bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pitfalls in Diagnosis of Early-Onset Inflammatory Bowel Disease
Authors: Triana Junco Paloma , Sánchez Galán Alba , Prieto Gerardo , Ramos Esther , Muñoz Romo Martha , Gómez Cervantes Manuel , Hernández Francisco , Martínez Leopoldo , López Santamaría Manuel , Dore Mariela 
Published: July 2017

Aim The onset of inflammatory bowel disease (IBD) in patients younger than the age of 5 years is rare. Moreover, when there is exclusive colonic inflammation, diagnosis can be challenging. Our aim was to describe the difficulties and pitfalls in the diagnosis of early-onset IBD (eoIBD) and their repercussions in treatment decisions.
Patients and Methods Patients with eoIBD (Crohn's disease [CD], ulcerative, and unclassified colitis) treated at our center between 1990 and 2016 were studied retrospectively. Demographic, clinical, medical, and surgical treatment data were analyzed.
Results A total of 19 patients were diagnosed with eoIBD at 21 (1–46) months of age. Bloody diarrhea, growth failure, and abdominal pain were present in 90, 42, and 16%, respectively. After 9 (1–62) months from the onset, patients were classified as ulcerative colitis (nine), CD (two), and unclassified colitis (eight). Unresponsiveness to medical treatment was observed in 10 and prompted surgical assessment. A partial colectomy was performed in one, and nine underwent a total colectomy (one end stoma and eight ileoanal anastomosis [IAA]). At least one surgical complication occurred in 80% and ultimately six patients with an IAA required an end stoma. Overtime, final diagnosis of 5 out of the 10 surgical patients changed due to biopsy findings, unresponsiveness to medical treatment, or extraintestinal and perianal manifestations. After a 12-year (1–22) follow-up, 57.9% of the diagnoses of all patients were modified.
Conclusion EoIBD poses a challenge due to ambiguous presentation and absence of specific diagnostic tests. Surgical evaluation is often needed and surgeons must be mindful of possible initial misdiagnosis, in addition to short- and long-term outcomes before deciding aggressive surgical measures as well as intestinal reconstruction.
Suspensory Tethers and Critical Point Membrane Displacement in Endolymphatic Hydrops
Authors: Pender Daniel 
Published: July 2017

Introduction Grossly displaced membranes are characteristic of endolymphatic hydrops. The process whereby physiological membrane displacement becomes pathological may be mediated by stress, but the membrane biomechanics underlying this transition are unclear.
Objective This study seeks to determine the role of suspensory tethers during pressure-induced membrane displacement in the generation of the membranous lesions seen in this disease entity using a biomechanical model approach.
Methods The location of membrane suspensory tethers was identified histologically. The influence of tethers on model membrane configuration during displacement was assessed graphically. The relationship of membrane configuration during displacement to curvature radius was quantified trigonometrically. The relationship of curvature radius to stress susceptibility was determined mathematically. The net effect of suspensory tethers on membrane stress levels for various degrees of membrane distention and displacement was then calculated numerically.
Results In the inferior labyrinth, suspensory tethers are found to occur on the membranes' boundaries. Such tethering is found to impose a biphasic effect on membrane curvature with increasing degrees of displacement. As a consequence, tensile stress susceptibility is found to decline with initial membrane displacement to a critical point nadir beyond which stress then increases monotonically. No such effect was found for the superior labyrinth.
Conclusion Boundary tethers in the inferior labyrinth are associated with significant tensile stress reductions until a critical point of membrane displacement is reached. Displacements short of the critical point may be physiological and even reversible, whereas such displacements beyond the critical point are apt to be overtly hydropic and irreversible.
Vermeidung unbeabsichtigter perioperativer Hypothermie: ein Leitfaden
Authors: Iden Timo , Höcker Jan 
Published: July 2017

ZusammenfassungDie unbeabsichtigte perioperative Hypothermie (Körperkerntemperatur < 36 °C) ist ein potenziell komplikationsträchtiges, schwerwiegendes Ereignis: Sie führt zu einer erhöhten Inzidenz an Wundinfektionen und vermehrten Blutverlusten/Transfusionsbedarf. Dieser Beitrag thematisiert die praktische Umsetzung der AWMF-S3-Leitlinie „Vermeidung von perioperativer Hypothermie“ von 2014 1. Er soll als Leitfaden für die tägliche klinische Arbeit dienen.
Verstehen statt fachsimpeln
Authors: Uhl Birgit Beatrix 
Published: July 2017

