bluuebunny/crossref_metadata_2025_split huggingface dataset:
Free Rehabilitation Is Safe After Isolated Meniscus Repair
Authors: Lind Martin , Nielsen Torsten , Faunø Peter , Lund Bent , Christiansen Svend Erik 
Published: October 2013

Background: The optimal rehabilitation program after meniscus repair has not been established. Numerous regimens have been suggested as beneficial for meniscus healing, but no controlled trials exist in the literature. Hypothesis: The purpose of this prospective randomized trial was to investigate outcome with a free or a restricted rehabilitation regimen after isolated meniscus repair. The hypothesis was that free rehabilitation would result in increased failure of meniscus healing. Study Design: Randomized controlled clinical trial; Level of evidence, 1. Methods: A total of 60 patients were included in this study within 2 to 3 days after meniscus repair. No patients with concomitant ligament reconstruction or cartilage repair surgery were included. Meniscus repair was performed with the all-inside technique; only vertical meniscus lesions close to the capsule were repaired. Patients were randomized to free (n = 32) or restricted (n = 28) rehabilitation. Free rehabilitation consisted of 2 weeks (range of motion [ROM], 0°-90°, no brace) and touch weightbearing, with unrestricted activity and free ROM allowed thereafter. Restricted rehabilitation consisted of 6 weeks of hinged brace use with a gradual increase ROM to 90° and only touch weightbearing during the 6 weeks. Patients were seen for follow-up at 3 months, 1 year, and 2 years. Those patients with joint line pain at the 3-month follow-up underwent MRI scanning to evaluate meniscus healing; a subsequent arthroscopy was performed for final evaluation meniscus healing if the MRI indicated lack of meniscus healing. At follow-up, the Knee Osteoarthritis Outcome Score (KOOS), Tegner function score, pain assessment, and patient satisfaction were used to evaluate outcomes. Results: Eleven patients were lost to follow-up. Repeat arthroscopy in patients with persistent symptoms demonstrated partial healing or lack of healing in 28% and 36% of patients in the free and the restricted rehabilitation groups, respectively ( P = .53, nonsignificant). The KOOS and Tegner function scores were similar between groups at all follow-up times, as was patient satisfaction. Patients who underwent subsequent partial meniscectomy because of meniscus repair failure had lower KOOS score and Tegner function score than did patients without repair failure. Conclusion: Free rehabilitation after meniscus repair is safe and does not entail increased failure rates compared with restricted rehabilitation. Subjective and functional outcomes at 1- and 2-year follow-up were not affected by rehabilitation regimen. Clinical outcomes in patients with repair failure who underwent subsequent partial meniscectomy were poorer than in those with healed meniscus repairs. A concern is the 30% overall lack of healing for patients with isolated meniscus lesions repaired with the all-inside technique.
A Biomechanical Evaluation of All-Inside 2-Stitch Meniscal Repair Devices With Matched Inside-Out Suture Repair
Authors: Ramappa Arun J. , Chen Alvin , Hertz Benjamin , Wexler Michael , Grimaldi Bournissaint Leandro , DeAngelis Joseph P. , Nazarian Ara 
Published: October 2013

