bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Anatomy of the Gastrocnemius Recession (Strayer Procedure)
Authors: Pinney Stephen J. , Sangeorzan Bruce J. , Hansen Sigvard T. 
Published: January 2017

Background: The Strayer procedure (gastrocnemius recession) is a treatment option for patients with clinically relevant gastrocnemius equinus contracture. The purpose of this study was to review the surgical anatomy of the Strayer procedure with specific reference to 1) the location of the sural nerve, and 2) the gastrocnemius tendon release point. Methods: Forty consecutive Strayer procedures in 33 patients (15 males, 18 females) served as the study group. Recorded measurements included: 1) the location of the sural nerve relative to the deep fascia, 2) the distance from the medial border of the gastrocnemius tendon to the sural nerve, and 3) the distance from the distal end of the gastrocnemius muscle belly (identified by surface landmarks) to the actual release site. Results: At the point of the gastrocnemius release, the sural nerve was located superficial to the fascia in 17/40 legs (42.5%) and deep to the fascia in 23/40 legs (57.5%). In five legs (12.5%), the nerve was directly applied to the gastrocnemius tendon and needed to be gently dissected off the tendon. The gastrocnemius release point was located an average of 18 mm distal (range, 20 mm proximal to 57 mm distal) to the surface landmark created by the distal extent of the gastrocnemius muscle belly. Conclusion: Knowledge of the relevant anatomy associated with the gastrocnemius recession should allow surgeons to minimize the rate of sural nerve injuries and improve cosmesis by decreasing the length of the surgical incision. A posteromedial incision that begins 2 cm distal to the gastrocnemius indentation and extends proximally will minimize the length of the incision required.
Posttraumatic Pediatric Distal Tibiofibular Synostosis: A Case Report
Authors: Munjal Kevin , Kishan Shyam , Sabharwal Sanjeev 
Published: January 2017

Introduction: Posttraumatic pediatric distal tibiofibular synostosis is a rare complication of fractures at this level, unreported at this time. Implications include limb length discrepancy, angular malalignment, and gait and biomechanical abnormalities. Materials and Methods: The authors present a case report of this complication in a 7-year-old child and review the relevant English literature. The patient was treated for a closed distal tibia-fibula fracture and developed a synostosis at that level, with valgus malalignment of the ankle joint. The synostosis was resected and latest follow-up 16 months postresection showed near normalization of the ankle malalignment. Possible etiologies, the anatomical and functional ramifications, and treatment recommendations for this condition are discussed. Summary: Posttraumatic tibiofibular synostosis is a rare complication that has a potential effect on limb length and alignment, both at the ankle and the knee in the skeletally immature patient. Prevention, early recognition, and prompt treatment prevent the anatomic and functional abnormalities that could result from it.
Health-Related Quality of Life in Patients with Transtibial Amputation and Reconstruction with Bone Bridging of the Distal Tibia and Fibula
Authors: Pinzur Michael S. , Pinto Marco A. Guedes S. , Saltzman Matthew , Batista Fabio , Gottschalk Frank , Juknelis Dainius 
Published: January 2017

Background: Bone-bridging (arthrodesis of the distal tibia and fibula) at the time of transtibial amputation is a controversial operative technique that is anecdotally reported to improve the weightbearing capacity of the residual limb and to decrease residual limb discomfort. Methods: Thirty-two consecutive patients with multiple diagnoses had transtibial amputation with a distal tibial-fibular bone-bridge, all done by a single surgeon (MAP). At an average of 16.3 months after surgery all patients completed the Prosthetics Evaluation Questionnaire (PEQ), a validated outcomes instrument specifically created to evaluate quality of life and functional demands in patients with a lower extremity amputations. Their responses were compared with those of 17 preselected, highly functional transtibial amputees from two academic medical centers who previously had transtibial amputations using a traditional non bone-bridge operative technique; their time since amputation averaged 14.7 years. Results: The “nonselected” consecutive patients with a bone-bridged residual limb scored higher (more favorable) in the Ambulation ( p = 0.037) and Frustration ( p < 0.001) domains of the PEQ and lower (less favorable) in the Appearance ( p = 0.025) subscale. Their scores were similar in the other six domains. Conclusions: Patients of multiple ages with multiple diagnoses who had bone-bridging of the distal tibia and fibula at the time of transtibial amputation had scores on a validated outcomes instrument that were better than or comparable to those of a selected group of highly functional transtibial amputees. The results of this study suggest that bone-bridging at the time of transtibial amputation may enhance patient-perceived functional outcomes.
Surgical Treatment of Mild Hallux Valgus Deformity: The State of Practice among Academic Foot and Ankle Surgeons
Authors: Pinney Stephen , Song Kyle , Chou Loretta 
Published: January 2017

