bluuebunny/crossref_metadata_2025_split huggingface dataset:
Poster 261: The Influence of Slope Reducing Osteotomy on Patella Height in Patients Undergoing Revision ACL Reconstruction: An Evaluation of a Tibial Tubercle-Sparing Anterior Closing-Wedge Osteotomy Technique
Authors: Saithna Adnan , Guy Sylvain , Ferreira Alexandre , Carrozzo Alessandro , Vieira Thais Dutra , Ollivier Matthieu , Sonnery-Cottet Bertrand 
Published: October 2024

Objectives: The purpose of this study was to evaluate the effect of tibial tubercle-sparing anterior closing-wedge osteotomy on patellar height in revision ACL reconstructions (ACLR). Methods: Patients who underwent arthroscopic revision ACLR combined with retro-tibial tubercle anterior closing wedge high tibial osteotomy (ACW-HTO) from 01/01/2016 to 31/03/2021 were assessed for eligibility. Patellar height was measured on full weightbearing lateral x-rays according to the Insall-Salvati index (ISI) and Caton-Deschamps index (CDI) or frontal x-rays using the Femoral Patellar Height Index (FPHI). The PTS was evaluated using the proximal anatomic axis of the tibia on standard short lateral x-rays. The delta (post-operative - preoperative) and the ratio (pre-operative / post-operative) of the three patellar height indices and PTS were calculated. Preoperative to postoperative patellar height were compared using independent t tests for each index. It was also investigated whether patients changed patellar height category (baja, norma, or alta). Results: Among 475 revision ACLR, 47 tibial tubercle-sparing ACW-HTOs were performed. No significant difference in patellar height was found between pre- and postoperative x-rays regardless of the index (ISI P = .1729, CDI P = .4034, FPHI P = .5130). Despite the lack of a statistically significant difference, 15 patients (31.9%) exhibited a post-operative change in their patellar height category when measured by the ISI (6 moved up a category, 9 moved down a category) and 18 (38.3%) patients changed category according to the CDI (10 moved up a category, 8 moved down a category). Conclusions: Although a statistically significant difference between pre- and postoperative patella height was not observed, changes in patellar height category were common after tibial tubercle-sparing anterior closing-wedge high tibial osteotomy, in patients undergoing revision ACL reconstruction. The clinical impact of these changes is unknown and further study is needed to investigate whether they may result in patellofemoral symptoms.
Poster 305: Redislocation After Medial Patellofemoral Ligament Reconstruction is Correlated with Preoperative Measurements and Intraoperative Instability Measurements
Authors: Phillips Andrew , Haneberg Erik , Elias Tristan , Sachdev Divesh , Kaplan Daniel , Wang Zachary , Credille Kevin , Chahla Jorge , Forsythe Brian , Verma Nikhil , Cole Brian , Yanke Adam 
Published: October 2024

Objectives: Medial patellofemoral ligament reconstruction is performed to address cases of patellar instability. Historically, this is a well-tolerated procedure though complications, including redislocation and recurrent instability can occur. While risk factors for redislocation following MPFLR have been proposed, there remains no agreed upon consensus. This is even more true in setting of isolated MPFL reconstruction, as concomitant procedures may naturally exclude certain anatomic risk factors. The purpose of this study was to correlate demographic, anatomical, and clinical risk factors to redislocation following isolated medial patellofemoral ligament reconstruction (MPFLR). Methods: A retrospective review of patients who underwent isolated MPFLR for recurrent patellar instability at a single institution between December 2015-June 2021 was performed. Included patients had a minimum of 2 years of follow-up data available. Demographic, pre-operative radiographic, surgical, and clinical data was compared between those who had a dislocation event after surgery and those who did not. Subluxation and subjective instability were not considered dislocation events. Independent samples T-test and univariate binary logistic regression was performed. Results: This study included 126 patients with a mean age of 21.74 ± 9.20 and a mean BMI of 25.93 ± 6.36. Of these, 67.5% were female and 61.9% of operations were on the left knee. In total, 8.7% (11/126) of patients experienced a redislocation event with a mean time to redislocation of 19.11 months after surgery (range 5 – 32 months). On preoperative magnetic resonance imaging (MRI), greater trochlear bump height measured to bone (p=0.032) and measured to cartilage (p=0.033) was associated with redislocation (Table 1). Additionally, patients who redislocated were found to have a wider sulcus angle (p=0.022). On examination under anesthesia, a greater flexion instability resolution angle – the angle of knee flexion at which the patella no longer dislocates – was found to be associated with redislocation (p=0.041) (Figure 1). These variables all retained significance during univariate regression. Conclusions: MPFLR is associated with a high level of success with a redislocation rate of 8.7% in this study. On pre-operative MRI, wide sulcus angle and increased bump height measured to bone and to cartilage were risk factors for redislocation. Additionally, redislocation was associated with a greater flexion instability resolution angle (IRA).
Poster 347: Return to Sports of ACL Primary Repair Versus Autograft ACL Reconstruction at 2-year Follow-Up
Authors: Rilk Sebastian , DiFelice Gregory , van der List Jelle , Vermeijden Harmen Daniel , Goodhart Gabriel , O'Brien Robert 
Published: October 2024

