bluuebunny/crossref_metadata_2025_split huggingface dataset:
Practice patterns in longitudinal lupus care provision: patient and physician perspectives
Authors: Kugasia A , Sehgal N , Dollear M , Sequeira W , Block J A , Jolly M 
Published: June 2017

Background/purpose To plan a quality improvement project, we need to understand the practice patterns of physicians. We undertook an online survey of systemic lupus erythematosus (SLE) patients and physicians providing care to SLE patients to determine the patterns of medical care provided to SLE patients. Materials and methods Two self-report surveys were developed. A 12-item survey for the patients and a 13-item survey for physicians enquired about longitudinal care for SLE. Surveys were administered online to physicians providing care to SLE patients, and to patients who self-identified as having SLE, through the Lupus Society of Illinois. Patient and physician data were analyzed for physician practice patterns for SLE care, using chi square tests and t tests. A P value of 0.05 or less was considered significant on two-tailed tests. Results A total of 283 patients completed the survey. Mean (SD) age and disease duration of patients were 45.9 (13.2) and 12.7 (9.7) years. Half of the participants were being seen at 3–4-month intervals. More than 70% of patients reported being tested for antinuclear antibody (ANA), and 20–30% anti-ENA antibody and Sjögren’s (SSA/SSB) antibodies, respectively, at each follow-up visit. Eighty-six rheumatologists completed the surveys. Mean (SD) age was 55 (12) years and 56% were men. More than half (54%) provided care only in a private practice setting. More than 80% of physicians reported seeing their SLE patients at 3–4-month interval. Only 2% reported performing ANA tests at each visit, while 4–5% performed anti-ENA and anti-SSA/SSB antibody tests at each visit for their SLE patients. More than 75% of physicians in private practice also ordered sedimentation rate at each visit for their SLE patients. Conclusions Unnecessary laboratory investigations may be being ordered routinely for patients at every visit. These results indicate a need for physician education on indications and utility of some of the laboratory tests such as ANA.
Ethical climate in nursing environment: A scoping review
Authors: Koskenvuori Janika , Numminen Olivia , Suhonen Riitta 
Published: June 2017

Background: In the past two decades, interest in the concept of ethical climate and in its research has increased in healthcare. Ethical climate is viewed as a type of organizational work climate, and defined as the shared perception of ethically correct behavior, and how ethical issues should be handled in the organization. Ethical climate as an important element of nursing environment has been the focus of several studies. However, scoping reviews of ethical climate research in nursing have not been conducted to guide further research in this area. Objective: The purpose of this scoping review is to describe and analyze studies focusing on ethical climate in nursing environment to elicit an overall picture of the research in this field. Methods: A scoping review methodology guided by Arksey and O’Malley and Levac et al. was used. Studies were identified by conducting electronic searches on PubMed/MEDLINE, CINAHL, Web of Science Core Collection, PsycINFO, and Scopus and Philosophers’ Index databases. Of 1051 citations, 56 articles matched the inclusion criteria. Ethical considerations: This study was conducted according to good scientific guidelines. Findings: Ethical climate is a topical research area which has been explored with different methods and outcomes, in different environments, and has mainly been perceived positively. The focus of the studies was on finding associations between ethical climate and work-related factors such as job satisfaction, moral distress, and turnover intentions. Methodologically, research was rather homogeneous using quantitative, descriptive, and correlative research designs. Conclusion: Novel perspectives and more diverse methodological approaches paying attentions to issues affecting generalizability of the findings could expand our knowledge in this area.
Leukopenia and Hepatotoxicity
Authors: Ponte Charles D. , Decker Edward L. 
Published: June 2017

A case report of a 72-year-old white female who was treated with a total of 260 mg chlorpromazine and who rapidly developed elevated serum glutamic oxalacetic transaminase, direct and total bilirubin, alkaline phosphatase, and lactic dehydrogenase and whose peripheral white blood cell count dropped to 2,500/mm3' is presented. The bone marrow was found to be hypocellular. Approximately 15 days following discontinuance of the drug, the laboratory values returned toward normal with marked clinical improvement in the patient. The possibility of other drugs causing similar changes in this patient is discussed as are the adverse effects of phenothiazines and methods of monitoring the patient who is receiving phenothiazine therapy.
Pain Assessment and Documentation — Making a Difference
Authors: Mcarthur Elizabeth , Cunliffe Mary 
Published: June 2017

