bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving the wellbeing of staff who work in palliative care settings: A systematic review of psychosocial interventions
Authors: Hill Rebecca C , Dempster Martin , Donnelly Michael , McCorry Noleen K 
Published: March 2016

Background: Staff in palliative care settings perform emotionally demanding roles which may lead to psychological distress including stress and burnout. Therefore, interventions have been designed to address these occupational risks. Aim: To investigate quantitative studies exploring the effectiveness of psychosocial interventions that attempt to improve psychological wellbeing of palliative care staff. Design: A systematic review was conducted according to methodological guidance from UK Centre for Reviews and Dissemination. Data sources: A search strategy was developed based on the initial scans of palliative care studies. Potentially eligible research articles were identified by searching the following databases: CINAHL, MEDLINE (Ovid), PsycINFO and Web of Science. Two reviewers independently screened studies against pre-set eligibility criteria. To assess quality, both researchers separately assessed the remaining studies using the Quality Assessment Tool for Quantitative Studies. Results: A total of 1786 potentially eligible articles were identified – nine remained following screening and quality assessment. Study types included two randomised controlled trials, two non-randomised controlled trial designs, four one-group pre–post evaluations and one process evaluation. Studies took place in the United States and Canada (5), Europe (3) and Hong Kong (1). Interventions comprised a mixture of relaxation, education, support and cognitive training and targeted stress, fatigue, burnout, depression and satisfaction. The randomised controlled trial evaluations did not improve psychological wellbeing of palliative care staff. Only two of the quasi-experimental studies appeared to show improved staff wellbeing although these studies were methodologically weak. Conclusion: There is an urgent need to address the lack of intervention development work and high-quality research in this area.
Postoperative renormalization of C-reactive protein with adjuvant lienal polypeptide and its association with tumour recurrence in T1 clear cell renal cell carcinoma
Authors: Guo Yijun , Hu Qingfeng , Sun Chuanyu , Gu Bin , Xu Ke , Xia Guowei 
Published: March 2016

Objectives To evaluate the effect of pre- and postoperative C-reactive protein (CRP) levels on tumour recurrence following curative nephrectomy in patients with stage T1 clear cell renal cell carcinoma (CCRCC). Methods Patients with stage T1 CCRCC were recruited. CRP was quantified 3 days before and 4 weeks after surgery. Patients were followed-up for clinical outcome every 3 months. A subset of patients received lienal polypeptide as adjuvant treatment. Results Patients with elevated preoperative CRP levels (≥8.2 mg/l; n = 61) had higher grade tumours, were more likely to require radical nephrectomy and were more likely to experience recurrence than those with normal CRP levels. Non-normalization of elevated preoperative CRP was associated with tumour recurrence, but elevated CRP was not an independent risk factor of tumour recurrence. Conclusion Postoperative renormalization of elevated CRP is associated with decreased risk of recurrence in CCRCC.
Plate Versus Intramedullary Nail Fixation of Anterior Tibial Stress Fractures
Authors: Markolf Keith L. , Cheung Edward , Joshi Nirav B. , Boguszewski Daniel V. , Petrigliano Frank A. , McAllister David R. 
Published: March 2016

Background: Anterior midtibial stress fractures are an important clinical problem for patients engaged in high-intensity military activities or athletic training activities. When nonoperative treatment has failed, intramedullary (IM) nail and plate fixation are 2 surgical options used to arrest the progression of a fatigue fracture and allow bone healing. Hypothesis: A plate will be more effective than an IM nail in preventing the opening of a simulated anterior midtibial stress fracture from tibial bending. Study Design: Controlled laboratory study. Methods: Fresh-frozen human tibias were loaded by applying a pure bending moment in the sagittal plane. Thin transverse saw cuts, 50% and 75% of the depth of the anterior tibial cortex, were created at the midtibia to simulate a fatigue fracture. An extensometer spanning the defect was used to measure the fracture opening displacement (FOD) before and after the application of IM nail and plate fixation constructs. IM nails were tested without locking screws, with a proximal screw only, and with proximal and distal screws. Plates were tested with unlocked bicortical screws (standard compression plate) and locked bicortical screws; both plate constructs were tested with the plate edge placed 1 mm from the anterior tibial crest (anterior location) and 5 mm posterior to the crest. Results: For the 75% saw cut depth, the mean FOD values for all IM nail constructs were 13% to 17% less than those for the saw cut alone; the use of locking screws had no significant effect on the FOD. The mean FOD values for all plate constructs were significantly less than those for all IM nail constructs. The mean FOD values for all plates were 28% to 46% less than those for the saw cut alone. Anterior plate placement significantly decreased mean FOD values for both compression and locked plate constructs, but the mean percentage reductions for locked and unlocked plates were not significantly different from each other for either plate placement. The percentage FOD reductions for all plate constructs and the unlocked IM nail were significantly less with a 50% saw cut depth. Conclusion: Plate fixation was superior to IM nail fixation in limiting the opening of a simulated midtibial stress fracture, and anterior-posterior placement of the plate was an important variable for this construct. Clinical Relevance: Results from these tests can help guide the selection of fixation hardware for patients requiring surgical treatment for a midtibial stress fracture.
Ketamine may be related to reduced ejection fraction in children during the procedural sedation
Authors: Eken C , Serinken M , Dogan M 
Published: March 2016

