bluuebunny/crossref_metadata_2025_split huggingface dataset:
Value of information analysis optimizing future trial design from a pilot study on catheter securement devices
Authors: Tuffaha Haitham W , Reynolds Heather , Gordon Louisa G , Rickard Claire M , Scuffham Paul A 
Published: August 2014

Background: Value of information analysis has been proposed as an alternative to the standard hypothesis testing approach, which is based on type I and type II errors, in determining sample sizes for randomized clinical trials. However, in addition to sample size calculation, value of information analysis can optimize other aspects of research design such as possible comparator arms and alternative follow-up times, by considering trial designs that maximize the expected net benefit of research, which is the difference between the expected cost of the trial and the expected value of additional information. Purpose: To apply value of information methods to the results of a pilot study on catheter securement devices to determine the optimal design of a future larger clinical trial. Methods: An economic evaluation was performed using data from a multi-arm randomized controlled pilot study comparing the efficacy of four types of catheter securement devices: standard polyurethane, tissue adhesive, bordered polyurethane and sutureless securement device. Probabilistic Monte Carlo simulation was used to characterize uncertainty surrounding the study results and to calculate the expected value of additional information. To guide the optimal future trial design, the expected costs and benefits of the alternative trial designs were estimated and compared. Results: Analysis of the value of further information indicated that a randomized controlled trial on catheter securement devices is potentially worthwhile. Among the possible designs for the future trial, a four-arm study with 220 patients/arm would provide the highest expected net benefit corresponding to 130% return-on-investment. The initially considered design of 388 patients/arm, based on hypothesis testing calculations, would provide lower net benefit with return-on-investment of 79%. Limitations: Cost-effectiveness and value of information analyses were based on the data from a single pilot trial which might affect the accuracy of our uncertainty estimation. Another limitation was that different follow-up durations for the larger trial were not evaluated. Conclusion: The value of information approach allows efficient trial design by maximizing the expected net benefit of additional research. This approach should be considered early in the design of randomized clinical trials.
Actor and partner effects of perceived HIV stigma on social network components among people living with HIV/AIDS and their caregivers
Authors: Hao Chun , Liu Hongjie 
Published: August 2014

Background: Few studies have investigated the relationship between HIV stigma and social network components at the dyadic level. The objective of this study was to examine the actor and partner effects of perceived HIV stigma by people living with HIV/AIDS (PLWHAs) and their caregivers on social network variables at the dyadic level. Method: An egocentric social network study was conducted among 147 dyads consisting of one PLWHA and one caregiver (294 participants) in Nanning, China. The actor-partner interdependence model (APIM) was used to analyze the relationships between perceived HIV stigma and social network components (network relations, network structures, and network functions) at the dyadic level. Results: We found in this dyadic analysis that: (1) social network components were similar between PLWHAs and their caregivers; (2) HIV stigma perceived by PLWHAs influenced their own social network components, whereas this influence did not exist between caregivers’ perceived HIV stigma and their own social network components; (3) a few significant partner effects were observed between HIV stigma and social network components among both PLWHAs and caregivers. Conclusion: The interrelationships between HIV stigma and social network components were complex at the dyadic level. Future interventions programs targeting HIV stigma should focus on the interpersonal relationship at the dyadic level, beyond the intrapersonal factors.
Enhancing Māori food security using traditional kai
Authors: McKerchar Christina , Bowers Sharron , Heta Craig , Signal Louise , Matoe Leonie 
Published: August 2014

