bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of Os Trigonum on CT Imaging
Authors: Zwiers Ruben , Baltes Thomas P. A. , Opdam Kim T. M. , Wiegerinck Johannes I. , van Dijk C. Niek 
Published: December 2017

Background: The os trigonum is known as one of the main causes of posterior ankle impingement. In the literature, a wide variation of occurrence has been reported. Methods: All foot and/or ankle computed tomography (CT) scans made between January 2012 and December 2013 were reviewed. CT images were assessed, blinded for patient characteristics, for the presence of an os trigonum, size of the os trigonum, and type of os trigonum. In addition, the shape of the lateral tubercle of the posterior talar process was assessed. Results: A total of 628 patients (1256 ankles) were included. In 32.5% of the patients of the cohort, an os trigonum was present. In 14.3% of these patients, it was present bilaterally. In a subgroup of patients without posterior ankle impingement the prevalence was 30.3%. Of the nonaffected ankles, an os trigonum was present in 23.7%. Patients with posterior ankle impingement were more likely to have an os trigonum (adjusted odds ratio [OR], 1.86). Afro-Caribbean/Surinamese/Central African origin was associated with a lower rate of occurrence of os trigonum (adjusted OR 0.43). In the ankles without an os trigonum, an enlarged lateral tubercle of the posterior talar process was found in 34.9% and 36.5% of the ankles. Conclusion: This study showed that os trigonum is a common accessory bone. With a prevalence of 30.3% in a population of patients with CT imaging of both ankles and 23.7% of the nonaffected ankles, the os trigonum is more common than previously reported. Patients with posterior ankle impingement complaints had a higher prevalence of an os trigonum. In one-third of the patients without an os trigonum, there was an enlarged lateral tubercle of the posterior talar process. Level of Evidence: Level III, retrospective comparative study.
Efficacy of Particulated Juvenile Cartilage Allograft Transplantation for Osteochondral Lesions of the Talus
Authors: Dekker Travis J. , Steele John R. , Federer Andrew E. , Easley Mark E. , Hamid Kamran S. , Adams Samuel B. 
Published: December 2017

Background: Particulated juvenile cartilage allograft transplantation (PJCAT) is a novel treatment option for osteochondral lesions of the talus (OLTs). It is typically employed as a salvage procedure after initial debridement and microfracture has failed as it is theorized to deliver viable hyaline cartilage. We hypothesized that PJCAT would be a safe and effective treatment option for OLTs. Methods: This is a retrospective case-control study of patients who underwent PJCAT for the treatment of OLTs at a single academic institution. Failure of the procedure was defined as no change or worsening of symptoms and/or the need for a subsequent cartilage restoration procedure. Variables recorded included preoperative magnetic resonance imaging (MRI) area and volume, intraoperative size, etiology, lesion location, sex, age, body mass index (BMI), history of prior surgery, American Orthopaedic Foot & Ankle Society score, and foot and ankle outcome score. Fifteen patients completed a minimum of 12 months of follow-up (mean, 34.6 months). Results: The failure rate of PJCAT in this series was 40% (6/15). Preoperative MRI area and intraoperative OLT size along with male sex were predictive of failure ( P < .05). Age, BMI, etiology, technique (open vs arthroscopic), history of prior surgery, and location of lesion were not predictors of failure in this limited series ( P > .05). Patients with lesions greater than 125 mm2 area had a significant increased risk of clinical failure ( P < .05). Functional outcome scores were significantly better at final follow-up in the patients who had undergone successful treatment vs those who did not. Conclusion: These findings demonstrate the association of preoperative MRI lesion area, intraoperative lesion size, and male sex as risk factors for failure of PJCAT setting of an already difficult to treat pathology. Level of Evidence: Level IV, retrospective case series.
How do aggregated patient-reported outcome measures data stimulate health care improvement? A realist synthesis
Authors: Greenhalgh Joanne , Dalkin Sonia , Gibbons Elizabeth , Wright Judy , Valderas Jose Maria , Meads David , Black Nick 
Published: December 2017