Objective: Ketamine is a dissociative anesthetic agent with sympathomimetic effects used commonly for procedural sedation in emergency department. The present study aimed to reveal the effect of ketamine on myocardium by measuring ejection fraction (EF). Methods: Patients less than 9 years old undergoing procedural sedation with ketamine secondary to minor trauma composed the study population by convenience sampling. Study patients received ketamine at a dose of 1.5 mg/kg. A cardiologist performed the measurements of cardiac contractility pre-ketamine and 10 min after the ketamine administration. Results: A total of 22 patients were enrolled into the study. Patient recruitment has been ceased after the 22nd patient because of the thought that more patients would not provide additional information. The study subjects had a mean age of 3.5 ± 2.2 years and 14 (64%) of them were male. EF reduced in 14 (63.6%) patients (mean: 5.6 ± 3.1; median: 5; interquartile range (IQR): 3.75–7; minimum–maximum (min–max): 1–14). Systolic blood pressures reduced in 10 of 14 patients with decreased EF and increased in 8 of 10 patients without decreased EF. The changes in systolic blood pressure in patients with decreased EF ( n = 14) were as follows: −7.6 ± 10.9; median: −7.5; IQR: −16.5 to 1.75; and min–max: −30 to 9. There were two patients with elevated high-sensitive troponin. Conclusion: Ketamine may reduce EF and systolic blood pressure in children less than 9 years old undergoing procedural sedation.
The substrate of increased cortical FA in MS: A 7T post-mortem MRI and histopathology study
Authors: Jonkman Laura E , Klaver Roel , Fleysher Lazar , Inglese Matilde , Geurts Jeroen JG 
Published: March 2016

Background: Using diffusion tensor imaging (DTI), it was previously found that demyelinated gray matter (GM) lesions have increased fractional anisotropy (FA) when compared to normal-appearing gray matter (NAGM) in multiple sclerosis (MS). The biological substrate underlying this FA change is so far unclear; both neurodegenerative changes and microglial activation have been proposed as causal contributors. Objective: To test the proposed hypothesis that microglia activation is responsible for increased FA in cortical GM lesions. Methods: We investigated post-mortem cortical DTI changes in hemispheric, coronally cut sections and investigated the underlying histopathology using immunohistochemistry. Results: Overall, there were few activated microglia/macrophages, and no difference between GM lesions and NAGM was observed. However, cell density was increased in GM lesions compared to NAGM (309.67 ± standard deviation (SD) 124.44 vs 249.95 ± SD 56.75, p = 0.002). Conclusion: FA increase was not due to lesional and non-lesional differences in microglia activation and/or proliferation. We found an increase in general cellular density without a notable difference in cellular size, that is, tissue compaction, as a possible alternative explanation.
The effect of infliximab on bone healing in osteoporotic rats
Authors: Durmuşlar M Cenk , Türer Akif , Ballı Umut , Yılmaz Zehra , Önger Mehmet Emin , Çelik H Hamdi , Vatansever Alper 
Published: March 2016

