bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of a user-adaptive prosthetic knee on quality of life, balance confidence, and measures of mobility: a randomised cross-over trial
Authors: Prinsen Erik C , Nederhand Marc J , Olsman Jeroen , Rietman Johan S 
Published: October 2014

Objective: To study the influence of a transition from a non-microprocessor controlled to the Rheo Knee® II on quality of life, balance confidence and measures of mobility. Design: Randomised crossover trial. Setting: Research department of a rehabilitation centre. Subjects: Persons with a transfemoral amputation or knee disarticulation ( n=10). Interventions: Participants were assessed with their own non-microprocessor controlled knee and with the Rheo Knee® II. The low-profile Vari-Flex with EVO foot was installed in both knee conditions, followed by eight weeks of acclimatisation. The order in which knees were tested was randomised. Main measures: Prosthesis Evaluation Questionnaire with addendum, Activities-specific Balance Confidence scale, Timed “up & go” test, Timed up and down stairs test, Hill Assessment Index, Stairs Assessment Index, Standardized Walking Obstacle Course and One Leg Balance test. Results: Significant higher scores were found for the Rheo Knee® II on the Residual Limb Health subscale of the Prosthesis Evaluation Questionnaire when compared to the non-microprocessor controlled prosthetic knee (median [interquartile range] resp. 86.67 [62.21-93.08] and 68.71 [46.15-94.83]; P=0.047) In addition, participants needed significantly more steps to complete an obstacle course when walking with the Rheo Knee® II compared to the non-microprocessor controlled prosthetic knee (median [interquartile range] resp. 23.50 [19.92-26.25] and 22.17 [19.50-25.75]; P=0.041). On other outcome measures, no significant differences were found. Conclusions: Transition towards the Rheo Knee® II had little effect on the studied outcome measures.
Transtibial Versus Tibial Inlay Techniques for Posterior Cruciate Ligament Reconstruction
Authors: Song Eun-Kyoo , Park Hyeong-Won , Ahn Yeong-Seub , Seon Jong-Keun 
Published: October 2014

Background: The most common technique for posterior cruciate ligament (PCL) reconstruction is transtibial or tibial inlay. However, few studies have reported long-term outcome comparisons between the 2 techniques. Hypothesis: Tibial inlay PCL reconstruction with patellar tendon autograft will exhibit better clinical and radiographic outcomes than transtibial PCL reconstruction with hamstring autograft. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 66 patients (66 knees) treated with PCL reconstruction for chronic injuries constituted the study cohort. Patients were divided into 2 groups: transtibial with hamstring (36 patients) and tibial inlay with patellar tendon (30 patients). The mean time from injury to reconstruction was 12.2 months (range, 2-60 months), and the mean follow-up was 148 months (range, 98-196 months). Outcomes were measured by use of Lysholm knee scores, Tegner activity scores, return to preinjury sports activity, posterior drawer test, laxity test with a Telos device, and development of osteoarthritis. Results: The preoperative mean Lysholm knee score was 59.9 (range, 37-70) in the transtibial group and 54.5 (range, 22-76) in the tibial inlay group, improving postoperatively to 89.9 (range, 74-100) and 92.1 (range, 80-100), respectively. The mean Tegner activity scores increased from 2.5 (range, 2-5) to 5.9 (range, 4-7) in the transtibial group and 2.3 (range, 2-4) to 6.0 (range, 3-8) in the tibial inlay group. Twenty-one patients (58.3%) in the transtibial group and 19 patients (63.3%) in the tibial inlay group were able to return to preinjury sports activity. In the posterior drawer test, 6 patients in the transtibial group and 4 patients in the tibial inlay group showed grade II laxity. The mean side-to-side difference was 10.1 mm (range, 7-12 mm) in the transtibial group and 10.4 mm (range, 9-13 mm) in the tibial inlay group, improving postoperatively to 4.1 mm (range, 0-8 mm) and 4.2 mm (range, 1-8 mm), respectively. There was significant improvement between preoperative and final follow-up values. However, there were no significant differences between the 2 groups in final follow-up outcomes. Final follow-up radiographs showed that 6 patients (16.7%) in the transtibial group and 3 patients (10.0%) in the tibial inlay group were rated grade C according to International Knee Documentation Committee guidelines. Conclusion: Clinical and radiographic outcomes between the 2 PCL reconstruction techniques were comparable. Osteoarthritis was observed in patients, with a significant proportion presenting loss of joint space. Examined factors, excluding meniscectomy, were not correlated with the development of osteoarthritis.
The Multiligament Quality of Life Questionnaire
Authors: Chahal Jaskarndip , Whelan Daniel B. , Jaglal Susan B. , Smith Peter , MacDonald Peter B. , Levy Bruce A. , Davis Aileen M. 
Published: October 2014

