bluuebunny/crossref_metadata_2025_split huggingface dataset:
Palliative care education for medical students: Differences in course evolution, organisation, evaluation and funding: A survey of all UK medical schools
Authors: Walker Steven , Gibbins Jane , Paes Paul , Adams Astrid , Chandratilake Madawa , Gishen Faye , Lodge Philip , Wee Bee , Barclay Stephen 
Published: October 2016

Background: A proportion of newly qualified doctors report feeling unprepared to manage patients with palliative care and end-of-life needs. This may be related to barriers within their institution during undergraduate training. Information is limited regarding the current organisation of palliative care teaching across UK medical schools. Aims: To investigate the evolution and structure of palliative care teaching at UK medical schools. Design: Anonymised, web-based questionnaire. Settings/participants: Results were obtained from palliative care course organisers at all 30 UK medical schools. Results: The palliative care course was established through active planning (13/30, 43%), ad hoc development (10, 33%) or combination of approaches (7, 23%). The place of palliative care teaching within the curriculum varied. A student-selected palliative care component was offered by 29/30 (97%). All medical schools sought student feedback. The course was reviewed in 26/30 (87%) but not in 4. Similarly, a course organiser was responsible for the palliative care programme in 26/30 but not in 4. A total of 22 respondents spent a mean of 3.9 h (median 2.5)/week in supporting/delivering palliative care education (<1–16 h). In all, 17/29 (59%) had attended a teaching course or shared duties with a colleague who had done so. Course organisers received titular recognition in 18/27 (67%; no title 9 (33%); unknown 3 (11%)). An academic department of Palliative Medicine existed in 12/30 (40%) medical schools. Funding was not universally transparent. Palliative care teaching was associated with some form of funding in 20/30 (66%). Conclusion: Development, organisation, course evaluation and funding for palliative care teaching at UK medical schools are variable. This may have implications for delivery of effective palliative care education for medical students.
Minimally Invasive Double-Button Fixation of Displaced Lateral Clavicular Fractures in Athletes
Authors: Ranalletta Maximiliano , Rossi Luciano A. , Barros Hugo , Nally Francisco , Tanoira Ignacio , Bongiovanni Santiago L. , Maignon Gastón D. 
Published: October 2016

Background: Early union and a rapid return to prior function are the priorities for young athletes with lateral clavicular fractures. Furthermore, it is essential to avoid nonunion in this subgroup of patients, as this is frequently associated with persistent pain, restriction of movement, and loss of strength and endurance of the shoulder. Purpose: To analyze the time to return to sport, functional outcomes, and complications in a group of athletes with displaced lateral clavicular fractures treated using closed reduction and minimally invasive double-button fixation. Study Design: Case series; Level of evidence, 4. Methods: A total of 21 athletes with displaced lateral clavicular fractures were treated with closed reduction and minimally invasive double-button fixation between March 2008 and October 2013. Patients completed a questionnaire focused on the time to return to sport and treatment course. Functional outcomes were assessed with the Constant score and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Pain was evaluated with the visual analog scale (VAS). Radiographs were reviewed to identify radiographic union, malunion, and nonunion. Results: Of the 21 study patients, 20 returned to sport after treatment; 100% returned to the same level. The mean time to return to play was 78 days (range, 41-120 days). Four patients (20%) returned to sport less than 6 weeks after surgery, 14 (70%) returned between 6 and 12 weeks after surgery, and 2 (10%) returned after 12 weeks. The mean Constant score was 89.1 ± 4.2 (range, 79-100), the mean QuickDASH score was 0.4 ± 2.6 (range, 0-7.1), and the mean VAS pain score was 0.4 ± 1.0 (range, 0-3) at final follow-up (mean, 41 months). The only complication was asymptomatic nonunion. Hardware removal was not necessary in any patient. Conclusion: Closed reduction and minimally invasive double-button fixation of displaced lateral clavicular fractures in athletes was successful in terms of returning to the previous level of athletic activity regardless of the type of sport, with excellent clinical results and a low rate of complications.
