bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intramedullary Nailing or Percutaneous Plating in Fixing Distal Metaphyseal Fractures of the Tibia
Authors: Emily Beamish Rebecca , Barry Matthew 
Published: June 2024

Abstract
This is a prospective randomized trial comparing intramedullary nailing (IMN) and percutaneous locking compression plating for closed distal extra-articular tibial fractures (AO type 43A). One hundred and eleven patients were randomized to either IMN or plating. Eighty-five patients were analyzed at one year. The principal conclusions were that both IMN and plating were safe but IMN had the advantage of lower mean operative and radiation times (97.9 vs. 81.2 minutes [p &lt; 0.001] and 3.0 vs. 2.12 minutes [p &lt; 0.001], respectively), as well as easier implant removal. Relevant other studies including the UK FixDT trial are also discussed.
Metal-on-Metal Hip Failure
Authors: Davidson Donald , Sugand Kapil , Abdul-Jabar Hani B. 
Published: June 2024

Abstract
Metal-on-metal (MoM) hip bearings were marketed from the late 1990s. Their use was heralded as a solution to wear-induced osteolysis, a major cause for hip replacement failure, as well as their larger head size used to improve stability. At peak usage, 15% of all hip bearing surfaces were MoM; however, it became apparent that these hips were failing at a two- to threefold higher rate than other bearing types. It was noted that metal debris from the failing implant was being deposited within the periarticular soft tissues (metallosis), causing a locally destructive immune response, and metal ions were being leached into the bloodstream. This study aimed to determine if blood metal ion levels could detect the failed implant.
Dual Mobility and Large Femoral Head Diameter Are Implants for Safety in Total Hip Arthroplasty
Authors: Mabrouk Ahmed , van Duren Bernard H. , Sidhom Sameh A. 
Published: June 2024

Abstract
Instability/dislocation is a well-documented and recognized complication after primary and revision total hip arthroplasty (THA). Among available modern implant options, particular design characteristics may reduce the risk of dislocation and revision, such as big femoral head diameters (BTHA), dual mobility (DMTHA) acetabular components, and constrained liners (CTHA). This systematic review included eleven studies (nine comparative and two randomized controlled trials, 4084 patients). Postoperative dislocation and revision for any reason were compared. Network meta-analysis showed that the risk of revision and dislocation of DMTHA was significantly lower when compared to standard total hip arthroplasty (STHA). Based on short-term outcomes (0–5 years), the authors recommend using DMTHA and BTHA for safety.
Patellar Resurfacing in Total Knee Arthroplasty
Authors: Haider Zakir , Sri-Ram Kesavan 
Published: June 2024

Abstract
Patellar resurfacing in total knee arthroplasty remains a controversial topic. A large body of evidence exists in the form of randomized controlled trials and meta-analyses comparing total knee arthroplasty with and without patella resurfacing. This research provides conflicting evidence on measures such as anterior knee pain, efficacy, and patient outcomes, with no clear favorite. Consequently, no current guidelines or agreed-upon best practice currently exists to help guide clinicians. This chapter reviews and discusses current evidence on patellar resurfacing along with factors considered to affect postoperative outcomes in patients who have undergone patellar resurfacing in total knee arthroplasty.
Operative versus Nonoperative Treatment for Calcaneal Fractures
Authors: Park Chang , Sugand Kapil , Oguz Cenk , Allardice Garth 
Published: June 2024

Abstract
This is a multicenter randomized controlled trial to assess if operative treatment of closed intra-articular displaced fractures improves outcomes. One hundred and fifty-one patients were randomly allocated into the two arms of operative (n = 73) and nonoperative treatment (n = 78). The primary outcome measured was pain and function by the Kerr-Atkins score at two years postinjury. There was no statistically significant difference in pain and function at two years postinjury, and there was an increase in complications and need for reoperation in those managed operatively. Therefore, the study suggests that operative treatment is not recommended for the treatment of such fractures.
Bisphosphonates and Fractures of the Subtrochanteric or Diaphyseal Femur
Authors: Guevel Borna , Imbuldeniya Arjuna 
Published: June 2024

