autonomously, adjusted every 3 seconds to achieve a predetermined MAP.

RESULTS:
The CLC maintained MAP within 5 mm Hg of the target for (mean ± standard deviation) 93.5% ± 3.9% of the time versus 72.4% ± 26.8% for the MD treatment (P = .054). The mean (standard deviation) percentage of time that the CLC and MD interventions were above target range was 2.1% ± 3.3% and 25.8% ± 27.4% (P = .06), respectively. Control statistics, performance error, median performance error, and median absolute performance error were not different between CLC and MD interventions. PHP infusion rate adjustments by the physician were performed 12 to 80 times in individual studies over a 60-minute period. The total dose of PHP used was not different between the 2 interventions.

CONCLUSIONS:
The CLC system performed as well as an anesthesiologist totally focused on MAP control by infusing PHP. Computerized CLC infusion of PHP provided tight blood pressure control under conditions of experimental vasodilation.
Closed-Loop Feedback Computer-Controlled Phenylephrine for Maintenance of Blood Pressure During Spinal Anesthesia for Cesarean Delivery: A Randomized Trial Comparing Automated Boluses Versus Infusion
Authors: Ngan Kee Warwick D. , Tam Yuk-Ho , Khaw Kim S. , Ng Floria F. , Lee Shara W. Y. 
Published: April 2017

BACKGROUND:
We previously described the use of closed-loop feedback computer-controlled infusion of phenylephrine for maintaining blood pressure (BP) during spinal anesthesia for cesarean delivery. In this study, we report a modified system in which phenylephrine is delivered by intermittent boluses rather than infusion. We hypothesized that the use of computer-controlled boluses would result in more precise control of BP compared with infusions.

METHODS:
Two hundred fourteen healthy patients having spinal anesthesia for elective cesarean delivery were randomized to have their systolic BP maintained by phenylephrine administered by computer-controlled continuous infusion or computer-controlled intermittent boluses. From induction of anesthesia until the time of uterine incision, a noninvasive BP monitor was set to cycle at 1-minute intervals. In the infusion group, the infusion rate was automatically adjusted after each BP measurement using a previously described algorithm. In the bolus group, the algorithm was modified so that the mass of drug that would have been delivered over 1 minute was instead injected as a rapid intravenous bolus after each BP measurement. The precision of BP control was assessed using performance error calculations and compared between groups, with the primary outcome defined as median absolute performance error, and the latter being a measure of inaccuracy showing an average of the magnitudes of the differences of measured BP values above or below the target values.

RESULTS:
The precision of BP control was greater, as shown by smaller values for median absolute performance error, in the bolus group (median 4.38 [quartiles 3.22, 6.25] %) versus the infusion group (5.39 [4.12, 7.04] %, P = .008). In the bolus group, phenylephrine consumption was smaller; this was associated with smaller values for median performance error compared with the continuous infusion group (P < .001), which indicates that values for systolic BP, averaged over time, were slightly lower in the bolus group. There were no differences in cardiac output, nausea or vomiting, or neonatal outcome between groups.

CONCLUSIONS:
We confirmed the hypothesis that BP control was more precise when computer-controlled phenylephrine was delivered using intermittent boluses rather than continuous infusion. However, the difference between groups was small and was not associated with any difference in clinical outcomes. In the infusion group, greater doses of phenylephrine were delivered, which was related to the time taken for the noninvasive BP monitor to complete measurements. The use of intermittent boluses may be a useful alternative in the design of closed-loop vasopressor systems.