Zusammenfassung
Wie gelingen die Phasen der Bezugspflege? Damit Patienten bereit sind,
sich selbst zu reflektieren, ressourcenorientiert zu denken und zu handeln,
benötigen sie vor allem Empathie von Seiten der Pflegenden. Aufbauend auf dem
RokoKom-Konzept und dem Pflegemodell nach Marie-Luise Friedemann stellt unsere
Autorin anhand eines Fallbeispiels dar, wie eine tragfähige Beziehung gestaltet
werden kann, in der der Patient sich verstanden und angenommen fühlt.
Zertifizierung des Qualitätsmanagements nach DIN EN ISO 9001:2015
Authors: Enders Christian , Lang Gabriele , Lang Gerhard , Werner Jens 
Published: July 2017

ZusammenfassungSinnvoll genutztes Qualitätsmanagement verbessert die Strukturen, Prozesse und Ergebnisse von Organisationen verschiedenster Art. Viele Praxen und Kliniken lassen ihr vorhandenes Qualitätsmanagementsystem gemäß ISO 9001 zertifizieren, u. a. um das eigene Qualitätsmanagementsystem zu überprüfen oder um ein Zeugnis gegenüber Dritten zu erhalten. Die neueste Version ISO 9001:2015 enthält einige Veränderungen; sowohl strukturell als auch inhaltlich. Diesen Veränderungen kann mit vertretbarem Aufwand entsprochen werden. Eine Zertifizierung nach ISO 9001:2015 stellt einen Mehrwert für die eigene Organisation dar, diese Vorteile sind aber oft nicht direkt messbar.
Endoscopic submucosal dissection of early colorectal neoplasms with a monopolar scissor-type knife: short- to long-term outcomes
Authors: Kuwai Toshio , Yamaguchi Toshiki , Imagawa Hiroki , Sumida Yuki , Takasago Takeshi , Miyasako Yuki , Nishimura Tomoyuki , Iio Sumio , Yamaguchi Atsushi , Kouno Hirotaka , Kohno Hiroshi , Ishaq Sauid 
Published: July 2017

Abstract
Background and study aims Endoscopic submucosal dissection (ESD) for colorectal neoplasms remains challenging because of technical issues imposed by the complex anatomical features of the large intestine. We evaluated the feasibility, and the short- and long-term clinical outcomes of ESD for early colorectal neoplasms performed using the Stag-beetle Knife Jr. (SB Knife Jr.)
Patients and methods We retrospectively assessed 228 patients who underwent ESD for 247 colorectal lesions with the SB Knife Jr. Clinicopathological characteristics of the neoplasms, complications, and various short- and long-term outcomes were evaluated.
Results Mean tumor size was 34.3 mm and median procedure time was 76 minutes. The SB Knife Jr. achieved 98.4 % en bloc resection, 93.9 % complete resection, and 85.4 % curative resection. No perforations occurred during the procedure, and a delayed bleeding rate of 2.4 % was observed. Long-term outcomes were favorable with no distant recurrence, 1.1 % local recurrence, a 5-year overall survival rate of 94.1 % and 5-year tumor-specific survival rate of 98.6 % in patients with cancer.
Conclusions ESD using the SB Knife Jr. is technically efficient and safe in treating early colorectal neoplasms and is associated with favorable short- and long-term outcomes.
Chirurgische Methoden in der Behandlung des Aderhautmelanoms
Authors: Blatsios Georgios , Haas Gertrud , Zehetner Claus , Bechrakis Nikolaos 
Published: July 2017

ZusammenfassungIn der Behandlung von Aderhautmelanomen wurden in den letzten Jahrzehnten signifikante Fortschritte erzielt. Die lokale Tumorkontrolle kann mit Strahlentherapie je nach Methodik in bis zu 98% der Fälle erreicht werden. Chirurgische Techniken werden zur Behandlung von Strahlenkomplikationen, wie dem sogenannten toxischen Tumorsyndrom, oder zur primären Therapie des Tumors in Kombination mit oder ohne Strahlentherapie angewendet. Hierzu werden endo- und transsklerale Resektionstechniken für Melanome der Aderhaut und des Ziliarkörpers oder Iridotrabekulozyklektomie für Melanome der Iris und des Ziliarkörpers verwendet. Darüber hinaus spielt die Tumorbiopsie eine zunehmend wichtigere Rolle bei der Diagnose, Behandlung und Nachbehandlung von choroidalen Melanomen. Diese Übersichtsarbeit erläutert die therapeutischen Indikationen und chirurgischen Techniken sowie die Ergebnisse und Komplikationen im Rahmen der Exzision und Biopsie von Aderhautmelanomen.
Interiority in Sloterdijk and Deleuze
Authors: Wambacq Judith , van Tuinen Sjoerd 
Published: July 2017

