bluuebunny/crossref_metadata_2025_split huggingface dataset:
Geometric Analysis of the Weil Osteotomy
Authors: Grimes Jerry , Coughlin Michael 
Published: January 2017

Background: The Weil osteotomy has been reported to be a clinically effective treatment of metatarsalgia and intractable plantar keratosis. The plantar inclination of the metatarsal influences the effect of the osteotomy but has never been studied in detail. Methods: This study examined five fresh or fresh-frozen cadaver specimens. The data obtained from the specimens was used to model the geometry of the Weil osteotomy. The effect of thick saw blades on the Weil osteotomy was determined. Results: The inclination of the second metatarsal averaged 24.6 (range 19 to 31) degrees. The displacement of the capital fragment in the plantar direction was dependent on the angle of the osteotomy and the inclination of the metatarsal. A 5-mm proximal displacement along a 25-degree osteotomy displaced the capital fragment in a plantar direction if the inclination of the metatarsal was 19 degrees and displaced it dorsally if the inclination was 25 degrees or more. Conclusions: The results of this study showed that a thick saw blade could offset a portion of the plantar displacement of the capital segment that can occur with the Weil osteotomy. A 1-mm thick saw blade is recommended for most osteotomies, and a 2-mm thick saw blade is recommended for shortening of more than 5 mm or with plantar inclination of the lesser metatarsal of less than 19 degrees. A thicker saw blade should be considered for the treatment of plantar keratosis.
Relationship Between Tightness of the Posterior Muscles of the Lower Limb and Plantar Fasciitis
Authors: Bolívar Yolanda Aranda , Munuera Pedro V. , Padillo Juan Polo 
Published: January 2017

Background: The aim of this study was to determine whether tightness of the posterior muscles of the lower extremity was associated with plantar fasciitis. Methods: A total of 100 lower limbs of 100 subjects, 50 with plantar fasciitis and 50 matching controls were recruited. Hamstring and calf muscles were evaluated through the straight leg elevation test, popliteal angle test, and ankle dorsiflexion (knee extended and with the knee flexed). All variables were compared between the 2 groups. In addition, ROC curves, sensitivity, and specificity of the muscle contraction tests were also calculated to determine their potential predictive powers. Results: Differences between the 2 groups for the tests used to assess muscular shortening were significant ( P < .001) in all cases. The straight leg elevation test and ankle dorsiflexion with the knee extended presented respective sensitivities of 94% and 100% and specificities of 82% and 96% as diagnostic tests for the participants in this study. Conclusion: Tightness of the posterior muscles of the lower limb was present in the plantar fasciitis patients, but not in the unaffected participants. Clinical Relevance: The results of this study suggest that therapists who are going to employ a stretching protocol for treatment of plantar fasciitis should look for both hamstring as well as triceps surae tightness. Stretching exercise programs could be recommended for treatment of plantar fasciitis, focusing on stretching the triceps surae and hamstrings, apart from an adequate tissue-specific plantar fascia-stretching protocol. Level of Evidence: Level III, case control study.
Total and Distributed Plantar Loading in Subjects With Stage II Tibialis Posterior Tendon Dysfunction During Terminal Stance
Authors: Neville Christopher , Flemister A. Samuel , Houck Jeff 
Published: January 2017

Background: In subjects with stage II tibialis posterior tendon dysfunction (TPTD), the function of the tibialis posterior muscle is altered and may be associated with a change in total and distributed loading. Methods: Thirty subjects with a diagnosis of stage II TPTD and 15 matched control subjects volunteered to participate in a study to examine the total and distributed plantar loading under the foot during the terminal stance phase of gait. Plantar loading, measured as the subject walked barefoot, was assessed using instrumented flexible insoles. A secondary analysis was done to explore the contribution of flatfoot kinematics to plantar loading patterns. Results: Overall, there was reduced total plantar loading in subjects with stage II TPTD compared with controls. Accounting for differences in total loading, the presence of clinically measured weakness in subjects with TPTD was associated with reduced lateral forefoot loading. Medial longitudinal arch height was significantly correlated with loading patterns but explained only 21% of the variance in observed loading patterns. Conclusion: Subjects with TPTD who are strong exhibited loading patterns similar to controls. Changes in total and distributed loading during terminal stance suggest there are altered ankle mechanics at push-off during the functional task of gait. Clinical Relevance: Strength, in the presence of TPTD, may be important to stabilize the midfoot during gait and might be important in rehabilitation protocols.
Total Ankle Arthroplasty With Combined Calcaneal and Metatarsal Osteotomies for Treatment of Ankle Osteoarthritis With Accompanying Cavovarus Deformities
Authors: Jung Hong-Geun , Jeon Seung-Hyub , Kim Tae-Hoon , Park Jong-Tae 
Published: January 2017

