bluuebunny/crossref_metadata_2025_split huggingface dataset:
Learning Curve of Laparoscopy-Assisted Gastrectomy Using a Standardized Surgical Technique and an Established Educational System
Authors: Tokunaga M. , Hiki N. , Fukunaga T. , Miki A. , Ohyama S. , Miyata S. , Yamaguchi T. 
Published: January 2017

Background and Aims: The learning curve of a trainee for laparoscopy-assisted gastrectomy in a high volume center, in which an educational system and a standardized laparoscopic procedure are already established, remains unclear. Material and Methods: The early surgical outcomes of the patients of two trainees were investigated. Both trainees followed a training program where they performed at least 20 cases being the camera assistant, 20 cases being the first assistant, before performing the surgery as an operator. Results: The average operation time, intraoperative bleeding, the number of retrieved lymph nodes, and morbidity rate were 240.2 min, 45.7 ml, 35.4, and 13.0%, respectively. There was no learning curve effect observed except with the operation time of one trainee. Conclusions: In a high volume center with an established educational system, trainees could perform laparoscopy-assisted gastrectomy safely, although there might be a learning curve effect in operation time and the surgeries took longer operation time in trainee's initial cases.
Endoscopic Snare Resection Followed by Laser Ablation in the Treatment of Large, Sessile Rectal Adenomas
Authors: Nesbakken A. , Kristinsson J. , Svindland A. , Lunde O. C. 
Published: January 2017

Background and Aims: Large sessile rectal adenomas can be difficult to eradicate, and different treatment modalities are available. The aim of this study was to evaluate outcome after endoscopic snare resection followed by Nd: YAG laser ablation. Material and Methods: Over a 10-year period 92 of 99 (93%) patients were registered prospectively and attended follow-up examinations with endoscopy and biopsies. Results: Fifty-four (59%) men and 38 (41%) women were included; 67 patients (73%) had high grade (severe) intraepithelial dysplasia or intramucosal neoplasia. The adenomas ranged from 2–9 cm (median 4 cm) in diameter, and were located 2–15 cm (median 5 cm) from the anal verge. A median of two (range 1–6) piecemeal snare resection sessions and a median of one (range 1–7) laser treatments were performed for each patient. Complete eradication was achieved in 86 patients (93%). Over a median follow-up period of 26 months, 20/86 (23%) suffered local recurrence, eight of whom were given a second laser treatment without developing further recurrence. In five of eight frail patients considered unsuitable for more radical treatment, repeated laser treatment was effective in keeping the adenoma small and symptoms at a minimum. As a whole the treatment was successful in 74/92 (80%) and partially successful in 5/92 (5%) of the patients. Conclusions: Snare resection followed by laser ablation is safe and still has a place in the treatment of old, frail patients with large rectal adenomas. However, there is a risk of missing an infiltrating carcinoma, and other treatment options are preferable in fit patients.
Impact of Coronary Artery Bypass Surgery on Ischemic Mitral Regurgitation
Authors: Mustonen J. , Suurmunne H. , Kouri J. , Pitkänen O. , Hakala T. 
Published: January 2017

Introduction: To determine the course of ischemic mitral regurgitation (IMR) after coronary artery bypass grafting (CABG), and evaluate preoperative factors which predict the development of the severity of IMR after CABG. Methods: Between 1992–2005, 1995 patients underwent CABG and 170 of them had IMR. Data of 131 patients were retrospectively analyzed and living patients (n = 112) had a clinical follow-up visit. The mean follow-up time was 6.5 years. Results: At the time of CABG, 66% of the 131 cases analyzed had mild, 31% had moderate, and 3% had severe IMR. At the time of follow-up, 52% of patients had either no IMR or mild IMR, 27% had moderate IMR, 6% had severe IMR and 15% suffered from cardiac related death. During follow-up IMR grade reduced in 25% of study patients. None of the patient had re-operation due to the mitral regurgitation. Multivariate analysis showed that left ventricular ejection fraction (LVEF) was an independent predictor of good prognosis (O.R. 1.4, 95% C.I. 1.15–1.83/10% increase of LVEF, p = 0.02). Conclusion: Half of the patients, who have IMR at the time of CABG, have no IMR or only mild IMR postoperatively. Good LVEF adds to the probability that CABG only can reduce IMR.
Fascial Incision and Adhesiolysis Combined with Radiofrequency Microtenotomy in Treatment of Chronic Midportion Achilles Tendinopathy
Authors: Sarimo J. , Orava S. 
Published: January 2017

