bluuebunny/crossref_metadata_2025_split huggingface dataset:
Regional Primary Care Team to Deliver Best-Practice Diabetes Care
Authors: Segal Leonie , Leach Matthew J. , May Esther , Turnbull Catherine 
Published: February 2013

OBJECTIVE
Best-practice diabetes care can reduce the burden of diabetes and associated health care costs. But this requires access to a multidisciplinary team with the right skill mix. We applied a needs-driven evidence-based health workforce model to describe the primary care team required to support best-practice diabetes care, paying particular attention to diverse clinic populations.

RESEARCH DESIGN AND METHODS
Care protocols, by number and duration of consultations, were derived for twenty distinct competencies based on clinical practice guidelines and structured input from a multidisciplinary clinical panel. This was combined with a previously estimated population profile of persons across 26 patient attributes (i.e., type of diabetes, complications, and threats to self-care) to estimate clinician contact hours by competency required to deliver best-practice care in the study region.

RESULTS
A primary care team of 22.1 full-time-equivalent (FTE) positions was needed to deliver best-practice primary care to a catchment of 1,000 persons with diabetes with the attributes of the Australian population. Competencies requiring greatest contact time were psychosocial issues and dietary advice at 3.5 and 3.3 FTE, respectively (1 FTE/∼300 persons); home (district) nursing at 3.2 FTE; and diabetes education at 2.8 FTE. The annual cost of delivering care was estimated at just over 2,000 Australian dollars (∼2,090 USD) (2012) per person with diabetes.

CONCLUSIONS
A needs-driven approach to primary care service planning identified a wider range of competencies in the diabetes primary and community care team than typically described. Access to psychosocial competences as well as medical management is required if clinical targets are to be met, especially in disadvantaged groups.
Serum Inflammatory Markers and Preeclampsia in Type 1 Diabetes
Authors: Du Mei , Basu Arpita , Fu Dongxu , Wu Mingyuan , Centola Michael , Jenkins Alicia J. , Hanssen Kristian F. , Garg Satish K. , Hammad Samar M. , Scardo James A. , Aston Christopher E. , Lyons Timothy J. 
Published: February 2013

OBJECTIVE
Inflammation and endothelial dysfunction have been associated with the immunobiology of preeclampsia (PE), a significant cause of adverse pregnancy outcomes. The prevalence of PE is elevated several fold in the presence of maternal type 1 diabetes mellitus (T1DM). Although cross-sectional studies of pregnancies among women without diabetes have shown altered inflammatory markers in the presence of PE, longitudinal studies of diabetic women are lacking. In maternal serum samples, we examined the temporal associations of markers of inflammation with the subsequent development of PE in women with T1DM.

RESEARCH DESIGN AND METHODS
We conducted longitudinal analyses of serum C-reactive protein (CRP), adhesion molecules, and cytokines during the first (mean ± SD, 12.2 ± 1.9 weeks), second (21.6 ± 1.5 weeks), and third (31.5 ± 1.7 weeks) trimesters of pregnancy (visits 1–3, respectively). All study visits took place before the onset of PE. Covariates were BMI, HbA1c, age of onset, duration of diabetes, and mean arterial pressure.

RESULTS
In women with T1DM who developed PE versus those who remained normotensive, CRP tended to be higher at visits 1 (P = 0.07) and 2 (P = 0.06) and was significantly higher at visit 3 (P &lt; 0.05); soluble E-selectin and interferon-γ–inducible protein-10 (IP-10) were significantly higher at visit 3; interleukin-1 receptor antagonist (IL-1ra) and eotaxin were higher and lower, respectively, at visit 2 (all P &lt; 0.05). These conclusions persisted following adjustment for covariates.

CONCLUSIONS
In pregnant women with T1DM, elevated CRP, soluble E-selectin, IL-1ra, and IP-10 and lower eotaxin were associated with subsequent PE. The role of inflammatory factors as markers and potential mechanisms of the high prevalence of PE in T1DM merits further investigation.
Nurse–Community Health Worker Team Improves Diabetes Care in American Samoa
Authors: DePue Judith D. , Dunsiger Shira , Seiden Andrew D. , Blume Jeffrey , Rosen Rochelle K. , Goldstein Michael G. , Nu'usolia Ofeira , Tuitele John , McGarvey Stephen T. 
Published: February 2013

OBJECTIVE
To evaluate the effectiveness of a culturally adapted, primary care–based nurse–community health worker (CHW) team intervention to support diabetes self-management on diabetes control and other biologic measures.

