bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Preoperative ‘6 Pack’ for Patients With Ankle Arthritis
Authors: Siddique Malik S. , Ramaskandhan Jayasree R. , Chuter Graham S. , Gower Andrew , Murty Aradhyula N. , Patterson Paul R. , Townshend David , Torres Paulo 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: There is paucity of literature relating to information needs of patients in Orthopaedic Surgery, despite the fact that Orthopaedic Surgeons in the UK welcome the use of patient decision aids for joint replacement surgery. This multi- centre study aimed to study the information needs of patients for surgical treatment of ankle arthritis from 6 different hospitals across the North East region of England. Methods: Ethical permissions were obtained for this multi-centre qualitative research study. The study recruited 18 patients from 6 hospitals across the North East of England. They were invited to take part in patient focus group meetings. 3 focus groups were conducted with 4-8 patients/ group. These groups were facilitated by independent researchers using a semi-structured discussion approach. Patients were asked for their views on information needs for surgical treatment of ankle arthritis. The focus group meetings were digitally recorded and transcribed verbatim. Data was analysed using the nVIVO software with framework analysis. Results: The analysis highlighted 4 main themes: A) Factors influencing surgical decision making B) Information needs of patients C) Information provision and D) Patient expectations. Theme B is discussed in detail for this abstract. Primary information needs requested by over 70% of patients were: 1. Desire to meet with patients who had undergone similar surgical procedure 2. Information on post-operative rehabilitation 3. Information on return to work and driving 4. Experience of consultant team 5. Written information regarding procedures (advantages, disadvantages, survivorship and outcomes) and 6. Personalized decision support based on individual patient’s lifestyle and preferences. These components form the Preoperative/information ‘6 pack’. Conclusion: When developing information materials and decision tools for patients, providing them with the Ankle Arthritis ‘6 pack’ will enable them to make a more informed choice of the surgical options offered by the consultant.
The Use of SPECT-CT in the Diagnosis and Surgical Decision Making for the Treatment of Muller- Weiss Disease
Authors: Li ShuYuan , Zhang JianZhong 
Published: October 2016

Category: Hindfoot Introduction/Purpose: Muller Weiss disease (MWD) is an idiopathic avascular necrosis of the navicular, caused by abnormal forces on the immature navicular. The disease is characterized by hindfoot varus, a paradoxical flatfoot deformity, and middle foot pain associated with arthritis. According to Maceira the progress of the disease can be divided into five stages, with the increasing of deformity and fragmentation. However, the stage of disease does not correspond with an increase in symptoms. In addition, neither XR nor CT provides sufficient information to assist with clinical decision making. For early stage cases with minimal clinical and radiological changes, diagnosis is difficult, and for advanced cases, with extensive arthritis and deformity, it is difficult to distinguish which joints are involved in the disease process. Methods: We present the use of SPECT-CT in the diagnosis and surgical decision making for the treatment of Muller-Weiss Disease. We propose that it will be helpful to make the diagnosis of early stage disease, and facilitate decision making with respect to the involved joints in advanced disease. The use of SPECT-CT is particularly helpful when the arthritis appears to include both the talonavicular (TN) and navicular-cuneiform (NC) joints, but may isolate one or more joints which require arthrodesis. 5 cases of MWD were prospectively studied with SPECT-CT. There were 4 females and 1 male with a mean age of 52 years, and each with a different stage of the disease process . The clinical outcomes of the treatment were evaluated. We present the unique findings of each patient and the use of SPECT-CT in planning treatment. One patient was successfully treated non operatively with orthotic support. Results: One patient was treated with an isolated talonavicular arthrodesis despite radiographs demonstrating arthritis in the NC joint, but with a normal SPECT CT at that joint. One patient was treated with a triple arthrodesis when the SPECT CT did not support the radiographic findings of involvement of the NC joints . One patient who had a postitive uptake of both TN and NC joints on SPECT CT underwent a TN-NC arthrodesis. One patient underwent a triple arthrodesis, but with continued pain, and the SPECT CT was able to clarify the source of pain not as a non union but as arthritis of the NC joint. Conclusion: SPECT CT was found to be accurate and predict the course of treatment in these five cases. It is very useful in early diagnosis as well as decision making of advanced stage MWD, with a high sensitivity and ability to specify the clinically involved joints, which had not been possible with plain radiographs in any of these patients.
The Validity of Using ICD-9 Codes for Identifying Venous Thromboembolism Following Below Knee Surgery
Authors: Lubberts Bart , Heijboer Reinout R. , Van Dijk Pim A. , Vopat Bryan G. , Johnson Holly H. , Guss Daniel , DiGiovanni Christopher W. 
Published: October 2016