Objectives: To evaluate the psychological readiness to return to sports (RTS), and assess the rates of RTS at preinjury level in patients undergoing anterior cruciate ligament (ACL) primary repair (ACLPR) with suture versus autograft ACL reconstruction (ACLR) at minimum 2-year follow-up (FU). Methods: Consecutive patients <50 years old and a preinjury Tegner score of ≥5, undergoing either ACLPR or ACLR by a single surgeon, between January 2018 and April 2021, were considered for eligibility. Surgical indication for either ACLPR with suture augmentation or autograft ACLR (58% hamstring- and 42% quadriceps tendon graft) was based on intra-operatively determined ACL tear type and tissue quality. ACLPR was performed in all patients with proximal type I or II types and good to excellent tissue quality, whereas ACLR was only performed when tear characteristics contraindicated ACL repair. To evaluate success of RTS, activity level (Tegner Activity Scale), psychological readiness to RTS (ACL-Return to Sport After Injury [RSI] score) and instrumented anterior-tibial translation side-to-side difference (ATT-SSD) were evaluated at minimum 2-year FU. Results: A total of 181 patients (100 ACLPR, 81 ACLR), were evaluated at final FU (mean ± SD (range), 3.2 ± 0.9 (2 to 5) years). A significantly greater number of patients undergoing ACLPR returned to their preinjury activity level (73% vs. 47%, p < .001), and further presented significantly better ACL-RSI scores (75.3 ± 22.2 vs. 66.6 ±24.2, p = .023) at minimum 2-year FU. Instrumented knee laxity revealed similar results for both treatment groups (ACLPR, 0.80 ±1.2 mm vs. ACLR, 0.97 ± 1.2 mm, p = .449). Conclusions: Patients undergoing ACLPR demonstrate greater return to preinjury activity level and greater confidence in their operated knee when performing their respective sport at 2-year FU compared to ACLR.
Poster 399: The 10-Year Decreasing Trend of Youth Soccer Concussions Presenting to U.S. Emergency Departments
Authors: Chun Alex , Snyder Eli , Obana Kyle , Ashinsky Beth , Parisien Robert , Bottiglieri Thomas , Ahmad Christopher , Trofa David 
Published: October 2024

Objectives: Soccer is one of the most popular youth sports with nearly 3 million annual participants in the United States alone. Importantly, concussion incidence and awareness in youth soccer has prompted implementation of various protective measures. Despite these interventions, no studies have investigated the prevalence of youth soccer concussions over time. The purpose of this study is to analyze trends and etiologies of youth soccer concussions presenting to United States emergency departments (EDs). Methods: Data from National Electronic Injury Surveillance System were analyzed for soccer players 2 to 18 years old sustaining concussions from January 2013 to December 2022. Patient data collected included age, sex, mechanism of injury, diagnosis, loss of consciousness, and disposition. Raw data were used to calculate national estimates based on assigned statistical sample weight of each hospital. Results: 182,462 youth soccer concussions were diagnosed in US EDs (52.6% male). Most common mechanism of injury was head to ball (29%). Between 2013 and 2022, concussions decreased 28%. Overall concussions decreased by 1,449 per year (95% CI: -2383 to -515, p=0.007). Not specified concussions decreased by 340 per year (95% CI: -501 to -180, p=0.001), head to body by 378 per year (95% CI: -527 to -229, p<0.001), head to ground by 275 per year (95% CI: -463 to -87, p=0.01), and other mechanisms by 56 per year (95% CI: -109 to -3, p=0.04). There were no changes in head to ball or head-to-head mechanisms. Exclusion of years 2020 and 2021 due to COVID demonstrated decreases in not specified concussions by 256 per year (95% CI = -394 to -118, p=0.004), head to body by 314 per year (95% CI: -431 to -196, p=0.001), and head to ground by 182 per year (95% CI: -331 to -33, p=0.02). Conclusions: There is a decreasing trend in youth soccer concussions from 2013 to 2022. Although concussion risk is greatest from contact with the ball, there was no decrease in head to ball concussions during the study period despite implementation and utilization of protective gear. This study contributes to growing literature regarding concussions in youth soccer athletes.
Opioids for the palliation of symptoms in people with serious respiratory illness: a systematic review and meta-analysis
Authors: Smallwood Natasha E. , Pascoe Amy , Wijsenbeek Marlies , Russell Anne-Marie , Holland Anne E. , Romero Lorena , Ekström Magnus 
Published: October 2024