Background: Our study evaluated the short-term clinical and radiographic results of total ankle arthroplasty (TAA) with combined bony reconstructions for treatment of end-stage ankle osteoarthritis with accompanying cavovarus/hindfoot varus deformities. Methods: This study included 8 patients (10 ankles) with ankle osteoarthritis (OA) who were treated by TAA with combined calcaneal and metatarsal osteotomies between September 2004 and June 2010 and were followed an average of 17.9 months (12-43 months). Visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, radiographic measurements, and patient satisfaction were evaluated. Results: The average patient age was 66.2 years (range, 55-76 years). Eighteen bony reconstruction procedures such as lateral sliding calcaneal osteotomy (n = 9) and first metatarsal dorsiflexion osteotomy (n = 4) were performed in addition to TAA. VAS pain score improved from an average of 8.8 (range, 6-10) preoperatively to an average of 2.4 (range, 0-7) ( P < .05), and the AOFAS score improved from 36.9 (range, 14-71) preoperatively to 89.3 (range, 68-100) ( P < .05). Ninety percent of the patients were satisfied with the results. Radiographically, the tibiocalcaneal angle (TCA) improved from a preoperative average of 19.0 degrees (range, 13-23 degrees) to 0.2 degrees (range, –5.4 to 2.8 degrees), the tibial axis–talar dome angle (TA-TDA) improved from a preoperative average of 15.6 degrees (range, 11.1-18.0 degrees) to 3.3 degrees (range, 1.7-5.6 degrees), and the talar dome–ground surface angle (TD-GSA) improved from a preoperative average of 21.2 degrees (range, 15.4-27.5 degrees) to 5.1 degrees (range, 1.8-10.2 degrees) ( P < .05). Conclusion: We found that it was occasionally necessary to perform combined calcaneal and metatarsal osteotomies with TAA in order to successfully treat ankle OA with an accompanying cavovarus/varus deformity. The TD-GSA and TCA were also found to be important radiographic parameters in assessing varus ankles. Level of Evidence: IV, retrospective case series.
A Comparison of Botulinum Toxin A and Intralesional Steroids for the Treatment of Plantar Fasciitis
Authors: Elizondo-Rodriguez Jorge , Araujo-Lopez Yariel , Moreno-Gonzalez J. Alberto , Cardenas-Estrada Eloy , Mendoza-Lemus Oscar , Acosta-Olivo Carlos 
Published: January 2017

Background: The objective of this study was to compare intramuscularly applied botulinum toxin A (BTX-A) in the gastroc-soleus complex with intralesional steroids for the treatment of plantar fasciitis. Methods: The patients were randomly divided into 2 groups according to the treatment received. The patients were evaluated over 6 months. The evaluation scores included the Visual Analog Scale (VAS), Maryland Foot and Ankle, Foot and Ankle Disability Index (FADI), and American Orthopaedic Foot and Ankle Society (AOFAS) score. Moreover, patients were instructed to perform plantar fascia stretching exercises over the course of the study. The final number of patients was 36, of whom 19 received BTX-A (10 men and 9 women) and 17 (6 men and 11 women) received steroids. Results: When compared to patients who received steroids, the patients who received BTX-A exhibited more rapid and sustained improvement over the duration of the study. Conclusion: A combination of BTX-A and plantar fascia stretching exercises yielded better results for the treatment of plantar fasciitis than intralesional steroids. Level of Evidence: Level I, therapeutic studies.
The Role of Public Health Nurses in Service Delivery to Youth with Mental Disabilities
Authors: Kennedy Carol W. , Polivka Barbara J. , Chaudry Rosemary V. 
Published: January 2017

