bluuebunny/crossref_metadata_2025_split huggingface dataset:
Applying Research to Health Care Policy and Practice: Medical and Managerial Views on Effectiveness and the Role of Research
Authors: Rosen Rebecca 
Published: January 2017

Objectives: This study explores the way in which doctors and managers think about the effectiveness of health care interventions and how this shapes the evidence they use to support decision-making. Methods: Case studies of the introduction of three new medical technologies in nine National Health Service (NHS) hospitals and health authorities. Results: Effectiveness research provides essential evidence on clinical and cost-effectiveness and is used primarily by clinicians and public health doctors for this purpose. However, research fails to provide the ‘evidence’ required by managerial decision-makers, whose objectives relate as much to the effect of a technology on organisational performance as on patient health and well-being. The evidence used to inform technology adoption decisions reflects the professional role and objectives of different decision-makers. Conclusions: The assumed relationship between ‘research’ and ‘evidence’ for the purpose of promoting effective health care does not take account of the wide range of objectives pursued by different health care decision-makers and the varied sources of ‘evidence’ they use to support their decisions.
Demand for Plastic Surgical Operations after Primary Breast Cancer Surgery
Authors: Meretoja T. , Suominen E. 
Published: January 2017

Background and Aims: The aim of this study is to evaluate the demand for plastic operations after primary breast cancer surgery. In addition, this study aims to increase knowledge on factors affecting the wish of women for breast reconstruction. Material and Methods: A questionnaire was sent to some 111 patients who had undergone either mastectomy or breast conserving surgery. The response rate was 76 %. The questionnaire consisted of 20 structured questions. The data was analysed statistically using the t test and the chi-square test. Results: 28 % of the mastectomized patients wanted a breast reconstruction. Factors found to affect the patient's wish for reconstruction were age ( p < 0.001) and whether the patient had received radio- ( p < 0.05) or chemotherapy ( p < 0.05). A difference was found between the mastectomy group and the breast conserving surgery group as to satisfaction in the general ( p < 0.05) and the cosmetic ( p < 0.05) outcome of the surgery, as well as patient's expectations regarding the outcome ( p < 0.01). Conclusions: Rather fewer mastectomized patients wanted a reconstruction. The proportion, however, grew significantly larger in the younger age groups. This study also shows that receiving radio- or chemotherapy seems to predict a woman's choice against a reconstruction. Patients who receive radio- or chemotherapy may consider their illness more severe and life-threatening than those not receiving such treatments.
Comparison of Digital and Conventional Radiostereometric Image Analysis in an Ankle Phantom Model
Authors: Mäkinen T. J. , Mattila K. T. , Määttänen H. , Aro H. T. 
Published: January 2017

Background and Aims: Radiostereometric analysis (RSA) allows accurate three-dimensional measurements of micromotion in skeletal structures. The current RSA techniques are based on the analysis of scanned plain films. This study was undertaken to compare digital filmless RSA technique to conventional scanning technique using a phantom model of the ankle mortise. Material and Methods: In the first experiment, the relative displacement of the markers inserted to the fibula in relation to the markers inserted to the tibia was studied by means of double examinations and the precision of DICOM images were compared to scanned images of printed radiographs. In the second experiment, the film pair of double examination was re-imported or re-scanned and self-compared in order to show merely the error related to the image processing. Results: The precision of RSA using scanned images of printed radiographs was compatible to DICOM images. However, the mean error of rigid body fitting (ME) values were significantly lower in use of DICOM images compared with scanned radiographs, indicating less deformation of rigid body segments in filmless analysis. Conclusions: Precision of the RSA method was improved under the completely filmless environment. Therefore, this technique can be recommended for clinical studies of radiostereometric analysis.
The Clinical Importance of Monitoring Intra Abdominal Pressure after Ruptured Abdominal Aortic Aneurysm Repair
Authors: Björck M. , Wanhainen A. , Djavani K. , Acosta S. 
Published: January 2017

