bluuebunny/crossref_metadata_2025_split huggingface dataset:
Peritoneal Microdialysis. Earlydiagnosis of Anastomotic Leakage after Low Anterior Resection for Rectosigmoid Cancer
Authors: Pedersen M. Ellebæk , Qvist N. , Bisgaard C. , Kelly U. , Bernhard A. , Pedersen S. Møller 
Published: January 2017

Background: The aim of the present study was to evaluate the efficacy and safety of intraperitoneal microdialysis in early detection of anastomotic leakage after low anterior resection for rectosigmoid cancer. Methods: In a series of 116 consecutive patients scheduled for low anterior resection for rectosigmoid cancer, a total of 50 patients consented to participate. Peritoneal microdialysis was performed by a 1 mm thin catheter anchored in close proximity to the anastomosis. Five patients were excluded due to catheter malfunction. Average microdialysis time in the remaining 45 patients was 177.6 (80–252) hours. Samples were collected every 4-hours, and the concentration of glucose, lactate, pyruvate and glycerol was measured. Results: Four patients developed symptomatic anastomotic leakage. Two patients developed non-abdominal sepsis. In 38 patients the postoperative course was uncomplicated, considering major complications, and they served as controls. In three patients with late (≥ 10 days) anastomotic leakage a significant increase in concentration of lactate and lactate/pyruvate ratio (L/P-ratio) was seen several days prior to development of clinical symptoms. In one patient with early anastomotic leakage it coincided with the development of clinical symptoms. In the two patients with non-abdominal sepsis the values were within normal range. Conclusion: Peritoneal microdialysis is a safe and promising tool in early diagnosis of anastomotic leakage after low anterior resection for rectosigmoid cancer.
Modeling the Length of the Care Episode after Hip Fracture: Does the Type of Fracture Matter?
Authors: Sund R. , Riihimäki J. , Mäkelä M. , Vehtari A. , Lüthje P. , Huusko T. , Häkkinen U. 
Published: January 2017

Background and Aims: Hip fractures are common events that require intensive operative hospital care and a lengthy rehabilitation. The effect of hip fracture type on successful rehabilitation is not well known. The aim of this study is to model and compare the length of the care episodes between intra- and extracapsular hip fractures in Finland. Material and Methods: 15544 hip fracture patients living at home in Finland 1998–2001 were followed using register-based data. Patient characteristics, outcomes, and length of stay (LOS) distributions were analyzed using a Bayesian nonparametric multilayer perceptron (MLP) network model. Results: Mortality was similar in intra- and extracapsular hip fractures. Patients were more likely to need long-term care after extracapsular hip fracture. The average LOS at the surgical ward was similar for intra- and extracapsular fractures (1.7 weeks), but there was a considerable difference for the total inpatient LOS between the groups (5.2 weeks vs. 6.9 weeks). Intracapsular fractures had a simple unimodal LOS distribution, whereas the LOS distribution for the extracapsular fractures was multimodal with two clear peaks. Patients with more comorbidities required a longer LOS. Conclusions: The causes for differences in LOS between fracture types were most likely due to the different surgical methods and rehabilitation practices for the fracture types. As national guidelines suggest similar rehabilitation for all hip fracture patients, there is a need for early and aggressive rehabilitation of patients with extracapsular fractures, including full-weight bearing for all but selected patients.
Sub-Lobar Lung Resection of Peripheral T1N0M0 NSCLC Does Not Affect Local Recurrence Rate
Authors: De Giacomo T. , Stasio M. Di , Diso D. , Anile M. , Venuta F. , Coloni G. Furio 
Published: January 2017

