bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ergebnisqualität der Schlaganfallrehabilitation in der BAR-Phase D
Authors: Bussmann Marie-Luise , Neunzig Hans-Peter , Gerber Joachim , Steinmetz Jochen , Jung Svenja , Deck Ruth 
Published: January 2018

Zusammenfassung
Hintergrund Der Schlaganfall ist ein Krankheitsbild von hoher epidemiologischer Bedeutung. In Deutschland erleiden jährlich ca. 200 000 Menschen einen Schlaganfall. Der Schlaganfall ist nach Herz-Kreislauf- und Krebserkrankungen die häufigste Todesursache, gleichzeitig ist der Schlaganfall die Hauptursache für erworbene Behinderung im Erwachsenenalter. Rund ein Viertel der Schlaganfallüberlebenden ist 3 Monate nach dem Akutereignis von schweren Einschränkungen in den Aktivitäten des täglichen Lebens betroffen. Die häufigsten Schlaganfallfolgen sind Störungen im sensomotorischen, kognitiven und im emotional-affektiven Bereich. Bei der Bewältigung der Krankheitsfolgen kommt der Schlaganfallrehabilitation eine zentrale Bedeutung zu. Angesichts der großen Anzahl der Betroffenen und der teils gravierenden Folgen stellt sich die Frage, welche Teilhabezugewinne durch die medizinische Rehabilitation erreicht werden können.
Methodik Es wurde eine prospektive, multizentrische Beobachtungsstudie in 6 stationären neurologischen Rehabilitationseinrichtungen in Deutschland durchgeführt. Eingeschlossen wurden Rehabilitanden nach zerebrovaskulärem Akutereignis, die den Schweregrad der BAR-Phase D aufwiesen. Die Rehabilitanden wurden zu 3 Messzeitpunkten schriftlich befragt: zu Beginn und am Ende der Rehabilitation sowie 4 Monate nach deren Abschluss. Primäres Zielkriterium war Teilhabe, sekundäre Zielgrößen beinhalteten verschiedene Parameter des subjektiven Gesundheitserlebens. Darüber hinaus wurden die Nutzung von Nachsorgeangeboten und die Zufriedenheit mit der Rehabilitationsmaßnahme erfasst.
Ergebnisse Die Patienten weisen zu Beginn der Rehabilitation hohe Teilhabestörungen und deutliche Einschränkungen in allen erfassten sekundären Zielgrößen auf. Am Ende der Rehabilitation zeigen sich in allen Outcomeparametern signifikante Verbesserungen mit kleinem, bei der Teilhabe mit mittlerem Effekt. Zum Katamnesezeitpunkt reduzieren sich diese Effekte wieder, erreichen aber bis auf 2 der betrachteten Zielgrößen nicht die Ausgangswerte vor der Rehabilitation. Die Patienten bewerten sowohl den Reha-Aufenthalt als auch die Reha-Ergebnisse äußerst positiv. Zwei Drittel der Rehabilitanden erhalten eine Nachsorgeempfehlung, die meisten Rehabilitanden (83 %) nehmen eine Form der Nachsorge wahr.
Schlussfolgerungen Die Ergebnisse der Studie sprechen dafür, dass die Schlaganfallrehabilitation zu signifikanten und nachhaltigen Effekten führt. Insbesondere die Teilhabe scheint durch die Rehabilitation positiv beeinflusst zu werden. Der teilweise Rückgang der Effekte im Katamnesezeitraum wirft die Frage nach einer adäquaten Reha-Nachsorge auf.
The effect of pre-strain on tensile behaviour of 316L austenitic stainless steel
Authors: Peng Jian , Li Kaishang , Peng Jian , Pei Junfeng , Zhou Changyu 
Published: January 2018

The effect of pre-strain on tensile behaviour of 316L austenitic stainless steel was investigated, focusing on strain rate sensitivity, temperature sensitivity and strain hardening. Experimental data showed that strain rate sensitivity, temperature sensitivity and strain hardening were weakening with pre-strain. Meanwhile, the variation of microstructure with pre-strain was observed by optical microscopy, scanning electronic microscopy and X-ray diffraction. Then, the mechanical properties of pre-strained material were correlated with the increase in dislocation density and mechanical twinning with pre-strain. Finally, an improved Arrhenius-PS model considering the effect of pre-strain was developed. This paper is part of a thematic issue on Nuclear Materials.
Interventions to Engage Affective Forecasting in Health-Related Decision Making: A Meta-Analysis
Authors: Ellis Erin M , Elwyn Glyn , Nelson Wendy L , Scalia Peter , Kobrin Sarah C , Ferrer Rebecca A 
Published: January 2018