Issue: Lack of food security is one of the major nutrition issues facing Māori today. Loss of traditional kai (food) gathering places and practices following colonisation and urbanisation has impacted negatively on food security for Māori. This paper explores the role of Māori in enhancing Māori food security through revitalising traditional kai. Methods: A narrative literature review of peer reviewed and grey literature on revitalising traditional kai for Māori was conducted. The focus was on two areas: increasing the availability of traditional kai to Māori households (such as through replenishing fish stocks, and gardening projects) and increasing the financial means available to Māori households to purchase food (by economic development of traditional kai industries and employment creation). Results: A range of activities to improve food security for Māori by revitalising traditional kai was identified in the literature. Māori are now significant players in New Zealand’s fishing industry, and are developing their horticultural resources. Gardening initiatives have also grown considerably in Māori communities. Enabling factors included: the return of traditional kai resources by the Crown, and successful pursuit by Māori of the legal rights to develop them; development of Māori models of governance; government policy around Māori economic development and healthy eating; and Māori leadership on the issue. Barriers to revitalising traditional kai that remain to be addressed include: tensions between Government and Māori goals and models of resource management; economic pressures resulting in severely depleted fishing stocks; and pollution of marine and freshwater fish. Conclusion: Revitalising traditional kai has considerable potential to improve food security for Māori, both directly in terms of food supply and by providing income, and warrants policy and practical support. These findings have implications for other indigenous cultures who are struggling to be food secure.
Midwives’ perceptions and experiences of health promotion practice in Ghana
Authors: Owusu-Addo Ebenezer 
Published: August 2014

Introduction: This research explores midwives’ perceptions and experiences of health promotion practice in Ghana. Methods: A qualitative descriptive exploratory design was used in order to gain better insight into midwives’ perceptions and experiences of health promotion practice. A total of 21 midwives took part in the study. Data were collected by individual in-depth semi-structured interviews. Thematic analysis was used to analyse the transcript. Results: Five dominant themes emerged from the interview transcripts, namely: health promotion as education, health promotion activities, the value of health promotion, client participation, and midwives’ barriers to promoting health. Although midwives underscored the importance of health promotion to their work, their reports indicated that, in practice, midwives mostly delivered health education and behaviour change communication rather than health promotion. The midwives expressed the view that by way of their close association with women, they were in a better position to influence women’s health. Health promotion activities engaged by the midwives included weight management, healthy eating, infection prevention, personal hygiene, counselling on family planning, and screening for hazardous and harmful substance use such as alcohol and smoking. All the midwives mentioned that clients participated in their health promotion activities. Factors that were identified by the midwives to enhance client participation were trust, attitude of the midwife, building rapport, creating enabling environment, listening and paying attention to clients and using simple language. The barriers to health promotion identified by the midwives included time, stress, culture, lack of training and inadequate health educational materials. Discussion: Midwives in this study had limited knowledge about health promotion, yet could play a significant role in influencing health; thus there is a need for on-going in-service training for midwives to focus on health promotion.
Athletic Trainers’ Management Practices and Referral Patterns for Adolescent Athletes After Sport-Related Concussion
Authors: Williams Richelle M. , Welch Cailee E. , Weber Michelle L. , Parsons John T. , Valovich McLeod Tamara C. 
Published: August 2014

Background: Athletic trainers (ATs) play an important role in the evaluation, management, and referral of student-athletes after sport-related concussion. Understanding factors that influence ATs’ patient care decisions is important to ensure best practices are followed. Purpose: To identify ATs’ current concussion management practices and referral patterns for adolescent student-athletes after sport-related concussion as well as the factors associated with those practices. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: A total of 851 participants from a convenience sample of 3286 ATs employed in the secondary school setting (25.9% response rate) completed the Athletic Trainers’ Beliefs, Attitudes, and Knowledge of Pediatric Athletes with Concussions (BAKPAC-AT) survey. The BAKPAC-AT consists of several questions to assess ATs’ concussion management, referral practices, and established relationships with other health care professionals. Results: The majority of ATs had a written concussion policy (82.4%, n = 701) and standing orders approved by their directing physician (67.3%, n = 573); 75.1% (n = 639) of ATs conduct baseline testing, with the majority using computerized neurocognitive tests (71.2%, n = 606). Follow-up concussion testing was employed by 81.8% (n = 696). Years of certification ( P = 0.049) and type of secondary school ( P = 0.033) predicted ATs’ use of baseline testing. Nearly half of the respondents (48.8%, n = 415) refer 100% of concussion cases to a physician. The most influential factors that lead to a referral were state law (40.3%, n = 343), personal preference (34.7%, n = 295), and school district policy (24.8%, n = 211). Conclusion: Of the ATs surveyed, most were engaged in baseline and follow-up testing, primarily with neurocognitive tests. Most ATs refer patients to physicians after concussion. While state regulation and personal preference were primary factors influencing referral decisions, it is unclear at what point of care the referral occurs.
Socioeconomic differences in the menopausal experience of Chinese women
Authors: Huseth-Zosel Andrea , Strand Mark , Perry Judith 
Published: August 2014

