bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relevance of radiological and clinical measurements in predicting difficult intubation using light wand (Surch-lite™) in adult patients
Authors: Kim Joungmin , Im Kyong Shil , Lee Jae Myeong , Ro Jaehun , Yoo Kyung Yeon , Kim Jong Bun 
Published: December 2015

Objective To determine the correlation between anatomical features of the upper airway (evaluated via computed tomography imaging) and the ease of light wand-assisted endotracheal intubation in patients undergoing ear, nose and throat surgery under general anaesthesia. Methods Mallampati class, laryngoscopic grade, thyromental distance, neck circumference, body mass index, mouth opening and upper lip bite class were assessed. Epiglottis length and angle, tongue size and narrowest pharyngeal distance were determined using computed tomography imaging. Intubation success rate, time to successful intubation (intubating time) and postoperative throat symptoms were documented. Results Of 152 patients, 148 (97.4%) were successfully intubated on the first attempt (mean intubating time 11.5 ± 6.7 s). Intubating time was positively correlated with laryngoscopic grade and body mass index in both male and female patients, and Mallampati class and neck circumference in male patients. Epiglottis length was positively correlated with intubating time. Conclusions Ease of intubation was influenced by epiglottis length. Radiological evaluation may be useful for preoperative assessment of patients undergoing endotracheal intubation with light wand.
Soccer Injuries in Players Aged 7 to 12 Years
Authors: Rössler Roland , Junge Astrid , Chomiak Jiri , Dvorak Jiri , Faude Oliver 
Published: December 2015

Background: As part of a risk-management approach, sound epidemiological data are needed to develop prevention programs. A recent review on soccer injuries of players younger than 19 years concluded that prospective data concerning children are lacking. Purpose: To analyze the incidence and characteristics of soccer injuries in children aged 7 to 12 years. Study Design: Descriptive epidemiological study. Methods: The present survey was a prospective descriptive epidemiological study on soccer injuries over 2 seasons in the Czech Republic and Switzerland. Exposure of players during training and match play (in hours) and injury data were reported by coaches via an Internet-based registration system. Location, type, and severity of injuries were classified according to an established consensus. Injury characteristics are presented as absolute numbers and injury incidence rates (injuries per 1000 hours of soccer exposure). An injury was defined as any physical complaint sustained during a scheduled training session or match play resulting in at least 1 of the following: (1) inability to complete the current match or training session, (2) absence from subsequent training sessions or matches, and (3) injury requiring medical attention. Results: In total, 6038 player-seasons with 395,295 hours of soccer exposure were recorded. The mean (±SD) age of the players was 9.5 ± 2.0 years, and 3.9% of the participants were girls. A total of 417 injuries were reported. Most (76.3%) injuries were located in the lower limbs, with 15.6% located in the upper limbs. Joint and ligament injuries comprised 30.5%, contusions 22.5%, muscle and tendon injuries 18.5%, and fractures and bone injuries 15.4% of all injuries; 23.7% of injuries led to more than 28 days of absence from sport participation. The overall injury incidence was 0.61 (95% CI, 0.53-0.69) injuries per 1000 hours of soccer exposure during training sessions and 4.57 (95% CI, 4.00-5.23) during match play. Injury incidence rates increased with increasing age. Conclusion: The observed injury incidences were lower compared with studies in youth players. Children showed a relatively high proportion of fractures and bone stress and of injuries to the upper limbs. Clinical Relevance: The study provides an evidence base for injury incidence rates and injury characteristics in children’s soccer. These data are the basis to develop an age-specific injury-prevention program.
Ketamine for Analgosedation in the Intensive Care Unit: A Systematic Review
Authors: Patanwala Asad E. , Martin Jennifer R. , Erstad Brian L. 
Published: December 2015