AbstractBackgroundPeople often use affective forecasts, or predictions about how a decision will make them feel, to guide medical and health decision making. However, these forecasts are susceptible to biases and inaccuracies that can have consequential effects on decision making and health.PurposeA meta-analysis was performed to determine the effectiveness of intervening to address affective forecasting as a means of helping patients make better health-related choices.MethodsWe included between-subjects experimental and intervention studies that targeted variables related to affective forecasting (e.g., anticipated regret, anticipated affect) as a means of changing health behaviors or decisions. We determined the overall effect of these interventions on targeted affective constructs and behavioral outcomes, and whether conceptual and methodological factors moderated these effects.ResultsA total of 133 independent effect sizes were identified from 37 publications (N = 72,020). Overall, affective forecasting interventions changed anticipated regret, d = 0.24, 95% confidence interval (CI) (0.15, 0.32), p &lt; .001, behavior, d = 0.29, 95% CI (0.13, 0.45), p &lt; .001, and behavioral intentions, d = 0.19, 95% CI (0.11, 0.28), p &lt; .001, all measured immediately postintervention. Interventions did not change anticipated positive and negative affect, and effects on intentions and regret did not extend to follow-up time points, ps &gt; .05. Generally, effects were not moderated by conceptual model, intervention intensity, or behavioral context.ConclusionsAffective forecasting interventions had a small consistent effect on behavioral outcomes regardless of intervention intensity and conceptual framework, suggesting such constructs are promising intervention targets across several health domains.
Pulsatile Hemodynamics Are Associated With Exercise Capacity in Patients With Exertional Dyspnea and Preserved Left Ventricular Ejection Fraction
Authors: Broufa Maria , Wassertheurer Siegfried , Hametner Bernhard , Zweiker Robert , Binder Ronald K , Weber Thomas 
Published: January 2018

Abstract

BACKGROUND
Pulsatile hemodynamics are associated with left ventricular filling pressures and diastolic dysfunction. We investigated their relationship with maximum workload and peak oxygen uptake (peak VO2) in patients with exertional dyspnea and preserved left ventricular ejection fraction (LVEF).

METHODS
Radial waveforms from tonometry were processed with a transfer function, pulse wave analysis and wave separation analysis, yielding central aortic pressures and measures of forward (amplitude of forward wave-Pf) and reflected waves (augmentation index-AIx, augmentation pressure-AP, amplitude of backward wave-Pb) and their ratio (reflection magnitude). Aortic pulse wave velocity (aoPWV) was estimated with a validated formula from single-point waveforms. Ergospirometry for assessment of exercise capacity was performed on a bicycle ergometer, using a ramp protocol.

RESULTS
Sixty-six patients were included (43 females; mean age 66 years; 83% hypertensives; mean body mass index 28.3 kg/m2). Mean peak VO2 was 17.0 ml/min/kg, mean achieved maximum workload 104.5 watts (80.9% of a reference population). Maximum workload and peak VO2 showed significant inverse relationships with AIx, AP, Pb, and aoPWV (r = −0.26 to −0.57). In multiple adjusted regression models, brachial and aortic pulse pressure, AP, Pf, Pb, and aoPWV were significant independent predictors of maximum workload, whereas AP, AIx75, Pf, Pb, and aoPWV were independently related to peak VO2.

CONCLUSIONS
Pulsatile hemodynamics are independently associated with objective measures of exercise capacity in patients with normal LVEF.
Closing the loop with an enhanced referral management system
Authors: Ramelson Harley , Nederlof Amanda , Karmiy Sam , Neri Pamela , Kiernan David , Krishnamurthy Rajlakshmi , Allen Adrienne , Bates David W 
Published: January 2018

Abstract

Objective
To evaluate the impact of a referral manager tool on primary care practices.

Materials and Methods
We evaluated a referral manager module in a locally developed electronic health record (EHR) that was enhanced to improve the referral management process in primary care practices. Baseline (n = 61) and follow-up (n = 35) provider and staff surveys focused on the ease of performing various steps in the referral process, confidence in completing those steps, and user satisfaction. Additional metrics were calculated that focused on completed specialist visits, acknowledged notes, and patient communication.