Background: Existing knee joint–specific outcome questionnaires lack content pertinent to patients with multiligament knee injuries. Purpose: To develop and test the reliability and validity of a novel disease-specific quality of life questionnaire for patients with multiligament knee injuries. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Participants in this study included patients with multiligament knee injuries and clinician experts. Inclusion criteria were (1) patients with multiligament knee injury (age, 18-60 years), (2) ≥6 months after injury, and (3) operative or nonoperative treatment. Exclusion criteria were (1) preexisting osteoarthritis or inflammatory arthritis and (2) intracerebral/spinal cord injury. In phase I of the study, 85 eligible patients were mailed a questionnaire composed of 132 items from 11 existing knee questionnaires. Items were rated with regard to importance and frequency on a 5-point Likert scale. Criteria for inclusion in the first draft of the Multiligament Quality of Life (MLQOL) questionnaire included mean importance rating ≥3.5 and frequency <30% for the response “never experienced.” In phase II, patient focus groups and expert interviews were conducted until no further new content was generated for the MLQOL, and in phase III, 99 eligible patients across 2 centers were mailed a preliminary MLQOL questionnaire along with the Tegner activity scale, Short Form (SF)–36, and anchor questions. Interitem and item-to-total correlations were used to perform item reduction to generate a final MLQOL instrument, which was tested for internal consistency (Cronbach alpha), test-retest reliability (interclass correlation coefficient [ICC]), and construct validity. Results: At the end of phase III, a final MLQOL instrument was developed that was composed of 4 domains (physical impairments [PI], emotional impairments [EI], activity limitations [AL], and societal involvement [SI]) with 52 items in total. The MLQOL had adequate content validity, as none of the domains had any floor or ceiling effects. The Cronbach alpha was .94 (PI), .93 (EI), .94 (AL), and .91 (SI); ICC values were .89 (PI), .86 (EI), .91 (AL), and .88 (SI). Seven of 8 a priori hypotheses were satisfied, indicating good construct validity. Conclusion: The MLQOL instrument is a novel disease-specific quality of life tool that has demonstrated excellent content validity, reliability, and construct validity.
Strategies for handling ethical problems in end of life care: obstacles and possibilities
Authors: Rejnö Åsa , Berg Linda 
Published: October 2014

Background: In end of life care, ethical problems often come to the fore. Little research is performed on ways or strategies for handling those problems and even less on obstacles to and possibilities of using such strategies. A previous study illuminated stroke team members’ experiences of ethical problems and how the teams managed the situation when caring for patients faced with sudden and unexpected death from stroke. These findings have been further explored in this study. Objective: The aim of the study was to illuminate obstacles and possibilities perceived by stroke team members in using strategies for handling ethical problems when caring for patients afflicted by sudden and unexpected death caused by stroke. Research design: A qualitative method with combined deductive and inductive content analysis was utilized. Participants and research context: Data were collected through individual interviews with 15 stroke team members working in stroke units of two associated county hospitals in western Sweden. Ethical considerations: The study was approved by the Regional Ethics Review Board, Gothenburg, Sweden. Permission was also obtained from the director of each stroke unit. Findings: All the studied strategies for handling of ethical problems were found to have both obstacles and possibilities. Uncertainty is shown as a major obstacle and unanimity as a possibility in the use of the strategies. The findings also illuminate the value of the concept “the patient’s best interests” as a starting point for the carers’ ethical reasoning. Conclusion: The concept “the patient’s best interests” used as a starting point for ethical reasoning among the carers is not explicitly defined yet, which might make this value difficult to use both as a universal concept and as an argument for decisions. Carers therefore need to strengthen their argumentation and reflect on and use ethically grounded arguments and defined ethical values like dignity in their clinical work and decisions.
Socio-economic Disparities in Health Care Seeking Behaviour, Health Expenditure and Its Source of Financing in Orissa
Authors: Sahoo Amit Kumar , Madheswaran S. 
Published: October 2014