Background and Aims: Achilles tendinopathy is a common problem that can cause disturbing symptoms in activities of daily living as well as prevent sports activities. The purpose of this study was to evaluate the effects of fascial incision and adhesiolysis combined with radiofrequency microtenotomy in treatment of chronic midportion Achilles tendinopathy. Material and Methods: Twenty-four patients were included in this study. The cases were studied retrospectively. The mean age of the patients was 54 years (range, 39 to 72) and there were 12 women and 12 men. A final evaluation was done at an average of 30 months (range, 18 to 45) after surgery, including radiofrequency microtenotomy. Results: In all cases the Nirschl Pain Phase Scale of Athletic Overuse Injuries score improved and the difference was statistically significant (p < 0.0001). The patients themselves rated the result excellent in 14 cases and good in 10 cases. Conclusion: Fascial incision and adhesiolysis combined with radiofrequency microtenotomy seems to be a useful alternative in treatment of chronic midportion Achilles tendinopathy in cases of unsuccessful non-operative treatment.
From Home to Operation (FHTO) — A New Surgical Admission Centre: Does the Comprehensive Initialisation of a New Process Harm Surgery Outcome?
Authors: Keränen J. , Keränen U. 
Published: January 2017

Background and Aims: FHTO — From Home To Operation is a same day admission model developed at Finland Hyvinkää Hospital from as early as year 2000. In September 2006, a new FHTO centre was opened, through which surgical patients walk into the operation room. This article describes how an extensive FHTO process transition effects patients operation outcome. Methods: The data was collected of all elective surgical patients between March and May in 2006 and in 2007, six months before and after the new FHTO centre was opened. Patient demographics and surgery outcome measurements were reported and analysed between the two study periods. One month postoperative follow-up was recorded. Results: Overall 1206 patients were included, 592 in 2006 and 614 in 2007. Before the extensive process change in 2006 54% of patients were admitted through old limited FHTO unit, and 46% through surgical ward. Six months after FHTO centre opening in 2007 same figures were 90,5% and 9,5% respectively. The baseline statistics differed statistically in kidney failure, that increased in 2007. Two deaths were recorded during postoperative follow-up each year. Conclusions: FHTO process transition included different surgical specialities and did not have negative impact on surgery outcome. Preoperative process should be debated thoroughly in every public hospital. The preoperative process transition from preoperative hospital stay to same day admission through new centre can be accomplished without harming surgery outcome.
Traumatic colonic injuries in Westmead Hospital – A paradigm shift in management over 10 years
Authors: Lorenzo Aldenb , Pham Helen , Zahid Assad , Nguyen Ba , Pathmanathan Nimalan , Ctercteko Graeme , Hsu Jeremy M 
Published: January 2017

Over the years, there has been a shift towards more conservative treatment, with primary repair of colonic injuries being preferred over faecal diversion. We present a cohort study of the management of penetrating colon injury over the past 10 years from a major trauma hospital in western Sydney. We aim to evaluate the trend of operative management of penetrating colonic injuries. Methods Patients were identified via the prospectively collected trauma registry at Westmead Hospital from 2003 to 2013. Fifty-seven patients initially identified with a proven diagnosis of penetrating colonic injury had their medical records reviewed. Excluded in the study are patients who had rectal injuries or serosal tears of the colon. Patient characteristics, mechanisms of injury, treatment course and complications were analysed. Extent of colonic injury was graded of using American Association for the Surgery of Trauma scalings. Results A total of 55 patients were then included in the study. Primary repair of colon injuries was the most common method used (63.6%, n = 35) followed by resection and primary anastomosis (21.8% n = 12), diverting colostomy (14.3%, n = 5) and non-operative management (5.5%, n = 3). There was a higher rate of diversion in the earlier time period (2003–2007) when compared to the later time period (2008–2013), p = 0.03. Over the 10-year period, there was no significant difference with regards to complications among groups, particularly intra-abdominal complications. Conclusion From 2003 to 2013, there is a shift of management of penetrating colonic injuries from diversion to resection and primary anastomosis to that of primary repair. Primary repair of colonic injuries is a safe option and is associated with low morbidity. It should be considered as a valid tool in the armamentarium of today’s surgeon.
Culturally Responsive Interventions to Enhance Immunosuppressive Medication Adherence in Older African American Kidney Transplant Recipients
Authors: Russell Cynthia L. 
Published: January 2017