Objective: To evaluate the evidence for the use of intravenous ketamine for analgosedation in the intensive care unit. Methods: MEDLINE and EMBASE were queried from inception until July 2015. Search terms used included ketamine, intensive care, and critical care. The search retrieved 584 articles to be screened for inclusion. The intent was to include randomized controlled studies using sustained intravenous infusions (>24 hours) of ketamine in the critically ill patients. Results: One trial evaluated opioid consumption as an outcome in postoperative critically ill patients who were randomized to ketamine or saline infusions. The mean cumulative morphine consumption at 48 hours was significantly lower in the ketamine group (58 ± 35 mg) compared to the morphine-only group (80 ± 37 mg; P < .05). Other trials showed the potential safety of ketamine in terms of cerebral hemodynamics in patients with traumatic brain injury, improved gastrointestinal motility, and decreased vasopressor requirements. The observational study and case reports suggest that ketamine is safe and effective and may have a role in patients who are refractory to other therapies. Conclusion: Ketamine use may decrease analgesic consumption in the intensive care unit. Additional trials are needed to further delineate the role of ketamine for analgosedation.
Crucial contextual attributes of nursing leadership towards a care ethics
Authors: Gustafsson Lena-Karin , Stenberg Maja 
Published: December 2015

Background: It is of importance to understand and communicate caring ethics as a ground for qualitative caring environments. Research is needed on nursing attributes that are visible in nursing leadership since it may give bases for reflections related to the patterns of specific contexts. Aim: The aim of this study was to illuminate the meaning of crucial attributes in nursing leadership toward an ethical care of patients in psychiatric in-patient settings. Research design: The design of the study was descriptive and qualitative with a phenomenological hermeneutical approach. Participants and research context: The study comprised focus group interviews with nurses working in indoor psychiatric care who participated after giving informed consent. Ethical considerations: Since the topic and informants are not labeled as sensitive and subject to ethical approval, it is not covered by the ethics committee’s aim and purpose according to Swedish law. However, careful procedures have been followed according to ethics expressed in the Declaration of Helsinki. Findings: When identifying the thematic structures, analysis resulted in three major themes: To supply, including the following aspects: to supply evidence, to supply common space, and to supply good structures; To support, including the following aspects: to be a role model, to show appreciation and care, and to harbor; To shield, including the following aspects: to advocate, to emit non-tolerance of unethical behavior, and to reprove. Discussion: Leadership is challenging for nurses and plays an important role in ethical qualitative care. These findings should not be understood as a description about nurse manager’s role, which probably has different attributes and more focus on an organizational level. Conclusion: Making the understanding about crucial attributes explicit, the nurse may receive confirmation and recognition of crucial attributes for ethical care in order to move toward an ethical care.
Managerial Myopia in Mismanaging Renewable Resources
Authors: Barnabè Federico 
Published: December 2015

Background. Previous research demonstrates three main causes for frequent cases of overexploitation of renewable resources: open access, provision problem and misperception of dynamics. Aim. The aim of this study is to explore the role of a fourth factor for overexploitation of renewable resources, managerial myopia (also referred to as short-termism), as well as to further explore the role of mental models, personal heuristics and group dynamics in mismanagement of renewable resources. Method. For this purpose, the study adopts an experimental design using a System Dynamics (SD)-based Interactive Learning Environment (ILE). The SD-ILE offers sufficient information to the players who are instructed to operate in an oligopoly situation where open access is excluded. Findings. Managerial myopia seems to be a relevant factor in pushing players to develop short-term, over-aggressive policies. The simulations show that optimal or sufficient policies are rejected by players, even when correctly identified, due to perverse incentives generated by short-term accounting goals. A feasible solution for myopic behavior is identified and tested: measuring a larger, balanced set of performance indicators on which managers develop their strategies. Conclusions. The experiment shows that significant improvements in performance and mitigation of myopic behavior are possible. It also demonstrates the relevant role that SD-ILEs may play in studying renewable resource issues and assisting decision-makers in developing and implementing coherent policies.
Synchronous Mobile Audio-Visual Recording Technology (SMART) Cart for Healthcare Simulation Debriefing
Authors: Stephanian Don , Sawyer Taylor , Reid Jennifer , Stone Kimberly , Roberts Joan , Thompson Douglas , Pendergrass Tom 
Published: December 2015