Influence of female sex and fertile age on neuromyelitis optica spectrum disorders
Authors: Borisow Nadja , Kleiter Ingo , Gahlen Anna , Fischer Katrin , Wernecke Klaus-Dieter , Pache Florence , Ruprecht Klemens , Havla Joachim , Krumbholz Markus , Kümpfel Tania , Aktas Orhan , Ringelstein Marius , Geis Christian , Kleinschnitz Christoph , Berthele Achim , Hemmer Bernhard , Angstwurm Klemens , Weissert Robert , Stellmann Jan-Patrick , Schuster Simon , Stangel Martin , Lauda Florian , Tumani Hayrettin , Mayer Christoph , Zeltner Lena , Ziemann Ulf , Linker Ralf A , Schwab Matthias , Marziniak Martin , Then Bergh Florian , Hofstadt-van Oy Ulrich , Neuhaus Oliver , Winkelmann Alexander , Marouf Wael , Rückriem Lioba , Faiss Jürgen , Wildemann Brigitte , Paul Friedemann , Jarius Sven , Trebst Corinna , Hellwig Kerstin ,   on behalf of NEMOS (Neuromyelitis Optica Study Group)
Published: October 2016

Background: Gender and age at onset are important epidemiological factors influencing prevalence, clinical presentation, and treatment response in autoimmune diseases. Objective: To evaluate the impact of female sex and fertile age on aquaporin-4-antibody (AQP4-ab) status, attack localization, and response to attack treatment in patients with neuromyelitis optica (NMO) and its spectrum disorders (neuromyelitis optica spectrum disorder (NMOSD)). Methods: Female-to-male ratios, diagnosis at last visit (NMO vs NMOSD), attack localization, attack treatment, and outcome were compared according to sex and age at disease or attack onset. Results: A total of 186 NMO/SD patients (82% female) were included. In AQP4-ab-positive patients, female predominance was most pronounced during fertile age (female-to-male ratio 23:1). Female patients were more likely to be positive for AQP4-abs (92% vs 55%; p < 0.001). Interval between onset and diagnosis of NMO/SD was longer in women than in men (mean 54 vs 27 months; p = 0.023). In women, attacks occurring ⩽40 years of age were more likely to show complete remission ( p = 0.003) and better response to high-dose intravenous steroids ( p = 0.005) compared to woman at >40 years. Conclusion: Our data suggest an influence of sex and age on susceptibility to AQP4-ab-positive NMO/SD. Genetic and hormonal factors might contribute to pathophysiology of NMO/SD.
Isolated unilateral absence of the right pulmonary artery in two cats visualized by computed tomography angiography
Authors: Jordan Tyler JM , Scansen Brian A , Kent Agnieszka M , Hitchcock Lora S , Russell Duncan S 
Published: October 2016

Case series summary Two cats were evaluated for progressive exercise intolerance, dyspnea and unilateral infiltrate of the left lung. Computed tomography angiography (CTA) revealed absence of the right pulmonary artery in both cats with systemic arterial collateral vessels perfusing the right segmental pulmonary arteries. In one case, the collateral vessels arose from the esophageal artery, while in the other case they derived off the right costocervical trunk. One cat was diagnosed with pulmonary hypertension and was euthanized owing to progressive respiratory distress despite medical management with sildenafil, pimobendan, clopidogrel and furosemide. The other cat, without echocardiographic evidence of pulmonary hypertension, was successfully managed with furosemide and enalapril for more than 4 years. Relevance and novel information CTA allowed visualization of a rare congenital heart malformation, unilateral absence of the right pulmonary artery, in two cats and accurately characterized the source of collateral blood supply to the affected lung. Severe pulmonary hypertension may be a negative prognostic factor in cats with this condition as medical therapy in the cat without evidence of pulmonary hypertension resolved clinical signs, while the cat with severe pulmonary hypertension died from the disease.