BACKGROUND: The mental health needs of children and adolescents are not being adequately addressed. OBJECTIVES: To describe the roles of public health nurses in the care of children and adolescents with mental disabilities and to explore incentives and barriers to expansion of the role in the care of this population. METHODS: Directors of nursing of public health agencies and executive directors of mental health agencies in Ohio responded to a mailed survey. RESULTS: The majority of respondents reported that public health nurses currently work with youth with mental disabilities, primarily in the roles of referral and providing physical health care. Both groups of directors saw potential for increasing roles-provided public health nurses received education and consultation. Both groups reported that barriers to expanding public health nurses' roles were the organization and funding of mental and public health systems. CONCLUSION: Although better utilization of public health nurses could improve children's health care and make more efficient use of scarce specialty mental health resources, financial and organizational barriers present significant challenges to collaboration.
Cutaneous Angiosarcoma of the Scalp Masquerading as a Squamous Cell Carcinoma: Case Report and Literature Review
Authors: Dhanasekar Padmanabhan , Karthikeyan Vilvapathy Senguttuvan , Rajkumar Nagarajan , Sistla Sarath Chandra , Ali S. Manwar , Basu Debdatta , Malathi Munisamy 
Published: January 2017

Background: Cutaneous angiosarcoma is a rare tumor of the elderly male, most commonly affecting the head and neck region. It is difficult to differentiate this tumor from hemangiomas, hemangioblastomas, Kaposi sarcoma, squamous cell carcinoma and anaplastic melanomas. Methods: Case report and review of pertinent English medical literature. Case summary: We report a case of a 60-year-old male presenting with multiple nodules over the scalp where a preoperative histopathologic diagnosis of squamous cell carcinoma was made by wedge biopsy from the tumor. Postoperative histopathology and immuno histochemistry of the wide local excision specimen proved the tumor to be cutaneous angiosarcoma and the patient completed adjuvant radiotherapy. He is now on regular follow-up for 1 year without recurrence. Conclusions: Cutaneous angiosarcoma must be kept in mind in view of its rarity especially in extensive involvement of the scalp by malignancy. The primary treatment is wide local excision with adequate skin cover and adjuvant chemotherapy and radiotherapy in positive margins and lymph node metastasis.
Actinic Superficial Folliculitis in a 29-Year-Old Man
Authors: Laberge Lauren , Glassman Steven , Kanigsberg Nordau 
Published: January 2017

Background: Since actinic superficial follicultis was first described in 1985, only three further cases have been published. The characteristics of this disease are monomorphous, superficial, follicular pustules that appear on the back, upper chest, and shoulders annually after the first sun exposure of the year. The lesions resolve on their own within 10 days. Recurrence occurs under similar conditions after a latency period of at least 4 weeks. Methods: A 29-year-old man presented to our clinic with a 5-year history of an intermittent follicular rash. These eruptions occurred on his back and chest only when he was exposed to the sun, with his shirt off. They developed 24 to 36 hours after the first sun exposure of the year and resolved spontaneously after 5 to 7 days. Photographs of the affected area were impressive, with follicular pustules grouped along his left flank. Conclusion: According to our literature search, this is the sixth reported case of actinic superficial folliculitis. This is the first case in which provocative phototesting was done. We review the clinical and pathologic attributes of actinic superficial folliculitis.
Efficacy of Topical Calcineurin Inhibitors in Lichen Planus
Authors: Samycia Michael , Lin Andrew N. 
Published: January 2017