Results
Of 1341 referrals that were initiated during the course of the study, 76.8% were completed. All the steps of the referral process were easier to accomplish following implementation of the enhanced referral manager module in the EHR. Specifically, tracking the status of an in-network referral became much easier (+1.43 [3.91–2.48] on a 5-point scale, P &lt; .0001). Although we found improvement in the ease of performing out-of-network referrals, there was a greater impact on in-network referrals.

Discussion
Implementation of an electronic tool developed using user-centered design principles along with adequate staff to monitor and intervene when necessary made it easier for primary care practices to track referrals and to identify if a breakdown in the process occurred. This is especially important for high-priority referrals. Out-of-network referrals continue to present challenges, which may eventually be helped by improving interoperability among EHRs and scheduling systems.

Conclusion
An enhanced referral manager system can improve referral workflows, leading to enhanced efficiency and patient safety and reduced malpractice risk.
Which Clients are Deserving of Help? A Theoretical Model and Experimental Test
Authors: Jilke Sebastian , Tummers Lars 
Published: January 2018

Abstract
Street-level bureaucrats have to cope with high workloads, role conflicts, and limited resources. An important way in which they cope with this is by prioritizing some clients, while disregarding others. When deciding on whom to prioritize, street-level bureaucrats often assess whether a client is deserving of help. However, to date the notion of the deserving client is in a black box as it is largely unclear which client attributes activate the prevailing social/professional category of deservingness. This article, therefore, proposes a theoretical model of three deservingness cues that street-level bureaucrats employ to determine whom to help: earned deservingness (i.e., the client is deserving because (s)he earned it: “the hardworking client”), needed deservingness (i.e., the client is deserving because (s)he needs help: “the needy client”), and resource deservingness (i.e., the client is deserving as (s)he is probably successful according to bureaucratic success criteria: “the successful client”). We test the effectiveness of these deservingness cues via an experimental conjoint design among a nationwide sample of US teachers. Our results suggest that needed deservingness is the most effective cue in determining which students to help, as teachers especially intend to prioritize students with low academic performance and members of minority groups. Earned deservingness was also an effective cue, but to a lesser extent. Resource deservingness, in contrast, did not affect teachers’ decisions whom to help. The theoretical and practical implications of our findings for discretionary biases in citizen-state interactions are discussed.
Characteristics and Long-Term Outcome of 127 Children With Cerebral Arteriovenous Malformations
Authors: Oulasvirta Elias , Koroknay-Pál Päivi , Hafez Ahmad , Elseoud Ahmed Abou , Lehto Hanna , Laakso Aki 
Published: January 2018

Abstract

BACKGROUND
Population-based long-term data on pediatric patients with cerebral arteriovenous malformations (AVMs) are limited.

OBJECTIVE
To clarify the characteristics and long-term outcome of pediatric patients with AVM.

METHODS
A retrospective analysis was performed on 805 consecutive brain AVM patients admitted to a single center between 1942 and 2014. The patients were defined as children if they were under 18 yr at admission. Children were compared to an adult cohort. Changing patterns of presentation were also analyzed by decades of admission.

RESULTS
The patients comprised 127 children with a mean age of 12 yr. The mean follow-up time was 21 yr (range 0-62). Children presented more often with intracerebral hemorrhage (ICH) but less often with epilepsy than adults. Basal ganglia, cerebellar, and posterior paracallosal AVMs were more common in pediatric than in adult patients. Frontal and temporal AVMs, in contrast, were more common in adult than in pediatric patients. As the number of incidentally and epilepsy-diagnosed AVMs increased, ICH rates dropped in both cohorts. In total, 22 (82%) pediatric and 108 (39%) adult deaths were assessed as AVM related. After multivariate analysis, small AVM size and surgical treatment correlated with a favorable long-term outcome.

CONCLUSION
Hemorrhagic presentation was more common in children than in adults. This was also reflected as lower prevalence of epileptic presentation in the pediatric cohort. Lobar and cortical AVM locations were less frequent, whereas deep and cerebellar AVMs were more common in children. Hemorrhagic presentation correlated negatively with incidentally and epilepsy-diagnosed AVMs. In children, AVM was a major cause of death, but in adults, other factors contributed more commonly to mortality.
Reassessing the Duration of the Second Stage of Labor in Relation to Maternal and Neonatal Morbidity
Authors: Grantz Katherine L. , Sundaram Rajeshwari , Ma Ling , Hinkle Stefanie , Berghella Vincenzo , Hoffman Matthew K. , Reddy Uma M. 
Published: January 2018

OBJECTIVE:
To assess the morbidity associated with continuing the second-stage duration of labor, weighing the probability of spontaneous vaginal birth without morbidity compared with birth with serious maternal or neonatal complications.