A Novel Method for Measurement of Ankle Joint Reaction Force and Response to Syndesmotic Injury
Authors: Kelly Meghan , Maqsoodi Noorullah , Vasconcellos Daniel , Osman Walid , Oh Irvin C. , Fowler Xavier , Elfar John C. , Olles Mark , Ketz John 
Published: October 2016

Category: Ankle. Introduction/Purpose: Increasing evidence has suggested that alterations in joint mechanics results in articular pathology. Previous studies demonstrated noninvasive measurements of joint reactive forces (JRF) can be performed reliably without destruction of the peri-articular soft tissue in medium and small size joints of the upper extremity. This study presents a novel, noninvasive measurement of the JRF to investigate the normal and the effects of a syndesmotic injury. The JRF of the tibiotalar joint was also evaluated following anatomic reduction with fixation and malreduction of the syndesmosis. Methods: Eight fresh-frozen human cadaveric lower extremity limbs were obtained disarticulated above the knee. A distraction force was applied across the tibio-talar joint to determine the baseline (normal) ankle force displacement curve. Next, a syndesmotic injury was created by releasing the interosseous syndesmotic ligaments, the transverse tibiofibular ligament and the anterior and posterior tibiofibular ligaments. Prior to sectioning, two drill holes were placed across the joint and tapped to ensure anatomic reduction. JRF were measured using a quadricortical technique with a single or double screw configuration. The syndesmosis was malreduced by anteriorly displacing the fibula 5 mm. After each step, the resultant JRFs were determined using a distraction force across the tibiotalar joint. Results: Force displacement curves obtained from multiple measurements from each specimen with a mean ankle JRF of 31.4 + 2.6 N. Syndesmotic injury resulted in a 35% decrease in tibiotalar JRF (20.3 + 3.0 N, p=0.002). Fixation of the injury using one syndesmotic screw resulted in significant increase in JRF compared to injury JRF (28.7 + 1.4 N, p=0.02). Syndesmotic fixation with 2 screws also demonstrated a trend towards restoration of tibiotalar JRF (28.3 + 2.2 N, p=0.06). There was no statistical difference between fixation of one versus two syndesmotic screws. The JRF for the malreduced syndesmosis was 31.5 + 1.8 N (p=0.03,) resulting in increased forces approaching the baseline JRF. Conclusion: This study demonstrates a non-destructive model by which to measure joint reactive forces (JRF) across the tibiotalar joint and that these forces are diminished as a result of a syndesmotic injury, suggesting joint instability. Surgical stabilization with either 1 or 2 screws creates JRF that are similar to the normal JRF. Even with a malreduced syndesmosis, there appeared to be a JRF similar to baseline tibiotalar joint forces. However malreduction of the syndesmosis may alter the joint dynamics of the ankle in ways that were not measured in this study.
Clinical Trial of Osteochondral Lesion of Talus Treated with Human Mesenchymal Stem Cell
Authors: Sung Ki Sun , Yim Hyun Seok , Hong Sung-Ha 
Published: October 2016

Category: Ankle. Introduction/Purpose: The aim of surgery for osteochondral lesion of talus is to restore the damaged articular surface with a nearly normal cartilage and supporting subchondral bone. The operative treatment paradigms are still controversial. Though arthroscopic bone-marrow stimulation, autologous osteochondral transplantion and chondrocyte implantation have been performed, but the limitations of these techniques necessitate innovative methods such as cell-based treatment. We investigated the safety and efficacy of human umbilical cord-blood derived mesenchymal stem cell product (CartistemTM) in the treatment of symptomatic osteochondral lesion of the talus. Methods: Between Feb 2014 and March 2015, 25 symptomatic OLT patiens were enrolled and randomized into 2 groups with informed consents. They have all suffered from ankle pain more than 6 months despite of conservative treatment. The control group(12 patients) underwent the standard arthroscopic curettage and microfracture, and the study group(13 patients) had additional application of Cartistem on the defect after the same procedure. We measured and analyzed AOFAS ankle-hindfoot scale and MRI features of T2mapping, dGEMRIC, and MOCART scale as well as arthroscopic gross finding with ICRS(international cartilage repair society) scale at 48th week after the index surgery. Also any adverse reactions or complications were recorded. We acquired IRB approval and registered this study at clinicalTrial.gov as NCT02338375. Results: There was no adverse effect or complication related to procedures and test drug. Clinically AOFAS ankle-hindfoot score was improved significantly after surgery in both groups, but there was no difference between them. Radiologically both groups showed significant improvement of MRI features without any differences. However on second look arthroscopic exam there was a tendency of better regenerative pattern(ICRS gross finding) in study group. Conclusion: There was no adverse reaction and additional benefit of human mesenchymal stem cell product in treatment of symptomatic OLT. However in terms of arthroscopic findings, it might help better histologic regeneration. Further investigation with longer term follow-up can guarantee its usefulness in treatment of OLT.