Background and Aims: The use of sub-lobar resection versus lobectomy for stage I non small cell lung cancer is still controversial. This study was undertaken to compare the results of limited resection in terms of survival and local recurrence rate to lobectomy in patients with peripheral stage I non small cell lung cancer. Material and Methods: During the 8 year period from 1999 to 2007, 152 consecutive patients with stage I non-small cell lung cancer underwent lung resection at our thoracic surgery unit. In 116 cases we performed a standard lobectomy while in the remaining 36 cases we did sub lobar resection through mini-thoracotomy or video-assisted thoracoscopy. The survival, local recurrence rate and the clinical outcome were analyzed and compared. Results: Fifty-one patients were staged as T1 N0 M0, 22 in the sub-lobar resection group (61,1%) and 29 (25%) in the lobectomy group. The remaining were staged as T2 N0 M0. Although the patient population undergone to sub-lobar resection was older, with poorer lung function and more co-morbidities, the Kaplan-Meier survival proportion at 5 year did not differ significantly between the two groups: 64% for lobectomy group vs 66,7% for sub-lobar resection group. Overall local recurrence did approach significance in favour of lobectomy group but analyzing only T1 patients, no differences in terms of survival and local recurrence rate were observed. Conclusions: The results of this study indicate that in patients with peripheral T1N0M0 non small cell lung cancer the outcome of limited resection is comparable with that of pulmonary lobectomy.
Kidney Graft Survival in Italy and Factors Influencing it
Authors: Pugliese Orsola , Quintieri Francesca , Mattucci Dino Alberto , Venettoni Sante , Taioli Emanuela , Costa Alessandro Nanni 
Published: January 2017

Purpose National registry data are often a suitable basis for examination of transplant outcomes. Using data supplied by the Italian National Transplant Registry, established in 1995, we performed the first nationwide analysis of this kind. Methods A retrospective analysis of 4893 recipients of cadaveric kidneys transplanted in all Italian centers from 1995 through 2000 was done to study 5-year graft survival. The association between some donor and recipient variables and outcomes in renal transplantation was analyzed. Graft survival was 93% at 3 months, 89% at 1 year, 82% at 3 years, and 80% at 5 years after transplantation. Results A significant association between graft survival and donor age (old vs young, relative risk [RR] = 1.62, 95% CI 1.27–2.06) and recipient age (old vs young, RR = 1.25, 95% CI 1.02–1.53). Graft survival was also associated with cold ischemia time (24–36 hours, RR=1.39, 95% CI 1.05–1.85 and >36 hours, RR=1.94, 95% CI 1.32–2.86 vs 0–24 hours) and donor/recipient sex mismatch (female/male vs male/male, RR=1.50, 95% CI 1.17–1.93). Conclusion The quality of kidney transplantation in Italy is satisfactory and is comparable to that in other developed countries. Furthermore, our experience confirms that both donor and recipient factors are major determinants of renal allograft function.
An International Perspective: Job Satisfaction among Transplant Nurses
Authors: Russell Cynthia L. , Van Gelder Frank 
Published: January 2017

Context The high demand for transplant nurses across the world leads us to examine job design and job satisfaction because job satisfaction is linked to better outcomes for patients. Objective To describe international transplant nurses' perspectives of job design and job satisfaction by using Herzberg's theory of motivation. Methods Descriptive, correlational design. An electronic version of the Job Design and Job Satisfaction survey was mailed to all members of the International Transplant Nurses Society. Results A total of 331 members of the International Transplant Nurses Society responded to the survey. The mean age of respondents was 44.12 years, they had worked a mean of 19.12 years in nursing and 10.22 years in transplantation, and 50.6% of respondents were transplant nurse coordinators. Respondents were very satisfied overall with their jobs; they perceived that transplant nursing requires a high level of nonrepetitive, complex skills, autonomy in personal initiative and judgment, cooperation and collaboration with others, and that the job allows for completion of the work. Respondents were satisfied with pay, fringe benefits, and supervision. The feeling that the job could positively and significantly affect others was very strong. Conclusions Results of this study provide empirical evidence supporting the perceived benefits and challenges of working in transplantation and support Herzberg's theory that motivators leading to job satisfaction include achievement, recognition, the work itself, responsibility, and advancement. Transplant nursing includes many of these motivators and desirable characteristics, including autonomy and working with a multidisciplinary team on a clear, patient-centered goal.
Optimal Transplant Education for Recipients to Increase Pursuit of Living Donation
Authors: Waterman Amy D. , Barrett Ann C. , Stanley Sara L. 
Published: January 2017