Background: The purpose of this study was to determine the operative procedure of choice among academic foot and ankle surgeons practicing in the United States for treatment of mild hallux valgus deformity. Methods: A hypothetical patient was created: a 60-year-old woman with a mild hallux valgus deformity (first intermetatarsal angle of 11 degrees and hallux valgus angle of 22 degrees). The patient complained of pain around the bunion, nonoperative treatment had failed, and she desired operative correction. The case was sent to academic foot and ankle surgeons to identify their operative treatment of choice. The overall response rate was 83.7% (128 of 153). To be included in the study group each surgeon had 1) foot and ankle patients comprising 50% or more of their clinical practice and 2) direct responsibility for teaching orthopaedic surgery residents. One hundred and three respondents met the inclusion criteria and formed the study group. Results: Eighty-seven percent (90 of 103) reported that they would use a distal chevron osteotomy as their primary procedure to correct the mild hallux valgus. Ten percent (10 of 103) reported that they would also add an Akin osteotomy of the proximal phalanx to enhance correction. Conclusions: Most respondents chose a distal chevron osteotomy as their primary procedure to correct the mild hallux valgus deformity.
Role of Patient Information Handouts Following Operative Treatment of Ankle Fractures
Authors: Mayich D. Joshua , Tieszer Christina , Lawendy Abdel , McCormick William , Sanders David 
Published: January 2017

Background: Widespread evidence exists for directed patient information interventions (eg, pamphlets) in the setting of several orthopaedic conditions and interventions. Up until now, no study had assessed the role of these interventions in the management of patients following ankle fractures. Methods: Between 2005 and 2007, 40 patients who suffered an operative ankle fracture were randomized to either a standard treatment group for an ankle fracture or an enhanced information group who received an American Academy of Orthopaedic Surgeons ankle fracture information pamphlet that explained postoperative routine at our institution and a physiotherapy handout depicting a standard protocol. Study participants were followed for 3 months clinically and radiographically. At the 6-week and 3-month intervals, study participants completed the Olerud-Molander Questionnaire and 2 questions regarding their level of satisfaction. The primary outcome measure was the Likert-scale-based survey question determining the level of satisfaction with the treating staff. Results: Participants in the enhanced information group were more satisfied with treatment at 3 months (9.2 vs 6.3; P < .001). There were significant improvements in work/activity ability at 6 weeks ( P = .01), but this advantage disappeared at 3 months ( P = .24). No differences in postoperative complication rates were noted. Conclusions: Information enhancement in the form of pamphlets can be helpful in providing patients with accessible information in the postoperative period. While they do not seem to have a sustained impact on postoperative outcomes, handouts may enhance the interaction between staff and patient at postoperative visits, improving patient satisfaction. Level of Evidence: Level I, appropriately powered randomized prospective cohort study.
Biologic Therapy in Psoriasis: Perspectives on Associated Risks and Patient Management
Authors: Papp Kim A. , DeKoven Joel , Parsons Laurie , Pirzada Syed , Robern Michael , Robertson Lynne , Tan Jerry K.L. 
Published: January 2017

Background: Previous publications have described practical considerations for initiating biologic therapy in psoriasis patients. However, most publications have focused on anti–tumor necrosis factor (TNF) therapy. Objective: To create an evidence-based, practical tool that provides guidance on patient management for all biologics currently approved in Canada and the United States. Methods: Psoriasis publications regarding safety issues in the initiation or monitoring of adalimumab, alefacept, etanercept, infliximab, or ustekinumab therapy were identified through a PubMed search. Phase III trials and open-label extensions (regardless of indication) and relevant guidelines from Health Canada were used to compile this review. Results: Although these biologic agents have demonstrated efficacy in patients with psoriasis and are generally considered safe and well tolerated, rare but serious safety issues (ie, demyelination, infection, tuberculosis, malignancy, lymphoma, cardiovascular outcomes, hepatitis, pregnancy, surgery, and vaccination) have been observed. Attention to specific aspects of patient management (ie, prescreening requirements, symptoms to watch for, appropriate treatment, and referrals) is required to mitigate risk. Conclusion: Much of the evidence regarding the long-term safety of these agents has been based on experience in other patient populations. However, it does serve to guide us in understanding the risks that may impact the management of psoriasis patients.
Clinical Usefulness of Ultrasonography in Interdigital Pilonidal Sinus
Authors: Imanishi Hisayoshi , Tsuruta Daisuke , Nomura Nami , Nakagawa Koichi 
Published: January 2017