Prospective Evaluation of Structural Allograft Transplantation for Osteochondral Lesions of the Talar Shoulder
Authors: Adams Samuel B. , Schiff Adam P. , Gross Christopher E. , Nunley James A. , Easley Mark E. 
Published: October 2016

Category: Ankle. Introduction/Purpose: The management of large osteochondral lesions of the talar shoulder remains a clinical challenge. Their size, three-dimensional geometry, and subchondral cystic degeneration often preclude treatment with traditional measures such as microfracture and osteochondral autograft transplantation. Structural or bulk osteochondral allograft transplantation has demonstrated efficacy in several retrospective reviews. The purpose of this study was to prospectively evaluate patients who received fresh structural allograft transplantation to the talus. Methods: A prospective evaluation of consecutive patients who underwent fresh structural allograft transplantation for an OLT form 2010 to 2013 was performed under Institutional Review Board approval. All patients failed a minimum of 6 months of conservative management. Preoperative MRI and/or CT, as well as plain radiographs were obtained on all patients. The following patient reported outcomes questionnaires were administered preoperatively and yearly after surgery: 100 mm VAS pain scale, AOFAS Ankle-Hindfoot Scale, SF-36, and the Short Musculoskeletal Functional Assessment (SMFA). Pre- and postoperative radiographs were assessed for allograft incorporation and the development of arthritis. Results: Fourteen patients underwent fresh osteochondral allograft transplantation. The mean follow-up was 47 months (range 24-73). The average size of the OLT was 2,269 mm3 (range 813-8,366) based on CT imaging and 5,797 mm3 (range 1,136-12,489) based on MRI imaging. There was significant improvement in the VAS pain score, AOFAS Ankle-Hindfoot Scale score, the SF-36 total score, and the SMFA functional and bother indices. Five (36%) of the patients required subsequent arthroscopy and removal of the screw(s) used to secure the graft. Three of these second-look patients had stable grafts without chondral damage. Two grafts demonstrated cartilage delamination. One of these patients had continued pain and progression of arthritis without additional surgery and one was converted to an ankle replacement. Therefore, the failure rate was 14%. Conclusion: Significant improvement in pain and function can be achieved with structural allograft transplantation for large OLTs. However, it is important to council patients that painful hardware and stiffness can occur in approximately one-third of patients. An unstable graft and cartilage delamination are indicators of subsequent failure. The use of a structural allograft does not preclude subsequent ankle arthrodesis or arthroplasty.
How do 5 Year Patient Reported Outcomes (PROMs) of Total Ankle Arthroplasty Compare to Total Hip and Knee Arthroplasty?
Authors: Ramaskandhan Jayasree R. , Rashid Anjum , Siddique Malik S. 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Ankle arthritis is a leading cause of pain and disability. The effect of this condition on physical and mental health is similar to end stage hip arthritis. There is paucity of literature on PROMS outcomes following total ankle replacements (TAR) in comparison to total hip replacement (THR) or knee replacement (TKR). We aimed to study the 5 year outcomes of TAR in comparison with TKR and THR Methods: PROMS data from patients who underwent a primary THR, TKR or TAR from March 2003 to 2013 were collected from our hospital patient registry. They were divided into 3 groups based on the type of primary joint replacement. Patient demographics and patient reported outcomes (WOMAC, SF-36 scores and patient satisfaction scores at follow up) were compared at pre-op and 5 year follow up. Results: There was data available on 1920 THR, 2582 TKR and 248 TAR patients. Pre-operatively, TAR patients reported higher function scores when compared to THR and TKR (40.2 vs. 34.2 and 35.8; p < 0.05). For SF-36 scores, there was no difference between groups for general health, role emotional components (P>0.05); TAR patients reported similar scores to TKRs for physical domains; to THRs for the mental domains (P>0.05). At 5 years post-op, TARs reported lower scores than THRs and TKRs for function and stiffness. For SF-36 scores, TARs reported similar outcomes to THR and TKR for mental health components (p>0.05), similar scores to TKR for 3/4 physical domains (p < 0.05), but lower satisfaction rates for ADL and recreation when compared to THR (P < 0.05). Conclusion: TAR patients had similar outcomes to THR or TKR patients for disease specific and mental health domains, and lower patient satisfaction rates in terms of pain relief, ADL and recreation. Further research is warranted including clinical outcomes along with PROMS with a long term follow up.