Context Immunosuppressive medication nonadherence is variable among older kidney transplant recipients and is a problem in African American recipients despite the severe consequences of this behavior. Many factors place older African American recipients at risk for medication nonadherence. Objective To provide an overview of interventions to enhance immunosuppressive medication adherence in older African American kidney transplant recipients using a culturally responsive model. Culturally sensitive, innovative, and transformation interventions are discussed. Situations when each intervention would be most and least appropriate are described. Conclusion Moving culturally appropriate interventions forward into practice and testing their effectiveness in improving adherence outcomes in vulnerable, older African American kidney transplant recipients is a worthy practice and research goal for transplant nursing.
Analysis of Morbidity in Liver Transplant Recipients following Human Albumin Supplementation: A Retrospective Pilot Study
Authors: Johnson Peter N. , Romanelli Frank , Smith Kelly M. , Ranjan Dinesh , Butler J. S. , Clifford Timothy M. 
Published: January 2017

Objectives To assess incidence of morbidity (ie, documented infection, acute renal failure, acute graft rejection, acute cardiovascular events, and hospital read-mission rates) 6 months following liver transplantation using linear regression as a function of cumulative albumin dose. Design Retrospective chart review. Setting A 473-bed tertiary care teaching facility with a solid-organ transplantation center. Patients Forty liver transplant recipients examined from January 1 to December 31, 2003. Measurements and Results Data from 40 liver transplant recipients were collected. Mean albumin dose administered was 190.9 ± 162.3 g. No statistical differences were identified in patients receiving less than 140 g (n = 20) or more than 140 g (n = 20) with respect to demographic data other than gender and ethnicity. The mean APACHE III (Acute Physiology and Chronic Health) score was 69.7 ± 24.3. Approximately 70 episodes of morbidity and 23 readmissions were observed. Regardless of the APACHE III score, albumin was associated with increased overall morbidity and cardiovascular complications. Liver transplant recipients receiving more than 140 g had a longer hospital stay (14 vs 8 days, P = .025) and intensive care unit stay (6 vs 3 days, P = .051) than patients receiving 140 g or less. No correlation with risk of acute rejection was seen with albumin or tacrolimus. Conclusion Albumin supplementation among liver transplant recipients was associated with a significant risk for cardiovascular complications and overall number of complications regardless of APACHE III score. Future prospective studies are needed to further define the potential risk for complications in this patient population.
Nonadherence with Immunosuppressive Drugs: Us Compared with European Kidney Transplant Recipients
Authors: Denhaerynck Kris , Desmyttere Ariane , Dobbels Fabienne , Moons Philip , Young Jim , Siegal Bonita , Greenstein Stuart , Steiger Jürg , Vanrenterghem Yves , Squifflet Jean-Paul , van Hooff Johannes P. , De Geest Sabina 
Published: January 2017