Aim: The aim of this paper was to review the literature on the clinical importance of monitoring intra-abdominal pressure (IAP) after ruptured abdominal aortic aneurysm (rAAA) repair. Method: The literature was searched for abdominal compartment syndrome (ACS) or intra-abdominal pressure and aortic aneurysm. Original articles were studied. Personal experiences were reported. Results: The consensus documents of the World society on the abdominal compartment syndrome ( wsacs.org ), with their definitions and guidelines, constitute an important step forward for the possibilities to study this clinical entity. Few papers were published describing the problem specifically in the patient population operated on for ruptured abdominal aortic aneurysm (rAAA). The incidence was approximately 5% when the patients were not monitored with IAP, and above 10% when IAP was monitored. The incidence seems to be similar irrespective if open or endovascular repair is performed, though comparative prospective studies were not published. Patients with intra-abdominal hypertension (IAH) or ACS have higher mortality and more complications. If IAH is recognized early conservative treatment may be effective to prevent development of ACS. After ACS has developed, surgical decompression is usually required. A proposed algorithm on how to act on different levels of IAH is presented. Conclusions: IAH/ACS is an important complication after operation on patients with rAAA. Monitoring IAP may be associated with improved outcomes.
Interaction between Marrow-Derived Human Mesenchymal Stem Cells and Peripheral Blood Mononuclear Cells in Endothelial Cell Differentiation
Authors: Joensuu K. , Paatero I. , Alm J. J. , Elenius K. , Aro H. T. , Heino T. J. , Hentunen T. A. 
Published: January 2017

Background and Aims: In adult connective tissues, mesenchymal stem cells (MSCs) play a key role in normal tissue turnover and repair. MSCs can participate in these processes not only through proliferation and differentiation but also through paracrine/autocrine functions. These characteristics make MSCs the optimal target in the development of cell-based therapies. This study describes a novel interaction between human MSC and blood mononuclear cells (MNCs), resulting in formation of blood vessel-like structures. Materials and Methods: Human marrow-derived MSCs and peripheral blood MNCs were co-cultured in monolayer cultures as well as in bovine collagen sponge up to 20 days. No exogenously supplied growth factors were applied. Morphological changes and formations of three dimensional structures were detected by light microscopy. The process was further studied for the expression of different endothelial cell markers. The expression of PECAM-1 and endoglin was studied by immunohistochemistry and the expression of vascular endothelial growth factor receptors 1 and 2 using quantitative real time PCR. Results: In co-cultures of human MSCs and MNCs, the previously nonadherent cells attached and started to elongate and formed tube-like structures within one week. At day 10, elongated PECAM-1 and endoglin expressing cells were detected in co-cultures. At day 20, PECAM-1 and endoglin-positive vessel-like structures were observed. VEGFR1 was up-regulated in co-cultures after 10 days, and expression levels increased with time. No PECAM-1, endoglin or VEGFR1 expressing cells were discovered in MSC-cultures without MNCs at any time point. Conclusions: This study demonstrates induction of endothelial differentiation in co-cultures of human MSCs and MNCs, indicating a mechanism by which local application of MSCs could induce angiogenesis in vivo.
Kidney and Liver Living Donors: A Comparison of Experiences
Authors: Rudow Dianne LaPointe , Charlton Marian , Sanchez Carla , Chang Sara , Serur David , Brown Robert S. 
Published: January 2017

Background Living donor kidney transplantation is considered a safe and effective means to treat end-stage renal disease, and has now exceeded the number of deceased donor kidney transplantations performed annually. Living donor liver transplantation is more controversial and has received criticism in the medical and lay community. Studies focus on recipient outcomes and medical safety. The impact of the donation on donors is not well understood. Objective To compare experiences from both kidney and liver living donors, including their motivation, perceived risks, and postoperative experience. Methods Questionnaires about the donation experience were mailed to 70 patients who underwent laparoscopic donor nephrectomy and 85 patients who underwent hepatectomy at a large academic medical center. Results of kidney and liver donors were compared. Results No differences were found in mean age, marital status, ethnicity, relationship to the recipient, and employment status of the 2 groups. Women were more prevalent in both groups. The most common motivating factor in both kidney and liver donors was “because it was family,” 81% and 82%, respectively. Kidney donors describe the decision to donate as easy compared to the liver donors ( P=.049). In neither group did donors feel pressure to donate or have family conflicts regarding their decision to donate. Both groups felt they were well informed of the risks. Neither group described unexpected problems, and neither group regretted their decision to donate and would do it again if asked. Conclusion Donors in both groups reported favorable outcomes. A greater concern for risk of death, bleeding, altered appearance, and infection existed among liver donors compared to kidney donors. The actual outcomes were better than the perceived risks.
Family Experiences of Tissue Donation in Australia
Authors: Wilson Penelope , Sexton Wendy , Singh Andrea , Smith Melissa , Durham Stephanie , Cowie Anne , Fritschi Lin 
Published: January 2017