• Pain assessment is essential for effective pain management • Development of structured pain assessment and documentation of the child's pain history is vital • Involving the child and family in pain assessment is crucial for effective pain management • Pain management requires multiprofessional commitment and involvement • The role of the acute pain service is a vital element within a Children's Trust
Audit of computer literacy and skills
Authors: Browne Alison 
Published: June 2017

• Information technology (IT) has radically changed the way that many people work and think • This audit was designed to evaluate the IT skills and training needs of different professional groups • Most clerical staff but only about 33% of medical and nursing staff were able to use the current patient information system • 72% of the staff were interested in further training in information technology skills • The local college agreed to come to the hospital to run the CLAIT (Computer Literacy and Information Technology) course on our premises
Programming microphysiological systems for children’s health protection
Authors: Knudsen TB , Klieforth B , Slikker W 
Published: June 2017

Microphysiological systems (MPS) and computer simulation models that recapitulate the underlying biology and toxicology of critical developmental transitions are emerging tools for developmental effects assessment of drugs/chemicals. Opportunities and challenges exist for their application to alternative, more public health relevant and efficient chemical toxicity testing methods. This is especially pertinent to children’s health research and the evaluation of complex embryological and reproductive impacts of drug/chemical exposure. Scaling these technologies to higher throughput is a key challenge and drives the need for in silico models for quantitative prediction of developmental toxicity to inform safety assessments. One example is cellular agent-based models, constructed from extant embryology, that produce data useful to simulate critical developmental transitions and thereby predict phenotypic consequences of disruption in silico. Biologically inspired MPS models built from human induced pluripotent stem (iPS)-derived cells and synthetic matrices that recapitulate organ-specific physiologies and native tissue architectures are providing exciting new research opportunities to advance the assessment of developmental toxicity and offer the possibility of deriving a full ‘human on a chip’ system, or a ‘Homunculus.’ Impact statement This ‘commentary’ summarizes research needs and opportunities for engineered MPS models for developmental and reproductive toxicity testing. Emerging concepts can be taken forward to a virtual tissue modeling framework for assessing chemical (and non-chemical) stressors on human development. These models will advance children’s health research, both basic and translational and new ways to evaluate complex embryological and reproductive impacts of drug and chemical exposures to inform safety assessments.
Prediction of pathologic femoral fractures in patients with lung cancer using machine learning algorithms: Comparison of computed tomography-based radiological features with clinical features versus without clinical features
Authors: Oh Eunsun , Seo Sung Wook , Yoon Young Cheol , Kim Dong Wook , Kwon Sunyoung , Yoon Sungroh 
Published: June 2017

Purpose: The purpose of this article is to compare the predictive power of two models trained with computed tomography (CT)-based radiological features and both CT-based radiological and clinical features for pathologic femoral fractures in patients with lung cancer using machine learning algorithms. Methods: Between January 2010 and December 2014, 315 lung cancer patients with metastasis to the femur were included. Among them, 84 patients who underwent CT scan and were followed up for more than 3 months were enrolled. We examined clinical and radiological risk factors affecting pathologic fracture through logistic regression. Predictive analysis was performed using five different supervised learning algorithms. The power of predictive model trained with CT-based radiological features was compared to those trained with both CT-based radiological and clinical features. Results: In multivariate logistic regression, female sex (odds ratio = 0.25, p = 0.0126), osteolysis (odds ratio = 7.62, p = 0.0239), and absence of radiation therapy (odds ratio = 10.25, p = 0.0258) significantly increased the risk of pathologic fracture in proximal femur. The predictive model trained with both CT-based radiological and clinical features showed the highest area under the receiver operating characteristic curve (0.80 ± 0.14, p < 0.0001) through gradient boosting algorithm. Conclusion: We believe that machine learning algorithms may be useful in the prediction of pathologic femoral fracture, which are multifactorial problem.
A guide for the selection of routing protocols in WBAN for healthcare applications
Authors: Bhanumathi V. , Sangeetha C. P. 
Published: June 2017