RESEARCH DESIGN AND METHODS
Two hundred sixty-eight Samoan participants with type 2 diabetes were recruited from a community health center in American Samoa and were randomly assigned by village clusters to the nurse-CHW team intervention or to a wait-list control group that received usual care.

RESULTS
Participants had a mean age of 55 years, 62% were female, mean years of education were 12.5 years, 41% were employed, and mean HbA1c was 9.8% at baseline. At 12 months, mean HbA1c was significantly lower among CHW participants, compared with usual care, after adjusting for confounders (b = −0.53; SE = 0.21; P = 0.03). The odds of making a clinically significant improvement in HbA1c of at least 0.5% in the CHW group was twice the odds in the usual care group after controlling for confounders (P = 0.05). There were no significant differences in blood pressure, weight, or waist circumference at 12 months between groups.

CONCLUSIONS
A culturally adapted nurse-CHW team intervention was able to significantly improve diabetes control in the U.S. Territory of American Samoa. This represents an important translation of an evidence-based model to a high-risk population and a resource-poor setting.
Responsiveness and Predictive Validity of the Hierarchical Balance Short Forms in People With Stroke
Authors: Yu Wan-Hui , Chen Kuan-Lin , Chou Yeh-Tai , Hsueh I-Ping , Hsieh Ching-Lin 
Published: February 2013

BackgroundThe lack of knowledge about the responsiveness and predictive validity of a set of Hierarchical Balance Short Forms (the HBSF) in people with stroke limits the utility of the HBSF in both clinical and research settings.ObjectiveThe purpose of this study was to investigate the responsiveness and predictive validity of the HBSF in people receiving inpatient rehabilitation after stroke.DesignA prospective cohort study was conducted.MethodsSixty-six participants completed both the 6-item HBSF and the 12-item Postural Assessment Scale for Stroke (PASS) after admission to the rehabilitation ward and before hospital discharge. The standardized effect size (ES) and the standardized response mean (SRM) were used to investigate the internal responsiveness of the HBSF and the PASS. Changes in the Barthel Index and the mobility subscale of the Stroke Rehabilitation Assessment of Movement were used as the external criteria for examining external responsiveness. Moreover, the admission scores on the HBSF and the PASS and the discharge scores on the Barthel Index and mobility subscale of the Stroke Rehabilitation Assessment of Movement were analyzed to investigate the predictive validity of the 2 balance measures.ResultsThe internal responsiveness of the HBSF was high (ES&gt;0.9, SRM&gt;1.6). The SRM of the HBSF was significantly larger than that of the PASS, whereas the ES of the HBSF was not significantly larger than that of the PASS. The external responsiveness and predictive validity of the HBSF were sufficient and similar to those of the PASS (external responsiveness: r≥.35; predictive validity: r≥.67).LimitationsThe convenience sampling of people receiving inpatient rehabilitation after stroke may limit the generalization of the results.ConclusionsThe HBSF has sufficient responsiveness and predictive validity in people receiving inpatient rehabilitation after stroke and is thus recommended for both clinicians and researchers.
The impact of adjuvant stereotactic radiosurgery on atypical meningioma recurrence following aggressive microsurgical resection
Authors: Hardesty Douglas A. , Wolf Andrew B. , Brachman David G. , McBride Heyoung L. , Youssef Emad , Nakaji Peter , Porter Randall W. , Smith Kris A. , Spetzler Robert F. , Sanai Nader 
Published: February 2013

Object
Patients with atypical meningioma often undergo gross-total resection (GTR) at initial presentation, but the role of adjuvant radiation therapy remains unclear. The increasing prevalence of stereotactic radiosurgery (SRS) in the modern neurosurgical era has led to the use of routine postoperative radiation therapy in the absence of evidence-based guidelines. This study sought to define the long-term recurrence rate of atypical meningiomas and identify the value of SRS in affecting outcome.