Purpose: The aim of this study was to evaluate the effect of the infliximab on autogenous-mediated bone regeneration and resorption of autogenous graft in the ovariectomised rat model. Materials and methods: Forty rats underwent ovariectomy and 6 weeks later the animals were randomly assigned to four groups. Critical size defects were created in each rat calvarium. In the control group (C), the flap was closed without any further action. In the only infliximab group (In), the flap was closed without any further action. After the operation, intravenous infliximab was injected. In the autogenous graft group (Ag), autogenous bone was applied in to the defect. In autogenous graft + infliximab group (Ag+In), autogenous graft was placed on the defect. After the operation, intravenous infliximab was injected. The animals were sacrificed at 4 weeks. Bone formation was assessed by micro-computed tomography (micro-CT) scans and stereological analysis. Results: The mean new bone volume was the greatest in Ag+In group (1.76 ± 0.20), followed by the Ag group (1.51 ± 0.05) (statistically significant difference at P <0.05). The lowest new bone was found in the control group (1.05 ± 0.09), however no difference was observed from the In group (1.14 ± 0.08) ( P >0.05). Besides there was a statistically significant difference between the Ag+In group (1.00 ± 0.05) and Ag group (0.74 ± 0.04) in terms of the graft volume ( P <0.05). Conclusion: This study, despite its limitations, showed that infliximab has a beneficial effect for prevent graft resorption and bone regeneration in osteoporotic rats.
Cross-sectional area of the ulnar nerve after decompression at the cubital tunnel
Authors: Duetzmann S. , Krishnan K. G. , Staub F. , Kang J.-S. , Seifert V. , Marquardt G. 
Published: March 2016

A total of 48 patients undergoing surgical decompression of the ulnar nerve at the cubital tunnel between February 2010 and May 2013 were retrospectively studied to determine changes in the cross-sectional area of the nerve by the technique of neurosonography. The mean follow-up was 46 months. Post-operative follow-up examination of the cross-sectional area of the ulnar nerve showed a slight reduction in the mean value from 13.8 mm2 (pre-operative) to 12.9 mm2 (post-operative). Of the 48 patients, 36 showed a reduction in the cross-sectional area. No correlation was detected between the clinical and sonographic outcomes. Ultrasound seems to be of limited value in the post-operative assessment of patients with entrapment neuropathy of the ulnar nerve. Level of Evidence: IV
Risk of pneumonitis in cancer patients treated with immune checkpoint inhibitors: a meta-analysis
Authors: Abdel-Rahman Omar , Fouad Mona 
Published: March 2016

Background: A meta-analysis of the risk of pneumonitis associated with the use of immune checkpoint inhibitors in cancer patients has been conducted. Methods: Eligible publications included randomized trials of cancer patients on immune checkpoint inhibitors, describing events of all-grade and high-grade pneumonitis. Results: After exclusion of noneligible citations, a total of 11 clinical trials were eligible for the meta-analysis. The odds ratio was 3.96 [95% confidence interval (CI): 2.02–7.79; p < 0.0001] for all-grade pneumonitis and 2.87 (95% CI: 0.90–9.20; p = 0.08) for high-grade pneumonitis. Moreover, the odds ratio of all-grade pneumonitis with a nivolumab/ipilimumab combination versus ipilimumab monotherapy was 3.68 (95% CI: 1.59–8.50; p = 0.002) and, for high-grade pneumonitis, it was 1.86(95% CI: 0.36–9.53; p = 0.46). Subgroup analysis did not reveal a difference between lung cancer patients and other cancer patients in the risk of pneumonitis. Conclusions: Our analysis provided evidence that the use of immune checkpoint inhibitors is associated with an increased risk of all-grade pneumonitis compared with chemotherapy or placebo controls.
Diagnostic yield of electromagnetic navigational bronchoscopy
Authors: Al-Jaghbeer Mohammed , Marcus Mathew , Durkin Martin , McGuire Franklin R. , Iftikhar Imran H. 
Published: March 2016

Objectives: Peripheral lung nodules (PLNs) are a common and diagnostically challenging finding. Electronavigational bronchoscopy (ENB) is used to increase the diagnostic yield and is considered safe. Multiple factors have been correlated with a better diagnostic yield. We sought to assess the effect of nodule characteristics and prior workup on the diagnostic yield in ENB. Methods: This was a retrospective chart review of 98 ENB procedures in a community referral center. Two investigators reviewed patients’ charts and images independently. Multiple logistic regression analyses was used to determine if factors such as bronchus sign, ground glass opacification (GGO), distance from pleura, prior use of endobronchial ultrasound (EBUS) and positron emission tomography (PET) had an impact on the diagnostic yield. Results: We evaluated 98 ENBs performed in 92 patients. Most of the lesions were in the upper lobes. The diagnostic yield was 60%. A PET scan was performed prior to ENB in 47% of cases. EBUS was performed in 24% of cases. Bronchus sign was present in 60% of cases and GGO in only 6% of nodules. The odds ratio for diagnostic yield with a bronchus sign was 1.89 [95% confidence interval (CI): 0.83–4.33] and with nodules showing GGO characteristics it was 4.51 (95% CI: 0.51–39.68). Pneumothorax occurred in 6% of cases. Conclusion: In our cohort, diagnostic yield was 60% with a 6% pneumothorax rate. A suggestive trend for the presence of bronchus sign on computed tomography scan, albeit statistically nonsignificant, as a predictor for improved diagnostic yield needs to be validated in a larger cohort.
Improving Diagnostic Accuracy and Efficiency of Suspected Bone Stress Injuries
Authors: Nye Nathaniel S. , Covey Carlton J. , Sheldon Lucas , Webber Bryant , Pawlak Mary , Boden Barry , Beutler Anthony 
Published: March 2016