METHODS:
In a retrospective cohort, we analyzed singleton, vertex births at 36 weeks of gestation or greater without prior cesarean delivery (n=43,810 nulliparous and 59,605 multiparous women). We calculated rates of spontaneous vaginal birth and composite serious maternal or neonatal complications. Results were stratified by parity (nulliparous or multiparous) and epidural status (yes or no). Competing risks models were created for 1) spontaneous vaginal birth with no morbidity, 2) birth with maternal or neonatal morbidity, and 3) no spontaneous vaginal birth and no morbidity, and our main interest was in comparing number 1 against number 2.

RESULTS:
Rates of spontaneous vaginal birth without morbidity were slightly higher after the first half hour (greater than 0.5–1.0 hours) for nulliparous women, after which rates decreased with increasing second-stage duration. For multiparous women, rates of spontaneous vaginal birth without morbidity decreased with increasing second-stage duration. For illustration, for a nulliparous woman with an epidural at 3.0 hours of the second stage of labor who extended by another 1.0 hour, her likelihood of delivering by spontaneous vaginal birth was 31.4% compared with her likelihood of birth with any serious complication in the subsequent hour, which was 7.6%. The percentage of cesarean deliveries for nonreassuring fetal heart rate tracing were higher for women without compared with women with an epidural.

CONCLUSION:
Rates of spontaneous vaginal birth without serious morbidity steadily decreased for increasing second-stage duration except for the first half hour for nulliparous women. We did not observe an inflection point at a particular hour mark for either spontaneous vaginal delivery without morbidity or births with morbidity. Our findings will assist in decision-making for extending second-stage duration.
Early Results of Single-plug Autologous Osteochondral Grafting for Osteochondritis Dissecans of the Capitellum in Adolescents
Authors: Bae Donald S. , Ingall Eitan M. , Miller Patricia E. , Eisenberg Katherine 
Published: January 2018

Background:
Osteochondral autologous transplantation surgery (OATS) has been advocated for unstable osetochondritis dissecans (OCD) lesions of the adolescent capitellum, though limited information is available regarding clinical and radiographic results in North American patients. We hypothesize that single-plug OATS is safe and effective in alleviating pain and restoring function in unstable OCD.

Methods:
Twenty-eight patients with unstable OCD treated with single-plug OATS were evaluated. Mean age at surgery was 14.2 years; there were 14 males. Etiology of OCD was presumed to be sports participation, including baseball (n=5) and gymnastics (n=11). Indications for surgery included unstable, deep OCD lesions; 2 lesions were uncontained, and 3 patients (11%) had OATS after failed prior surgery. OATS was performed by an anconeus muscle-splitting approach; donor grafts were harvested from the lateral femoral condyle by small arthrotomy. Functional outcomes were quantified using the Timmerman instrument. Median clinical and radiographic follow-up was 6.3 months (range, 5.0 to 27.0 mo) and 5.7 months (range, 5.0 to 26.7 mo), respectively. Furthermore, all patients returned functional questionnaires at a median of 9 months postoperatively (range, 5 to 27 mo).

Results:
Of the 26 patients who reported preoperative tenderness, 19 (73%) patients had no tenderness at most recent clinical follow-up (P=0.02). Of 18 patients with restricted elbow motion preoperatively, 13 had achieved full range of motion (P=0.10). Both elbow flexion and extension improved significantly [flexion: median change (interquartile range)=10 degrees (0 to 10 degrees), P=0.009; extension: 0 degree (−5 to 0 degrees), P <0.001). On postoperative magnetic resonance imaging, 86% (P<0.001) of elbows had restoration of articular congruity and 93% had complete graft incorporation. Objective [median change (interquartile range)=5 degrees (0 to 15 degrees)], subjective [25 degrees (15 to 40 degrees)], and overall [35 degrees (15 to 45 degrees)] Timmerman scores improved significantly (P=0.001, <0.001, and <0.001, respectively). Of the 13 patients with >6 months follow-up, 9 patients (69%) had returned to their primary sport (P=0.27) and 100% had returned to general sports participation. There were no postoperative complications. At final follow-up, all donor knees were asymptomatic with full motion and strength.

Conclusion:
Single-plug OATS is safe and effective in improving pain and elbow function in adolescents with unstable OCD, with high return to sports rates and little donor-site morbidity.