Objective This study explores the effect of employment status, occupation and education on menopausal symptoms experienced by women in an urban community in China. Study design Cross-sectional survey. Main outcome measures Menopausal symptoms, medication/supplement use to relieve menopausal symptoms, sociodemographic variables. Results Risks for more burdensome menopausal symptoms include less education, non-white collar occupation and unemployment/retirement status. Being employed in a white collar occupation and having higher formal education were protective for hot flashes, dry skin/eyes, heart palpitations and insomnia and were associated with increased usage of medication to alleviate menopausal symptoms. Conclusions As Chinese women age and continue working longer, they will spend increasing amounts of time postmenopausal and in the workplace. The development of worksite-based health programmes would be advantageous to female workers of menopausal age in China.
Vertical Tears of the Lateral Meniscus
Authors: Goyal Kanu S. , Pan Tiffany J. , Tran Diane , Dumpe Samuel C. , Zhang Xudong , Harner Christopher D. 
Published: August 2014

Background: Lateral meniscal tears are often seen with acute anterior cruciate ligament (ACL) injury and may be left in situ, repaired, or treated with meniscectomy. Clinical studies have shown good outcomes with vertical tears left in situ and poor outcomes following meniscectomy. However, clinically relevant studies are needed to establish a biomechanical foundation for treatment of these tears, particularly regarding the effects of meniscectomy. Purpose: To compare tibiofemoral joint mechanics following vertical lateral meniscal tears and meniscectomies. We hypothesized that a peripheral vertical tear of the lateral meniscus would alter joint mechanics, increasing contact pressure and area, and that more drastic effects would be seen following meniscectomy, at higher knee flexion angles, and with increased loads. Study Design: Controlled laboratory study. Methods: Ten fresh-frozen cadaveric knees (average age, 55 ± 12 years) were tested with 5 lateral meniscus states: intact, short vertical tear, extended vertical tear, posterior horn partial meniscectomy (rim intact), and posterior horn subtotal meniscectomy (rim excised). The specimens were loaded axially at knee flexion angles of 0°, 30°, and 60°, and musculotendinous forces were applied, simulating a 2-legged squat. Intra-articular contact pressures were measured using pressure-sensitive Fuji film. Kinematic data were acquired through digitization of fiducial markers. Results: Vertical tears did not cause a significant change in contact pressure or area. Partial meniscectomy increased maximum contact pressures in the lateral compartment at 30° and 60° from 5.3 MPa to 7.2 MPa and 7.6 MPa, respectively ( P = .02, P = .007). Subtotal meniscectomy (8.4 MPa) significantly increased contact pressure compared with partial meniscectomy (7.6 MPa) at 60° ( P = .04). Both meniscectomy states significantly increased contact pressures with increasing flexion from 0° to 60° ( P < .001, P < .001). Conclusion: Vertical tears of the lateral meniscus during a simulated 2-legged squat did not significantly change contact pressures and areas compared with an intact meniscus. However, treating these tears with partial and complete meniscectomy significantly increased maximum contact pressures. Clinical Relevance: Biomechanical evidence supports treating vertical lateral meniscus tears with meniscal-sparing techniques as opposed to meniscectomy, which may lead to progressive degenerative joint disease from altered joint biomechanics.
Return to Play After Shoulder Stabilization in National Football League Athletes
Authors: White Matthew J. , Fleisig Glenn S. , Aune Kyle , Andrews James R. , Dugas Jeffrey R. , Cain E. Lyle 
Published: August 2014