Background: Topical calcineurin inhibitors have been studied in many skin disorders, including lichen planus. Objective: To evaluate published reports of the use of topical calcineurin inhibitors in lichen planus. Methods: We searched PubMed, Ovid/Cochrane, and Embase using the keywords “tacrolimus,” “pimecrolimus,” “topical calcineurin inhibitors,” and “lichen planus.” Results: We examined 5 double-blind studies, 1 investigator-blinded study, 10 open prospective studies, 6 retrospective studies, and 28 case reports evaluating tacrolimus or pimecrolimus for oral, vulvovaginal, and cutaneous lichen planus. Conclusions: Strong evidence (double-blind and open studies) supports the use of topical tacrolimus ointment in oral lichen planus, with efficacy at least equal to topical clobetasol propionate 0.05% ointment. Treatment of oral lichen planus with topical tacrolimus ointment can result in demonstrable blood tacrolimus levels, but without clinically significant adverse events. Strong evidence (double-blind and open studies) supports the use of topical pimecrolimus 1% cream in oral lichen planus, with efficacy equal to that of topical triamcinolone acetonide 0.1% paste. For vulvovaginal lichen planus, pimecrolimus was superior to placebo in one double-blind study, and tacrolimus was effective in open studies. Only case reports support the efficacy of topical calcineurin inhibitors in cutaneous lichen planus.
Vitiligo and Associated Autoimmune Disease: Retrospective Review of 300 Patients
Authors: Sawicki Jakub , Siddha Sanjay , Rosen Cheryl 
Published: January 2017

Background: Vitiligo, the most common cutaneous depigmentation disorder, has reported associations with other autoimmune diseases. However, literature on the strengths of the associations is conflicting, and no data on the subject exist from a Canadian population. Objective: To determine autoimmune disease associations with vitiligo and which, if any, screening bloodwork is appropriate in vitiligo patients. Methods: A retrospective review of vitiligo patients admitted to the Toronto Western Hospital phototherapy unit was conducted from January 1, 2000, to August 30, 2009. Data regarding patient characteristics, vitiligo clinical features (family history, age at onset, type, extent), associated diseases in the patient and family, and admission bloodwork (hemoglobin, vitamin B12, thyroid-stimulating hormone [TSH], antinuclear antibody) were recorded and compared, using the Fisher exact test where applicable. Results: A total of 300 patient charts were reviewed (average age 41.5 ± 15.5 years; 47% male, 53% female). Hypothyroidism was present in 12.0% and pernicious anemia in 1.3% of patients—significant increases over the population prevalence. No other differences in prevalence were seen compared to the general population. TSH was increased in 3.7% of patients without a history of hypothyroidism. Hemoglobin and vitamin B12 were decreased in 0.3% of vitiligo patients without a history of pernicious anemia. Conclusion: We found a significantly higher prevalence of hypothyroidism and pernicious anemia in vitiligo patients.
The British Quasi-Market in Health Care: A Balance Sheet of the Evidence
Authors: Mays Nicholas , Mulligan Jo-Ann , Goodwin Nick 
Published: January 2017

Objectives: To summarise the findings from a comprehensive review of research on the effects of the three main elements of the quasi-market reforms of the UK National Health Service (NHS) introduced in 1991/92: General practices becoming fundholders by volunteering to purchase elective care for their patients; Health authorities becoming purchasers of emergency, unplanned and elective services, together with a range of alternatives to fundholding operating under their auspices; The conversion of providers of hospital and community health services to NHS trusts separate from their local health authorities. Methods: Published and unpublished studies which included any data on the impact of the three main planks of the quasi-market changes, produced between 1991 and late 1998, were identified using a combination of electronic databases, library catalogues at the King's Fund, London, bibliographies, reference lists of individual studies, a survey of NHS directors of public health and consultations with subject area experts. Each main element of the quasi-market was assessed in relation to its impact on: efficiency (primarily productivity); equity; quality; choice and responsiveness; and accountability. Results: There was relatively little measurable change that could be related unequivocally to the core mechanisms of the quasi-market. Conclusions: The incentives were generally too weak and the constraints too strong to generate the consequences predicted by either proponents or critics of the quasi-market. On the other hand, the way in which the NHS operates was changed irrevocably by the reforms.
Were Practice Nurses Distributed Equitably across England and Wales, 1988–1995?
Authors: Hirst Michael , Lunt Neil , Atkin Karl 
Published: January 2017