Category: Other Introduction/Purpose: To determine the incidence of venous thromboembolism (VTE) after surgeries performed below the knee, previous studies have used the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes to identify a DVT (deep vein thrombosis) or PE (pulmonary embolism) event. The purpose of this study was (1) to determine the incidence of VTE in a large cohort of patients who had undergone surgery below the knee, and (2) to assess the validity of the ICD-9-CM procedure codes used. Methods: Current Procedural Terminology codes and ICD-9-CM codes were used to identify patients who had undergone below knee surgery and a reported VTE. The medical records of 21,904 patients were evaluated to assess the validity of the VTE ICD-9-CM code against the documentation of DVT or PE in radiology reports. Positive predictive value (PPV) and sensitivity of ICD-9-CM codes were calculated. Results: The incidence of VTE was 2.5% (552/21,904). Of those patients identified as having VTE, 344 (62.3%) had a DVT, 130 (23.6%) had a PE, and 78 (14.1%) were recorded as having both a DVT and PE. The PPV of ICD-9-CM coding were 55.7% (327/587) for DVT, 84.4% (108/128) for PE, 60.2% (59/98) for DVT/PE combined, and 60.8% (494/813) for VTE in total. The resulting sensitivity scores were 95.1% (327/344) for DVT, 83.1% (108/130) for PE, 75.6% (59/78) for DVT/PE combined, and 89.5% (494/552) for VTE in total. Conclusion: The overall rate of VTE after below knee surgery was 2.5%. This study found that ICD-9 code use had an 89.5% sensitivity rate for VTE. Using ICD-9 codes to search for a VTE demonstrated a low PPV, however, because only 60.8% could be verified by a radiological study. By comprehensively assessing the incidence of VTE after below knee surgery, we illustrated a potential source of inaccuracy in the use of retrospective ICD-9 based data capture methodologies.
Toe Plantarflexion Exercise for Prevention of Falls
Authors: Amaha Kentaro 
Published: October 2016

Category: Other Introduction/Purpose: Toe plantarflexion weakness has been suggested to be associated with a range of disorders and dysfunction. Although toe plantar strength (TPS) clearly contributes to the balance and gait problem, relationship between toe plantarflexion weakness and the prevention of falls is poorly understood. Therefore, we developed a new device that measures toe plantarflexion strength as strength to press the floor. The aim of this study was to assess the hypothesis that toe plantarflexion exercise can be the prevention of falls in elderly persons. Methods: A single-blinded randomized controlled trial was conducted in community-dwelling older adults (N = 99, mean age 74.4±6) without major cognitive impairment. The subjects were divided into two groups: 47 females in the toe plantarflexion exercise (Ex) group and 52 in the control (Cr) group by the simple random sampling method. Ex group participated toe exercise program under the supervision of a physiotherapist. The maximum toe plantarflexion forces of all participants were measured by using push-type toe grip strength meter in both upright and sitting position. The number of falls, Timed Up and Go Test (TUGT), one-legged stance time, Functional Reach Test (FRT), Fall Efficacy Score (FES) were assessed at baseline and 2 months, 6 months. All participants were prospectively followed up for one year to count the number of falls. Results: There was no difference in the total falls incidence between groups (p = 0.18). Ex group showed significantly improved maximum plantarflexion strength at 6 months assessment (left sitting; p = 0.03, left upright; P = 0.157, right sitting; P = 0.007, right upright; P = 0.047). One-legged stance time, FRT, FES did not differ between groups. Conclusion: Although the toe exercise program enhanced toe plantarflexion forces, the total falls incidence, one-legged stance time, FRT, FES did not differ between groups. Future research is needed to determine the role of toe plantarflexion force in the enhancement of strength, balance, and mobility.
Strategies before, during, and after hematopoietic cell transplantation to improve T-cell immune reconstitution
Authors: de Koning Coco , Nierkens Stefan , Boelens Jaap Jan 
Published: October 2016