AbstractIn the present scenario, the term wireless body area network (WBAN) is becoming an integral part of human day to day life due its wide variety of applications, especially in the field of healthcare systems. To design such a reliable body area network system, there are a number of factors to be considered both in hardware and software levels. One of such factors still developing is the design and the analysis of routing protocols in the network layer. Routing protocols are a set of protocols which can identify and maintain the routes in the network so that the data can be exchanged between the nodes efficiently. Hence, routing protocol plays a vital role in the wireless sensor networks for reliable communication between the sensor nodes. In this paper, different routing protocols for body area networks are surveyed and observed that they are affected by factors like energy, network topology, various quality of services (QoS) in the nodes, node temperature, transmission range of nodes, human posture, etc. An evocative taxonomy of protocols is presented such as cluster-based, cross-layered, postural movement based, QoS aware and temperature-aware routing protocols. From the survey, it is found that the selection of a routing protocol is application dependent. For example, the energy efficient protocols like reinforcement learning based routing with QoS support or wireless autonomous spanning tree protocol can be used for daily health monitoring systems due to its high packet delivery ratio. If the system is for in vivo networks, routing algorithm for network of homogeneous and Id-less biomedical sensor nodes or mobility-supporting adaptive threshold-based Thermal-aware energy-efficient multi-hop protocols are the suitable ones. For critical and emergency cases, where accuracy with little delay is the major concern, the protocols like critical data routing, reliability aware routing, data-centric multi objective QoS-aware routing protocol, etc. can be rightly chosen. This entire survey paper can be used by the researchers as a reference for studying various WBAN routing protocols, especially in the field of medical health care systems.
Participant-Reported Symptoms and Their Effect on Long-Term Adherence in the International Breast Cancer Intervention Study I (IBIS I)
Authors: Smith Samuel George , Sestak Ivana , Howell Anthony , Forbes John , Cuzick Jack 
Published: June 2017

Purpose To assess the role of participant-reported symptoms on long-term adherence to preventive therapy in the United Kingdom sample of the International Breast Cancer Intervention Study (IBIS-I). IBIS-I was a randomized controlled trial that investigated the effectiveness of tamoxifen in reducing the risk of breast cancer among women at increased risk of the disease. Participants and Methods Women were randomly assigned to tamoxifen versus placebo (20 mg/day; n = 4,279). After 456 exclusions, 3,823 women were included in this analysis. Adherence (< 4.5 years or ≥ 4.5 years) was calculated using data from six monthly clinical visits. Analyses were adjusted for age, Tyrer-Cuzick risk, smoking, use of hormone replacement therapy, menopausal status, baseline menopausal symptoms, and treatment. Results Overall, 69.7% of women were adherent for at least 4.5 years (tamoxifen: 65.2% v placebo: 74.0%; P < .001). Differences in adherence between treatment arms were observed from 12 months onward (all P < .01) and were largest at 54 months. Dropout rates were highest in the first 12 to 18 months and decreased thereafter. Women reporting nausea/vomiting were less likely to be adherent in both the tamoxifen (odds ratio [OR], 0.57; 95% CI, 0.37 to 0.86; P = .007) and placebo (OR, 0.58; 95% CI, 0.37 to 0.93; P = .023) arms. Headaches were associated with adherence only in the placebo arm (OR, 0.62; 95% CI, 0.42 to 0.91; P = .016), whereas gynecologic symptoms were significant only in the tamoxifen arm (OR, 0.77; 95% CI, 0.62 to 0.97; P = .024). Effect sizes for each symptom on adherence were not significantly different between the treatment groups ( P > .05). In both treatment arms, we observed significant trends for lower adherence with increasing severity for all symptoms ( P < .01) except headaches ( P = .054). Conclusion In the IBIS-I trial, experiencing predefined symptoms in the first 6 months reduced long-term adherence. Effects were similar between treatment arms, suggesting that women were attributing age-related symptoms to preventive therapy. Interventions were required to support symptom management.
Two new polyploid species closely related to Alnus glutinosa in Europe and North Africa – An analysis based on morphometry, karyology, flow cytometry and microsatellites
Authors: Vít Petr , Douda Jan , Krak Karol , Havrdová Alena , Mandák Bohumil 
Published: June 2017