Context: Lower extremity stress fractures among athletes and military recruits cause significant morbidity, fiscal costs, and time lost from sport or training. During fiscal years (FY) 2012 to 2014, 1218 US Air Force trainees at Joint Base San Antonio–Lackland, Texas, were diagnosed with stress fracture(s). Diagnosis relied heavily on bone scans, often very early in clinical course and often in preference to magnetic resonance imaging (MRI), highlighting the need for an evidence-based algorithm for stress injury diagnosis and initial management. Evidence Acquisition: To guide creation of an evidence-based algorithm, a literature review was conducted followed by analysis of local data. Relevant articles published between 1995 and 2015 were identified and reviewed on PubMed using search terms stress fracture, stress injury, stress fracture imaging, and stress fracture treatment. Subsequently, charts were reviewed for all Air Force trainees diagnosed with 1 or more stress injury in their outpatient medical record in FY 2014. Study Design: Clinical review. Level of Evidence: Level 4. Results: In FY 2014, 414 trainees received a bone scan and an eventual diagnosis of stress fracture. Of these scans, 66.4% demonstrated a stress fracture in the symptomatic location only, 21.0% revealed stress fractures in both symptomatic and asymptomatic locations, and 5.8% were negative in the symptomatic location but did reveal stress fracture(s) in asymptomatic locations. Twenty-one percent (18/85) of MRIs performed a mean 6 days (range, 0- 21 days) after a positive bone scan did not demonstrate any stress fracture. Conclusion: Bone stress injuries in military training environments are common, costly, and challenging to diagnose. MRI should be the imaging study of choice, after plain radiography, in those individuals meeting criteria for further workup.
Preexisting Rotator Cuff Tears as a Predictor of Outcomes in National Football League Athletes
Authors: Gibbs Daniel B. , Lynch T. Sean , Gombera M. Mustafa , Saltzman Matthew D. , Nuber Gordon W. , Schroeder Gregory D. , Labelle Mark , Hollett Brian P. 
Published: March 2016

Background: A preexisting rotator cuff tear may affect the draft status and career performance of National Football League (NFL) players. Hypothesis: Preexisting rotator cuff tears decrease a player’s draft status, performance, and longevity in the NFL. Study Design: Retrospective cohort study. Level of Evidence: Level 3. Methods: Medical reports of prospective NFL players during the NFL Scouting Combine from 2003 to 2011 were evaluated to identify players with a previous rotator cuff tear. Athletes were matched to control draftees without documented shoulder pathology by age, position, year drafted, and round drafted. Career statistics and performance scores were calculated. Results: Between 2003 and 2011, 2965 consecutive athletes were evaluated. Forty-nine athletes had preexisting rotator cuff tears: 22 athletes underwent surgical intervention for their tear and 27 were treated nonoperatively. Those with a rotator cuff tear were significantly less likely to be drafted than those without a previous injury (55.1% vs 77.5%, P = 0.002). The 27 drafted athletes with preexisting rotator cuff tears started significantly fewer games (23.7 vs 43.0, P = 0.02) and played significantly fewer years (4.3 vs 5.7, P = 0.04) and significantly fewer games (47.1 vs 68.4, P = 0.04) than matched control athletes without rotator cuff tears. Conclusion: Athletes with a preexisting rotator cuff tear were less likely to be drafted and had decreased career longevity.
Long-Term Outcomes after Autologous Chondrocyte Implantation
Authors: Pareek Ayoosh , Carey James L. , Reardon Patrick J. , Peterson Lars , Stuart Michael J. , Krych Aaron J. 
Published: March 2016