Methods
The authors identified 228 patients with microsurgically treated atypical meningiomas who underwent a total of 257 resections at the Barrow Neurological Institute over the last 20 years. Atypical meningiomas were diagnosed according to current WHO criteria. Clinical and radiographic data were collected retrospectively.

Results
Median clinical and radiographic follow-up was 52 months. Gross-total resection, defined as Simpson Grade I or II resection, was achieved in 149 patients (58%). The median proliferative index was 6.9% (range 0.4%–20.6%). Overall 51 patients (22%) demonstrated tumor recurrence at a median of 20.2 months postoperatively. Seventy-one patients (31%) underwent adjuvant radiation postoperatively, with 32 patients (14%) receiving adjuvant SRS and 39 patients (17%) receiving adjuvant intensity modulated radiation therapy (IMRT). The recurrence rate for patients receiving SRS was 25% (8/32) and for IMRT was 18% (7/39), which was not significantly different from the overall group. Gross-total resection was predictive of progression-free survival (PFS; relative risk 0.255, p < 0.0001), but postoperative SRS was not associated with improved PFS in all patients or in only those with subtotal resections.

Conclusions
Atypical meningiomas are increasingly irradiated, even after complete or near-complete microsurgical resection. This analysis of the largest patient series to date suggests that close observation remains reasonable in the setting of aggressive microsurgical resection. Although postoperative adjuvant SRS did not significantly affect tumor recurrence rates in this experience, a larger cohort study with longer follow-up may reveal a therapeutic benefit in the future.
Decompressive craniectomy using gelatin film and future bone flap replacement
Authors: Oladunjoye Azeem O. , Schrot Rudolph J. , Zwienenberg-Lee Marike , Muizelaar J. Paul , Shahlaie Kiarash 
Published: February 2013

Object
Decompressive craniectomy plays an important role in the management of patients with traumatic brain injury (TBI) and stroke. Risks of decompressive craniectomy include those associated with cranioplasty, and may be related to adhesions that develop between the brain surface and overlying scalp and temporalis muscle. The authors report their institutional experience using a multilayered technique (collagen and gelatin film barriers) to facilitate safe and rapid cranioplasty following decompressive craniectomy.

Methods
The authors conducted a retrospective chart review of 62 consecutive adult and pediatric patients who underwent decompressive craniectomy and subsequent cranioplasty between December 2007 and January 2011. Diagnoses included TBI, ischemic stroke, intraparenchymal hemorrhage, or subarachnoid hemorrhage. A detailed review of clinical charts was performed, including anesthesia records and radiographic study results.

Results
The majority of patients underwent unilateral hemicraniectomy (n = 56), with indications for surgery including midline shift (n = 37) or elevated intracranial pressure (n = 25). Multilayered decompressive craniectomy was safe and easy to perform, and was associated with a low complication rate, minimal operative time, and limited blood loss.

Conclusions
Decompressive craniectomy repair using an absorbable gelatin film barrier facilitates subsequent cranioplasty by preventing adhesions between intracranial contents and the overlying galea aponeurotica and temporalis muscle fascia. This technique makes cranioplasty dissection faster and potentially safer, which may improve clinical outcomes. The indications for gelatin film should be expanded to include placement in the epidural space after craniectomy.
Brain carcinoid metastases: outcomes and prognostic factors
Authors: Mallory Grant W. , Fang Shanna , Giannini Caterina , Van Gompel Jamie J. , Parney Ian F. 
Published: February 2013

Object
Carcinoid tumors are rare and have generally been regarded as indolent neoplasms. Systemic disease is often incurable; however, patients may live years with this disease. Furthermore, metastatic brain lesions are extremely uncommon. As such, few series have examined outcomes and prognostic factors in those with brain involvement.

Methods
The authors performed a retrospective review of patients who underwent primary treatment at Mayo Clinic in Rochester, Minnesota, for metastatic carcinoid tumors to the brain between 1986 and 2011. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier statistics. Cox proportional hazards were used to determine predictors of survival.