Objective: To examine whether variations in the number of whole-time equivalent (wte) practice nurses across family health services authorities (FHSAs) can be explained by population characteristics and the organisation of general practice. Methods: Analysis of nine health and 16 social indicators for 98 FHSAs identified three factors underlying health care needs. These factors and seven practice characteristics were analysed by stepwise regression. A formula for allocating health care resources and a logistic growth model were used to estimate the ‘expected’ number of nurses. Results: Past trends indicate an eventual (wte) practice nurse workforce of 12 500 (95% CI ± 3500). Although geographical disparities have declined, there was a two-fold variation in nurse numbers across FHSAs. Around 2000 (wte) posts would be required to bring under-provided areas, mostly in northern England and metropolitan districts, up to the highest level of provision. There were more nurses in areas with higher proportions of elderly people but fewer where deprivation, morbidity and mortality levels were above average. The number of general practitioners was the most significant predictor of practice nurse provision ( t = 5.0); population needs and practice characteristics explained 24% of the variation. Conclusions: The distribution of practice nurses scarcely corresponded with health care needs at the FHSA level. Despite a lack of evidence that nurses are a cost-effective addition to the primary health care team, their role and numbers will be driven by the extent to which they take on responsibilities performed by doctors. Achieving equity in practice nurse provision probably requires explicit consideration in a formula for allocating primary care funds, backed by audit of the services they provide.
Managed Care: US Research Evidence and its Lessons for the NHS
Authors: Steiner Andrea , Robinson Ray 
Published: January 2017

Objectives: To review the high quality US evidence on performance of managed health care organisations and the available US evidence on specific managed care techniques; namely, financial incentives, utilisation management and review, physician profiling and disease management. Methods: Literature searches were conducted using numerous databases including Medline, Embase, the Social Sciences Citation Index and the National Health Service (NHS) Centre for Reviews and Dissemination library. For inclusion of evaluations of overall performance, studies had to use a comparison group (typically fee-for-service patients), make appropriate statistical adjustments for differences between groups, and be published in a peer-reviewed journal from 1980 forward. For assessments of techniques, less-demanding inclusion criteria reflected the paucity of generalisable literature; however, more current results were required (1990 forward). Results: We identified 70 articles for systematic review, covering 18 dimensions of performance (e.g. utilisation, quality of care, consumer satisfaction, equity). The strength of the evidence varied by dimension. It was strongest for utilisation and quality. In general, managed care seems to reduce hospitalisation and use of high-cost discretionary services, to increase preventive screening, and to be neutral in terms of patient outcomes. As for specific techniques, we identified 19 articles for review, but limitations of these studies prevented our drawing any definite conclusions about techniques' effectiveness. This is an important, if somewhat negative, conclusion. Conclusions: Applying US evidence is complicated by an irrelevant comparator and a higher baseline of utilisation. Managed care brought Americans the familiar NHS practices of population-based health care and resource management through gatekeeping; hence, changes due to UK adoption of managed care techniques may be modest. US evidence should be used to generate hypotheses, not to predict UK behaviour.
Do Minutes Count? Consultation Lengths in General Practice
Authors: Carr-Hill Roy , Jenkins-Clarke Sue , Dixon Paul , Pringle Mike 
Published: January 2017

Objective: To document the variability in consultation length and to examine the relative weight of different kinds of characteristics (of the patients, of the general practitioner (GP), or of the practice) in affecting consultation length, and, thus, to assess whether consultation length can legitimately be used as a quality marker. Design: A multilevel statistical analysis of 836 consultations across 51 GPs in ten practices. Setting and subjects: Ten general practices across four regions in England with varying list sizes, number of partners and fundholding status. Main outcome measures: Length of time face-to-face with patients in consultation measured in minutes and fractions of minutes. Results: There is substantial inter-practice variation in consultation length, from a mean of 5.7 minutes to one of 8.5 minutes. In some practices the longest average GP consultation time is about twice that of the shortest. Trainees and new partners spend, on average, about 1 minute less than their longer-serving colleagues. Consultation lengths for individual GPs range from a mean of 4.4 minutes to 11 minutes. Late middle-aged women (55–64 years) receive the longest consultations, followed by elderly people, with children receiving the shortest consultations. The number of topics raised affects the length of the consultation by about 1 minute per additional topic. When female patients consult female GPs, approximately 1 minute is added to the average consultation. A significant fraction of the variability in consultation lengths can be explained in terms of characteristics of patients, of GPs and of practices. Conclusions: The fact that there is little unexplained variation in GP consultation lengths that might be attributable to variations in quality (i.e. GP-related) throws doubt on the proposition that length of consultation can be used as a marker for quality of consultation in general practice.