Objectives Internationally, there has been considerable debate about the role of data in supporting quality improvement in health care. Our objective was to understand how, why and in what circumstances the feedback of aggregated patient-reported outcome measures data improved patient care. Methods We conducted a realist synthesis. We identified three main programme theories underlying the use of patient-reported outcome measures as a quality improvement strategy and expressed them as nine ‘if then’ propositions. We identified international evidence to test these propositions through searches of electronic databases and citation tracking, and supplemented our synthesis with evidence from similar forms of performance data. We synthesized this evidence through comparing the mechanisms and impact of patient-reported outcome measures and other performance data on quality improvement in different contexts. Results Three programme theories were identified: supporting patient choice, improving accountability and enabling providers to compare their performance with others. Relevant contextual factors were extent of public disclosure, use of financial incentives, perceived credibility of the data and the practicality of the results. Available evidence suggests that patients or their agents rarely use any published performance data when selecting a provider. The perceived motivation behind public reporting is an important determinant of how providers respond. When clinicians perceived that performance indicators were not credible but were incentivized to collect them, gaming or manipulation of data occurred. Outcome data do not provide information on the cause of poor care: providers needed to integrate and interpret patient-reported outcome measures and other outcome data in the context of other data. Lack of timeliness of performance data constrains their impact. Conclusions Although there is only limited research evidence to support some widely held theories of how aggregated patient-reported outcome measures data stimulate quality improvement, several lessons emerge from interventions sharing the same programme theories to help guide the increasing use of these measures.
Ghosts, tigers and landmines in the nursery: Attachment narratives of loss in Tamil refugee children with dead or missing fathers
Authors: Ratnamohan Lux , Mares Sarah , Silove Derrick 
Published: December 2017

Objective: To build an account of how bereaved Tamil refugee and asylum seeker children, resettled in Australia, had processed the loss of their dead or missing fathers. Method: Phenomenological and discourse analysis was applied to attachment narratives of nine children (aged 11–17 years) and their surviving mothers in families that lost fathers in war-related circumstances. The narratives were analysed through the lens of Crittenden’s Dynamic-Maturational Model of Attachment and Adaptation (DMM) and Klass’ cross-cultural model of grief. Results: Two divergent pathways — ‘burying the past’ and ‘reifying the past’ — emerged, encompassing the children’s contrasting patterns of information processing regarding loss and trauma (dismissing or preoccupying) and representation of the past (distant-buried or rich-reconstructed). Each pathway reflected a strategic compromise between the constraints and resources presented to the child by the circumstances of the loss (ambiguous or confirmed), the response of their surviving parent (stricken or stoic) and the collective narrative surrounding the loss (silenced or valorised). Conclusion: The DMM’s conceptualisation of attachment as self-protective strategies for navigating danger was helpful in explaining the contrasting adaptations of refugee children to loss and trauma. However, to understand the multivalent meanings of these adaptations, there was a need to situate child–parent attachment relationships within the wider sociocultural reconfigurations arising from contexts of political violence.
Gastrointestinal Complications After Surgical Correction of Neuromuscular Scoliosis: A Retrospective Cohort Study
Authors: Jalanko T. , Helenius I. , Pakarinen M. , Koivusalo A. 
Published: December 2017

Study Design: A retrospective cohort study of consecutively operated neuromuscular scoliosis patients. Background and Aim: Surgical correction of neuromuscular scoliosis can be complicated by early gastrointestinal complications, but data on the extent and severity of them is scarce. The aim of the study was to determine the incidence, course, and risk factors of gastrointestinal complications after neuromuscular scoliosis correction. Material and Methods: Ninety-one patients (<21 years of age) were consecutively operated on for neuropathic neuromuscular scoliosis during 2000–2011. Patients who developed marked postoperative gastrointestinal complications were identified and clinical, operative, and radiographic records, death certificates, and post-mortem reports were examined. Results: The average age at surgery was 14.5 (SD 2.9) and follow-up time was 4.9 (SD 2.3) years. Gastrointestinal complications occurred in 12 (13%) patients and included prolonged paralytic ileus (7%, 6/91), dysphagia (7%, 6/91), and gastroparesis (1%, 1/91). Hospital stay was 22 (SD 11) days in patients with gastrointestinal complications and 16 (SD 20) days in non-complicated patients (p = 0.005). Dysphagia required permanent feeding gastrostomy in one patient whereas other complications were transient and none caused death. The risk factors for postoperative gastrointestinal complications were preoperative main curve correction <30% in traction/bending radiographs (Relative Risk (RR) = 28 (95% Confidence Interval (CI) 4.4–180); p < 0.001), preoperative main curve >90° (RR = 5.5 (95% CI 1.3–23); p = 0.020), disturbance in intraoperative spinal cord monitoring (RR = 6.0 (95% CI 1.1–34); p = 0.043), and intravenous opioid medication over 5 days postoperatively (RR = 7.9 (95% CI 1.8–35), p = 0.006). Conclusion: Gastrointestinal complications occurred in 13% of patients after neuromuscular scoliosis correction. Marked gastrointestinal complications extended postoperative hospitalization period, but they were transient in majority (92%) of cases and none caused death. Rigid scoliosis was the most significant risk factor for gastrointestinal complications. Gastrointestinal complications appear to be less frequent after posterior only spinal fusion with total pedicle screw instrumentation and Ponte osteotomies.
Sleep disturbance in patients with an implantable cardioverter defibrillator: Prevalence, predictors and impact on health status
Authors: Habibović M , Mudde L , Pedersen SS , Schoormans D , Widdershoven J , Denollet J 
Published: December 2017