Level of Evidence:
Level IV—case series.
How Do You Feel? Subjective Perception of Recovery as a Reliable Surrogate of Cognitive and Functional Outcome in Cardiac Arrest Survivors
Authors: Juan Elsa , De Lucia Marzia , Beaud Valérie , Oddo Mauro , Rusca Marco , Viceic Dragana , Clarke Stephanie , Rossetti Andrea O. 
Published: January 2018

Objectives:
To show that subjective estimate of patient’s condition is related to objective cognitive and functional outcome in cardiac arrest survivors.

Design:
Longitudinal cohort study.

Setting:
ICU and Neuropsychology Service in two hospitals in Switzerland.

Patients:
Fifty survivors included from a prospective cohort of 138 patients admitted at the ICU for cardiopulmonary arrest.

Interventions:
Comprehensive cognitive and functional evaluation at 6 months follow-up.

Measurements and Main Results:
Subjectively, 70% of survivors reported satisfactory recovery and 29% reported no complaints. Objectively, 76% were classified as good neurologic outcome (Cerebral Performance Category 1), 26% as having no symptoms (modified Rankin Scale 0), and 38% as upper good recovery (Glasgow Outcome Scale Extended 1). Cognitive assessment detected substantial cognitive impairment in 26%, primarily concerning processing speed, language, long-term memory, and executive functions. Subjective complaints severity correlated significantly with objective cognitive impairment (r

S
= 0.64; p < 0.001). Finally, patients reporting unsatisfactory recovery displayed lower functional scores than those reporting satisfactory recovery (e.g., quality of life satisfaction: 64% vs 81%; Z = 2.18; p = 0.03) and more cognitive impairment (three vs one cognitive domains impaired; Z = –3.21; p < 0.001), concerning in particular learning and long-term verbal and visual memory.

Conclusions:
Long-term subjective and objective outcome appears good in the majority of cardiac arrest survivors. Specific functional and cognitive impairments were found in patients reporting unsatisfactory recovery. Subjective recovery was strongly correlated with objective assessment.
Healthcare Utilization and Infection in the Week Prior to Sepsis Hospitalization*
Authors: Liu Vincent X. , Escobar Gabriel J. , Chaudhary Rakesh , Prescott Hallie C. 
Published: January 2018

Objectives:
To quantify healthcare utilization in the week preceding sepsis hospitalization to identify potential opportunities to improve the recognition and treatment of sepsis prior to admission.

Design:
Retrospective study.

Setting:
Two large integrated healthcare delivery systems in the United States.

Participants:
Hospitalized sepsis patients.

Interventions:
None.

Measurements and Main Results:
We quantified clinician-based encounters in each of the 7 days preceding sepsis admission, as well as on the day of admission, and categorized them as: hospitalization, subacute nursing facility, emergency department, urgent care, primary care, and specialty care. We identified the proportion of encounters with diagnoses for acute infection based on 28 single-level Clinical Classification Software categories. We also quantified the use of antibiotics over the same interval and used linear regression to evaluate time trends. We included a total of 14,658 Kaiser Permanente Northern California sepsis hospitalizations and 31,369 Veterans Health Administration sepsis hospitalizations. Over 40% of patients in both cohorts required intensive care. A total of 7,747 Kaiser Permanente Northern California patients (52.9%) and 14,280 Veterans Health Administration patients (45.5%) were seen by a clinician in the week before sepsis. Prior to sepsis, utilization of subacute nursing facilities remained steady, whereas hospital utilization declined. Primary care, specialty care, and emergency department visits increased, particularly at admission day. Among those with a presepsis encounter, 2,648 Kaiser Permanente Northern California patients (34.2%) and 3,858 Veterans Health Administration patients (27.0%) had at least one acute infection diagnosis. An increasing percentage of outpatient encounters also had infectious diagnoses (3.3%/d; 95% CI, 1.5%–5.1%; p < 0.01), particularly in primary and specialty care settings. Prior to sepsis hospitalization, the use of antibiotics also increased steadily (2.1%/d; 95% CI, 1.1%–3.1%; p < 0.01).

Conclusions:
Over 45% of sepsis patients had clinician-based encounters in the week prior to hospitalization with an increasing frequency of diagnoses for acute infection and antibiotic use in the outpatient setting. These presepsis encounters offer several potential opportunities to improve the recognition, risk stratification, and treatment prior to sepsis hospitalization.