Introduction. Video-assisted debriefing is commonly used in healthcare simulation. The ability to conduct video-assisted debriefing during in situ simulation is limited by the capacity to quickly and easily record and playback video in the clinical environment. Methods. We developed the Synchronous Mobile Audio-visual Recording Technology Cart (SMART-Cart) to improve the ability to conduct video-assisted debriefing during in situ simulation. The SMART-Cart is composed of a compact metal cart, integrated dual wide-angled pan-tilt-zoom cameras, microphones, high-performance audio-video computer with two rear facing video monitors, and a large front-facing video screen positioned for easy video playback and review. Results. During pilot-testing involving 75 simulations with the capture of over 10 GB of audiovisual data, the SMART-Cart functioned extremely well with no technical issues. Setup and take down speeds were significantly faster using the SMART-Cart as compared to traditional in situ video debriefing methods. Use of the SMART-Cart was also resulted in a 50% reduction in the overall foot-print of the simulation recording equipment. Discussion. Based on our experience, the SMART-Cart provides a fast and reliable option to facilitate video-assisted debriefing during in situ simulation. Further investigation into the process of video-assisted debriefing using the SMART-Cart are warranted.
Giant Abdominal Aortic Aneurysms
Authors: Ullery Brant W. , Itoga Nathan K. , Lee Jason T. 
Published: December 2015

Introduction: Giant abdominal aortic aneurysms (AAAs), defined as those measuring greater than 13.0 cm in transverse diameter, represent a rare clinical entity and present unique anatomic challenges. Methods: A retrospective review of a prospectively maintained aneurysm database from 2000 to 2013 was performed at a single academic referral center. Preoperative comorbid status, aneurysm characteristics, procedural details, and perioperative course were recorded for all patients. Results: Four patients (male, n = 3) with a mean age of 75.2 years (range, 71-80 years) underwent open repair of giant AAAs. The mean AAA size was 14.4 cm (range, 13.2-15.5 cm). All giant AAAs were associated with neck length <10 mm and/or severe neck angulation. At a mean follow-up of 22 months, there has been 1 late death due to nonaneurysm-related causes. Conclusion: Due to anatomic limitation with currently available aortic endografts, giant AAAs have been traditionally repaired using a standard open surgical approach. The feasibility of endovascular aortic aneurysm repair (EVAR) with or without the use of adjunct techniques, including snorkel/chimney or fenestrated EVAR, has yet to be elucidated.
A case of two pial arteriovenous fistulas with giant venous pouches treated by endovascular coil embolization: Therapy with and without anticoagulation
Authors: Ji Wenjun , Liu Aihua , Lv Xianli , Li Youxiang , Yang Xinjian , Jiang Chuhan , Wu Zhongxue 
Published: December 2015

Background Endovascular coil embolization of pial arteriovenous fistulas (AVF) has been reported as an effective treatment. However, venous thrombosis and intracranial hemorrhage developing after endovascular occlusion of a pial AVF have not been adequately reported. Case description A 37-year-old man presented with left middle cerebral artery (MCA) AVF and right posterior cerebral artery (PCA) AVF with giant venous pouches. Staged endovascular coil embolization was performed. The MCA AVF was completely occluded by coils at the first stage. Intravenous heparin (3000 IU) was administered during the procedure, and then low molecular weight heparin (subcutaneous injection, 0.4 mL/12 hours) was administered for two days. The PCA AVF was near completely occluded by coils without anticoagulation therapy at the second stage. Rapid progressive venous thrombosis and intracranial hemorrhage were confirmed by computerized tomography brain scan postoperatively, and the patient was then transferred to the neurological intensive care unit for further treatment. Finally, the patient recovered well at the five-month follow-up. Conclusions Endovascular occlusion of a high-flow pial AVF with a giant venous pouch resulting in significant blood stasis could precipitate thrombosis in the venous system. Further studies are required to establish whether anticoagulation therapy is necessary.
Motorcyclist’s thumb: carpometacarpal injuries of the thumb sustained in motorcycle crashes
Authors: Alexander C. , Abzug J. M. , Johnson A. J. , Pensy R. A. , Eglseder W. A. , Paryavi E. 
Published: December 2015

