bluuebunny/crossref_metadata_2025_split huggingface dataset:
Uterine fibroid embolization with acrylamido polyvinyl microspheres: prospective 12-month clinical and MRI follow-up study
Authors: Duvnjak Stevo , Ravn Pernille , Green Anders , Andersen Poul Erik 
Published: November 2016

Background Uterine fibroid embolization (UFE) is an effective minimally invasive treatment aimed to obtain complete fibroid infarction. Purpose To evaluate the degree of fibroid infarction after embolization with acrylamido polyvinyl alcohol microspheres (Bead Block). Material and Methods This prospective study included 26 pre-menopausal women in the period October 2013 to January 2015. UFE with the use of Bead Block microspheres 700–900 µm was obtained until flow stasis was achieved. Contrast-enhanced magnetic resonance imaging (MRI) was used to define residual contrast enhancement in the total fibroid burden and enhancement >10% was defined as insufficient embolization. The dominant fibroid volume and total uterine volume changes were assessed. Clinical outcome was analyzed using the quality of life questionnaire (UFS-QOL). Results Twenty-four of the 26 patients (92%) had a technically successful UFE with complete flow-stop in both uterine arteries. Twenty-two of the 26 patients (85%) completed 3 months of MRI control and 20 patients (77%) completed 12 months of MRI control. There were 16 of 22 patients (73%) with complete fibroid burden infarction and/or without residual contrast enhancement of the fibroids of more than 10% at 3 months of control. Six of 22 patients (27%) had insufficient fibroid burden infarction with residual contrast enhancement of more than 10%. Twenty-two and 18 of 26 patients completed the 3-month and 12-month questionnaire, respectively. UFS-QOL analyses showed that 91% of the patients had significant clinical improvement. Conclusion Sixteen of the 22 patients had complete fibroid burden infarction using Bead Block microspheres (700–900 µm); however, unacceptably high insufficient fibroid burden infarction in almost one-fourth of the patients were recorded.
Additional functional outcomes after endovascular treatment for intermittent claudication
Authors: Larsen Anne Sofie F , Jacobsen Morten B. , Wesche Jarlis , Kløw Nils Einar 
Published: November 2016

Background Endovascular treatment (EVT) for intermittent claudication (IC) is performed in selected patients where conservative treatment and training fail. Treatment outcomes reported in vascular registries (survival, limb-survival, and re-intervention rate) are inadequate for low-risk patients with IC. Additional measurements of blood flow reduction and functional impairment clarify the indication for treatment and facilitate outcome evaluation. Purpose To analyze the additional outcome information on peripheral arterial pressures and walking capacity obtained from a local registry of EVT. Material and Methods Patients with IC treated with endovascular technique (angioplasty or stent) were prospectively entered into a local registry in addition to the national registry (NORKAR), with information on arterial pressures (ankle brachial index [ABI]) and treadmill performance (maximum walking distance [MWD]). Results A total of 242 consecutive patients (41% women; median age, 70 years) receiving the first treatment between July 2010 and December 2012 were included, 61% with aorto-iliac lesions. After 3 months, mean ABI increased from 0.62 (0.59–0.64) to 0.85 (0.83–0.87). The median MWD increased from 160 m to 410 m. Sixty-two percent reached the test maximum of 10 min. The improvement in ABI and MWD persisted after 1 year. When preoperative ABI was moderately reduced (0.5–0.9), ABI was normal in 61% after 3 months and in 55% after 1 year. When preoperative ABI was low (<0.5), ABI was normal in 43% both after 3 months and 1 year. Conclusion ABI and walking capacity were important outcome variables and improved after EVT. ABI improvement was better for patients with moderately reduced preoperative ABI than with low ABI.
Development of a driving readiness program for adolescents and young adults with cerebral palsy and spina bifida
Authors: Lafrance Marie-Elaine , Benoit Dana , Dahan-Oliel Noémi , Gélinas Isabelle 
Published: November 2016