Background System factors increasingly are suggested as important yet understudied correlates of nonadherence. Objective To explore the relationship between healthcare system and prevalence of nonadherence with immunosuppressive regimen by studying variation in nonadherence between European and US kidney transplant recipients and as well as nonadherence in European countries. Methods We performed a secondary data analysis on data collected in 3 independent cross-sectional studies using comparable methodology including patients from the United States, the Netherlands, Belgium, and Switzerland. Nonadherence was measured using 1 item of the Siegal questionnaire. Patients were categorized as nonadherent if they reported missing a dose of immunosuppression in the last 4 weeks. Analyses were performed by multiple mixed logistic regression, with center as a random effect and clinical and demographical differences between groups as fixed effects. Results 1563 US and 614 European patients from 3 different countries (Belgium [n=187], the Netherlands [n=85], and Switzerland [n=342]) were included. Prevalence of nonadherence in the United States and Europe was 19.3% and 13.2.%, respectively. This higher nonadherence in US patients was confirmed in a multiple logistic regression analysis (OR=1.78; 95% CI, 1.10–2.89). Nonadherence differed between Belgium (16%) and the Netherlands (14.1%) (OR=0.27; 95% CI, 0.09–0.80) and between Belgium and Switzerland (11.4%; OR=0.17; 95% CI, 0.0–0.42). Conclusion This is the first study showing differences in prevalence of nonadherence between European and US patients and among European patients. Further research should aim at unraveling the dynamics explaining these differences.
Design and Evaluation of a Workplace Intervention to Promote Organ Donation
Authors: Quinn Michael T. , Alexander G. Caleb , Hollingsworth Diane , O'Connor Kate Grubbs , Meltzer David ,   For the Corporate Contributions for Life Consortium
Published: January 2017

Background A number of efforts have been made to improve rates of deceased organ donation. However, few have been specifically designed for implementation in the workplace. Objectives To design and evaluate a workplace intervention to increase documentation of intention to be posthumous organ donors, communication of donation intention to families, and family members' documentation of their donation intentions. Methods The study was a randomized controlled trial of corporate employees. Within each corporation, worksites were randomized to a control condition or 1 of 2 educational interventions. Measures included baseline and 1-month postintervention measures of stage of organ donation intention, stage of family notification, and family members' organ donation intention. Results Across 12 corporations, 40 worksites with a total of 754 participants were randomized. At 1-month follow-up, 495 participants (66%) completed a posttreatment questionnaire. The percentage of participants who signed organ donor cards increased in the 2 intervention groups (29%, P < .001, and 31%, P < .002) but not in the control group (17%, P = .454). The percentage who discussed their donation intentions with family members increased significantly across all 3 arms (39%-47%, P < .001). The mean percentage of participants' family members who signed organ donor cards increased by 14% in the control group ( P = .016) and by 17% in the 2 intervention groups ( P < .001). Conclusions Educational interventions in the corporate workplace setting can be effective in increasing organ donation intention, family notification, and recruitment of family members as potential organ donors.
Intention to Register as Organ Donors: A Survey of Adolescents
Authors: Baughn Daniel , Rodrigue James R. , Cornell Danielle L. 
Published: January 2017

Background Little is known about factors that influence the intention of adolescents to register as organ donors. The identification of such factors has important implications for the development and implementation of educational programs and subsequent donor registration rates. Objective To determine whether adolescents with an expressed commitment to becoming organ donor registrants differ significantly from nondonors on sociodemographic characteristics and factors influencing their decision. Participants Four hundred forty-five adolescents visiting a Department of Motor Vehicles office for a permit or license (n = 153) or attending a driver's education course (n = 292) completed a semistructured interview and questionnaire. Results Female (52.6%) and white (55.8%) adolescents were more likely to have favorable donation intentions relative to male (45.6%) and nonwhite (39.0%) adolescents (χ2 = 7.5, P = .02, and χ2 = 19.7, P = .003, respectively). Those with favorable donation intentions also endorsed significantly more positive factors (benevolence, need awareness, existentialism) as being more important in their decision. Adolescents who did not want to donate (58.7%) and those who were undecided (23.1%) were less likely to have discussed their decision with parents than were those who wanted to donate (67.7%, χ2 = 63.6, P = .0001). Finally, providing adolescents with a free driver's license in exchange for organ donor registration would have the greatest impact on registering undecided adolescents (29.8%, χ2 = 33.2, P = .0001). Conclusions There is a pressing need for more systematic and culturally sensitive organ donation education directed toward adolescents, and the Department of Motor Vehicles and driver's education courses may be appropriate venues. An educational program from the US Department of Health and Human Services, Decision: Donation, could be used in this context.
In My Shoes: Children's Quality of Life after Heart Transplantation
Authors: Green Angela , McSweeney Jean , Ainley Kathy , Bryant Janet 
Published: January 2017