Background: Many all-inside suture-based devices are currently available, including the Meniscal Cinch, FasT-Fix, Ultra FasT-Fix, RapidLoc, MaxFire, and CrossFix System. These different devices have been compared in various configurations, but to our knowledge, the Sequent meniscal repair device, which applies running sutures, has not been compared with the Ultra FasT-Fix, nor has it been compared with its suture, No. 0 Hi-Fi, using an inside-out repair technique. Purpose: To assess the quality of the meniscal repair, all new devices should be compared with the gold standard: the inside-out repair. To that end, this study aims to compare the biomechanical characteristics of running sutures delivered by the Sequent meniscal repair device with 2 vertical mattress sutures applied using the Ultra FasT-Fix device and with 2 vertical mattress sutures using an inside-out repair technique with No. 0 Hi-Fi suture. Study Design: Controlled laboratory study. Methods: Paired (medial and lateral), fresh-frozen porcine menisci were randomly assigned to 1 of 3 groups: Sequent (n = 17), Ultra FasT-Fix (n = 19), and No. 0 Hi-Fi inside-out repair (n = 20). Bucket-handle tears were created in all menisci and were subjected to repair according to their grouping. Once repaired, the specimens were subjected to cyclic loading (100, 300, and 500 cycles), followed by loading to failure. Results: The Sequent and Ultra FasT-Fix device repairs and the suture repair exhibited low initial displacements. The Sequent meniscal repair device demonstrated the lowest displacement in response to cyclic loading. No. 0 Hi-Fi suture yielded the highest load to failure. Conclusion: With the development of the next generation of all-inside meniscal repair devices, surgeons may use these findings to select the method best suited for their patients. Clinical Relevance: The Sequent meniscal repair device displays the least amount of displacement during cyclic loading but has a similar failure load to other devices.
Arthroscopic Repair of Large U-Shaped Rotator Cuff Tears Without Margin Convergence Versus Repair of Crescent- or L-Shaped Tears
Authors: Park Jin-Young , Jung Seok Won , Jeon Seung-Hyub , Cho Hyoung-Weon , Choi Jin-Ho , Oh Kyung-Soo 
Published: October 2013

Background: For large-sized tears of the rotator cuff, data according to the tear shape have not yet been reported for repair methodology, configuration, and subsequent integrity. Hypothesis: The retear rate after the repair of large mobile tears, such as crescent- or L-shaped tears, is believed to be lower compared with retear rates after the repair of large U-shaped tears that are accompanied by anterior or posterior leaves of the rotator cuff. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected and analyzed from 95 consecutive patients with a large-sized rotator cuff tear who underwent arthroscopic suture-bridge repair. Patients were divided into 2 groups: those having crescent- or L-shaped tears (mobile tear group, 53 patients) and those having U-shaped tears (U-shaped tear group, 42 patients). The integrity of the repaired constructs was determined by ultrasonography at 4.5, 12, and 24 months. Moreover, clinical evaluations were performed by using the Constant score, the American Shoulder and Elbow Surgeons (ASES) score, and muscle strength at intervals of 3, 6, 12, and 24 months postoperatively. Results: On ultrasonography at 4.5, 12, and 24 months, a retear was detected in 6, 2, and 1 patients in the mobile tear group and in 5, 2, and 1 patients in the U-shaped tear group, respectively. Significant differences in retear rates were not detected between the groups overall or at each time point. Moreover, clinical scores were similar between groups, except for the presence of a temporarily higher Constant score at 12 months in the mobile tear group. With regard to shoulder strength, between-group comparisons indicated no statistically significant difference, either in abduction or external rotation, except for the presence of temporarily higher external rotation strength at 3 months in the mobile tear group. Conclusion: Arthroscopic repair of large-sized rotator cuff tears yielded substantial improvements in shoulder function, regardless of tear retraction, during midterm follow-up. Moreover, the findings did not indicate significant differences in retear rates between the repair of crescent- or L-shaped tears and that of U-shaped tears either overall or at a particular time point.
Jogging After Total Hip Arthroplasty
Authors: Abe Hirohito , Sakai Takashi , Nishii Takashi , Takao Masaki , Nakamura Nobuo , Sugano Nobuhiko 
Published: October 2013