Over the years various plans and programmes have been initiated and implemented by the state government of Orissa. But, state’s health indicators have not improved substantially. Moreover, in recent years, health seeking behaviour of the people has been affected due to increasing cost of health care. Health care is not free of cost any more due to introduction of user fee, increasing trend of privatization and the technological innovation. As a result, out of pocket expenditure has increased enormously affecting the socio-economically disadvantaged groups the most. In consequence, they tend to depend more upon borrowing, dis-saving, selling valuable assets and curtailing expenditure on education of their children. Hence, in this paper we try to investigate broadly into three main aspects, namely, health seeking behaviour, health care burden and most importantly the source of financing of their health expenditure across socio-economic groups by using bi-variate and regression techniques (logit) to provide policy suggestions with respect to health care financing, especially focusing health insurance.  Our findings show that there exists a statistical significant difference in health seeking behaviour, health expenditure and financing health care among socio-economic groups. Socio-economic groups fall behind in terms of health care utilization and experiencing higher health care burden as well as depending more on inefficient mechanism to finance their health expenditure. Hence, we advocate that state government should increase its expenditure share towards health sector substantially to achieve desired outcomes and also provide comprehensive health insurance to the targeted socio-economic backward groups.
Scope and Impact of Global Actions under UNDESD
Authors: Hopkins Charles 
Published: October 2014

As the UN Decade of Education for Sustainable Development ends, there will be celebrations and the inevitable reporting on activities and outcomes. Countless meetings, events, and sessions have occurred around the world. This opinion piece acknowledges three significant events or outcomes that are shaping the future of ESD within formal education on a global scale. For this author, the first major outcome was the UNESCO World Conference in Bonn (2009) where representatives from most influentially significant ministries of education discussed and planned the future of ESD. The second was the movement conceptually of ESD from the periphery to a core component of quality education. The third was the concept of ESD more as a purpose of education comprised of not only curriculum content but new approaches to pedagogy. In closing the determination of nations to launch the new Global Action Programme is a testimony of the success of the UNDESD.
Greening in the Red Zone
Authors: Mering Sabine von 
Published: October 2014

Keith Tidball and Marianne Krasny (Eds), Springer Science and Business Media, Dordrecht, 2014, 503 pages, $126.35 (hard cover [Amazon]). ISBN: 978-90-481-99471. http://www.springer.com/environment/environmental+management/book/978-90-481-9946-4
Natural History of Nonoperatively Treated Osteochondral Lesions of the Talus
Authors: Klammer Georg , Maquieira Gerardo J. , Spahn Silke , Vigfusson Vanessa , Zanetti Marco , Espinosa Norman 
Published: October 2014

Background: We hypothesized that patients undergoing nonoperative treatment for asymptomatic or minimally symptomatic osteochondral lesions of the talus (OLTs) would not deteriorate clinically or radiologically over time. Methods: Forty-eight patients (mean age = 48 years; range, 13-78 years) with an OLT confirmed by magnetic resonance imaging (MRI) who had not undergone ankle joint surgery were retrospectively reviewed. All patients were evaluated after a minimum follow-up of 2 years (mean = 52 months; range, 27-124 months). All patients filled out an individual questionnaire and underwent a physical and radiographic assessment (radiograph and hindfoot MRI). Results: At final follow-up, 43 ankles (86%) in 41 patients were pain-free (visual analogue scale [VAS] 0, n = 12) or less painful (VAS 1-3, n = 31). Radiographically, osteoarthritis was absent in 47%, and grade 1 and 2 osteoarthritis each were found in 27% (van Dijk classification). Magnetic resonance imaging revealed no substantial progression in staging or lesion size. Pain at time of follow-up correlated with the depth of the lesion at initial MRI ( P < .05) and with subchondral cyst formation and presence or change of bone marrow edema at follow-up MRI ( P < .05). Conclusion: Minimally symptomatic OLTs did not appear to progress or worsen over time when treated nonoperatively. Level of Evidence: Level IV, case series.
Postoperative Pain and Preemptive Local Anesthetic Infiltration in Hallux Valgus Surgery
Authors: Gądek Artur , Liszka Henryk , Wordliczek Jerzy 
Published: October 2014