The purpose of this study was to investigate motorcycle crash thumb injury patterns. We hypothesized that ulnar collateral ligament injuries at the thumb metacarpophalangeal joint would be most common and there would be a side predilection due to the clutch and brake positions. Motorcyclist admissions following injury between 2002 and 2013 were reviewed, and phalangeal and metacarpal injuries treated acutely identified. Demographics, injury, and treatment characteristics were recorded. Association between laterality and injury type was assessed. Of 128 patients, 59 underwent acute treatment for thumb injuries. Eleven patients sustained thumb ulnar collateral ligament injuries; 27 sustained thumb carpometacarpal injuries. Most carpometacarpal injuries were fracture-dislocations (19/27). Thumb carpometacarpal injuries had no overall side predilection; ulnar collateral ligament injuries occurred more on the right. Carpometacarpal fractures and dislocations are the most frequent motorcycle crash thumb injury, probably due to the mechanics of gripping handlebars and the high-energy force directed into the palm and against the metacarpal base. Level of evidence: Level IV
Integrated Personalized Diabetes Management (PDM)
Authors: Kulzer Bernhard , Daenschel Wilfried , Daenschel Ingrid , Siegel Erhard G. , Schramm Wendelin , Parkin Christopher G. , Messinger Diethelm , Weissmann Joerg , Djuric Zdenka , Mueller Angelika , Vesper Iris , Heinemann Lutz 
Published: December 2015

Background: Collaborative use of structured self-monitoring of blood glucose (SMBG) data and data management software, utilized within a 6-step cycle enables integrated Personalized Diabetes Management (PDM). The 2 PDM-ProValue studies shall assess the effectiveness of this approach in improving patient outcomes and practice efficiencies in outpatient settings. Methods: The PDM-ProValue studies are 12-month, prospective, cluster-randomized, multicenter, trials to determine if use of integrated PDM in daily life improves glycemic control in insulin-treated type 2 diabetes patients. Fifty-four general medical practices (GPs) and 36 diabetes-specialized practices (DSPs) across Germany will be recruited. The practices will be randomly assigned to the control groups (CNL) or the intervention groups (INT) via cluster-randomization. CNL practices will continue with their usual care; INT practices will utilize integrated PDM. The sample size is 1,014 patients (n = 540 DSP patients, n = 474 GP patients). Each study is designed to detect a between-group difference in HbA1c change of at least 0.4% at 12 months with a power of 90% and 2-sided significance level of .05. Differences in timing and degree of treatment adaptions, treatment decisions, blood glucose target ranges, hypoglycemia, self-management behaviors, quality of life, patients attitudes, clinician satisfaction, practice processes, and resource consumption will be assessed. Study endpoints will be analyzed for the modified intent-to-treat and per protocol populations. Trial results are expected to be available in late 2016. Discussion: Effective and efficient strategies to optimize diabetes management are needed. These randomized studies will help determine if PDM is beneficial.
Primary Tumors of the Foot and Ankle
Authors: Kennedy John G. , Ross Keir A. , Smyth Niall A. , Hogan MaCalus V. , Murawski Christopher D. 
Published: December 2015

Tumors of the foot and ankle are rarely encountered in the general patient population. Even among studies of tumor patients, foot and ankle neoplasms are uncommon. Given the weight-bearing demands of the foot and its relatively small area, even small masses are likely to be symptomatic and/or palpable to both patient and physician. Only 3% of osseous neoplasms are found in this region, while 8% of benign soft tissue tumors and 5% of malignant soft tissue tumors are localized to the foot and ankle. Despite the rarity of presentation, it is important for orthopaedic surgeons to be familiar with the diagnostic criteria and therapeutic options for these patients, as each tumor varies in its presentation, level of aggressiveness, and natural history of the disease. With appropriate diagnostic tests and treatment, patients can anticipate a reasonable chance of survival and preservation of function. In this review article, the authors survey the current literature regarding the presentation, diagnostic workup, and treatment for the most common benign and malignant tumors of the foot and ankle. Levels of Evidence: Level IV: Literature Review
Varus Deformity of the Distal Tibia From Physeal Growth Arrest Treated Using a Titanium Metal Porous Wedge
Authors: Bridgforth Andrew B. , Burrus M. Tyrrell , Park Joseph S. 
Published: December 2015