Secondary Fusions Following Total Ankle Arthroplasty
Authors: Gross Christopher E. , Adams Samuel B. , Huh Jeannie , Easley Mark E. , DeOrio James K. , Nunley James A. , Shi Glenn G. 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: While it is thought that stresses through the subtalar and talonavicular joints will be decreased in total ankle replacement (TAR) relative to ankle fusion, progressive arthritis or deformity of these joints may require a fusion after a successful TAR. However, after ankle replacement, it is unknown how hindfoot biomechanics and blood supply may have been affected. Consequently, subsequent hindfoot joint fusion may be adversely affected. We hypothesize that fusion rates are not significantly affected following a TAR. Methods: We retrospectively identified a consecutive series of 1001 primary TARs performed between January 1998 and December 2014. We identified patients who underwent a secondary triple, subtalar or talonavicular arthrodesis to treat progressive arthritis or pes planus deformity. Clinical outcomes including pain and functional outcome scores, revision procedures, delayed union, nonunion, complications, and failure rates were recorded. We then compared these patients to patients who had a subtalar fusion after an ankle arthrodesis (13). Results: 26 patients required a subtalar (18), talonavicular (3), talonavicular and subtalar (3), or triple arthrodesis (2) with a mean 70.9 months follow-up. The mean time between TAR and secondary fusion was 37.5 months. 92.7% of the patients went successfully fused. Two patients (7.7%) had a delayed union. Two patients had a nonunion who had one revision talonavicular and one revision subtalar fusion. The mean time to radiographic and clinical fusion was 26.5 weeks. Pain and functional outcome scores improved significantly. There were no differences in the rates of subsequent fusions among implant choices. Compared to thirteen patients with prior ipsilateral ankle arthrodeses and subtalar fusions, patients who had TAR had a higher fusion rate (p=0.03), but did not have a longer time to fusion. Conclusion: Hindfoot arthrodesis following a TAR is safe and effective in improving function and pain. Additionally, arthrodesis following a TAR is more successful than a subtalar fusion following an ankle arthrodesis. While the time to healing is relatively long, various hindfoot fusions can be used to treat progressive arthritis and deformity with high fusion rates.
Predictors of Time to Clinical Union in Ankle Fractures
Authors: Matson Andrew P. , Hamid Kamran S. , Adams Samuel B. 
Published: October 2016

Category: Ankle Introduction/Purpose: Ankle fractures are an increasingly common musculoskeletal injury and represent a substantial source of societal economic loss due to missed days of work and utilization of healthcare resources. While common protocols exist for postoperative management of these fractures, predictors of time to union have not been analyzed. We aim to evaluate patient characteristics, injury features and perioperative factors that predict time to union and may allow for optimized postoperative protocols and improved patient counseling. Methods: A cohort of consecutive patients with isolated, closed operative ankle fractures treated by multiple surgeons at a tertiary care academic medical center from 2008-2012 was retrospectively reviewed for time to clinical union. Clinical union was defined as plain film radiographic evidence of bony healing and minimal to no pain clinically. Patients with pilon fractures, open injuries, additional fractures and incomplete outcomes data were excluded from analysis. Means and standard deviations were calculated and multivariate linear regression modeling was utilized to identify predictors of time to clinical union. Results: A total of 108 isolated, closed operative ankle fractures met inclusion criteria. Of these, 99.1% achieved clinical union in less than 6 months and the remaining one patient completed union in a delayed fashion with the use of non-operative adjuncts. Mean time to union was 14.1 weeks (SD 5.3 weeks). Statistically significant negative predictors of time to union were BMI, dislocation of the tibiotalar joint, external fixation for initial stabilization and delay of definitive management (all p < 0.05). Sex, age, diabetes mellitus, tobacco usage and high-energy mechanism were not significant after adjustment (Table 1). Fracture pattern and definitive operative fixation technique did not contribute to a parsimonious regression model and were excluded from final analysis. Conclusion: Time to clinical union after ankle fracture is significantly correlated with BMI, tibiotalar dislocation, external fixation for initial stabilization and delay of definitive management. In these instances, it is important to counsel patients about the potential for nonunion and consideration should be given to healing adjuncts such as prolonged non-weightbearing immobilization, bone stimulation and vitamin D.