Background: Jogging has been classified as a high-impact sport, and jogging after total hip arthroplasty (THA) has not been well documented. Purpose: To investigate the participation rate for postoperative jogging as well as jogging parameters and the influence of jogging on implant stability and bearing wear. Study Design: Case-control study; Level of evidence, 3. Methods: Included in this study were 804 hips in 608 patients (85 men, 523 women) who underwent THA between 2005 and 2011 with follow-up longer than 1 year. The mean patient age was 62 years (range, 26-98 years), and mean follow-up duration was 4.8 years (range, 2.3-7.8 years). Hip resurfacing arthroplasty (HRA) was performed in 81 patients and conventional THA in 527 patients. During routine postsurgical visits, patients were given a questionnaire concerning preoperative and postoperative jogging routines. For joggers, frequency, distance, duration, and velocity of jogging were recorded. Patients who did not jog postoperatively were asked to provide reasons for not jogging. Radiographs concerning implant migration and polyethylene wear were evaluated with specialized software, and serum cobalt and chromium ion concentrations were investigated for patients with metal-on-metal articulation. Results: A total of 33 patients (5.4%) performed jogging preoperatively, and 23 patients (3.8%) performed jogging postoperatively. Of the 23 who jogged postoperatively, conventional THA was performed in 13 patients and HRA in 10 patients. Postoperatively, joggers trained a mean of 4 times (range, 1-7 times) per week, covering a mean distance of 3.6 km (range, 0.5-15 km) in a mean time of 29 minutes (range, 5-90 minutes) per session and at a mean speed of 7.7 km/h (range, 3-18 km/h). No patient complained of pain or showed serum cobalt and chromium ion elevation greater than 7 ppb. No hip showed loosening, abnormal component migration, or excessive wear at a mean 5-year follow-up. There were 74 postoperative non-joggers with an interest in jogging. The reasons given for avoiding jogging included anxiety (45 patients; 61%); impossible because of several reasons, including pain, decreased range of motion, and muscle weakness (18 patients; 24%); and lumbar or knee pain (11 patients; 15%). Multivariate analysis revealed that male sex and a history of preoperative jogging demonstrated significant relationships with postoperative jogging. Conclusion: A total of 3.8% of THA patients participated in postoperative jogging. Short-term postoperative follow-up did not identify any negative influence of jogging on implant survival.
Indications for and Early Complications Associated With Use of Temporary Invasive Distraction for Osteochondral Graft Transfer Procedures for Treatment of Lateral Osteochondral Lesions of the Talus
Authors: Orr Justin D. , Dutton Jason H. , Nelson James R. , Hsu Joseph R. 
Published: October 2013

Background: A recent cadaveric study demonstrated that a novel technique termed temporary invasive distraction (TID), which uses intraoperative external fixation, can improve lateral talar dome exposure for osteochondral graft transfer procedures for treatment of lateral osteochondral lesions of the talus (OCLTs). The current study was performed to report our early complications using TID during open treatment of lateral OCLTs to determine whether this technique poses any risk of increased short-term patient morbidity. Methods: Electronic and manual surgeon logs were searched for all cases of osteochondral graft procedures. Lateral lesions treated with TID were analyzed. Inpatient and outpatient medical records were reviewed for early complications associated with TID for this application to assess initial safety of this new technique. Complications were defined as pin tract infection, fracture, neurovascular injury, pin site pain, or pin site wound-healing problems. Complications were stratified into major and minor based on severity. Twelve consecutive patients had open osteochondral graft transfer procedures using temporary invasive distraction with and without fibular osteotomies. All patients were male, active-duty US military service members with an average age of 38.4 (range, 23.8-52.5) years. Results: Use of TID resulted in no early major complications and only 2 early minor complications. Minor complications included 2 cases of residual postoperative pin site pain that resolved completely at 12 weeks postoperatively. By 12 weeks postoperatively, no patients demonstrated any residual complications or symptoms related to the use of TID. At mean latest follow-up of 90.5 weeks (20.9 months), there were no residual complications directly associated with the use of the TID device. Conclusions: Temporary invasive distraction with use of intraoperative external fixation can be safely performed with minimal risk of increased morbidity and offers potential technical advantages during open osteochondral graft transfer procedures for treatment of lateral OCLTs. Level of Evidence: Level IV, retrospective chart study.
‘New’ and distributed leadership in quality and safety in health care, or ‘old’ and hierarchical? An interview study with strategic stakeholders
Authors: McKee Lorna , Charles Kathryn , Dixon-Woods Mary , Willars Janet , Martin Graham 
Published: October 2013