Context Although research exists examining the experiences of organ donor families, little is known about the specific needs of tissue donor families. Understanding family experiences in tissue donation is important to improve the process and potentially increase the number of families who consent to tissue donation. Objective To examine the experiences of recent tissue donor families and to identify potential areas for improvement of the donation process. Design Cross-sectional survey by mailed questionnaire. Setting and Participants Participants were families who had been approached by DonateWest, the coordinating organization in Western Australia, and had agreed to tissue donation. Main Outcome Measures Quantitative and qualitative analysis of data with regards to satisfaction with the approach method, reasons for consent, and appropriateness of support services. Results Seventy-seven of 140 mailed questionnaires were returned. Almost all respondents expressed satisfaction with the approach to donate, and this did not differ with the mode of approach, that is, by phone or in person. The most common reason for agreeing to donation was that it was known to be the donor's wish. The majority of respondents felt they had sufficient time and information to decide to donate, and almost all were happy with their decision and thought they had received adequate support during and after the process.
Attitudes toward Death Criteria and Organ Donation among Healthcare Personnel and the General Public
Authors: DuBois James M. , Anderson Emily E. 
Published: January 2017

Objective To examine attitudes toward death criteria and their relation to attitudes and behaviors regarding organ donation. Data Sources This article reviews empirical studies on the attitudes of healthcare personnel and the general public regarding death criteria and organ donation. Study Selection and Data Extraction The review was restricted to studies that had as a primary focus attitudes toward 1 or more of the following 3 specific criteria for determining death: (1) brain death, the irreversible loss of all functions of the entire brain; (2) higher brain death, the loss of cerebral cortex function alone; and (3) the circulatory-respiratory criteria commonly used in donation after cardiac death. Data Synthesis Studies consistently show that the general public and some medical personnel are inadequately familiar with the legal and medical status of brain death; attitudes toward the dead donor rule are strong predictors of willingness to donate organs using controversial criteria; concerns about donation after cardiac death surround the withdrawal of life support more than the actual death criteria used; and concerns about death criteria correlate with less favorable attitudes toward organ donation. Conclusions Both general and ethical education may serve to guide policy and facilitate family member requests and informed consent dialogues. Furthermore, helping families to understand and accept not only medical and legal criteria for determining death, but also ethical criteria for withdrawing life support may help them be more comfortable with their decisions.
The Usefulness of the New “Double-Catheter Technique” in the Treatment of Parent Artery Incorporated Wide-Necked Aneurysm with Guglielmi Detachable Coils
Authors: Shin Yong Sam , Kim Dong-Ik , Lee Seung Ik , Chung Jin Il , Yoon Pyeong Ho , Lee Kyu Chang 
Published: January 2017

We describe a technique used to treat a wide-necked aneurysm in which the neck is incorporated with the parent artery. The patient was a 54-year-old woman who had suffered a grade III subarachnoid haemorrhage. Angiogram and three-dimensional CT showed a large, wide-necked aneurysm of the basilar bifurcation area with the right posterior cerebral artery incorporated in the aneurysm sac. A microcatheter was placed in the right posterior cerebral artery (PCA). Another catheter was placed within the aneurysm lumen. When making a first frame with a GDC, we made sure that the frame of the coil did not overlap the PCA positioned microcatheter. Then, with the microcatheter positioned at the PCA, the angiogram was done. The flow pattern and dye-disappearance time were checked. Subsequent coils were introduced, but not beyond the frame of the first coil to maintain PCA flow. This new “double-catheter technique” represents a viable option for treating wide-necked aneurysms, especially when the parent artery is incorporated in a wide-necked aneurysm and the delineation of the parent artery is impossible.
Embolisation of Small (< 3 cm) Brain Arteriovenous Malformations
Authors: Willinsky R. , Goyal M. , Terbrugge K. , Montanera W. , Wallace M.C. , Tymianski M. 
Published: January 2017