Context Inadequate transplant education may stop kidney patients from beginning or completing evaluation or limit recipients from considering living donation. Objective To learn about recipients' decision making about living donation and preferred transplant education resources. Design Retrospective, cross-sectional survey. Patients—304 kidney recipients. Main Outcome Measures Living donation comfort, concerns, education preferences. Results Recipients spent 10 median hours learning about transplant, primarily by speaking to medical staff (2–3 hours) and reading transplant brochures (0–1 hour). Twelve percent had not received any education before coming to the transplant center. At least 75% wanted education discussing the evaluation, surgery, and medical tests required of recipients and donors, as well as common transplant-related fears. Recipients who received living donor transplants were more interested in information about donors' evaluation ( P< .001), surgery ( P< .001), medical tests ( P< .001), and donation concerns ( P= .004) than were other recipients. Recipients who had living donors evaluated were more comfortable accepting family members or friends who volunteered rather than asking potential donors because of concerns about pressuring donors (85%), harming their health (83%), or causing them pain or inconvenience (76%). Besides providing accurate medical information, education that addresses recipients' fears about transplantation, explains living donors' donation experiences, and teaches patients how to pursue living donation may increase recipients' pursuit of living donation.
Living Kidney Donation among Hispanics: A Qualitative Examination of Barriers and Opportunities
Authors: Alvaro Eusebio M. , Siegel Jason T. , Turcotte Dana , Lisha Nadra , Crano William D. , Dominick Alexander 
Published: January 2017

Context Despite their increasing need for kidneys and low nonliving donation rates, minimal research has been conducted to ascertain the perceptions of Hispanic Americans about living organ donation and the process of asking for such a donation. Objective To examine perceptions of Hispanics regarding barriers to and benefits of living donation as well as the process of asking someone to be a living donor. Design A qualitative study consisting of 10 focus groups conducted in 2 series. Participants Adult Spanish-language-dominant Hispanic members of the general population of Tucson, Arizona. Results The main barriers to living organ donation were a lack of knowledge or information and fear of the donation process. Knowing that one has helped save or improve another's life was the central benefit. Most participants reported being willing to ask a relative to be a living donor if they were ever in need. Two main responses typified these individuals: no concern about asking because of a strong desire to fight for one's health and for one's family, or asking despite difficulties and concerns about the process. A significant minority of participants indicated they would not ask for a donation, because of either a desire to avoid harming others or the expectation that a relative would initiate an offer.
Effects of Information, Education, and Communication Training about Organ Donation for Gatekeepers: Clerks at the Department of Motor Vehicles and Organ Donor Registries
Authors: Harrison Tyler R. , Morgan Susan E. , Corcia Mark J. Di 
Published: January 2017

Context Clerks at the Department of Motor Vehicles (DMV) serve as gatekeepers in the quest to fill organ donor registries. Most people who join organ donor registries do so through their local driver's license bureau. Objective To improve knowledge, attitudes, and behavior toward organ donation among DMV clerks, and to improve strategies for communicating with the public about organ donation, resulting in more people joining DMV-based organ donor registries. Setting DMV offices in 8 counties in a southern state. Participants A general survey of 1504 participants in 8 counties was conducted to assess knowledge, attitudes, beliefs, and behaviors toward organ donation. All 76 DMV clerks in those counties participated in surveys before and after a training intervention. Interventions DMV clerks received a 1-hour training intervention focused on the nature of the new organ donor registry, information about organ donation, and communication strategies for interacting with the public. Main Outcome Measures Knowledge, attitudes, beliefs, behaviors, and behavioral intentions toward organ donation were measured for the general public survey and for DMV clerks. Results Clerks were more knowledgeable about brain death and religious stances on organ donation than the general public, but otherwise both groups shared similar knowledge, attitudes, beliefs, behaviors, and behavioral intentions toward organ donation. Overall the general public and clerks had favorable attitudes toward organ donation but low to moderate knowledge, beliefs, and behaviors and behavioral intentions. Training significantly increased DMV clerks' knowledge, attitude, beliefs, and behavioral intention toward donation. Organ donor registration rates were a mean of 14% higher in counties where clerks were trained than in control counties and were 9% higher than statewide. Conclusions Training DMV clerks is an effective way to increase knowledge, attitudes, and beliefs for gatekeepers of organ donor registries and may increase donor registration rates among the public.
The Kidney Transplant Failure Experience: A Longitudinal Case Study
Authors: Gill Paul , Lowes Lesley 
Published: January 2017