During a cheerleading event, a 14-year-old female sustained a right ankle physeal fracture that was treated nonoperatively with casting. She developed a distal medial tibial physeal arrest, and as the onset of menses was at age 16, she subsequently developed a varus distal tibial deformity. At the age of 19, she was no longer able to participate in collegiate cheerleading due to lateral ankle pain, ankle instability, and peroneal subluxation. After failing conservative treatment, she underwent an ankle arthroscopy, Broström-Gould procedure, peroneal retinacular repair with peroneal tenolysis, and a distal tibial medial opening wedge osteotomy using a porous titanium metal wedge and a one-third tubular plate. At 6-month follow-up, her osteotomy site showed abundant callus formation, and her lateral ankle pain had almost completely resolved. At 22-month follow-up, there were no residual ankle instability or pain complaints, and she had returned to collegiate cheerleading. This case report highlights a very useful, previously not described, application of porous titanium metal wedges for medial supramalleolar opening wedge osteotomies of the tibia. Such wedges are familiar to many foot and ankle orthopaedic surgeons and continue to have expanding indications. Levels of Evidence: Therapeutic, Level IV: Case report
Prenatal exposure to antibiotics and wheezing in infancy: a birth cohort study
Authors: Popovic Maja , Rusconi Franca , Zugna Daniela , Galassi Claudia , Merletti Franco , Migliore Enrica , Trevisan Morena , Nannelli Tiziana , Gagliardi Luigi , Richiardi Lorenzo 
Published: December 2015

The role of prenatal antibiotic exposure in the development of childhood wheezing is debated. We evaluated whether this association could potentially be explained by confounding factors.Antibiotic use in the first and third trimester of pregnancy, wheezing in children aged ≤18 months and confounding factors were assessed in singletons participating in the NINFEA (Nascita e Infanzia: gli Effetti dell'Ambiente) birth cohort (n=3530 for first-trimester exposure and n=3985 for third-trimester exposure).There was no evidence of an association between antibiotic exposure in the first trimester of pregnancy and ever-wheezing (adjusted risk ratio (RR) 1.02, 95% CI 0.80–1.30) or recurrent wheezing (RR 0.99, 95% CI 0.54–1.82). For the third-trimester exposure, the crude RRs (95% CI) of ever-wheezing and recurrent wheezing were 1.34 (1.10–1.64) and 2.72 (1.80–4.11), respectively, which decreased to 1.12 (0.90–1.39) and 2.09 (1.32–3.29) after adjustment. The RRs of wheezing after genitourinary infections during pregnancy were increased independently of antibiotic treatment.In conclusion, the association between prenatal antibiotic exposure and infant wheezing could be largely explained by confounding factors, in particular respiratory infections during pregnancy. An excess risk of wheezing after antibiotic exposure during the third trimester of pregnancy remains after adjustment.
Cost–benefit analysis of Xpert MTB/RIF for tuberculosis suspects in German hospitals
Authors: Diel Roland , Nienhaus Albert , Hillemann Doris , Richter Elvira 
Published: December 2015

Our objective was to assess the cost–benefit of enhancing or replacing the conventional sputum smear with the real-time PCR Xpert MTB/RIF method in the inpatient diagnostic schema for tuberculosis (TB).Recent data from published per-case cost studies for TB/multidrug-resistant (MDR)-TB and from comparative analyses of sputum microscopy, mycobacterial culture, Xpert MTB/RIF and drug susceptibility testing, performed at the German National Reference Center for Mycobacteria, were used. Potential cost savings of Xpert MTB/RIF, based on test accuracy and multiple cost drivers, were calculated for diagnosing TB/MDR-TB suspects from the hospital perspective.Implementing Xpert MTB/RIF as an add-on in smear-positive and smear-negative TB suspects saves on average €48.72 and €503, respectively, per admitted patient as compared with the conventional approach. In smear-positive and smear-negative MDR-TB suspects, cost savings amount to €189.56 and €515.25 per person, respectively. Full replacement of microscopy by Xpert MTB/RIF saves €449.98. In probabilistic Monte-Carlo simulation, adding Xpert MTB/RIF is less costly in 46.4% and 76.2% of smear-positive TB and MDR-TB suspects, respectively, but 100% less expensive in all smear-negative suspects. Full replacement by Xpert MTB/RIF is also consistently cost-saving.Using Xpert MTB/RIF as an add-on to and even as a replacement for sputum smear examination may significantly reduce expenditures in TB suspects.