Background: Interdigital pilonidal sinus is an uncommon occupational disease produced by short sharp hairs that penetrate the interdigital space of the hand. Although surgical excision is the preferred therapy for interdigital pilonidal sinus, preoperative diagnosis and characterization of pilonidal sinuses may be difficult. Objective: To report the usefulness of ultrasonography in making the diagnosis and evaluating for the size, shape, and internal structure of interdigital pilonidal sinus preoperatively. Methods: We performed ultrasonography (Xario SSA-660A, Toshiba Medical Systems Corporation, Tochigi, Japan) using an 8 MHz linear transducer in B mode. Results: A round to oval echo-poor area with sharp borders, enhanced dorsal reflection, and lateral echo-free streaks corresponded to the short axial cross section of sinus, and hyperechoic foci within the sinus represented hairs. Conclusion: Our case highlights the ability to determine key features of sinus tracts and diagnose interdigital pilonidal sinus accurately by ultrasonography. Ultrasonography, in combination with the history and physical examination, increases the diagnostic accuracy of interdigital pilonidal sinus and can help in determining the extent of surgery required to fully remove the interdigital pilonidal sinus.
Rosai-Dorfman Disease Treated with Methotrexate and Low-Dose Prednisone: Case Report and Review of the Literature
Authors: Nasseri Eiman , Belisle Annie , Funaro Deana 
Published: January 2017

Background: Rosai-Dorfman disease is a rare condition characterized by an accumulation of histiocytes within lymph nodes and tissue. Treatment is indicated when the condition is highly symptomatic and when widespread involvement causes vital organ compression. Objective: To review the classic physical and histologic findings in Rosai-Dorfman disease and summarize the literature supporting the use of methotrexate in this condition. Methods and Results: We describe a case of Rosai-Dorfman disease that failed to respond to monotherapy with systemic corticosteroids but improved with the addition of methotrexate. Methotrexate alone or in combination with other agents has been described in at least 12 other cases in the literature and lead to a partial or complete resolution of disease in over half of these. Conclusion: The rapid improvement of clinical and physical symptoms with minimal side effects in our case and others reinforces the utility of antimetabolites in patients with Rosai-Dorfman disease who fail to respond to corticosteroids.
Unilateral Keratoderma in a Mother and Her Son
Authors: O'toole Ashley , O'malley Maureen 
Published: January 2017

Background: Keratoderma is a group of conditions characterized by hyperkeratosis affecting the skin on the soles of the feet and palms of the hands bilaterally. The classification of keratodermas depends on whether it is inherited or acquired and on its clinical features, including diffuse or focal involvement of the skin and the morphology of lesions present. Case Report: We describe the rare case of a 54-year-old female who presented with a nearly 40-year history of punctate keratoderma on her right palm and sole. History taking revealed that her biologic son also has unilateral left-sided keratoderma. The clinical presentation of unilateral keratoderma has been reported only four times in the literature.
Who Answers ‘Willingness to Pay’ Questions?
Authors: Thomas Ruth , Donaldson Cam , Torgerson David 
Published: January 2017

Objectives: The objectives of this study were twofold. The first was to compare characteristics of responders and non-responders to a survey of women attending a bone mineral density screening service in Aberdeen concerned with the screening process which contained questions on attenders' willingness to pay (WTP) and willingness to wait (WTW) for screening. The second objective was to compare the characteristics of those responding to either the WTP or the WTW questions relative to those who responded to both. Methods: After receiving a scan, women completed the questionnaire at the clinic or returned it by post. Logistic regression analysis was used to compare the characteristics of the responders and non-responders. Results: Those who smoked were less likely to return the questionnaire, whilst those who drank alcohol were more likely to return it. The majority of respondents answered both WTP and WTW questions. The proportions responding to the WTW and WTP questions were 93.2% and 81.5% for the two questions, respectively (95% confidence interval of difference = 9.4% to 13.9%). The only result which was statistically significant at the 1% level showed that, relative to those who answered the WTW but not the WTP questions, those who answered both were more likely to be older when they left full-time education. A weaker statistical association (at the 5% level) revealed that those who were older when leaving full-time education were more likely to answer a WTP question than not. Conclusions: WTP questions seem to be less acceptable to those who leave full-time education earlier. Analysts may need to account for this in future studies. Whether such results can be replicated and reasons for non-response should be investigated.
In Pursuit of Patient-Centred Outcomes: A Qualitative Evaluation of the ‘Measure Yourself Medical Outcome Profile’
Authors: Paterson Charlotte , Britten Nicky 
Published: January 2017