Purpose To explore participants' experiences of kidney transplant failure. Background Kidney transplants are effective and efficient but not without complications. About 7% to 12% of kidney transplants fail within a year, and rates of failure increase over time. Graft failure can have profound effects, often resulting in depression and, occasionally, suicidal feelings. Despite these issues, the personal dimensions of graft failure have been poorly researched. Methods One donor-recipient couple experienced irreversible graft rejection immediately after a kidney transplant. This article is a longitudinal case study of this family's experiences. Data were collected through 3 semistructured interviews, conducted before the transplant and at 3 and 10 months after the transplant. Interviews were recorded, transcribed verbatim, and data coded into categories arising from the participants' accounts. Results Transplantation represented a significant source of hope. Fear of transplant failure was a major concern, but was dealt with by using emotion-focused coping mechanisms. Graft rejection was devastating, causing feelings of grief, loss, suicide, and depression. Depression improved as physical health and a sense of personal control improved. The recipient felt inadequately prepared for graft failure and poorly supported by health professionals. Conclusion The primary source of grief and depression appeared to be related to the recipient's “loss of imagined future” (ie, the life that she anticipated after transplant). Study findings have potential implications for the provision of care, i nformation, and support for patients and their families before and after transplantation and for future related research.
Improving Donation Outcomes: Hospital Development and the Rapid Assessment of Hospital Procurement Barriers in Donation
Authors: Siminoff Laura A. , Traino Heather M. 
Published: January 2017

Context Deficiencies in the donation process continue to contribute to the shortage of organs available for transplant. Continuous quality improvement of hospitals' donation processes is needed to identify and correct the problems. Objective To test the Rapid Assessment of Hospital Procurement Barriers in Donation (RAPiD), a direct observation technique with a focused ethnographic strategy, for assessing hospitals' donation processes and identifying areas in need of continuous quality improvement interventions. Design A pre-post assessment of hospitals' barriers to patient identification and referral, and family consent to donation. Setting and Participants Seventeen hospitals within the catchment area of a Northeastern organ procurement organization were assessed by using the RAPiD method. Hospital administrators, health care providers, and staff (N = 537) were interviewed as part of the assessments. Intervention Interventions, including on-site training and education, and the use of in-house coordinators, were specifically tailored to each hospital's unique set of barriers to donation. The interventions were delivered to the hospitals in the form of recommendations. The participating organ procurement organization was responsible for implementation of the interventions. Results The RAPiD hospital evaluations revealed gaps in respondents' knowledge of organ donation, brain death, and referral criteria; a reluctance to declare brain death; and a rocky relationship between the hospitals and the organ procurement organization. As a result of the interventions, 9 hospitals' environments for organ donation improved, 7 showed no change, and 1 was worse.
Relevance of Occlusion Test in Endovascular Coiling of Posterior Cerebral Artery (P2 Segment) Aneurysms
Authors: Jayakumar P. N. , Desai S. , Srikanth S. G. , Ravishankar S. , Kovoor J. M. E. 
Published: January 2017