AbstractT-cell immune reconstitution (IR) after allogeneic hematopoietic cell transplantation (allo-HCT) is highly variable between patients and may take several months to even years. Patients with delayed or unbalanced T-cell IR have a higher probability of developing transplantation-related morbidity, mortality, and relapse of disease. Hence, there is a need for strategies to better predict and improve IR to reduce these limitations of allo-HCT. In this review, we provide an update of current and in-near-future clinically relevant strategies before, during, and after transplantation to achieve successful T-cell IR. Potent strategies are choosing the right HCT source (eg, donor-recipient matching, cell dose, graft manipulation), individualized conditioning and serotherapy (eg, antithymocyte globulin), nutritional status, exercise, home care, modulation of microbiota, enhancing homeostatic peripheral expansion, promoting thymopoiesis, and the use of adjuvant-targeted cellular immunotherapies. Strategies to prevent graft-versus-host disease are important as well because this complication and the subsequent need for immunosuppression affects T-cell IR and function. These options aim for personalized precision transplantation, where allo-HCT therapy is designed to boost a well-balanced T-cell IR and limit complications in individual patients, resulting in overall lower morbidity and higher survival chances.
Longitudinal Changes in Depression Symptoms and Survival Among Patients With Lung Cancer: A National Cohort Assessment
Authors: Sullivan Donald R. , Forsberg Christopher W. , Ganzini Linda , Au David H. , Gould Michael K. , Provenzale Dawn , Slatore Christopher G. 
Published: October 2016

Purpose Depression symptoms are common among patients with lung cancer; however, longitudinal changes and their impact on survival are understudied. Methods This was a prospective, observational study from the Cancer Care Outcomes Research and Surveillance Consortium from five US geographically defined regions from September 2003 through December 2005. Patients enrolled within 3 months of their lung cancer diagnosis were eligible. The eight-item Center for Epidemiologic Studies Depression scale was administered at diagnosis and 12 months’ follow-up. The main outcome was survival, which was evaluated using Kaplan-Meyer curves and adjusted Cox proportional hazards modeling. Results Among 1,790 participants, 681 (38%) had depression symptoms at baseline and an additional 105 (14%) developed new-onset depression symptoms during treatment. At baseline, depression symptoms were associated with increased mortality (hazard ratio [HR], 1.17; 95% CI, 1.03 to 1.32; P = .01). Participants were classified into the following four groups based on longitudinal changes in depression symptoms from baseline to follow-up: never depression symptoms (n = 640), new-onset depression symptoms (n = 105), depression symptom remission (n = 156), and persistent depression symptoms (n = 254) and HRs were calculated. Using the never-depression symptoms group as a reference group, HRs were as follows: new-onset depression symptoms, 1.50 (95% CI, 1.12 to 2.01; P = .006); depression symptom remission, 1.02 (95% CI, 0.79 to 1.31; P = .89), and persistent depression symptoms, 1.42 (95% CI, 1.15 to 1.75; P = .001). At baseline, depression symptoms were associated with increased mortality among participants with early-stage disease (stages I and II; HR, 1.61; 95% CI, 1.26 to 2.04), but not late-stage disease (stages III and IV; HR, 1.05; 95% CI, 0.91 to 1.22). At follow-up, depression symptoms were associated with increased mortality among participants with early-stage disease (HR, 1.71; 95% CI, 1.27 to 2.31) and those with late-stage disease (HR, 1.32; 95% CI, 1.04 to 1.69). Conclusion Among patients with lung cancer, longitudinal changes in depression symptoms are associated with differences in mortality, particularly among patients with early-stage disease. Symptom remission is associated with a similar mortality rate as never having had depression.
Randomized Trial Comparing R-CHOP Versus High-Dose Sequential Chemotherapy in High-Risk Patients With Diffuse Large B-Cell Lymphomas
Authors: Cortelazzo Sergio , Tarella Corrado , Gianni Alessandro Massimo , Ladetto Marco , Barbui Anna Maria , Rossi Andrea , Gritti Giuseppe , Corradini Paolo , Di Nicola Massimo , Patti Caterina , Mulé Antonino , Zanni Manuela , Zoli Valerio , Billio Atto , Piccin Andrea , Negri Giovanni , Castellino Claudia , Di Raimondo Francesco , Ferreri Andrés J.M. , Benedetti Fabio , La Nasa Giorgio , Gini Guido , Trentin Livio , Frezzato Maurizio , Flenghi Leonardo , Falorio Simona , Chilosi Marco , Bruna Riccardo , Tabanelli Valentina , Pileri Stefano , Masciulli Arianna , Delaini Federica , Boschini Cristina , Rambaldi Alessandro 
Published: October 2016