AbstractIn the present study, we investigate the variation of European representatives of Alnus subg. Alnus, i.e., Alnus glutinosa and A. incana, in Europe and partly North Africa. Four distinct Alnus taxa were recognized using a multidisciplinary approach based on multivariate morphometrics, karyology, flow cytometry and nuclear microsatellite analyses. Besides the long‐recognized diploid taxa (2n = 2x = 28) A. glutinosa and A. incana, we revealed the presence of morphologically, cytologically and genetically noticeably delimited tetraploid populations (2n = 4x = 56), which we consider new species. These form two geographically well‐delimited clusters located in the Iberian Peninsula and the adjacent part of North Africa, designated here as Alnus lusitanica, and in the Dinaric Alps extending south‐easterly to Greece, denominated here as Alnus rohlenae. Detailed information concerning their diagnosis and geographical distribution is presented, and photographs of type specimens are provided.
External rotation of the femoral component increases asymmetry of the posterior condyles
Authors: Bonnin M. P. , Saffarini M. , Nover L. , van der Maas J. , Haeberle C. , Hannink G. , Victor J. 
Published: June 2017

AimsThe morphometry of the distal femur was largely studied to improve bone-implant fit in total knee arthroplasty (TKA), but little is known about the asymmetry of the posterior condyles. This study aimed to investigate the dimensions of the posterior condyles and the influence of externally rotating the femoral component on potential prosthetic overhang or under-coverage.Patients and MethodsWe analysed the shape of 110 arthritic knees at the time of primary TKA using pre-operative CT scans. The height and width of each condyle were measured at the posterior femoral cut in neutral position, and in 3º and 5º of external rotation, using both central and medial referencing systems. We compared the morphological characteristics with those of 14 TKA models.ResultsIn the neutral position, the dimensions of the condyles were nearly equal. Externally rotating the femoral cut by 3º and 5º with ‘central referencing’ induced width asymmetry > 3 mm in 23 (21%) and 33 (30%) knees respectively, while with ‘medial referencing’ it induced width asymmetry > 3 mm in 43 (39%) and 75 (68%) knees respectively. The asymmetries induced by rotations were not associated with gender, aetiology or varus-valgus alignment.ConclusionExternal rotation may amplify the asymmetry between the medial and lateral condyles, and exacerbate prosthetic overhang, particularly in the superolateral zone. ‘Central referencing’ guides result in less potential prosthetic overhang than ‘medial referencing’ guides. Cite this article: Bone Joint J 2017;99-B:894–903
The prevention of a lateral hinge fracture as a complication of a medial opening wedge high tibial osteotomy
Authors: Ogawa H. , Matsumoto K. , Akiyama H. 
Published: June 2017

AimsWe aimed to investigate factors related to the technique of medial opening wedge high tibial osteotomy which might predispose to the development of a lateral hinge fracture.Patients and MethodsA total of 71 patients with 82 osteotomies were included in the study. Their mean age was 62.9 years (37 to 80). The classification of the type of osteotomy was based on whether it extended beyond the fibular head. The level of the osteotomy was classified according to the height of its endpoint.ResultsAt a mean follow-up of 20 months (6 to 52), a total of 15 lateral hinge fractures (18.3%) were identified. A sufficient osteotomy, in which both anterior and posterior tibial cortices were involved with extension into the lateral aspect of the plateau in relation to an anteroposterior line tangential to the medial edge of the fibular head in the CT axial plane, was seen in 48 knees (71.6%) in those without a lateral hinge fracture and in seven (46.7%) in those with a lateral hinge fracture. An osteotomy which ended above the level of the fibular head was seen in nine (13.4%) of the knees without a lateral hinge fracture and seven (46.7%) of the those with a lateral hinge fracture. There was a significant relationship between the absence of a lateral hinge fracture and both a sufficient osteotomy and one whose endpoint was at the level of the fibular head (p = 0.0451 and p = 0.0214, respectively).ConclusionA sufficient osteotomy involving both the anterior and posterior cortices, whose endpoint is at the level of the fibular head, should be performed when undertaking a medial opening wedge high tibial osteotomy if a lateral hinge fracture is to be avoided as a complication. Cite this article: Bone Joint J 2017;99-B:887–93.
Prospective randomised trial of non-operativeversusoperative management of olecranon fractures in the elderly
Authors: Duckworth A. D. , Clement N. D. , McEachan J. E. , White T. O. , Court-Brown C. M. , McQueen M. M. 
Published: June 2017