Introduction Occupational therapists are amongst the certified driving rehabilitation specialists providing driving rehabilitation and training. This study aimed at gathering information on driving readiness in adolescents and young adults with physical and/or cognitive impairments related to cerebral palsy and spina bifida to guide the development of a driving readiness program for this clientele. Method A review of the scientific literature was performed. Seventy-four driving rehabilitation specialists across North America were surveyed, of whom eight were subsequently interviewed. Results Learner drivers with cerebral palsy and spina bifida lack the basic skills (such as information processing, visual memory, attention span) for and familiarity with community mobility and self-efficacy, often resulting in a lengthy and difficult learning process for automobile driving. The literature findings were corroborated by a survey and interview of specialized driving rehabilitation therapists. There is a therapist-driven desire to improve pre-requisite skills for driving through a driving readiness program tailored to this population’s specific needs. An outline of such a program was developed based on the person–environment–occupation model. Conclusion A driving readiness program may act as an important clinical tool intended to optimize pre-driving skills in adolescents with cerebral palsy or spina bifida in order to facilitate the driving training process and ensure greater community independence in this population.
A qualitative evaluation of occupational therapy-led work rehabilitation for people with inflammatory arthritis: Patients’ views
Authors: Prior Yeliz , Amanna Aparna Evangelina , Bodell Sarah Jane , Hammond Alison 
Published: November 2016

Introduction This qualitative study, nested in a pilot feasibility randomised controlled trial, explored the views of working people with inflammatory arthritis on the impact of a work rehabilitation programme received. Method Thirty-two participants, drawn from the 55 participants in the associated randomised controlled trial, were recruited from secondary care in the United Kingdom. Semi-structured telephone and face-to-face interviews were conducted at six ( n = 32) and nine months follow-up ( n = 31). Interviews were audio-recorded, transcribed, and analysed using a constant comparative approach, under the theoretical framework of critical realism. Findings Three overarching themes emerged: (1) intervention group participants valued the work rehabilitation programme received, and highlighted the benefits of occupational therapy; (2) control group participants reported no benefits in relation to the written work advice pack, and lacked future aspirations to stay employed; (3) the majority of participants reported not reading the written work advice pack provided, which was the only work advice received by the control group. Conclusion Working people with inflammatory arthritis highly valued the practical support received from the therapists, and emphasised the value of the therapeutic relationship in the rehabilitation process. A tailor-made work rehabilitation programme, which incorporates cognitive-behavioural strategies into patient education, may help to reduce work instability in people with inflammatory arthritis, and increase their perceived self-efficacy.
Incidence, Mechanisms, and Severity of Match-Related Collegiate Men’s Soccer Injuries on FieldTurf and Natural Grass Surfaces: A 6-Year Prospective Study
Authors: Meyers Michael C. 
Published: November 2016

Background: Numerous injuries have been attributed to playing on artificial turf. More recently, newer generations of artificial turf have been developed to duplicate the playing characteristics of natural grass. Although artificial turf has been deemed safer than natural grass in some studies, few long-term studies have been conducted comparing match-related collegiate soccer injuries between the 2 playing surfaces. Hypothesis: Collegiate male soccer athletes do not experience any difference in the incidence, mechanisms, or severity of match-related injuries between FieldTurf and natural grass. Study Design: Cohort study; Level of evidence, 2. Methods: Male soccer athletes from 11 universities were evaluated over 6 seasons. Demographic features and predictors included player position, cleat design, player weight, turf age, and environmental factors. Outcomes of interest included injury incidence, injury category, time loss, injury mechanism and situation, type of injury, injury grade and anatomic location, injury severity, head and lower extremity trauma, and elective medical procedures. All match-related injuries were evaluated by the attending head athletic trainer and team physicians on site and subsequently in the physician’s office when further follow-up and treatment were deemed necessary. In sum, 765 collegiate games were evaluated for match-related soccer injuries sustained on FieldTurf or natural grass during 6 seasons. Results: Overall, 380 team games (49.7%) were played on FieldTurf versus 385 team games (50.3%) played on natural grass. A total of 722 injuries were documented, with 268 (37.1%) occurring on FieldTurf and 454 (62.9%) on natural grass. Multivariate analysis per 10 team games indicated a significant playing surface effect: F2,720 = 7.260, P = .001. A significantly lower total injury incidence rate (IIR) of 7.1 (95% CI, 6.6-7.5) versus 11.8 (95% CI, 11.3-12.2; P < .0001) and lower rate of substantial injuries, 0.7 (95% CI, 0.5-1.0) versus 1.9 (95% CI, 1.5-2.3; P < .03), were documented on FieldTurf versus natural grass, respectively. Analyses also indicated significantly less trauma on FieldTurf when comparing injury category, time loss, player position, injury mechanism and situation, injuries under various environmental conditions, cleat design, turf age, anatomic location, and elective medical procedures. No significant difference (F11,710 = 0.822, P = .618) between surfaces by knee injury was observed, with the majority of knee injuries involving patellar tendinopathies/syndromes followed by medial collateral ligament injuries on both surfaces. Conclusion: Although similarities existed between FieldTurf and natural grass during competitive match play, FieldTurf is, in many cases, safer than natural grass when comparing injuries in collegiate men’s soccer. The findings of this study, however, may not be generalizable to other levels of competition or to other artificial surfaces.
Multiple Ligament Reconstruction Femoral Tunnels: Intertunnel Relationships and Guidelines to Avoid Convergence
Authors: Moatshe Gilbert , Brady Alex W. , Slette Erik L. , Chahla Jorge , Turnbull Travis Lee , Engebretsen Lars , LaPrade Robert F. 
Published: November 2016