BackgroundPeople living with serious respiratory illness experience a high burden of distressing symptoms. Although opioids are prescribed for symptom management, they generate adverse events, and their benefits are unclear.MethodsWe examined the efficacy and safety of opioids for symptom management in people with serious respiratory illness. Embase, MEDLINE and the Cochrane Central Register of Controlled Trials were searched up to 11 July 2022. Reports of randomised controlled trials administering opioids to treat symptoms in people with serious respiratory illness were included. Key exclusion criteria included <80% of participants having a nonmalignant lung disease. Data were extracted regarding study characteristics, outcomes of breathlessness, cough, health-related quality of life (HRQoL) and adverse events. Treatment effects were pooled using a generic inverse variance model with random effects. Risk of bias was assessed using the Cochrane Risk of Bias tool version 1.ResultsOut of 17 included trials, six were laboratory-based exercise trials (n=70), 10 were home studies measuring breathlessness in daily life (n=788) and one (n=18) was conducted in both settings. Overall certainty of evidence was “very low” to “low”. Opioids reduced breathlessness intensity during laboratory exercise testing (standardised mean difference (SMD) −0.37, 95% CI −0.67– −0.07), but not breathlessness measured in daily life (SMD −0.10, 95% CI −0.64–0.44). No effects on HRQoL (SMD −0.42, 95% CI −0.98–0.13) or cough (SMD −1.42, 95% CI −3.99–1.16) were detected. In at-home studies, opioids led to increased frequency of nausea/vomiting (OR 3.32, 95% CI 1.70–6.51), constipation (OR 3.08, 95% CI 1.69–5.61) and drowsiness (OR 1.37, 95% CI 1.01–1.86), with serious adverse events including hospitalisation and death identified.ConclusionsOpioids improved exertional breathlessness in laboratory exercise studies, but did not improve breathlessness, cough or HRQoL measured in daily life at home. There were significant adverse events, which may outweigh any benefits.
Manual flagging failed to identify pseudohyperkalemia in acute myeloid leukemia: case report
Authors: Cao Yangming 
Published: October 2024

Abstract
Background
Pseudohyperkalemia is well known in acute or chronic lymphocytic leukemia, but it is very rare in acute myeloid leukemia (AML). The lab flagging system for leukocytosis to prevent pseudohyperkalemia may not work.

Case presentation
A 55 year-old white man with AML was sent to emergency department for transfusion due to severe anemia. Blood test showed severe leukocytosis and elevated potassium. Repeated blood test showed his potassium was even higher. Anti-hyperkalemic medical treatment was given. He was then diagnosed with pseudohyperkalema.

Investigation
I was repeatedly reassured that the lab’s manual flagging system for leukocytosis was the key in reaching the correct diagnosis. My persistent inquiries, however, revealed that the flagging system was not functioning in the care of this patient. It was clinicians’ suspicion of pseudohyperkalema that led to the correct diagnosis, although the clinicians’ recommendation of obtaining a heparinized plasma for test did not play a role because all blood samples were already heparinized. The cause of pseudohyperkalemia was pneumatic tube transport. After this incident, our laboratory is investigating the options of using the Laboratory Information System to automatically flag the results and Clinical Laboratory Scientists to make the chemistry team more aware of potentially erroneous potassium results due to pseudohyperkalemia.