Objectives: To ascertain the ability of a patient-generated outcome measure, the ‘Measure Yourself Medical Outcome Profile’ (MYMOP), to reflect the outcomes of consultations which patients consider are most important, as derived from qualitative interviews. Methods: A qualitative study using a constant comparative method to analyse semistructured interviews which were then compared with the results of MYMOP questionnaires. A variable-orientated analysis was used to develop themes and a case-orientated analysis was used to develop narrative summaries called vignettes from the interviews. The MYMOP questionnaire was completed by the interviewees ( n= 20), a minimum of twice and a maximum of nine times over a four-month period. The scores were displayed on individual MYMOP charts. For each individual, the outcome as measured by MYMOP was compared with the outcome data from the qualitative interviews. The interviewees were attending a variety of complementary practitioners in primary care. Results: The treatment effects which people described were encompassed by five themes: reduction in symptoms; reduction in disability; reduction in, or avoidance of, medication; gaining control and improving coping skills; and securing support and hope through the patient—practitioner relationship. The vignettes demonstrated how individuals identified and valued these various effects and weighed them up in evaluating the overall benefit of the treatment. Their MYMOP charts were able to measure some effects better than others. Conclusions: The treatment effects, as quantified using MYMOP, accorded with those described by most patients at interview, but some important limitations were identified with MYMOP, particularly an underplaying of the importance of medication avoidance or medication reduction in this patient group. This dimension is lacking in most outcome questionnaires and has been included in a new version of MYMOP. This study also showed that qualitative interview data can help in evaluating the ability of outcome questionnaires to measure the treatment effects that particular patient groups consider most important.
Conceptual and Practical Difficulties with the Economic Evaluation of Health Services Developments
Authors: Coast Joanna , Hensher Martin , Mulligan Jo-Ann , Shepperd Sasha , Jones Jeremy 
Published: January 2017

Five recent economic evaluations comparing hospital at home schemes with acute hospital care faced remarkably similar problems. This paper outlines these problems and considers what strategies can be derived from these experiences, which will be relevant to economic evaluations of other aspects of the organisation of care, particularly those crossing the interfaces between primary and secondary health care or the interface between health and social services. The difficulties experienced can be divided into conceptual and practical problems. Conceptual problems were primarily associated with issues of context and related to the choice of comparator, capacity constraints and size of schemes, and the choice between a short or a long run perspective. Practical problems were connected with the time at which schemes were evaluated, the type of clinical study alongside which studies were conducted and the types of data available for use in the analysis. Strategies which can be pursued in conducting economic evaluations of organisational change include giving greater attention to conceptual and hence contextual problems as well as reporting these contextual issues in detail, accepting the need for repeated economic evaluations as organisational changes become more widespread and considering carefully the clinical study design where economic evaluations of organisational change are conducted alongside. These strategies are of importance not just to those conducting economic evaluations but also to those funding appraisals of changes in the organisation of care. Use of different strategies such as those suggested here should be evaluated.
Private Provision of ‘outreach’ Clinics to Fundholding General Practices in England
Authors: Kerrison Susan , Corney Roslyn 
Published: January 2017

Objectives: To establish the contribution of the private sector in providing outpatient ‘outreach’ clinics in general practitioner fundholding practices. Method: Postal survey of all 13 first-wave fundholders and four of the 13 second-wave fundholders in the former South East Thames Region of the National Health Service in 1995. Results: Fourteen practices responded. Ten practices had set up at least one medical specialist ‘outreach’ clinic and 12 at least one paramedical clinic since becoming fundholders. Eight practices reported their arrangements for consultant ‘outreach’ clinics and ten practices their arrangements for paramedical clinics. Forty-nine per cent of the total medical specialist hours and 46% of total paramedical hours were provided by private practitioners. The largest number of hours provided privately was in gynaecology. Conclusion: This small study identified considerable private provision of fundholders' ‘outreach’ clinics. However, there is no system in the NHS to monitor the extent of this market, the types of activities undertaken or the relative quality and cost of the services provided.
Evaluating Interventions to Promote Patient Involvement in Decision-Making: By What Criteria Should Effectiveness be Judged?
Authors: Entwistle Vikki A , Sowden Amanda J , Watt Ian S 
Published: January 2017

Interventions to inform patients about health care options and to involve them in decisions about their care are now widely advocated. The question of which criteria should be used to judge the effectiveness of such interventions has, however, received little attention. The provision of research-based information about health care effectiveness to patients and the promotion of greater patient involvement in health care decision-making are likely to have a complex range of effects on: the information provided to patients; patients' acquisition of skills; patients' knowledge and emotions; how decisions are made; the quality of decisions; professional—patient relationships; the use of health care; the health of patients; satisfaction; and the organisation and cost of health services. Opinions about which effects are most important and how they should be measured and valued will be influenced by a variety of factors, including: the rationales and motives underlying interest in patient involvement in decision-making; the forms of patient involvement envisaged; and the types of interventions being considered. In the context of health care systems which aim primarily to improve health status and well-being, health outcomes should take priority over process variables such as decision-making behaviours and patients' knowledge.