Abstract
This study is a secondary analysis of three randomized bisphosphonate trials reviewing the relationship between atypical fractures of the femoral shaft and bisphosphonate use. Several recently published case series suggest an increased risk of atypical subtrochanteric and diaphyseal fractures with long-term bisphosphonate use. Of 14 195 women in total, 284 (2%, 284/14 195) had hip or femur fractures whereby 12 (4.2%, 12/284) of these were subtrochanteric or diaphyseal fractures. The study highlighted the scarcity of these fractures even in long-term bisphosphonate use, with no significant increase in fracture risk. Wide confidence intervals, however, make it difficult to draw definitive conclusions.
Challenging Cases in Palliative Care
Authors: Dewhurst Felicity , Edmonds Polly , Gillon Suzie , Hawkins Amy , Miller Mary , Yardley Sarah 
Published: June 2024

Abstract
Palliative care has evolved rapidly in recent years. Not only is the field dealing with an increasingly elderly and multi-morbid population, it is also addressing a wider variety of complex diagnoses such as heart failure, renal failure, advanced lung disease, frailty, and dementia. As part of our Challenging Cases series, the cases in this book not only cover a range of physical and psychosocial problems seen in palliative care; they also reflect the core curriculum for UK specialty trainees. Each case brings together expert interpretation of the available evidence, management strategies, guidelines, and best practice, while discussing complexities in clinical decision-making and controversies in approach.
Cancer-related Bone Pain
Authors: Schuberth Anna , Mulvey Matt 
Published: June 2024

Abstract
This case outlines the mechanisms, clinical presentation, investigation, diagnosis, and management of cancer-related bone pain. Non-pharmacological measures including Transcutaneous Electrical Nerve Stimulation (TENS), acupuncture, and the use of aids and adaptations are reviewed. Pharmacological management of cancer-related bone pain including non-steroidal anti-inflammatory drugs (NSAIDs), strong opioids, antidepressants, anticonvulsants, corticosteroids, and bisphosphonates are discussed in detail. Other interventions including radiotherapy, interventional analgesia, and surgical aspects of cancer-related bone pain management are explored. A discussion on future advances in the field of cancer-related bone pain is also presented.
Cancer-related Neuropathic Pain
Authors: Gemmell Rebecca , Montgomery Craig 
Published: June 2024

Abstract
A 55-year-old man with locally advanced mesothelioma was referred to the community palliative care team with symptoms in keeping with neuropathic pain. His pain was managed with opioids and a trial of antidepressants and antiepileptic medications, achieving adequate analgesia. He had unsuccessful trials of topical capsaicin, lidocaine plasters, and TENS (transcutaneous electrical nerve stimulation). This case defines neuropathic pain, explores its aetiology in the presence of cancer and provides a strategy for pain management. Referral of patients to specialist multidisciplinary teams and consideration of interventional analgesia are also discussed. A patient-centred approach is recommended, considering individual needs and preferences, tolerance of medication and comorbidities.
Interventional Pain Management
Authors: Hetherington Lucy , Mitchell Alison 
Published: June 2024

Abstract
This case describes a 63-year-old woman, Marie, with metastatic skeletal disease causing pain on movement. Analgesic medical management has not been sufficient in alleviating the pain, further radiotherapy and surgical management are not possible. This case discusses goal setting with Marie and a multi-professional assessment to guide decision-making. Intrathecal drug delivery and percutaneous cervical cordotomy are discussed in detail. An interventional approach is indicated in an estimated 5–15% of patients with cancer pain and is underused.
Chronic Non-cancer Pain
Authors: Simkiss Lauri , Jones Iain 
Published: June 2024

Abstract
This case describes a patient with a life-limiting condition and chronic pain. The patient presents to the palliative care service with pain and a complex mixture of medical, psychological, and social factors. This case develops the argument that condition-specific management alone, offered in ‘pursuit of cure’, often fails people with chronic pain. Pain management requires a coordinated biopsychosocial approach to support patients effectively. Small incremental positive change is made possible through access to a range of enabling treatments, including some specialist treatments. This case also describes how, for patients with complex pain, specialist input is needed in order to manage their care holistically.
Nausea, Vomiting, and Hiccups
Authors: McGuigan Holly , Sutherland Anna 
Published: June 2024