Background: Sleep disturbances are highly prevalent in patients with cardiac diseases and associated with poor health outcomes. However, little is known about sleep disturbance in patients with an implantable cardioverter defibrillator. Aims: We examined the prevalence and predictors of sleep disturbance and the impact on perceived health status in a Dutch cohort of implantable cardioverter defibrillator patients. Methods: Patients ( n=195) enrolled in the Web-based distress program for implantable cardioverter defibrillator patients (WEBCARE) trial completed questionnaires at the time of implantable cardioverter defibrillator implantation, three, six and 12 months afterwards. Sleep disturbance was assessed with the corresponding item #3 of the Patient Health Questionnaire 9. Results: At baseline, 67% ( n=130) reported sleep disturbance (cut off ≥1). One year later, the prevalence was 57% ( n=112). Younger age (odds ratio=0.96, 95% confidence interval 0.92–0.99; p=0.012) and high negative affectivity/low social inhibition (odds ratio=4.47, 95% confidence interval 1.52–13.17; p=0.007) were associated with sleep disturbance at 12 months in adjusted analyses. Sleep disturbance was not associated with health status at 12 months. Charlson Comorbidity Index, anxiety, Type D personality and high negative affectivity/low social inhibition were associated with impaired health status at follow-up. Conclusions: Sleep disturbance was highly prevalent in patients with an implantable cardioverter defibrillator. Younger age and high negative affectivity predicted sleep disturbance 12 months post-implantation independent of other demographic, clinical, intervention and psychological covariates. Sleep disturbance was not associated with impaired health status at the 12-month follow-up.
Retrospective review of the use of as-needed hydralazine and labetalol for the treatment of acute hypertension in hospitalized medicine patients
Authors: Gaynor Michelle F. , Wright Garth C. , Vondracek Sheryl 
Published: December 2017

Background: The aim of this study was to evaluate the use of as-needed (PRN) labetalol and hydralazine [intravenous (IV) or oral] in hospitalized medicine patients for the treatment of severe asymptomatic hypertension and to examine the potential negative outcomes associated with their use. Methods: The electronic health record of 250 medicine patients hospitalized at the University of Colorado Hospital between November 2014 and April 2016 who received at least one dose of PRN IV or oral hydralazine or labetalol were retrospectively reviewed. The primary outcome was to describe the use of PRN antihypertensive medications in this population. Results: A total of 573 PRN doses of antihypertensive medication were administered. Oral hydralazine was the most common (521 doses, 90.9%). A total of 36% of PRN administrations were given for a systolic blood pressure (SBP) <180 mmHg and diastolic blood pressure (DBP) <110 mmHg (cut-point for acute severe hypertension). No serious adverse events were related to PRN antihypertensive administration. Despite receiving at least one PRN antihypertensive medication during hospitalization, 40.8% of patients were not continued on their home antihypertensive medication(s) while hospitalized, and 62.4% of patients did not have their home regimens intensified at discharge. Conclusion: As-needed oral hydralazine is frequently prescribed for acute blood pressure lowering with administration thresholds often less than what are used to define acute severe hypertension. Many patients are prescribed PRN antihypertensive medication instead of being continued on their home regimens, and most patients do not have the intensity of their home regimens increased. Providers need to be educated about the use of PRN antihypertensive medication for the management of severe asymptomatic hypertension in the hospital setting.
A quality assurance investigation of CLABSI events: are there exceptions to never?
Authors: Strickler Samantha , Gupta Rohit R , Doucette John T , Kohli-Seth Roopa 
Published: December 2017