AbstractThis article constitutes one of the first comparisons between the philosophies of Peter Sloterdijk and the philosophical tandem Gilles Deleuze-Félix Guattari. The subject of the discussion between both philosophical positions is on communication with the exterior, and thus also how an interiority is to be conceived. Both philosophers raise these questions in reference to the work of the Estonian biologist Jacob von Uexküll. At first sight, Sloterdijk’s focus on immunity mechanisms seems to suggest a preference for restricting this communication, whereas Deleuze and Guattari’s interest in becomings seems to direct us in the opposite direction. However, a closer examination of both positions reveals that the difference lies in the nature of their approaches: whereas Deleuze and Guattari’s interest in opening up interiorities is ontologically motivated, Sloterdijk’s focus on shielding them off is existential. These findings might help us in demining the opposition between progressive socialism and conservatism.
Spatiotemporal dynamics of climate and agricultural landscape patterns in Xinjiang, China (2000-2015)
Authors: Huang T , Du Q Y , Zou J Q 
Published: July 2017

Abstract
This study integrated remote sensing, geographic information system, landscape ecology, and spatial analysis, and is based on meteorological data and four remote sensing images (2000-2015). The aim of this study was to analyse climate trends and spatiotemporal changes in agricultural landscape patterns, and calculate agricultural ecosystem service value (AESV) in Xinjiang, China. In addition, correlation analysis further enabled the quantification of agricultural landscape pattern changes in response to climate change. Results showed that temperature and precipitation registered a fluctuating ascending trend in most areas of Xinjiang. Landscape diversity and fragmentation increased during the same period. AESV showed a trend of gradual increase, the waste disposal and the water retention are the most important ecological functions. Besides, agricultural landscape pattern significantly correlated to climate and the effect of precipitation on agricultural landscape patterns has been greater than the effect of temperature during 2000-2015.
Medicine as a Community of Practice: Implications for Medical Education
Authors: Cruess Richard L. , Cruess Sylvia R. , Steinert Yvonne 
Published: July 2017

The presence of a variety of independent learning theories makes it difficult for medical educators to construct a comprehensive theoretical framework for medical education, resulting in numerous and often unrelated curricular, instructional, and assessment practices. Linked with an understanding of identity formation, the concept of communities of practice could provide such a framework, emphasizing the social nature of learning. Individuals wish to join the community, moving from legitimate peripheral to full participation, acquiring the identity of community members and accepting the community’s norms.
Having communities of practice as the theoretical basis of medical education does not diminish the value of other learning theories. Communities of practice can serve as the foundational theory, and other theories can provide a theoretical basis for the multiple educational activities that take place within the community, thus helping create an integrated theoretical approach.
Communities of practice can guide the development of interventions to make medical education more effective and can help both learners and educators better cope with medical education’s complexity. An initial step is to acknowledge the potential of communities of practice as the foundational theory. Educational initiatives that could result from this approach include adding communities of practice to the cognitive base; actively engaging students in joining the community; creating a welcoming community; expanding the emphasis on explicitly addressing role modeling, mentoring, experiential learning, and reflection; providing faculty development to support the program; and recognizing the necessity to chart progress toward membership in the community.
Toward a Utopian Model for Teaching and Nonteaching Services: Every Journey Begins With a First Step
Authors: Bellini Lisa M. , Ende Jack 
Published: July 2017