Background: Several techniques of anesthesia are used in foot surgery. Preemptive analgesia helps to prevent the development of hypersensitivity in the perioperative period. The aim of our study was to assess the role of preemptive local anesthetic infiltration and postoperative pain after hallux valgus surgery. Methods: We evaluated 118 patients who underwent modified chevron and miniinvasive Mitchell–Kramer bunionectomy of the first distal metatarsal. After spinal anesthesia each patient randomly received an infiltration of local anesthetic or the same amount of normal saline 10 minutes before the skin incision. We measured the intensity of pain 4, 8, 12, 16, 24, and 72 hours after the release of the tourniquet using a visual analogue scale (VAS). Rescue analgesia and all other side effects were noted. Results: Preemptive analgesia resulted in less pain during the first 24 hours after surgery. The decrease of VAS score was significantly lower in the study group during all the short postoperative periods measured. The rescue analgesia was administered in 11.9% of patients in the injected group and 42.4% in the placebo group ( P < .05). In the injected group we did not observe significant difference in VAS score between patients post–chevron and miniinvasive Mitchell–Kramer osteotomy of the first distal metatarsal. No systemic adverse effects were noted. One persistent injury of dorsomedial cutaneous nerve was observed. Conclusion: Preemptive local anesthetic infiltration was an efficient and safe method to reduce postoperative pain after hallux valgus surgery. The analgesic effect was satisfactory in both traditional and minimally invasive techniques. Level of Evidence: Level I, prospective randomized study.
Exposure via Sequential Release of the Metatarsophalangeal Joint for Plantar Plate Repair Through a Dorsal Approach Without an Intraarticular Osteotomy
Authors: Jastifer James R. , Coughlin Michael J. 
Published: October 2014

Background: Traditionally, plantar plate repairs have been performed from either a direct plantar approach or through a dorsal approach utilizing an intraarticular metatarsal osteotomy. It is unknown if a plantar plate repair can be reliably performed through a dorsal approach without an osteotomy. Methods: The second through fourth metatarsal phalangeal (MTP) joints of 4 fresh frozen cadavers were sequentially dissected and the exposure of the plantar plate was quantified with a digital micrometer. A suture passer was then utilized to pass a suture through the released plantar plate without a metatarsal osteotomy. Results: The mean plantar plate exposure after capsulotomy was 1.1 mm, after capsulotomy and release of the collateral ligaments exposure was 2.5 mm, after the addition of a release of plantar structures with a McGlamry elevator exposure was 4.1 mm, and after the addition of a plantar plate takedown the exposure was 5.3 mm. Every specimen had a minimum of 4 mm of exposure. Two sutures were successfully passed through every plantar plate with the exposure obtained. Conclusion: Significant improvement in exposure of the plantar plate was achieved with each successive structure released . Clinical Relevance: Successful plantar plate repair can be reliably performed through a dorsal approach without a metatarsal osteotomy in a cadaveric model.
Intraoperative and Perioperative Complications During Revision Arthroplasty for Salvage of a Failed Total Ankle Arthroplasty
Authors: Williams Joan R. , Wegner Nicholas J. , Sangeorzan Bruce J. , Brage Michael E. 
Published: October 2014