AimsThe aim of this prospective randomised controlled trial was to compare non-operative and operative management for acute isolated displaced fractures of the olecranon in patients aged ≥ 75 years.Patients and MethodsPatients were randomised to either non-operative management or operative management with either tension-band wiring or fixation with a plate. They were reviewed at six weeks, three and six months and one year after the injury. The primary outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score at one year.ResultsA total of 19 patients were randomised to non-operative (n = 8) or operative (n = 11; tension-band wiring (n = 9), plate (n = 2)) management. The trial was stopped prematurely as the rate of complications (nine out of 11, 81.8%) in the operative group was considered to be unacceptable. There was, however, no difference in the mean DASH scores between the groups at all times. The mean score was 23 (0 to 59.6) in the non-operative group and 22 (2.5 to 57.8) in the operative group, one year after the injury (p = 0.763). There was no significant difference between groups in the secondary outcome measures of the Broberg and Morrey Score or the Mayo Elbow Score at any time during the one year following injury (all p ≥ 0.05).ConclusionThese data further support the role of primary non-operative management of isolated displaced fractures of the olecranon in the elderly. However, the non-inferiority of non-operative management cannot be proved as the trial was stopped prematurely. Cite this article: Bone Joint J 2017;99-B:964–72.
Promising early results for trabecular metal acetabular components used at revision total hip arthroplasty
Authors: Mohaddes M. , Shareghi B. , Kärrholm J. 
Published: June 2017

AimsThe aim of this study was to compare the incidence of aseptic loosening after the use of a cemented acetabular component and a Trabecular Metal (TM) acetabular component (Zimmer Inc., Warsaw, Indiana) at acetabular revision with bone impaction grafting.Patients and MethodsA total of 42 patients were included in the study. Patients were randomised to receive an all- polyethylene cemented acetabular component (n = 19) or a TM component (n = 23). Radiostereometric analysis and conventional radiographic examinations were performed regularly up to two years post-operatively or until further revision.ResultsThe proximal migration was significantly higher in the cemented group. At two years, the median proximal migration was 1.45 mm and 0.25 mm in the cemented and TM groups, respectively (p = 0.02). One cemented component was revised due to dislocation. There were no revisions in the TM group.ConclusionLower proximal migration in the TM group suggests that this design might be associated with a lower risk of aseptic loosening in the long term compared with an all polyethylene cemented component. Longer follow-up is required to confirm the clinical advantages of using this component at acetabular revision. Cite this article: Bone Joint J 2017;99-B:880–6.
Primary hip and knee arthroplasty in a temporary operating theatre is associated with a significant increase in deep periprosthetic infection
Authors: Bloch B. V. , Shah A. , Snape S. E. , Boswell T. C. J. , James P. J. 
Published: June 2017

Aims Infection following total hip or knee arthroplasty is a serious complication. We noted an increase in post-operative infection in cases carried out in temporary operating theatres. We therefore compared those cases performed in standard and temporary operating theatres and examined the deep periprosthetic infection rates. Patients and methods A total of 1223 primary hip and knee arthroplasties were performed between August 2012 and June 2013. A total of 539 (44%) were performed in temporary theatres. The two groups were matched for age, gender, body mass index and American Society of Anesthesiologists grade. Results The deep infection rate for standard operating theatres was 0 of 684 (0%); for temporary theatres it was eight of 539 (1.5%) (p = 0.001). Conclusion Use of a temporary operating theatre for primary hip and knee arthroplasty was associated with an unacceptable increase in deep infection. We do not advocate the use of these theatres for primary joint arthroplasty. Cite this article: Bone Joint J 2017;99-B:917–20.