Background: Knee dislocations often require multiple concurrent ligament reconstructions, which involve creating several tunnels in the distal femur. Therefore, the risk of tunnel convergence is increased because of the limited bone volume within the distal aspect of the femur. Purpose: To assess the risk of tunnel convergence and determine the optimal reconstruction tunnel orientations for multiple ligament reconstructions in the femur. Study Design: Descriptive laboratory study. Methods: Three-dimensional knee models were developed from computed tomography scans of 21 patients. Medical image processing software was used to create tunnels for each of the primary ligamentous structures, replicating a surgical approach that would be used in multiple ligament reconstructions. Thereafter, the tunnel orientation was varied in surgically relevant directions to determine orientations that minimized the risk of tunnel convergence. The orientation of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tunnels was held constant throughout the study, while the orientation of the fibular collateral ligament (FCL), popliteus tendon (PLT), superficial medial collateral ligament (sMCL), and posterior oblique ligament (POL) tunnels was varied to avoid convergence. Results: A high risk of tunnel convergence was observed between the FCL and ACL tunnels when the FCL tunnel was aimed at 0° in the axial and coronal planes. Aiming the FCL tunnel 35° anteriorly minimized convergence with the ACL tunnel. No tunnel convergence was observed for the PLT tunnel aimed 35° anteriorly and parallel to the FCL tunnel. To avoid convergence between the sMCL and PCL tunnels, the sMCL tunnels should be aimed 40° proximally in the coronal plane and 20° to 40° anteriorly. During concomitant POL reconstruction, the sMCL should be aimed 40° proximally and anteriorly and the POL 20° proximally and anteriorly. The PLT and POL tunnels aimed at 0° in both the coronal and axial planes had an increased risk of violating the intercondylar notch. Conclusion: Femoral tunnel orientations during multiple ligament reconstructions need to be adjusted to avoid tunnel convergence. On the lateral side, aiming the FCL and PLT tunnels 35° anteriorly eliminated convergence with the ACL tunnel. On the medial side, tunnel convergence was avoided by orienting the sMCL tunnel 40° proximally and anteriorly and the POL tunnel 20° proximally and anteriorly. The POL and PLT tunnels aimed at 0° in the axial plane had an increased risk of violating the intercondylar notch. Clinical Relevance: The risk of tunnel convergence with the ACL and PCL femoral tunnels can be reduced by adjusting the orientation of the FCL and PLT tunnels and the sMCL and POL tunnels, respectively.
Results of Arthroscopic Bankart Repair for Anterior-Inferior Shoulder Instability at 13-Year Follow-up
Authors: Aboalata Mohamed , Plath Johannes E. , Seppel Gernot , Juretzko Julia , Vogt Stephan , Imhoff Andreas B. 
Published: November 2016