The role of embolisation in the treatment of small (< 3cm) brain arteriovenous malformations (AVMs) has not been elucidated. We reviewed our experience using embolisation in the treatment of small AVMs and correlated a proposed grading system based on the angioarchitecture to the percentage obliteration achieved by embolisation. Eighty-one small AVMs in 80 patients were embolised from 1984 to 1999. The age range was from 3 to 72 years. The AVMs were given a score from 0 to 6 based on the angioarchitecture. The assigned scores were as follows: nidus (fistula = 0, < 1 cm = 1, 1–3 cm = 2), type of feeding arteries (cortical = 0, perforator or choroidal = 1), number of feeding arteries (single = 0, multiple = 2) and number of draining veins (single = 0, multiple = 1). Angiographic results based on percentage obliteration were grouped into three categories: complete, 66–99%, and 0–65%. The goal of embolisation was cure in 27 AVMs, pre-surgical in 23, pre-radiosurgery in 26, and elimination of an aneurysm in five. Embolisation achieved complete obliteration in 22 (27%) of the 81 AVMs. In the AVMs where the goal was cure, 19 (70%) of 27 were completely obliterated. In the AVMs with angioarchitecture scores of 0–2, 12 (86%) of 14 were cured, with scores of 3–4, 8 (34%) of 24 were cured and with scores of 5–6, 2 (4%) of 44 were cured. Embolisation resulted in transient morbidity of 5.0%, permanent morbidity of 2.5%, and mortality of 1.2%. There were no complications in AVMs with scores of 0–2. Embolisation is an effective treatment of small AVMs when the angioarchitecture is favourable (scores 0–2). This includes pure fistulas and AVMs with a single, pial, feeding artery.
Treatment of Intracranial Venous Occlusive Disease with Sigmoid Sinus Angioplasty and Stent Placement in a Case of Infantile Multifocal Dural Arteriovenous Shunts
Authors: Vilela P. , Willinsky R. , terBrugge K. 
Published: January 2017

The infantile dural arteriovenous shunts are multifocal involving different dural sinuses and progress to an occlusive venopathy with sigmoid sinus and/or jugular bulb stenosis and subsequent occlusion. We report a successful angioplasty and stent placement of a sigmoid sinus — jugular bulb stenosis due to venous occlusive disease in a patient with infantile dural arteriovenous shunts. A five-year-old patient presented with status epilepticus due to severe venous congestive encephalopathy. The angiogram revealed multifocal dural arteriovenous shunts, occlusion of the right sigmoid sinus, absence of cavernous sinuses and significant stenosis of the left sigmoid sinus — jugular bulb. By transvenous approach, percutaneous transluminal balloon angioplasty and stent placement of the stenosed left sigmoid sinus — jugular bulb segment was performed. This resulted in a significant decrease of the venous pressure gradient across the stenosis and allowed a dramatic clinical recovery. Dural sinus angioplasty and stent placement appears to be a safe and effective procedure and should be considered in the treatment of the venous occlusive disease associated with infantile dural arteriovenous shunts.
Formation of a Liquid Jet by Interaction between a Laser-Induced Bubble and a Shock Wave
Authors: Hirano T. , Komatsu M. , Ezura M. , Uenohara H. , Takahashi A. , Takayama K. , Yoshimoto T. 
Published: January 2017

There are some problems such as a narrow therapeutic time window and severe side effects of fibrinolytics in the therapy of cerebral embolisms. Therefore, it is necessary to develop a new method to remove a cerebral thrombus more rapidly with fewer fibrinolytics. A Q-switch pulsed holmium (Ho): YAG laser with 86 mJ/pulse, pulse duration of 200ns and wavelength of 2.1 mm was used. The laser beam was transmitted through a 0.6 mm diameter quartz optical fiber. Experiments were conducted in a stainless steel container equipped with observation windows. The test chamber was filled with distilled water at 283K. At first, the formation of laser-induced bubbles in a 4 mm diameter glass tube was observed. The bubble gradually expanded and reached a maximum size at about Ims after irradiation. A shock wave induced by ignition of silver azide pellet was interacted with it at 500μs before Ho: YAG laser irradiation, which resulted in forming a liquid jet. This liquid jet penetrated into an artificial thrombus made of gelatin, and its maximum penetration depth was 4.2 mm, which was nearly twice deeper than the laser irradiation only (2.2 mm). Combination of this liquid jet and fibrinolytics will realize more rapid recanalization with fewer drugs.
Palmaz Stent Deployment for Subclavian and Brachiocephalic Arterial Occlusive Disease
Authors: Nakagawa H. , Kichikawa K. , Takayama K. , Sakamoto M. , Wada T. , Taoka T. , Fukusumi A. , Iwasaki S. , Uchida H. , Sakaki T. 
Published: January 2017