Objectives We aimed to explore the views of strategic level stakeholders on leadership for quality and safety in the UK National Health Service. Methods We interviewed 107 stakeholders with close involvement in quality and safety as professionals, managers, policy makers or commentators. Analysis was based on the constant comparative method. Results Participants identified the crucial role of leadership in ensuring safe, high quality care. Consistent with the academic literature, participants distinguished between traditional hierarchical ‘concentrated’ leadership associated with particular positions, and distributed leadership involving those with particular skills and abilities across multiple institutional levels. They clearly and explicitly saw a role for distributed leadership, emphasizing that all staff had responsibility for leading on patient safety and quality. They described the particular value of leadership coalitions between managers and clinicians. However, concern was expressed that distributed leadership could mean confusion about who was in charge, and that at national level it risked creating a vacuum of authority, mixed messages, and conflicting expectations and demands. Participants also argued that hierarchically based leadership was needed to complement distributed leadership, not least to provide focus, practical support and expertise, and managerial clout. Conclusions Strategic level stakeholders see the most effective form of leadership for quality and safety as one that blends distributed and concentrated leadership. Policy and academic prescriptions about leadership may benefit from the sophisticated and pragmatic know-how of insiders who work in organizations that remain permeated by traditional structures, cleavages and power relationships.
Multimorbidity and delivery of care for long-term conditions in the English National Health Service: baseline data from a cohort study
Authors: Bower Peter , Hann Mark , Rick Jo , Rowe Kelly , Burt Jenni , Roland Martin , Protheroe Joanne , Richardson Gerry , Reeves David 
Published: October 2013

Objectives Many patients with long-term conditions have multiple conditions. Current delivery of care is not designed around their needs and they may face barriers to effective self-management. This study assessed the relationships between multimorbidity, the delivery of care, and self-management. Methods We surveyed 2439 patients with long-term conditions concerning their experience of the delivery of care and self-management in England in 2011. We assessed multimorbidity in terms of a count of long-term conditions and the presence of ‘probable depression’. We explored the relationships between multimorbidity, patient experience of the delivery of care, and self-management Results Neither measure of multimorbidity was a significant predictor of patients’ experience of the delivery of care. Patients with multimorbidity reported higher levels of self-management behaviour, while the presence of depression was associated with less positive attitudes towards self-management. Conclusions The current data do not demonstrate a consistent impact of multimorbidity on patients’ experience of care or on self-management. Further research is required to assess those types of multimorbidity that are associated with significant deficits, or to identify other aspects of care that might be problematic in the context of multiple conditions.
Framing the cuts: An analysis of the BBC’s discursive framing of the ConDem cuts agenda
Authors: Kay Jilly Boyce , Salter Lee 
Published: October 2013

This study analyses the discursive framing of the British government’s economic policies by BBC News Online. Specifically, it focuses on the coverage of the government’s Comprehensive Spending Review in 2010, in which the details of the Chancellor of the Exchequer’s broader ‘austerity’ agenda were released. Using frame analysis informed by critical theory, we analyse three online BBC features and compare their framing of the economic crisis – and the range of possible policy responses to it – with that of the government’s. In addition, we analyse editorial blogs and training materials associated with the BBC’s special ‘Spending Review season’; we also situate the analysis in the historical context of the BBC’s relationship with previous governments at moments of political and economic crisis. Contrary to dominant ideas that the BBC is biased to the left, our findings suggest that its economic journalism discursively normalises neoliberal economics, not necessarily as desirable, but certainly as inevitable.
Self reported experiences of therapy following child sexual abuse: Messages from a retrospective survey of adult survivors
Authors: Allnock Debbie , Hynes Patricia , Archibald Martha 
Published: October 2013