Results
Fifteen patients underwent primary treatment for metastatic carcinoid tumors to the brain between 1986 and 2011. Their mean age was 58 ± 12 years. Eighty percent (n = 12) of patients underwent surgery, whereas 2 received stereotactic radiosurgery and 1 had whole-brain radiation therapy (WBRT) as the primary treatment. The median follow-up duration was 19 months (maximum 124 months). Systemic disease progression occurred in 73% and was the leading cause of death in known cases, while intracranial disease recurred in 40%. The median PFS and OS were 21 and 19 months, respectively. The use of adjuvant WBRT correlated with improved PFS (HR 0.15, CI 0.0074–0.95, p = 0.044). Those who underwent surgery as primary modalities trended toward longer progression-free intervals (p = 0.095), although this did not reach significance.

Conclusions
Metastatic carcinoid disease to the brain appears to have a worse prognosis than that of other extracranial metastases. Although there was a trend toward a survival advantage in patients who underwent surgery and WBRT, further study is needed to establish definitive treatment recommendations.
Treating pediatric hydrocephalus in Australia: a 3-year hospital-based cost analysis and comparison with other studies
Authors: Pham Alan Chuong Q. , Fan Christine , Owler Brian K. 
Published: February 2013

Object
The aim of this study was to quantify the financial costs of surgical intervention in patients with newly diagnosed hydrocephalus and patients with treatment failure or complications of previously treated hydrocephalus between 2007 and 2009 at the Children's Hospital at Westmead in Sydney, Australia.

Methods
This was a retrospective study of patients who underwent shunt insertion, shunt revision, treatment of an infected shunt, and endoscopic third ventriculostomy (ETV) between 2007 and 2009. Actual hospital costs associated with each inpatient stay were obtained from the accounting office of Children's Hospital at Westmead. Patients with hydrocephalus secondary to trauma, malignancy, or other complex conditions (except myelomeningocele) were excluded.

Results
Hydrocephalus-related procedures comprised approximately one-third of neurosurgical procedures performed each year. From 2007 to 2009, there were 192 admissions during which 300 procedures were performed for 162 patients. The total cost was $4.78 million (Australian) with an average cost of $1.59 million per year. The cost per admission for shunt insertion and ETV were similar ($13,905 vs $14,128, respectively). The average cost per admission for shunt revision was $9,753. However, shunt infection was associated with 40% of total costs, averaging $83,649 per admission. Management of patients with myelomeningocele undergoing insertion of shunt procedures in the same admission accounted for an average cost of $50,186.

Conclusions
Hydrocephalus is a chronic condition that imposes a significant and growing economic burden upon the Australian hospital system. Seventy-five percent of hydrocephalus-related hospital expenditure is used to surgically treat patients for complications or failure of previously treated hydrocephalus. Further research into the economic impact of pediatric hydrocephalus on the Australian health care system and concerted research efforts in the area of effective long-term surgical treatment and complication minimization are essential.
Functional outcomes of childhood dorsal rhizotomy in adults and adolescents with cerebral palsy
Authors: Hurvitz Edward A. , Marciniak Christina M. , Daunter Alecia K. , Haapala Heidi J. , Stibb Stacy M. , McCormick Sarah F. , Muraszko Karin M. , Gaebler-Spira Deborah 
Published: February 2013

Object
In this descriptive study the authors evaluated medical outcomes, interventions, satisfaction with life, and subjective impressions about selective dorsal rhizotomy (SDR) in older adolescents and adults who had undergone the procedure as children.

Methods
A survey was administered to older adolescents (16–20 years old) and adults with CP who had undergone SDR between 1986 and 2000 at two academic centers. The patients or their caregivers participated in telephone or clinic interviews. Subjective impressions about the SDR and a history of post-SDR medical interventions were obtained. Current functional status, history and ratings of pain, educational achievement, living situation, and subjective health status were also recorded. The Diener Satisfaction with Life Scale (SWLS) was administered.