Palmaz stent deployment is a useful method for subclavian and brachiocephalic arterial occlusive disease. We evaluated restenosis or intimal thickening after Palmaz stent deployment for nine lesions of subclavian or brachiocephalic arterial occlusive disease focusing on stent diameter, atheroma thickness near the stent, and degree of coverage for the lesion. Follow up DSA and IVUS at 5–14 months (mean 9) after therapy showed no significant changes in the size or shape of the stent itself. There were two lesions of thin in-stent intimal hyperplasia and five lesions of thick hyperplasia. There was no close relationship between intimal hyperplasia and stent diameter or atheroma size (relative thickness). There was some relationship between the degree of coverage of the lesion by the stent and degree of intimal hyperplasia, but to determine statistical significance, accumulation of a greater number of cases is necessary.
Clearance of Subarachnoid Clots after GDC Embolization for Acutely Ruptured Cerebral Aneurysm
Authors: Kobayashi S. , Satoh A. , Koguchi Y. , Wada M. , Tokunaga H. , Miyata A. , Nakamura H. , Watanabe Y. , Yagishita T. 
Published: January 2017

It is apparent that subarachnoid clots play an important role in the development of delayed vasospasm that is one of the major causes of mortality and morbidity in patients with acutely ruptured cerebral aneurysm. The purpose of this study is to compare the clearance of subarachnoid clots in the acute stage after the treatment with Guglielmi detachable coils (GDC) and after treatment with direct surgery. Forty-nine patients were treated by GDC embolization within four days of the ictus. After GDC embolization, adjunctive therapies, such as ventricular and/or spinal drainage (67%), intrathecal administration of urokinase (41%), continuous cisternal irrigation (16%), and external decompression (16%), were performed. Seventy-four surgically treated patients were subsequently treated by continuous cisternal irrigation with mock-CSF containing ascorbic acid for ten days. The clearance of subarachnoid clots was assessed by the Hounsfield number serial changes on the CT scans taken on days 0, 4, 7, 10 after subarachnoid hemorrhage. The incidence of symptomatic vasospasm was lower in the GDC group (6%) than in the surgery group (12%). The clearance of subarachnoid clots from both the basal cistern and the Sylvian fissure was more rapid in the GDC cases than in the surgery cases in the first four days. Intrathecal administration of urokinase accelerated the clearance significantly. GDC embolization followed by intrathecal administration of thrombolytic agents accelerates the reduction of subarachnoid clots and favorably acts to prevent delayed vasospasm.
Hemodynamic Changes in Drainage Systems following Treatment of Cerebral Arteriovenous Malformations
Authors: Miyachi S. , Negoro M. , Okamoto T. , Otsuka G. , Suzuki O. , Sahara Y. , Yoshida J. 
Published: January 2017

The authors studied 61 patients undergoing effective embolization for cerebral arteriovenous malformations (AVMs) and analyzed the hemodynamic changes in their drainage systems following embolization. The changes were classified into following 5 types: type A, disappearance of all the draining veins; type B, disappearance of a part of the cortical veins; type C, disappearance of a part of the deep-seated veins; type D, combined type B and C patterns; type E, disappearance of reflux into normal cortical veins. Each case was evaluated on the basis of these criteria from comparing pre- and post-embolization angiograms. The delay and reduction of shunt were observed in all cases. Forty-nine of them showed obvious hemodynamic changes in the draining systems including type A change in 9, type B in 19, C in 5, D in 3 and E in 13 cases, respectively. Two cases showed a spontaneous shift in the dominance of the main drainers. Thirteen of 15 cases showing successful results in subsequent radiosurgery exhibited various changes in draining pattern. Changes in drainage systems may be affected by the compartmentalization of the nidus, reduction in shunt flow, and spontaneous or progressive thromboses. These can be promoted by embolization and may be regarded as one of the indicators of successful pretreatment for radiosurgery.