Conclusions
Pseudohyperkalemia associated with leukocytosis still occurs. This is the first case of pneumatic tube transport causing pseudohyperkalemia associated with AML. When significant leukocytosis, thrombocytosis, hyperproteinemia, or hyperlipidemia is present, whole blood should be utilized for potassium measurements and walked to the lab instead of sent by pneumatic tube transport. Even in a lab with a manual flagging system, there is still room to improve by implementing an automatic flagging system.
Ethical self-efficacy among healthcare professionals caring for people with dementia: a brief pre- and post-report on the CARE intervention
Authors: Schou-Juul Frederik , Ferm Lucca-Mathilde Thorup , Kinch Simon , Skov Sofie Smedegaard , Ritz Christian , Lauridsen Sigurd 
Published: October 2024

Abstract
Background
Interventions targeting healthcare professionals’ confidence in managing ethical issues in dementia care are limited despite documented positive effects of educational programs on staff knowledge and self-efficacy. However, inconsistencies in the literature regarding the impact of educational programs underscore the need for targeted interventions. The CARE intervention, specifically designed to enhance confidence in ethical decision-making, aims to address this gap. This study evaluates the effectiveness of the CARE intervention in enhancing the ethical self-efficacy of healthcare professionals caring for people with dementia, particularly those with initially low levels of self-efficacy.

Methods
Using a non-experimental pre-post evaluation design, the CARE intervention was administered to healthcare professionals (n = 86), measuring ethical self-efficacy pre-and post-intervention. We hypothesized significant differences in ethical self-efficacy mean scores pre- and post-intervention for all participants, particularly those with low pre-measurement scores, whom we expected to benefit most from the intervention. Statistical analysis included paired t-tests and Wilcoxon tests for the low pre-measurement subgroup analysis.

Results
While no significant change was observed in the entire sample, participants with low initial self-efficacy showed a statistically significant improvement post-intervention.

Conclusions
The CARE intervention holds promise in improving ethical self-efficacy among healthcare professionals with initial low confidence levels. Targeted interventions are essential in addressing confidence gaps in managing ethical challenges in dementia care, with implications for professional well-being and quality of care. Further research should explore long-term effects and expand sample size to enhance generalizability and sustainability of findings.
Implementing a Medicines at Transitions Intervention (MaTI) for patients with heart failure: a process evaluation of the Improving the Safety and Continuity Of Medicines management at Transitions of care (ISCOMAT) cluster randomised controlled trial
Authors: Powell Catherine , Ismail Hanif , Breen Liz , Fylan Beth , Alderson Sarah L , Gale Chris P , Gardner Peter , Silcock Jonathan , Cundill Bonnie , Farrin Amanda , Mason Ellen , Moreau Lauren , Alldred David P ,   ISCOMAT Programme Management Team, Armitage Gerry , Blenkinsopp Alison , Turner Robert , Taylor Andrew , Kellar Ian , Hartley Suzanne , Bojke Chris , Wright John 
Published: October 2024

Abstract
Background
Heart failure is a major global health challenge incurring a high rate of mortality, morbidity and hospitalisation. Effective medicines management at the time of hospital discharge into the community could reduce poor outcomes for people with heart failure. Within the Improving the Safety and Continuity Of Medicines management at Transitions of care (ISCOMAT) programme, the Medicines at Transitions Intervention (MaTI) was co-designed to improve such transitions, with a cluster randomised controlled trial to test effectiveness. The MaTI includes a patient toolkit and transfer of discharge medicines information to community pharmacy. This paper aims to determine the degree to which the intervention was delivered, and identify barriers and facilitators experienced by staff for the successful implementation of the intervention.

Methods
The study was conducted in six purposively selected intervention sites. A mixed-methods design was employed using hospital staff interviews, structured and unstructured ward observations, and routine trial data about adherence to the MaTI. A parallel mixed analysis was applied. Qualitative data were analysed thematically using the Framework method. Data were synthesised, triangulated and mapped to the Consolidated Framework for Implementation Research (CFIR).

Results
With limited routines of communication between ward staff and community pharmacy, hospital staff found implementing community pharmacy-related steps of the intervention challenging. Staff time was depleted by attempts to bridge system barriers, sometimes leading to steps not being delivered. Whilst the introduction of the patient toolkit was often completed and valued as important patient education and a helpful way to explain medicines, the medicines discharge log within it was not, as this was seen as a duplication of existing systems. Within the CFIR the most applicable constructs were identified as ‘intervention complexity’ and ‘cosmopolitanism’ based on how well hospitals were networked with community pharmacies, and the availability of hospital resources to facilitate this.