P2 segment aneurysms are located on the posterior cerebral artery (PCA) between the junction of the posterior communicating artery with the PCA and the quadrigeminal cisternal part of the PCA. We reviewed our experience with endovascular coiling in such aneurysms. Clinical and pre-procedural data from four patients, referred for endovascular treatment of P2 segment aneurysms, were retrospectively studied for factors influencing post-interventional neurological deficits caused by ischemia of the PCA distal territory. Balloon occlusion was done in three patients and patient tolerance was assessed using clinical and anatomic criteria. Embryologic and anatomic features of the PCA were reviewed. Balloon occlusion test and endovascular coiling of aneurysms was possible in three patients. Control angiogram after embolization showed elimination of aneurysms from the circulation and the distal PCA filled through leptomeningeal anastomoses. One patient deteriorated due to aneurysmal rupture soon after the balloon occlusion test and coiling could not be done. In the other three patients post-intervention CT and MRI images showed PCA territory infarcts in spite of demonstration of good collateral circulation distal to the occluded PCA. In conclusion, P2 aneurysms can be effectively treated by endovascular coiling without a balloon occlusion test. While the balloon occlusion test does not contribute to clinical decision-making it may be associated with potential morbidity and mortality.
Metachronous Multiplicity of Spinal Cord Arteriovenous Fistula and Spinal Dural AVF in a Patient with Hereditary Haemorrhagic Telangiectasia
Authors: Ling J.C.M. , Agid R. , Nakano S. , Souza M.P.S. , Reintamm G. , terBrugge K.G. , Kim Taik-Kun 
Published: January 2017

HHT (Hereditary Haemorrhagic Telangiectasia or Rendu Osler Weber disease) is a known autosomal dominant dysplasia. The first clinical presentation of HHT in a child may be a cerebral or spinal AVM. We present the case of a young boy with HHT who had a previous spinal cord AVF treated by surgical obliteration and then presented with a spinal dural AVF nine months later. This patient had surgical obliteration of a spinal cord perimedullary AVF and subsequently developed a new spinal dural AVF at a different level. The diagnosis was made by spinal MR imaging and spinal angiography
Traumatic Bilateral Common Carotid Artery Dissection Due to Strangulation
Authors: Chokyu I. , Tsumoto T. , Miyamoto T. , Yamaga H. , Terada T. , Itakura T. 
Published: January 2017

We report a case of bilateral common carotid artery dissection due to strangulation successfully treated by stent placement, with a review of the literature. A 61-year-old woman was strangled by an apron strap. She was admitted to our hospital with tetraparesis, because of spinal cord injury. On the next day, her left hemiparesis aggravated and left facial palsy newly appeared. Diffusion weighted magnetic resonance imaging (MRI) showed new ischemic lesions in the right cerebral hemisphere. Aortography revealed bilateral common carotid artery dissection. Moreover, thrombus or intimal flap was recognized in the right common carotid artery. The right common carotid dissection was fixed with deployment of self expanding stents to prevent the aggravation of ischemic stroke at that time. The contralateral lesion was also treated ten days later because small ischemic lesions were newly recognized in the left hemisphere on MRI. No new neurological deficit appeared after bilateral carotid artery stenting. Her paraparesis completely improved two months after the spinal cord injury. Carotid artery stenting using self expanding stents was especially effective as the treatment for bilateral carotid artery dissection.
Pathological Result of Basilar Artery Stenosis Rapidly Progressed and Ruptured with Stent-Assisted Angioplasty
Authors: Nagashima H. , Naito K. , Oya F. , Koyama J. 
Published: January 2017

Intracranial artery angioplasty utilizing coronary stent is now widely tried as an effective alternative for treating intracranial artery stenosis, and several successful result of stent-assisted angioplasty for intracranial artery were reported. Authors experienced a case of the basilar artery stenosis, in which re-stenosis progressed rapidly after simple balloon angioplasty and resulted in vessel rupture during stent-assisted angioplasty. Pathological result achieved by autopsy showed vessel wall disruption at the stent and multiple interruptions and defect of elastic laminar.