Purpose The benefit of high-dose chemotherapy with autologous stem-cell transplantation (ASCT) as first-line treatment in patients with diffuse large B-cell lymphomas is still a matter of debate. To address this point, we designed a randomized phase III trial to compare rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP)-14 (eight cycles) with rituximab plus high-dose sequential chemotherapy (R-HDS) with ASCT. Patients and Methods From June 2005 to June 2011, 246 high-risk patients with a high-intermediate (56%) or high (44%) International Prognostic Index score were randomly assigned to the R-CHOP or R-HDS arm, and 235 were analyzed by intent to treat. The primary efficacy end point of the study was 3-year event-free survival, and results were analyzed on an intent-to-treat basis. Results Clinical response (complete response, 78% v 76%; partial response, 5% v 9%) and failures (no response, 15% v 11%; and early treatment-related mortality, 2% v 3%) were similar after R-CHOP versus R-HDS, respectively. After a median follow-up of 5 years, the 3-year event-free survival was 62% versus 65% ( P = .83). At 3 years, compared with the R-CHOP arm, the R-HDS arm had better disease-free survival (79% v 91%, respectively; P = .034), but this subsequently vanished because of late-occurring treatment-related deaths. No difference was detected in terms of progression-free survival (65% v 75%, respectively; P = .12), or overall survival (74% v 77%, respectively; P = .64). Significantly higher hematologic toxicity ( P < .001) and more infectious complications ( P < .001) were observed in the R-HDS arm. Conclusion In this study, front-line intensive R-HDS chemotherapy with ASCT did not improve the outcome of high-risk patients with diffuse large B-cell lymphomas.
Phase I/Phase II Study of Blinatumomab in Pediatric Patients With Relapsed/Refractory Acute Lymphoblastic Leukemia
Authors: von Stackelberg Arend , Locatelli Franco , Zugmaier Gerhard , Handgretinger Rupert , Trippett Tanya M. , Rizzari Carmelo , Bader Peter , O’Brien Maureen M. , Brethon Benoît , Bhojwani Deepa , Schlegel Paul Gerhardt , Borkhardt Arndt , Rheingold Susan R. , Cooper Todd Michael , Zwaan Christian M. , Barnette Phillip , Messina Chiara , Michel Gérard , DuBois Steven G. , Hu Kuolung , Zhu Min , Whitlock James A. , Gore Lia 
Published: October 2016

Purpose Blinatumomab is a bispecific T-cell engager antibody construct targeting CD19 on B-cell lymphoblasts. We evaluated the safety, pharmacokinetics, recommended dosage, and potential for efficacy of blinatumomab in children with relapsed/refractory B-cell precursor acute lymphoblastic leukemia (BCP-ALL). Methods This open-label study enrolled children < 18 years old with relapsed/refractory BCP-ALL in a phase I dosage-escalation part and a phase II part, using 6-week treatment cycles. Primary end points were maximum-tolerated dosage (phase I) and complete remission rate within the first two cycles (phase II). Results We treated 49 patients in phase I and 44 patients in phase II. Four patients had dose-limiting toxicities in cycle 1 (phase I). Three experienced grade 4 cytokine-release syndrome (one attributed to grade 5 cardiac failure); one had fatal respiratory failure. The maximum-tolerated dosage was 15 µg/m2/d. Blinatumomab pharmacokinetics was linear across dosage levels and consistent among age groups. On the basis of the phase I data, the recommended blinatumomab dosage for children with relapsed/refractory ALL was 5 µg/m2/d for the first 7 days, followed by 15 µg/m2/d thereafter. Among the 70 patients who received the recommended dosage, 27 (39%; 95% CI, 27% to 51%) achieved complete remission within the first two cycles, 14 (52%) of whom achieved complete minimal residual disease response. The most frequent grade ≥ 3 adverse events were anemia (36%), thrombocytopenia (21%), and hypokalemia (17%). Three patients (4%) and one patient (1%) had cytokine-release syndrome of grade 3 and 4, respectively. Two patients (3%) interrupted treatment after grade 2 seizures. Conclusion This trial, which to the best of our knowledge was the first such trial in pediatrics, demonstrated antileukemic activity of single-agent blinatumomab with complete minimal residual disease response in children with relapsed/refractory BCP-ALL. Blinatumomab may represent an important new treatment option in this setting, requiring further investigation in curative indications.
Factors Associated With Tyrosine Kinase Inhibitor Initiation and Adherence Among Medicare Beneficiaries With Chronic Myeloid Leukemia
Authors: Winn Aaron N. , Keating Nancy L. , Dusetzina Stacie B. 
Published: October 2016