Background: Anterior-inferior shoulder instability is a common injury in young patients, particularly those practicing overhead-throwing sports. Long-term results after open procedures are well studied and evaluated. However, the long-term results after arthroscopic repair and risk factors of recurrence require further assessment. Hypothesis: Arthroscopic Bankart repair results are comparable with those of open repair as described in the literature. Study Design: Case series; Level of evidence, 4. Methods: A total of 180 shoulders with anterior-inferior shoulder instability were stabilized arthroscopically, met the inclusion criteria and the patients were able to be contacted at a minimum of 10-year follow-up. Of these patients, 143 agreed to participate in the study. Assessment was performed clinically in 104 patients using the American Shoulder and Elbow Surgeons score, Constant score, American Academy of Orthopaedic Surgeons score, Rowe score, and the Dawson 12-item questionnaire. The Samilson-Prieto score was used to assess degenerative arthropathy in radiographs available for 100 shoulders. Additionally, 15 patients participated through a specific questionnaire and 24 patients through a telephone survey. Results: The overall redislocation rate was 18.18%. Redislocation rates for the different types of fixation devices were as follows: FASTak/Bio-FASTak, 15.1% (17/112); SureTac, 26.3% (5/19); and Panalok, 33.3% (4/12). Concomitant superior labral anterior-posterior repair had no effect on clinical outcome. Redislocation rate was significantly affected by the patient’s age and duration of postoperative rehabilitation. Redislocation rate tended to be higher if there had been more than 1 dislocation preoperatively ( P = .098). Severe dislocation arthropathy was observed in 12% of patients, and degenerative changes were significantly correlated with the number of preoperative dislocations, patient age, and number of anchors. The patient satisfaction rate was 92.3%, and return to the preinjury sport level was possible in 49.5%. Conclusion: Clinical outcome at a mean follow-up of 13 years after arthroscopic repair of anterior-inferior shoulder instability is comparable with the reported results of open Bankart repair in the literature and allows management of concomitant lesions arthroscopically. Modifiable risk factors of postoperative redislocation and arthropathy must be considered. Stabilization after the first-time dislocation achieves better clinical and radiological outcomes than after multiple dislocations.
Risk of Mortality of Catheter-Related Bloodstream Infections Caused by Acinetobacter Species
Authors: Lee Yi , Lee Yi-Tzu , Wang Yung-Chih , Chen Chung-Ting , Sun Jun-Ren , Liu Chang-Pan , Liu Yuan-Meng , Kuo Shu-Chen , Chiu Chun-Hsiang , Yang Ya-Sung , Lin Jung-Chung , Chen Te-Li 
Published: November 2016

Purpose: Bloodstream infections (BSIs) caused by Acinetobacter species have been extensively reported, however, which majorly focused on respiratory tract infections. The risk of mortality and the effect of early catheter removal on survival in catheter-related BSIs (CRBSIs) caused by Acinetobacter spp. remain unclear. This study aims to investigate that. Methods: This is a retrospective multicentric study conducted in Taiwan from 2012 to 2014. Patients with at least 1 positive blood culture and catheter culture for the same Acinetobacter spp., showing symptoms and signs of CRBSIs, were included (n = 119). Risk factors for 30-day mortality were analyzed using a logistic regression model. The characteristics of patients with early catheter removal (within 48 hours after CRBSIs) were compared to those without removal matching for age, sex, and disease severity. Results: There were no differences in 30-day mortality with regard to causative Acinetobacter spp., catheter type, site, and appropriateness of antimicrobial therapy. Patients with higher Acute Physiologic and Chronic Health Evaluation (APACHE) II scores (odds ratio [OR]: 1.12; 95% confidence interval [CI]: 1.02-1.23; P = .014), shock (OR: 6.43; 95% CI: 1.28-32.33; P = .024), and longer hospitalization before CRBSIs (OR: 1.04; 95% CI: 1.00-1.08; P = .027) had a significantly higher 30-day mortality rate. Early removal of catheters after CRBSIs was not associated with better survival benefits. Conclusion: Higher disease severity (APACHE II score), shock, and longer hospitalization before bacteremia were independently associated with a higher 30-day mortality in CRBSIs caused by Acinetobacter spp. In previous published guidelines, infected catheters were suggested to be removed in CRBSIs caused by gram-negative bacilli. Even though early removal of catheters did not associate with a better survival outcome in current results, it should be judiciously evaluated according to the clinical conditions and risks individually. For better elucidation of these issues, further well-controlled prospective study may be warranted.
Complexity Analysis of Decision-Making in the Critically Ill
Authors: Daly Barbara J. , Douglas Sara L. , O’Toole Elizabeth , Rowbottom James , Hoffer Alan , Lipson Amy R. , Burant Christopher 
Published: November 2016