• Summary: This article explores retrospective accounts of childhood sexual abuse survivors’ experiences of therapeutic support received before the age of 18 in the United Kingdom. The survey formed part of a broad programme of research on therapeutic interventions for children affected by sexual abuse, by the National Society for the Prevention of Cruelty to Children (NSPCC) under the Rebuilding Childhoods programme. The primary aim of the survey was to explore what was helpful in young survivors’ experiences ( n= 299) of therapy to inform the development of a new NSPCC service. Of these 299 respondents (aged 18–35), only 52 reported receiving formal therapeutic provision following the abuse and this article relates to this smaller subset. • Findings: Respondents revealed that therapeutic factors such as therapist characteristics and interpersonal communication were crucial in informing their perceptions of therapy received. However, pre-therapy factors such as high level of need and unstable personal circumstances at the time of accessing support also influenced respondent ability to engage in the therapeutic process. Although the types of therapy accessed differed for respondents, there were common elements reported relating to therapist characteristics and skills which were important in determining respondent views. • Applications: The findings suggest that while there is no one-size-fits all approach, there are key characteristics of the relationship between child and therapist that must be considered and that assessment and on-going professional judgement is key to engaging children and maximising their therapeutic experiences. The findings also suggest the importance of listening to children’s preferences and keeping children informed.
The Effect of Depressive Symptoms and CD4 Count on Adherence to Highly Active Antiretroviral Therapy in Sub-Saharan Africa
Authors: Memiah Peter , Shumba Constance , Etienne-Mesubi Martine , Agbor Solomon , Hossain Mian B. , Komba Patience , Niyang Mercy , Biadgilign Sibhatu 
Published: October 2013

Background: Studies have identified several programmatic and nonprogrammatic indicators that affect adherence to highly active antiretroviral therapy (HAART). Depression has been shown to impact adherence to HAART. This cross-sectional analysis of data collected from Nigeria, Uganda, Zambia, and Tanzania in 2008 examined the relationship between levels of depressive symptoms, clinical progression, and adherence to HAART. Methods: A multinational, multicenter, observational, retrospective cross-sectional evaluation of a population of focus comprised randomly selected patients on HAART. The dependent variable was adherence to HAART. The primary variable of interest to be assessed was patients’ level of depressive symptom score. A multivariable logistic regression model was used to examine the relationship between explanatory variables and adherence to HAART. Results: A total of 2344 patients were recruited for adherence survey. About 70% of the study sample reported having some level of depression. Logistic regression results show that patients who reported, respectively, low, moderate, and high levels of depressive symptoms are 35% ( P < .001), 56% ( P < .001), and 64% ( P < .001) less likely to adhere to HAART than those who reported having no depressive symptoms. At multivariate analysis, adherence to HAART was independently associated with the levels of depressive symptoms, older age, CD4 count >200 cells/mm3, Truvada (tenofovir [TDF]/emtricitabine [FTC])-based regimens, good knowledge about HAART, and longer period on therapy. Conclusions: These results indicate that mental health and clinical parameters are significant factors in determining patients’ adherence to their HAART, which need to be more aggressively addressed as a critical component of care and treatment support.
Characteristics and Factors Associated with the Clinical Forms of Lipoatrophy during Highly Active Antiretroviral Therapy in Ouagadougou, Burkina Faso
Authors: Guira Oumar , Tiéno Hervé , Yaméogo Bertille , Diendéré Arnaud Eric , Korsaga Nina , Sagna Yempabou , Zoungrana Lassané , Diallo Ismael , Traoré René , Drabo Joseph Youssouf 
Published: October 2013

Background: We aimed to study the factors associated with clinical forms of lipoatrophy in patients receiving highly active antiretroviral therapy (HAART) in Yalgado Ouédraogo Teaching Hospital, Ouagadougou, Burkina Faso. Methods: This cross-sectional review from March 10 to November 10, 2011, included a nonprobability sample of HIV-infected adults receiving antiretroviral (ARV) medications for at least 6 months and monitored in the internal medicine department. The diagnosis of lipoatrophy was clinical. Results: Three hundred patients were included. The sex ratio was 0.4 and the mean age was 42.1 ± 8.5 years. The mean duration of HAART was 73.2 ± 30.9 months. In all, 97 (32.3%) patients had lipoatrophy: 75 (25%) isolated and 22 (7.3%) mixed syndrome. Facial lipoatrophy was frequent (61.8%). Isolated lipoatrophy was associated with male sex ( P = .002) and body mass index ≤25 ( P < .05). Mixed syndrome was associated with female sex ( P = .002), age >42 years ( P < .05), physical activity ( P = .003), smoking ( P = .001), stavudine (d4T; P = .0001), or protease inhibitors ( P = .01). Conclusion: Prevention of lipoatrophy associated with HAART requires the exclusion of modifiable risk factors that we identified.