Background: In the USA, central line associated blood stream infections (CLABSIs) have been designated as ‘never events’, prompting initiatives towards a ‘zero CLABSIs’ standard. We propose that there are cascading risk factors predisposing certain patient cohorts to higher CLABSIs rates. Methods: A retrospective review of all CLABSI infections over a 12-month period was undertaken. Risk factors examined included catheter type, insertion site and parenteral nutrition (PN) status. Additional factors analysed included acute kidney injury (AKI), chronic kidney disease (CKD) and hospital-acquired infections (HAIs). Results: Thirty-four CLABSIs were identified in 33 adult patients (median age = 57 years). Temporary central venous catheters accounted for 12 (35%), peripherally inserted central catheters for five (14.7%), and permanent catheters for 17 CLABSIs (50%); the median duration from insertion was 15 days (interquartile range = 9–26). Among patient factors, immunosuppression and hyperglycaemia were the most common (n = 19, 55%), followed by PN and CKD (n = 17, 50.0%), AKI (n = 16, 47.1%) and HAIs (n = 13, 38.2%). A majority of patients with CLABSIs (n = 20 58.8%) had at least three risk factors. Discussion: These findings reflect the complexity of CLABSIs with multiple patient and hospital factors influencing incidence. It suggests the need for further studies to re-calibrate the zero CLABSI model towards one with greater relevance.
Prevalence and risk factors for bloodstream infection present on hospital admission
Authors: Aliyu Sainfer , Cohen Bevin , Liu Jianfang , Larson Elaine 
Published: December 2017

Background: Bloodstream infection present on hospital admission (BSI-POA) is a major cause of morbidity and mortality. The purpose of this study was to measure prevalence and describe the risk factors of patients with BSI-POA and to determine the prevalence of resistance in isolates by admission source. Methods: We conducted a retrospective cohort study of patients discharged from three hospitals in New York City between 2006 and 2014. BSI-POA was defined as BSI diagnosed within 48 h of hospitalisation. Results: The prevalence for BSI-POA was 5307/315,010 discharges (1.7%). The odds of being admitted with BSI-POA were greatest among patients admitted with renal failure, chronic dermatitis, malignancies and prior hospitalisation. Odds ratios and 95% confidence intervals (CI) were 2.72 (95% CI = 2.56–2.88), 2.15 (95% CI = 1.97–2.34), 1.76 (95% CI = 1.64–1.88) and 1.59 (95% CI = 1.50–1.69), respectively. The largest proportion of BSI-POA presented with Staphylococcus aureus (48.4%), followed by Enterococcus faecalis/faecium (20.3%), Klebsiella pneumoniae (16.2%), Streptococcus pneumoniae (8.7%), Pseudomonas aeruginosa (4.2%) and Acinetobacter baumannii (2.2%). Overall, 44% of those admitted from nursing homes presented with antibiotic resistant strains versus 34% from other hospitals and 31% from private homes ( P = 0.002). Conclusion: Understanding the risk factors of patients who present to the hospital with BSI could enable timely interventions and better patient outcomes.
Impact of choice of skin preparation solution in cardiac surgery on rate of surgical site infection: a propensity score matched analysis
Authors: Raja Shahzad G , Rochon Melissa , Mullins Clair , Morais Carlos , Kourliouros Antonios , Wishart Ellie , De Souza Anthony , Bhudia Sunil 
Published: December 2017