Results
Eighty-eight participants, mean age 25.6 ± 4.8 years (mean ± standard deviation), were interviewed at a mean of 19.6 ± 3.0 years after surgery. The distribution of current reported Gross Motor Function Classification System levels was as follows: I, 7%; II, 18%; III, 23%; IV, 36%; and V, 16%. Moreover, 56% of respondents were living with parents and 25% were living alone. Thirty-five percent were employed, and 39% were still in school. The mean overall SWLS score was 26.0 ± 7.3, indicating a high level of satisfaction with life. According to 65% of the patients, the SDR was helpful; 31% were uncertain about the procedure's efficacy. Sixty-five percent would recommend the procedure to others. Fifty-eight percent reported excellent to very good health. Forty-four percent reported pain in the past week. Fifty-one percent reported chronic back pain in general. Logistic regression analysis suggested that an increased satisfaction with life was a predictor (p = 0.01) of an affirmative response to the question about recommending the procedure to others and that better overall health showed a trend toward being such a predictor (p = 0.08). Additional interventions were frequently performed after the SDR. Seventy-four percent of participants underwent orthopedic surgery. Thirty-eight percent were currently taking oral medications for tone, and 53% had received botulinum toxin injections for spasticity treatment. Thirteen patients (15%) had an intrathecal baclofen pump placed.

Conclusions
The majority of adults who had undergone SDR as children would recommend the procedure to others. Very few reported negative impressions of the procedure. Levels of satisfaction with life were generally high. Pain prevalence was similar to what has been reported in the literature for adults with cerebral palsy. Despite the SDR, further interventions, both surgical and nonsurgical, were used in the majority of patients.
Incidence of and risk factors for superior facet violation in minimally invasive versus open pedicle screw placement during transforaminal lumbar interbody fusion: a comparative analysis
Authors: Lau Darryl , Terman Samuel W. , Patel Rakesh , La Marca Frank , Park Paul 
Published: February 2013

Object
A reported risk factor for adjacent-segment disease is injury to the superior facet joint from pedicle screw placement. Given that the facet joint is not typically visualized during percutaneous pedicle screw insertion, there is a concern for increased facet violation (FV) in minimally invasive fusion procedures. The purpose of this study was to analyze and compare the incidence of FV among patients undergoing minimally invasive transforaminal lumbar interbody fusion (MITLIF) and open transforaminal lumbar interbody fusion (TLIF). The impact of O-arm navigation compared with traditional fluoroscopy on FV in MITLIF is also assessed, as are risk factors for FV.

Methods
The authors identified a consecutive population of patients who underwent MITLIF with percutaneous pedicle screw placement, as well as a matched cohort of patients who underwent open TLIF. Postoperative CT imaging was assessed to determine intraarticular FV due to pedicle screw placement. Patients were stratified into minimally invasive and open TLIF groups. Within the MITLIF group, the authors performed a subanalysis of image guidance methods used in cases of FV. Two-tailed Student t-test, ANOVA, chi-square testing, and logistic regression were used for statistical analysis.

Results
A total of 282 patients were identified, with a total of 564 superior pedicle screw placements. The MITLIF group consisted of 142 patients with 284 screw insertions. The open TLIF group consisted of 140 patients with 280 screw insertions. Overall, 21 (7.4%) of 282 patients experienced FV. A total of 21 screws violated a facet joint for a screw-based FV rate of 3.7% (21 of 564 screws). There were no significant differences between the MITLIF and open TLIF groups in the percentage of patients with FV (6.3% vs 8.6%) and or the percentage of screws with FV (3.2% vs 4.3%) (p = 0.475 and p = 0.484, respectively). Further stratifying the MI group into O-arm navigation and fluoroscopic guidance subgroups, the patient-based rates of FV were 10.8% (4 of 37 patients) and 4.8% (5 of 105 patients), respectively, and the screw-based rates of FV were 5.4% (4 of 74 screws) and 2.4% (5 of 210 screws), respectively. There was no significant difference between the subgroups with respect to patient-based or screw-based FV rates (p = 0.375 and p = 0.442, respectively). The O-arm group had a significantly higher body mass index (BMI) (p = 0.021). BMI greater than 29.9 was independently associated with higher FV (OR 2.36, 95% CI 1.65–8.53, p = 0.039).

Conclusions
The findings suggest that minimally invasive pedicle screw placement is not associated with higher rates of FV. Overall violation rates were similar in MITLIF and open TLIF. Higher BMI, however, was a risk factor for increased FV. The use of O-arm fluoroscopy with computer-assisted guidance did not significantly decrease the rate of FV.