Abstract
Nausea, vomiting, and hiccups are common symptoms in palliative care which can be challenging to assess and manage. This case describes a patient with nausea, vomiting, and hiccups and explores how management is tailored to the cause of the symptoms. It stresses the importance of regular reassessment of a patient’s symptoms to appreciate evolving and multifactorial causes. The case reviews the evidence base for different approaches to management of nausea, vomiting, and hiccups. The case discusses side effects and contraindications of different antiemetics, and more complex clinical scenarios such as prescribing in Parkinson’s disease or myasthenia gravis. Finally, it suggests future directions for research and practice.
Prescribing Review
Authors: Hatton Luke Nathaniel , Presland Melinda 
Published: June 2024

Abstract
Medications are prescribed to benefit patients. Regular prescribing reviews are needed to consider the benefit of stopping and changing these medications. As medications are increasingly used when patients enter the final stages of life, prescribing reviews become key in optimizing symptom control and quality of life. This case considers prescribing reviews, and their use in encouraging deprescribing. This should be considered throughout a patient’s journey, from initial diagnosis with a life-limiting condition and as the patient deteriorates, considering the risk and benefit of each medication. Optimal prescribing reviews need to consider patient’s preferences and communicate clearly with the patient and family the rationale for medication changes. This case uses a case illustration to review how complex decisions around medications can be approached and the use of off-label prescribing in palliative care. It includes suggested resources to aid deprescribing and is written for prescribers of medications.
Cultural Care
Authors: Charles Max , Koffman Jonathan 
Published: June 2024

Abstract
‘Cultural Care’ deals with the potential diverse challenges of providing palliative care for patients from different cultural backgrounds. Clinicians often lack awareness of how their personal culture, as well as bias and beliefs common to UK healthcare professionals, impact their practice. Admitting cultural vulnerability can improve communication and avoid the risks of making assumptions. Issues experienced by patients and relatives within consultations are discussed, including lack of understanding of the person’s belief system, approach to ‘bad news’ and other potential barriers to holistic care. Different models of communication to better understand a patient’s culture and values are suggested to reduce uncertainty, help build trust and consequently deliver individualized palliative care.
Developing Compassionate Communities
Authors: Sawyer Joseph , Sallnow Libby 
Published: June 2024

Abstract
Developing compassionate communities examines the changing context for end-of-life care. Changes in global demographic profiles suggest care needs will shift towards those in old age, with frailty and multiple long-term conditions. The number of people requiring care is likely to outstrip current capacity based on existing models of care. At the same time, access to care for marginalized communities remains a criticism of mainstream services. Increasingly, people are seeking alternate frameworks to meet such challenges. New public health approaches to palliative care promote compassionate communities as a potential solution. The approach seeks to foster supportive networks and resource that exists within communities to meet the anticipated practical and emotional challenges in providing end-of-life care. This case reviews aspects of this approach, discussing how clinicians can integrate core principles into their practice at an individual and systems level.
Long-Term Survival after Kidney Transplantation
Authors: Vasudev Brahm , Hariharan Sundaram 
Published: June 2024

Abstract
Kidney transplantation is the best option for renal replacement therapy for end-stage kidney disease (ESKD). In the United States, over three decades the number of kidney transplant (KT) performed has increased, but not enough to keep up with demand. The success of a KT is a function of patient survival and the transplanted organ’s long-term survival. Survival rates have improved due to improvements in pretransplant processes, better surgical techniques, advances in immunosuppressive therapies, and prevention and treatment of post-transplant cardiovascular diseases, infections, and tumors. Improved platforms for human leukocyte antigen and antibody testing and crossmatch techniques, legislative changes, better communication through the electronic health record system, and the introduction of telemedicine have had a positive impact on patient care. This chapter provides current long-term survival rates, pre- and post-transplant factors that affect KT survival, and methods to improve survival rates further.
Transplantation in Children
Authors: Dandamudi Raja S. , Höcker Britta , Dharnidharka Vikas 
Published: June 2024