Nonteaching services are an imperfect step toward enabling inpatient teaching services to transition from an unregulated, natural state, driven solely by the exigencies of patient volume and throughput, to one that is more controlled and intends to achieve the proper balance between service and education. As career educators the authors prefer to view nonteaching services as critical components of an integrated system that enables the best possible patient care and learning, yet they acknowledge that, to meet the needs of patients and learners, teaching and nonteaching services alike must be truly complementary, collaborative, and integrated components of a single system.
In this Invited Commentary the authors offer a “utopian” view of a teaching service in an institution that explicitly acknowledges its contract with society to transform health care delivery. In this setting, highly engaged teachers and learners are supported by a high-performing cast of an advanced practice provider, primary nurses, a social worker, a case manager, a clinical pharmacist, and an analyst. This group forms a Clinical Learning Unit (CLU) where the curriculum has evolved into an interdependent framework of basic, clinical, and systems science. CLUs train tomorrow’s health care workforce through adaptive service learning made possible because the team has a manageable census, time for daily reflection, and inspiring relationships with trained teachers. CLUs cannot exist without complementary nonteaching services.
Elsewhere in this issue Repp and colleagues outline seven design principles to improve nonteaching services. These are a good first step toward the utopian vision outlined by the authors.
Quality and readability of online resources regarding shoulder osteoarthritis
Authors: Davis Daniel E. , Stoll Laura , Brolin Tyler , Updegrove Gary , Horneff John G. 
Published: July 2017

Background:
Education through internet searches is becoming more commonplace as patients look to become more involved in the medical decision-making process. Studies have shown poor quality and readability of online discussion of several orthopaedic conditions. The goal of this study was to evaluate the quality of online information available for arthritis of the shoulder.

Methods:
Three search engines were used to identify three common terms signifying shoulder osteoarthritis: “shoulder arthritis,” “glenohumeral arthritis,” and “shoulder joint disease.” The top resulting websites were collected, repeats were eliminated, and the resulting sites were evaluated. Four shoulder and elbow fellows evaluated each using a quality scoring system. The websites were also graded on readability using the Flesch-Kincaid system.

Results:
Forty-five unique websites were evaluated for quality and readability. The average quality of websites scored was 12.33±4.11 out of 25 with no significant difference due to search term or author. When scored for accuracy, “shoulder arthritis” was significantly lower than “glenohumeral arthritis” or “shoulder joint disease.” Flesh-Kincaid (FK) analysis revealed that zero studies were below an 8th grade reading level and overall mean FK score was 11.32±2.66 (range, 8.2 to 18.2).

Conclusions:
This study found that there is a consistently low quality of web-based information available to patients in regards to glenohumeral arthritis of the shoulder. Additionally, this information is presented in a way that is above the average reading level of the Unites States population. It is important that orthopaedic surgeons help to improve web-based material and provide this information to patients.
Coccygectomy for posttraumatic coccygodynia: a long-term prospective study
Authors: El Mohsen Arafa Abd , El Rady Mahmoud Abd , Zayan Mohammed , Kotb Ahmed 
Published: July 2017

Background:
Coccygodynia is pain around the coccyx; its most common etiology is trauma. About 20% of patients do not respond to conservative measures in the form of medical treatment, local injection, or physical therapy. Our prospective clinical study aims at highlighting the results of coccygectomy for coccygodynia caused by trauma that could not be treated conservatively.

Methods:
Thirty eight patients were included in the study with 28 women (73.7%) and 10 men (26.3%). After failure of conservative treatment measures, coccygectomy was done in all patients. The duration of symptoms before the surgical procedure varied between 9 and 48 mo with a mean of 19.6 mo. Clinical presentation of the local pain was quantified according to a visual analog scale (VAS) on deep manual palpation at the tip of coccyx preoperatively and at 4 mo, 12 mo, then at 2-year and 4-year follow-up.

Results:
The mean preoperative VAS was 9.2, at 4 mo it was 2.7, and at 12 mo it was 1.8. At 2 and 4-year postoperative follow-up, VAS was 1.5 and 1.3, respectively (P=0.0001).

Conclusion:
Coccygectomy for coccygodynia caused by a traumatic event affords significant pain relief postoperatively. Coccygectomy is recommended as a last resort treatment for coccygodynia after failed conservative treatment.

Level of Evidence:
Level IV (prospective study).
Isolated medial patellofemoral ligament reconstruction for posttraumatic recurrent lateral patellar instability. How can it be successful?
Authors: Azim Foda Adel Abdel , Aabdel Salam Mohamad A. 
Published: July 2017

Background:
Injury to the medial patellofemoral ligament (MPFL) occurs in nearly all cases of traumatic patellar dislocation. Reconstruction of the MFPL is the main treatment of such conditions. Other anatomical abnormalities that predispose to lateral patellar instability should be excluded for successful outcome after isolated MPFL reconstruction.