Objective Autologous chondrocyte implantation (ACI) has not been proven to be durable over the long-term. The purpose of this systematic review was (1) to evaluate activity level and knee function, (2) to evaluate reoperation and failure rates, and (3) to analyze risk factors for reoperation and failure of ACI at minimum long-term follow-up. Design A comprehensive review was performed for studies with long-term outcomes after ACI for cartilage defect repair. Studies reported outcome scores such as Tegner score, Lysholm score, and International Knee Documentation Society (IKDC) score along with rates of failure and reoperation. Modified Coleman Methodology Scores were calculated to assess study methodological quality. Results Nine studies with a total of 771 patients with a mean age of 33.4 ± 2.5 years, mean defect size of 5.9 ± 1.6 cm2, and mean follow-up of 11.4 years were included. Tegner score, Lysholm score, and IKDC score change from preoperative to final follow-up was 1.1 (95% CI 0.8-1.4, P < 0.001), 24.9 points (95% CI 18.8-31, P < 0.001), and 16.5 points (95% CI 5.4-27.5, P < 0.01), respectively. The mean failure and reoperation rates were 18% and 37%, respectively. Increased age and lesion size (>4.5 cm2) were significantly correlated with increased risk of reoperation and failure. Conclusions Overall, ACI demonstrated successful outcomes in 82% of patients over the long-term. Increased patient age and lesion size greater than 4.5 cm2 were risk factors for a higher reoperation and failure rate. Nonetheless, this review is limited by heterogeneity in surgical technique, and lesion and patient characteristics.
The Epidemiology of Hip/Groin Injuries in National Collegiate Athletic Association Men’s and Women’s Ice Hockey
Authors: Dalton Sara L. , Zupon Alyssa B. , Gardner Elizabeth C. , Djoko Aristarque , Dompier Thomas P. , Kerr Zachary Y. 
Published: March 2016

Background: There is limited research regarding the epidemiology of hip/groin injuries in ice hockey, the majority of which is restricted to time-loss injuries only. Purpose: To describe the epidemiology of hip/groin injuries in collegiate men’s and women’s ice hockey from 2009-2010 through 2014-2015. Study Design: Descriptive epidemiology study. Methods: Hip/groin injury data from the National Collegiate Athletic Association Injury Surveillance Program (NCAA-ISP) during the 2009-2010 through 2014-2015 seasons were analyzed. Injury rates, rate ratios (RRs), and injury proportion ratios (IPRs) were reported with 95% confidence intervals (CIs). Results: During the 2009-2010 through 2014-2015 seasons, 421 and 114 hip/groin injuries were reported in men’s and women’s ice hockey, respectively, leading to injury rates of 1.03 and 0.78 per 1000 athlete-exposures (AEs), respectively. The hip/groin injury rate was greater in men than in women (RR, 1.32; 95% CI, 1.08-1.63). In addition, 55.6% and 71.1% of hip/groin injuries in men’s and women’s ice hockey, respectively, were non–time loss (NTL) injuries (ie, resulted in participation restriction time <24 hours); 7.6% and 0.9%, respectively, were severe (ie, resulted in participation restriction time >3 weeks). The proportion of hip/groin injuries that were NTL injuries was greater in women than in men (IPR, 1.28; 95% CI, 1.11-1.48). Conversely, the proportion of hip/groin injuries that were severe was greater in men than in women (IPR, 8.67; 95% CI, 1.20-62.73). The most common hip/groin injury diagnosis was strain (men, 67.2%; women, 76.3%). Also, 12 (2.9%) and 3 (2.6%) cases of hip impingement were noted in men’s and women’s ice hockey, respectively. Conclusion: Hip/groin injury rates were greater in men’s than in women’s ice hockey. Time loss varied between sexes, with men sustaining more injuries with time loss over 3 weeks. Despite increasing concerns of femoroacetabular impingement in ice hockey players, few cases of hip impingement were reported in this dataset.
Circulating T follicular helper cells with increased function during chronic graft-versus-host disease
Authors: Forcade Edouard , Kim Haesook T. , Cutler Corey , Wang Kathy , Alho Ana C. , Nikiforow Sarah , Ho Vincent T. , Koreth John , Armand Philippe , Alyea Edwin P. , Blazar Bruce R. , Soiffer Robert J. , Antin Joseph H. , Ritz Jerome 
Published: March 2016

Key Points
cTFH are activated and skewed toward a Th2/Th17 phenotype promoting their B-cell help function during cGVHD. cTFH activation signature correlates with memory B-cell and plasmablast phenotype in cGVHD patients.