Abstract
Kidney transplantation (KT) is the treatment of choice for children with end-stage kidney disease (ESKD), providing a significant survival advantage over dialysis. The field of pediatric KT continues to evolve, with improvements in management strategies including immunosuppression and antiviral therapies. The etiology of ESKD, donor-recipient size mismatch, post-transplant complications, medication nonadherence, growth and neurocognitive development, social issues, and comorbidities associated with the lower urinary tract are unique challenges in pediatric KT and are addressed in this chapter.
Tolerance after Kidney Transplantation
Authors: Rogers Natasha M. , Thomson Angus W. 
Published: June 2024

Abstract
For patients with advanced chronic kidney disease (CKD) or end-stage kidney disease (ESKD), kidney transplantation remains the best treatment modality. Kidney transplantation as opposed to long-term dialysis offers longer life expectancy with better quality of life and is cost-effective. There is an effort to offer kidney transplantation as the preferred modality to many recipients. In 2019, the federal government of the United States signed an Executive Order “Advancing American Kidney Health” intending to facilitate and promote kidney transplantation. In 2021, a total of 24,670 kidneys were transplanted which was a record high despite the midst of the COVID-19 pandemic. The number of patients with functioning kidney transplants continues to increase. In the USA, 239,413 patients had a functional kidney transplant in 2019 which has doubled in 20 years from 1999. The largest population with functional kidney transplants are patients aged 45-64 years.3 Many of these patients would eventually have irreversible graft failure requiring repeat transplant or long-term dialysis treatment. It is prudent to know how best to manage patients with failing kidney transplants. In this chapter, we address various clinical aspects of failing and failed kidney transplants.
3
Authors: Cohen Lewis 
Published: June 2024

Abstract
In this chapter, the concept of “losing context” is explored, including how patients with a dementia may sometimes try to preserve pictures, stories, and family history to hold on to their embeddedness of self and the relationships they have formed throughout their lives. The chapter also explores the paradoxical nature of dementia, specifically how advance planning needs to ideally take place before a diagnosis is given, which poses practical difficulties. Dan’s own prognosis and his decision to terminate his life is addressed within this paradox. The various opinions of philosophers, bioethicists, and disability rights activists are shared as they explore the issue of family and family members caring for people with a dementia.
7
Authors: Cohen Lewis 
Published: June 2024

Abstract
This chapter focuses on the life, diagnosis, and death-hastening act of Dr. Sandra Bem, a pioneering psychologist. Her diagnosis of mild cognitive impairment, or MCI, leads to a discussion of the full spectrum of dementia and how each individual has a unique set of symptoms and experiences. The reader also learns about the Hemlock Society and its goals to provide information to dying people who thought about accelerating their deaths and to pass legislation permitting carefully regulated physician-assisted dying. Dr. Kevorkian, one of the most famous physicians of this era, is discussed, along with various states’ death-with-dignity laws. The first patient Dr. Kevorkian helped to die was Janet Adkins, who had early-onset Alzheimer’s disease.
17
Authors: Cohen Lewis 
Published: June 2024

Abstract
This chapter continues to explore Dan’s symptoms through his own words. As his dementia progresses, Dan experiences increasing forgetfulness, fatigue, hallucinations, and emotional lability. An overview is provided of what access to voluntary assisted dying for people with dementia looks like globally. The shortcomings of the death-with-dignity laws that are available in the United States, as seen from Dan’s point-of-view, are explored. The reader learns about how members of Dan’s immediate and extended family are taking the news of his plan to hasten his death. Some of them object, and while this is distressing, Dan does not want them identified. Ethical quandaries of being an author of this book are discussed.
18
Authors: Cohen Lewis 
Published: June 2024

Abstract
This chapter continues to chart the progress of Dan’s advancing dementia. Alterations continue to be made to Dan’s plan. The role and method of communication with family and friends is explored. The inability to communicate that many suffering from a dementia experience is addressed with a nursing expert. The chapter also goes back in time to explore in more detail Dan’s past, including the trauma he suffered and the guilt that resulted, and the addictions and personality features that he developed as a means of coping. Dan’s psychoanalyst is interviewed, and he is confident that his patient is not depressed or lacks the capacity to make decisions.
19
Authors: Cohen Lewis 
Published: June 2024