Background: Revision of a failed total ankle arthroplasty (TAA) remains a challenge. Advances in total ankle implant design have renewed interest in revision TAA as an alternative to ankle arthrodesis or amputation in the management of a failed TAA. The purpose of our study was to review a series of failed Agility TAA revised to INBONE II TAA and identify reasons for revision as well as perioperative complications. Methods: A retrospective review of 35 cases of failed Agility TAA revised to an INBONE II TAA was performed at 1 institution. Patient demographics, indications for revision, radiographs, and complications were reviewed. The average follow-up was 9.1 months (range, 0-28 months). All revisions were performed by 1 of 2 foot and ankle surgeons familiar with both prostheses. Results: The Agility TAA lasted a mean of 6.7 years prior to revision to an INBONE II TAA. Revision TAA was indicated due to mechanical loosening, osteolysis, periprosthetic fracture, and a dislocated prosthesis. Adjunctive procedures were performed in 31 of 35 cases. There were 6 intraoperative and 5 acute postoperative complications, leading to an overall 31.4% complication rate. There was 1 patient with continued pain postoperatively who underwent a second revision of the INBONE II 20 months postoperatively. Conclusion: Revision TAA was a viable treatment option for failed TAA. A high risk of perioperative complications remains, and physicians should be aware of the challenges that occur during these procedures in order to plan for them preoperatively. Level of Evidence: Level IV, retrospective case series.
Effect of Chronic Heart Rate Reduction by If Current Inhibitor Ivabradine on Left Ventricular Remodeling and Systolic Performance in Middle-Aged Rats With Postmyocardial Infarction Heart Failure
Authors: Dedkov Eduard I. , Bogatyryov Yevgen , McCooey Daniela Scaldaferri , Christensen Lance P. , Weiss Robert M. , Tomanek Robert J. 
Published: October 2014

Background: A large myocardial infarction (MI) initiates progressive cardiac remodeling that leads to systolic heart failure (HF). Long-term heart rate reduction (HRR) induced by the I f current inhibitor ivabradine (IVA) ameliorates left ventricular (LV) remodeling and improves systolic performance in young post-MI rats. However, the beneficial effects of chronic IVA treatment in middle-aged rats remain to be determined. Methods: A large MI was induced in 12-month-old rats by left coronary artery ligation. Rats were treated with IVA via osmotic pumps intraperitoneal in a dose of 10.5 mg/kg/d (MI + IVA) and compared with MI and sham-operated animals 12 weeks after MI. Results: Heart rate in MI + IVA rats was on average 29% lower than that of rats in the MI group. Left ventricular remodeling was comparable between post-MI groups, although MI + IVA rats did not show the compensatory thickening of the noninfarcted myocardium. Chronic HRR had no effect on transverse cardiac myocyte size and capillary growth, but it reduced the collagen content in noninfarcted myocardium. Left ventricular systolic performance remained similarly impaired in MI and MI + IVA rats. Moreover, abrupt IVA withdrawal led to worsening HF and reduction of coronary reserve. Conclusion: Our data reveal that chronic IVA-induced HRR does not provide sustainable benefits for LV systolic performance in middle-aged rats with post-MI HF.
Youth Justice Co-ordinators’ perspectives on New Zealand’s Youth Justice Family Group Conference process
Authors: Slater Christine , Lambie Ian , McDowell Heather 
Published: October 2014

Summary The article describes an evaluation of New Zealand’s Youth Justice Family Group Conference process from the perspectives of Youth Justice Co-ordinators. The study aimed to understand the development of practice, to identify factors constituting best practice and areas of process weakness. Data was obtained from semi-structured interviews with Youth Justice Co-ordinators ( n = 19) with at least 12 years’ experience (Project One) and four broader focus groups ( n = 27) (Project Two). Findings The Youth Justice Family Group Conference process was reported by participants to be effective for the majority of young people, but inadequate for recidivist, high-risk offenders. Best practice included: aligned professional approaches to conference philosophy and practice, service delivery by trained Youth Justice Co-ordinators, conference preparation quality, victim inclusion, and determining a strengths-based personalised plan for the young person. Several process weaknesses were identified. Applications Recommendations for process improvement included: addressing Co-ordinator training and service leadership, reviewing the process for recidivists, enhancing professional collaboration and Police training.