Conclusion
The MaTI was generally successfully implemented, particularly the introduction of the toolkit. However, implementation involving community pharmacy was more challenging and more effective communication systems are needed to support wider implementation.

Trial registration
11/04/2018 ISRCTN66212970. https://www.isrctn.com/ISRCTN66212970.
Private provider practices and incentives for hypertension management in rural and peri-urban Telangana, India– a qualitative study
Authors: Gupte Samriddhi S , Sachdeva Ashish , Kabra Aman , Singh Bhanu Pratap , Krishna Ashish , Pathni Anupam Khungar , Sharma Bhawna , Moran Andrew , Mamindla Amarendar Reddy , Kannuri Nanda Kishore , Deo Sarang 
Published: October 2024

AbstractHypertension poses a critical threat to health in India, being the predominant risk factor for mortality and disability. With over 70% of outpatient care being provided by the private sector, our study investigated the practices and incentives of private health providers in screening, diagnosing, treating, monitoring, and counseling hypertension patients in rural and peri-urban India. Conducted from April 2020 to February 2021, the qualitative study involved 46 participants, including various healthcare professionals and patients in three Telangana state districts. Analysis revealed a lack of recognition of hypertension’s gravity among private providers in these areas, leading to inconsistent screening practices and varied diagnostic thresholds, particularly among rural medical practitioners. Both formal and informal providers lacked standardized protocols and follow-up mechanisms, with limited technical knowledge about hypertension observed, especially among rural practitioners who were often the first point of contact. Drug effectiveness, and incentives from pharmaceutical sales representatives influenced prescribing practices. Diagnostic labs also offered financial incentives for patient referrals. Thus, aligning providers’ objectives with patient preferences and public health goals is crucial. To encourage evidence-based hypertension care, the government and NGOs could implement strategies such as tailored incentives, financial rewards, tax benefits, accreditation, and recognition for private healthcare providers. Professional bodies in the private sector should establish programs emphasizing quality assurance and certifications. Future research should focus on designing and testing new models for private sector hypertension service delivery, coupled with targeted interventions to enhance care in rural and peri-urban settings.
Inflammation scores based on C-reactive protein and albumin predict mortality in hospitalized older patients independent of the admission diagnosis
Authors: Di Rosa Mirko , Sabbatinelli Jacopo , Giuliani Angelica , Carella Miriam , Magro Daniele , Biscetti Leonardo , Soraci Luca , Spannella Francesco , Fedecostante Massimiliano , Lenci Federica , Tortato Elena , Pimpini Lorenzo , Burattini Maurizio , Cecchini Sara , Cherubini Antonio , Bonfigli Anna Rita , Capalbo Maria , Procopio Antonio Domenico , Balistreri Carmela Rita , Olivieri Fabiola 
Published: October 2024

AbstractSystemic inflammation significantly increases the risk of short- and long-term mortality in geriatric hospitalized patients. To predict mortality in older patients with various age-related diseases and infections, including COVID-19, inflammatory biomarkers such as the C-reactive protein (CRP) to albumin ratio (CAR), and related scores and indexes, i.e. Glasgow Prognostic Score (GPS), modified GPS (mGPS), and high sensitivity (hs)-mGPS, have been increasingly utilized. Despite their easy affordability and widespread availability, these biomarkers are predominantly assessed for clinical purposes rather than predictive applications, leading to their underutilization in hospitalized older patients. In this study, we investigated the association of CAR, GPS, mGPS, and hs-mGPS with short-term mortality in 3,206 geriatric hospitalized patients admitted for acute conditions, irrespective of admission diagnosis. We observed that unit increases of CAR, and the highest classes of GPS, mGPS, and hs-mGPS were significantly associated with a two- to threefold increased risk of death, even adjusting the risk for different confounding variables. Interestingly, a hs-mGPS of 2 showed the highest effect size. Furthermore, gender analysis indicated a stronger association between all CRP-albumin based parameters and mortality in men, underscoring the gender-specific relevance of inflammation-based circulating parameters in mortality prediction. In conclusion, scores based on serum CRP and albumin levels offer additional guidance for the stratification of in-hospital mortality risk in older patients by providing additional information on the degree of systemic inflammation.