Background Although heart transplantation has been offered for 2 decades to prolong the lives of children with end-stage heart disease, we know little about how these children view their lives, how they deal with their complicated medical regimen, and how the transplantation affects their quality of life. Objectives To examine the quality of life of school-aged heart transplant recipients and to identify the key factors they believe affect their quality of life. Design Focused ethnography. Participants and Setting Eleven children (7 girls, 4 boys) between the ages of 6 and 12 years (mean 9.1 years) who had received a transplant at least 6 months earlier were recruited from a large children's hospital. Data Collection and Analysis Semistructured interviews were conducted in private locations. Data were analyzed using content analysis and constant comparison. Results The children described their quality of life as “mostly good,” yet reported that life was “easy and not easy.” Ten factors that affected the children's quality of life were Doing Things/Going Places, Favorite School Activities, Hard Things About School, Being With Friends and Family, Doing Things/Going Places With Friends and Family, Interactions With Friends and Family, Taking Care of My Heart, My Body, The Transplant Team, and Other Health Problems. Based on similarities in meaning, these factors were combined into 3 themes: Doing What Kids Do, Being With Friends and Family, and Being a Heart Transplant Kid. The themes and factors can provide useful direction for interventions aimed at improving the quality of life for children after heart transplantation.
The Role of Women in the Donation Consent Decision: Building on Previous Research
Authors: Dodd-McCue Diane , Tartaglia Alexander , Cowherd Robin 
Published: January 2017

Background Recently published findings emphasize the dominant role of women in the donation discussion. With some noteworthy exceptions, the empirical literature on gender and donation, and the role of gender in healthcare decisions as well as donation, is limited. Objectives To provide preliminary information needed to begin theoretical or framework development and to initiate more rigorous research on the role of gender in donation discussions. Design This exploratory study is a descriptive qualitative retrospective study using focus group methodology. Setting and Participants Two focus groups were conducted in 2 major cities in the organ procurement organization's service area. Participants were women who were involved in the donation discussion within the past 5 years; 6 participated in 1 session, 8 in the other. Results The focus group discussions highlight the role of women in the donation process relative to information needs, information usage, and the ensuring dynamics of the donation discussion. Compared to men, women tend to seek more information and reframe this information for others. Because women are frequently central in family communication networks, they serve as a communication conduit for other family members and may influence others. Conclusions Involving key women decision makers in the early stages of the donation discussion and providing information elaboration build on women's central placement and role in family communication network processes. The significance of women's central placement may carry cultural implications, particularly for racial or ethnic groups with strong matriarchal or extended kinship structures.
Young Australian Adults' Knowledge and Beliefs about Organ Donation
Authors: Hyde Melissa K. , White Katherine M. 
Published: January 2017

Context Limited studies, particularly in Australia, are aimed at understanding young people's beliefs about organ donation. Identification of such beliefs may serve to increase donation decision registration and decision discussion rates among this age cohort. Objectives To examine young adults' knowledge about organ donation and to use a theory of planned behavior framework to determine the differences in behavioral, normative, and control beliefs between young adults who had and those who had not registered and discussed their organ donation decision with family or significant others. Participants Australian university students (N = 233) completed a questionnaire assessing knowledge about the organ donation process and beliefs related to organ donation decision registration and decision discussion. Results Young adults demonstrated knowledge deficits about the support of Western religious denominations for organ donation and the circumstances surrounding donation. Unregistered donors were more likely to focus on the costs of registering; however, no belief-based differences for decision discussion emerged. Young adults who had registered and discussed their decision were more likely to believe that family members and friends thought they should do so. Lack of motivation was reported as preventing registering and discussing, and uncertainty about how and when to raise the topic prevented young adults discussing their donation decision. Conclusions Understanding of young adults' knowledge and beliefs enables the development of strategies encouraging donation decision registration and donation decision discussion with family or significant others, thereby increasing the likelihood that the donor's wishes will be carried out.