Purpose There is substantial concern surrounding affordability of orally administered anticancer therapies, particularly for Medicare beneficiaries. We examined rates of initiation and adherence to tyrosine kinase inhibitors (TKIs) among Medicare beneficiaries with chronic myeloid leukemia (CML) with and without cost-sharing subsidies. We selected TKIs given their effectiveness and strong indication for use among patients diagnosed with CML. Patients and Methods Using SEER-Medicare data, we identified individuals diagnosed with CML from 2007 to 2011. We used Cox proportional hazards regression to assess time from diagnosis to TKI initiation. We used generalized estimating equations to examine treatment initiation within 180 days and TKI adherence among initiators. We defined adherence as at least 80% of days covered during the 6 months after TKI initiation. Results Among 393 individuals diagnosed with CML from 2007 to 2011, 68% initiated TKI treatment within 180 days after diagnosis. In multivariate analysis, individuals with cost-sharing subsidies, younger age, lower comorbidity, and later year of diagnosis were significantly more likely to initiate TKIs. Among TKI initiators, 61% were adherent; adherence was lower for individuals age 80 years or older versus 66 to 69 years. Conclusion Only 68% of Medicare beneficiaries with CML initiated TKI therapy within 6 months of diagnosis. Delayed initiation among individuals without cost-sharing subsidies suggests that out-of-pocket costs may be a barrier to timely initiation of therapy among individuals diagnosed with CML.
Cancer-Related Fatigue in Patients With and Survivors of Hodgkin Lymphoma: The Impact on Treatment Outcome and Social Reintegration
Authors: Behringer Karolin , Goergen Helen , Müller Horst , Thielen Indra , Brillant Corinne , Kreissl Stefanie , Halbsguth Teresa Veronika , Meissner Julia , Greil Richard , Moosmann Peter , Shonukan Oluwatoyin , Rueffer Jens Ulrich , Flechtner Hans-Henning , Fuchs Michael , Diehl Volker , Engert Andreas , Borchmann Peter 
Published: October 2016

Purpose Cancer-related fatigue occurs frequently in patients with Hodgkin lymphoma (HL) and has a major impact on their quality of life. We hypothesized that severe fatigue (sFA) might have an impact on patients’ treatment outcome and social reintegration. Methods Of 5,306 patients enrolled in the German Hodgkin Study Group’s fifth generation of clinical trials in HL (HD13, HD14, and HD15; nonqualified and older [> 60 years] patients excluded), 4,529 provided data on health-related quality of life. We describe sFA (defined as a score ≥ 50 on the 0 to 100 scale from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30) before and up to 9 years after therapy and analyze its impact on treatment outcome and social reintegration. Results The proportion of patients reporting sFA was 37% at baseline and ranged from 20% to 24% during follow-up. Baseline sFA was associated with significantly impaired progression-free survival and a trend to impaired overall survival, which can be overcome in patients receiving highly effective HL therapies as applied in our fifth-generation trials. Our analysis revealed a significant negative association of sFA and employment in survivors: 5 years after therapy, 51% and 63% of female and male survivors, respectively, with sFA were working or in professional education, compared with 78% and 90% without sFA, respectively ( P < .001 adjusted for age, sex, stage, baseline employment status, and treatment outcome). sFA was also associated with financial problems and the number of visits to a general practitioner and medical specialists. Conclusion sFA is an important factor preventing survivors from social reintegration during follow-up. This observation underscores the need to address fatigue as a significant diagnosis when treating patients with and survivors of cancer.