Methods:
In the period from June 2012 to January 2015, 18 patients with had recurrent posttraumatic unilateral lateral patellar instability caused by an isolated MPFL tear that was reconstructed with a semitendinosus autograft to reconstruct MPFL. The mean follow-up period was 24 mo. Patients with isolated MPFL tears were carefully chosen through a series of clinical and radiographic workups. The technique was done through a less invasive approach, with the graft fixed to the femur by a bioabsorbable interference screw and to the patella; the graft was passed through two transverse tunnels making a laterally based loop.

Results:
No dislocations or apprehension was recorded. Furthermore, there were no major complications, only persistent patellofemoral pain in patients with preoperative osteochondral patellar injuries. Kujala functional score improved from 35.6 preoperatively to 90.4.

Conclusions:
Careful patient selection and proper surgical technique are the two main items for patellar stabilization with isolated MPFL reconstruction.
Gross Motor Function Classification System in patients with cerebral palsy: interobserver reliability between parents and orthopaedic specialists
Authors: Peck Jeffrey B. , McMulkin Mark L. , Baird Glen O. , Caskey Paul M. , Elizondo Tayler , Tompkins Bryan 
Published: July 2017

Background:
The widely used Gross Motor Function Classification System (GMFCS) was designed to improve understanding and subsequent treatment of children with cerebral palsy. Previous studies investigating reliability between physician and family report of GMFCS have focused on limited age groups or mobility levels. The current study aims to investigate the GMFCS agreement between pediatric orthopaedic healthcare professionals (HCP) and families across all age groups for children with cerebral palsy.

Methods:
A total of 124 participants completed this prospective study at an orthopaedic children’s hospital. The HCP and family classified the mobility level of each child with cerebral palsy using the GMFCS. Each group was blinded to the other’s assessment of the child. Agreement reliability in GMFCS assessment between parents of children with cerebral palsy and HCP was determined.

Results:
The interclass correlation coefficient between parents and HCP was 0.92. There was agreement between HCP and parents in 69% of the children evaluated. These findings are similar to results of previous studies. Of those in which there was disagreement, 97% differed by one GMFCS level. In those that differed, the parents provided a lower functional level in 54%, in contrast to previous studies that reported much higher percentages.

Conclusions:
These findings add to the reliability of the GMFCS being used as a tool for effective communication between HCP and parents of those children with cerebral palsy across all age groups. This reliability can assist with the development of goals and expectations for that child.
Treatment and Complications of Patients With Ipsilateral Acetabular and Femur Fractures: A Multicenter Retrospective Analysis
Authors: Cannada Lisa K. , Hire Justin M. , Boyer Preston J. , Israel Heidi , Mir Hassan , Halvorson Jason , Della Rocca Gregory J. , Ming Bryan , Mullis Brian , Deshpande Chetan 
Published: July 2017

Objectives:
The purpose of this study was to review the treatment of patients with ipsilateral acetabular and femur fractures to provide descriptive demographic data, injury pattern classification, treatment, and evaluate the complication profile reflective of current practices.

Study Design:
Multicenter retrospective cohort.

Setting:
Eight Level 1 Trauma Centers.

Patients/Participants:
One hundred one patients met inclusion criteria.

Intervention:
Surgical treatment of both the acetabular and femur fractures.

Main Outcome Measurements:
The complications evaluated include avascular necrosis, heterotopic ossification, posttraumatic arthritis, deep venous thrombosis, pulmonary embolism and superficial/deep infection, fracture union, and secondary surgeries.

Results:
Forty-three patients had 31 type fractures (29A; 11B, and 3C), 60 had 32 type (37A, 8B; 15C), and 8 had 33 type (1A, 4B, 3C) femur fractures; 10 patients had combinations involving more than 1 femur fracture pattern. There were 35 62A type fractures, 47 62B, and 19 62C acetabular fractures. Age of 45 or older was associated with marginal impaction (P = 0.001). The aggregate infection rate was 17%. More than 30% of patients required secondary surgeries. The rate of avascular necrosis was higher in acetabular fractures combined with proximal femur fractures (P < 0.05). The rate of deep venous thrombosis was associated with increased age and time to surgical fixation (P < 0.05).

Conclusions:
We report the largest review of the surgical treatment and complications of ipsilateral acetabular and femoral fractures. This study provides useful information regarding the complications and provides some treatment recommendations regarding these injuries.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.