Abstract
This chapter addresses the trigger that finally causes Dan to settle on a date for his overdose. He describes “time stopping” during a trip to a local park, and how he becomes disoriented and does not know where he is for a brief period. The incident is analyzed by a neurologist, who goes into more detail about the concept of getting lost and why it is such a universal and deeply traumatic symptom for those suffering from dementia. This leads to a discussion of the mark, or trigger, for intolerable suffering, which is different for every individual suffering from dementia. The complex reaction of Dan’s family to a date being chosen is shared with the reader.
27
Authors: Cohen Lewis 
Published: June 2024

Abstract
A day-to-day rundown is given of the progression of Dan’s symptoms after he voluntarily stops eating and drinking (VSED). The chapter also explores the interactions Dan and his husband have with hospice. On day #9 of his fast, Dan became disoriented and incoherent, and hospice services are begun. A case is made for hospice organizations to expand the symptom management protocols and specifically for the initiation of hospice in situations where people have dementia and want to employ VSED. The reader learns by the end of the chapter about the circumstances of Dan’s death and the contents of an email he addressed to his friends and family members.
29
Authors: Cohen Lewis 
Published: June 2024

Abstract
John deals with the distribution of Dan’s assets and possessions. He talks about his ongoing grieving process. John remarks that VSED is a readily available death-accelerating method for people with dementia or those who are seeking a nontechnological death, “But I think we need to look at it, hopefully, as a temporary, short-term answer to the problem of those who want to die.” The question of whether people suffering from dementia should be included in assisted dying laws is revisited. There is a discussion of the politics, concerns over vulnerable populations, and public stigma that attend this question. The issue of whether they should have the privacy right to resist disclosing their plan is touched upon. A memorial event is held in Kansas City and attended by several of Dan’s family to raise money for ACLU internships in his name.
Spinal Pathology and Muscle Morphologies with Chronic Low Back Pain and Lower Limb Amputation
Authors: Butowicz Courtney M , Helgeson Melvin D , Pisano Alfred J , Cook John W , Cherry Alex , Dearth Christopher L , Hendershot Brad D 
Published: June 2024

ABSTRACT

Introduction
Low back pain (LBP) is highly prevalent after lower limb amputation (LLA) and contributes to substantial reductions in quality of life and function. Towards understanding pathophysiological mechanisms underlying LBP after LLA, this article compares lumbar spine pathologies and muscle morphologies between individuals with LBP, with and without LLA.

Materials and Methods
We queried electronic medical records of Service members with and without LLA who sought care for LBP at military treatment facilities between January 2002 and May 2020. Two groups with cLBP, one with (n = 15) and one without unilateral transtibial LLA (n = 15), were identified and randomly chosen from a larger sample. Groups were matched by age, mass, and sex. Lumbar muscle morphology, Pfirrmann grades, Modic changes, facet arthrosis, Meyerding grades, and lordosis angle were determined from radiographs and magnetic resonance images available in the medical record. Independent t-tests compared variables between cohorts while multiple regression models determined if intramuscular fat influenced Pfirrmann grades. Chi-square determined differences in presence of spondylolysis and facet arthrosis.

Results
Lordosis angle was larger with LLA (P = 0.01). Spondylolysis was more prevalent with LLA (P = 0.008; 40%) whereas facet arthrosis was similar between cohorts (P = 0.3). Muscle area was not different between cohorts, yet intramuscular fat was greater with LLA (P ≤ 0.05). Intramuscular fat did not influence Pfirrmann grades (P &gt; 0.15).

Conclusions
Despite similar lumbar muscle size, those with unilateral LLA may be predisposed to progress to symptomatic spondylolisthesis and intramuscular fat. Surgical and/or rehabilitation interventions may mitigate long-term effects of diminished spinal health, decrease LBP-related disability, and improve function for individuals with LLA.