Background: Antiseptic skin preparations containing chlorhexidine gluconate and povidone iodine are routinely used to reduce the risk of surgical site infection (SSI). This study assesses the efficacy of two alcohol-based solutions, 2% chlorhexidine-alcohol and 10% povidone iodine-alcohol, on the incidence of cardiac SSI. Methods: A total of 738 consecutive patients undergoing cardiac surgery had skin preparation with 2% chlorhexidine gluconate in 70% isopropanol (ChloraPrep, BD Ltd, UK) were propensity matched to 738 patients with skin prepared with 10% povidone–iodine in 30% industrial methylated spirit (Videne Alcoholic Tincture, Ecolab Ltd, UK). Continuous, prospective SSI surveillance data were collected for all these patients. A retrospective analysis of prospectively collected perioperative data was performed. Results: The overall rate of SSI was similar in the chlorhexidine–alcohol and povidone–iodine–alcohol groups (3.3% versus 3.8%; P = 0.14; relative risk [RR] = 0.98; 95% confidence interval [CI] = 0.52–1.78). Superficial (1.2% versus 1.8%; P = 0.18; RR = 0.97; 95% CI = 0.48–1.80) and deep incisional (1.2% versus 1.6%; P = 0.24) SSI rates were also similar with 10% povidone–iodine–alcohol being marginally more effective against organ-space infections (0.8% versus 0.4%; P = 0.05; RR = 0.38; 95% CI = 0.20–1.01). Conclusion: Our analysis confirms that alcohol-based skin preparation in cardiac surgery with povidone–iodine reduces the incidence of organ-space infections with no significant superiority in preventing incisional SSI compared with chlorhexidine-alcohol.
Clostridium difficile multidisciplinary team root cause analysis: impact on clinical care and circumvention of financial penalties posed by clinical commissioning groups, but at what cost?
Authors: Saeed Kordo , Petridou Christina , Gray Hazel , Dryden Matthew , Davis-Blues Karen , Lucero Sheryl , Parker Natalie , Keyser Taryn , Matthews Tanya , Cortes Nick , Kidd Stephen , Thomas Claire , Peacock Heather , Hornzee Joanna , Wake Bruce 
Published: December 2017

Background: In Hampshire Hospitals NHS Foundation Trust, in addition to an on-the-spot investigation into hospital-onset Clostridium difficile infection (CDI) by the infection prevention team, a multidisciplinary team root cause analysis (MDT-RCA) forum has been developed. The MDT-RCA aims to deliver a more thorough investigation into individual cases and the recommendation of cases to the clinical commissioning groups (CCG) appeals panel against potential financial penalties (£10,000 per breached case). We mainly aimed to investigate the financial impact of MDT-RCAs to the Trust. Methodology: Over two years, 84 cases of hospital-onset CDI cases were reviewed by the MDT-RCA forum. Results: Among this cohort, no additional learning outcomes were identified by the MDT-RCAs over those that were found by on-the-spot investigations. In total, 543 staff members attended the MDT-RCAs at a potential cost to the Trust of £23,795.74–£51,670.10. The Trust appealed against financial penalties for 27 cases and 14 were successful, i.e. £140,000 would have been avoided had targets been breached by 14 cases. However, targets were only breached by two cases, meaning only £20,000 in fines was avoided. Deducting this from the total costs of the MDT-RCA meant the Trust lost £3,795.74–£31,670.10. Conclusion: Over the two years reviewed, the MDT-RCA proved to be costly to the Trust, with no additional learning or quality improvement measures identified.
An evaluation of infection control in private and public sector intensive care units in South Africa
Authors: Mahomed Saajida , Sturm A Willem , Knight Stephen , Moodley Prashini 
Published: December 2017

Background: Appropriate infection control policies and practices are key to reducing the risk of healthcare-associated infections in patients in intensive care units (ICUs). Objective: To evaluate infection control in ICUs using the Infection Control Assessment Tool (ICAT). Methods: Six public and five private adult ICUs were included. Seven modules from the ICAT were administered including ICU, hand hygiene, and isolation and standard precautions. Modules were scored on a quantitative scale as per the tool guidelines and trained independent nurses observed practices. Results: All ICUs reported to have a 1:1 nurse-to-patient ratio. One public ICU did not have the required 1:2 hand wash basin-to-bed ratio. We observed 100% adherence to handwashing or alcohol rub at each of the five moments of hand hygiene; however, the correct amount of alcohol rub was used in only 2% (n = 2) of the 117 observations. The median score for isolation and standard precautions was 79%. Discussion: There was good infection control practice in ICUs. However, ICUs did not have isolation policies for all the infections listed in the ICAT and did not screen visitors to the ICU. We identified shortcomings in the ICAT and a more suitable tool is required for our healthcare setting.