Rationale: Despite multiple trials of interventions to improve end-of-life care of the critically ill, there is a persistent lack of understanding of factors associated with barriers to decision-making at the end of life. Objective: To apply the principles of complexity science in examining the extent to which transitions to end-of-life care can be predicted by physician, family, or patient characteristics; outcome expectations; and the evaluation of treatment effectiveness. Methods: A descriptive, longitudinal study was conducted in 3 adult intensive care units (ICUs). Two hundred sixty-four family surrogates of patients lacking decisional capacity and the physicians caring for the patients were interviewed every 5 days until ICU discharge or patient death. Measurements: Characteristics of patients, physicians, and family members; values and preferences of physicians and family; and evaluation of treatment effectiveness, expectations for patient outcomes, and relative priorities in treatment (comfort vs survival). The primary outcome, focus of care, was categorized as (1) maintaining a survival orientation (no treatment limitations), (2) transitioning to a stronger palliative focus (eg, some treatment limitations), or (3) transitioning to an explicit end-of-life, comfort-oriented care plan. Main Results: Physician expectations for survival and future cognitive status were the only variables consistently and significantly related to the focus of care. Neither physician or family evaluations of treatment effectiveness nor what was most important to physicians or family members was influential. Conclusion: Lack of influence of family and physician views, in comparison to the consistent effect of survival probabilities, suggests barriers to incorporation of individual values in treatment decisions.
Active Expiration and the Measurement of Central Venous Pressure
Authors: Magder Sheldon , Serri Karim , Verscheure Sara , Chauvin Renée , Goldberg Peter 
Published: November 2016

Purpose: To obtain a point prevalence estimate of alterations in central venous pressure (CVP) produced by active expiration in a consecutive series of intensive care patients. Methods: We evaluated CVP tracings taken by the nurses at their morning shift change in a consecutive series of 60 cardiac surgery and 59 noncardiac surgery patients. We also assessed change in values due to the change in transducer level. Three physicians and a nurse instructor independently reviewed the tracings and determined whether there was evidence of forced expiration and whether it was type A, defined by decreasing CVP during expiration, or type B, defined by increasing CVP during expiration. Results: Agreement for CVP value was 96% between a physician and a bedside nurse. Twenty-nine percent of participants had active expiration, evenly distributed between A and B types. Active expiration was not related to the type of surgery, use of bronchodilators, and the presence of chronic obstructive lung disease or abdominal distention. Active expiration was more common in nonventilated patients and patients not receiving vasopressor drugs, suggesting they were more awake. Conclusion: Active expiration is common in critically ill patients. Failure to recognize it can result in important errors in the estimation of CVP and other hemodynamic measurements.
Recovery, responsiveness and interpretability of patient-reported outcome measures after surgery for Dupuytren’s disease
Authors: Rodrigues J. N. , Zhang W. , Scammell B. E. , Davidson D. , Fullilove S. , Chakrabarti I. , Russell P. G. , Davis T. R. C. 
Published: November 2016

This prospective cohort study investigated the responsiveness and interpretability of the Disabilities of the Arm, Shoulder and Hand (DASH) and Unité Rhumatologique des Affections de la Main (URAM) outcome measures for assessing recovery after fasciectomy and dermofasciectomy for Dupuytren’s disease. DASH outcome scores at 1 year were significantly better than at 6 weeks, suggesting that recovery is not complete by 6 weeks. Of the 101 patients recruited to the DASH cohort, 71 completed preoperative, 6 week and 1 year postoperative DASH scores; 68 of them completed preoperative and 1 year postoperative DASH scores and an external anchor question. In the URAM cohort, 30/44 completed the preoperative and the 1 year postoperative URAM scores and the anchor question. The DASH score exhibited moderate responsiveness but poor interpretability on receiver operating characteristic curve analysis, such that a minimal important change could not be estimated. The URAM score showed acceptable responsiveness, and an MIC of 10.5 on receiver operating characteristic analysis. Level of evidence: II