Objectives: Shoulder instability is a common and limiting injury to football players. The return to play (RTP) percentage and factors affecting RTP after shoulder stabilization in National Football League (NFL) players are not defined. The purpose of this study was to determine the rate of return to professional football play in the NFL after shoulder stabilization and to determine what factors may affect RTP in these athletes. Methods: Sixty NFL players who had undergone shoulder stabilization at our institution were followed to determine the rate of RTP and factors predicting RTP. Chart review was performed to glean perioperative data and follow-up was performed by accessing the statistics database maintained by the NFL. Successful RTP was defined as return to play in at least one regular season NFL game following surgery. Chi square and Student’s t-tests were performed to examine differences between perioperative and athletic history variables and a player’s ability to RTP. Results: Ninety percent (54 of 60) of NFL players were able to return to game play following shoulder stabilization. The average time to RTP was 8.6 months. Age, number of games before surgery, and career length were not statistically different between those that returned and those that did not. Eleven of the sixty patients underwent open stabilization. Ninety-two percent (45/49) of the arthroscopically treated and eighty-two percent (9/11) of the openly treated athletes were able to RTP; these rates were not found to be significantly different. Playing history and demographics were similar between the open and arthroscopic groups. Players selected before the fourth round of the NFL draft were 7.6 times more likely to RTP. Circumferential labral tears were found in seven athletes, all of whom were able to RTP following surgery. Conclusion: The RTP rates for NFL players following shoulder stabilization are quite high (90%). There is no difference in RTP rates between open and arthroscopic repairs. Being selected in the first four rounds of the NFL draft is highly predictive of a player’s ability to RTP.
“Subcritical” Glenoid Bone Loss Increases Redislocation Rates in Primary Arthroscopic Bankart Repair
Authors: Shaha James S. , Cook Jay B. , Song Daniel J. , Rowles Douglas J. , Bottoni Craig R. , Shaha Steven H. , Tokish John M. 
Published: August 2014

Objectives: While bone loss is increasingly recognized as a risk factor for failure after arthroscopic stabilization, the precise definition of critical bone loss has not been defined. Additionally, there is no clarity on the amount of bone loss routinely present in patients presenting for primary arthroscopic stabilization of anterior glenohumeral instability. The purpose of this study is to report on the average bone loss measured in primary isolated Bankart reconstructions of the shoulder and to determine what amount of bone loss correlated to a recurrence of instability. Methods: This is a retrospective review of a consecutive series of 94 anterior instability patients (97 shoulders) who underwent arthroscopic labral repair at a single military institution by one of three fellowship trained orthopaedic surgeons. Data was collected on demographics and rate of redislocation as reported by the patient at the most recent follow-up. Glenoid bone loss was calculated from preoperative imagining using a “perfect-circle” technique. Patients were excluded if they had previously undergone any stabilization procedure. Results: The average age at surgery was 25.6 years (range, 16-42) with average follow-up of 36.8 months (range, 20-57). There were 5 females (5 shoulders) and 89 males (92 shoulders). The average bone loss in all patients was 14.4% (range, 0-34.7%). When analyzed based on the presence or absence of recurrence, there were 77 stable shoulders with no redislocations. In this group, the average bone loss was 14.5% (range, 0-33.3%) with a follow-up of 36.3 months (range, 20-57). There were 20 patients with recurrent dislocations who had an average of 20.8% (range, 0-33.3%) with a 39.1 month (range, 21-56) follow-up. There was a significantly greater amount of bone loss in those with redislocations (p=0.004). When further analyzed, there was a 95% likelihood of redislocation with 17.1% bone loss there was a 25% likelihood of redislocation with 7.0% bone loss. Conclusion: This study suggests that glenoid bone loss is a common finding in patients undergoing primary arthroscopic stabilization. Additionally, patients with “subcritical” bone loss of 17.1% are at a higher risk to have a recurrence than those with lesser amounts of bone loss. Patients with bone loss beyond this threshold should be counseled accordingly with consideration for alternative surgical procedures.
Classifying GBL: Severity And Attrition. Is There Enough Bone To Reconstruct The Glenoid?
Authors: McNeil John William , Bernhardson Andrew , LeClere Lance E. , Dewing Christopher , Lynch Joseph , Gaston Tistia , Provencher Matthew 
Published: August 2014

Objectives: Glenoid bone loss (GBL) continues to be a challenge in the management of recurrent anterior shoulder instability. Although the location of and percentage of GBL has been described, there is little information on how much bone is left to reconstruct the glenoid. Thus, the objective of this study is to describe a new GBL classification system that accounts for type of bone defect, amount of attritional loss, and correlate this to age, total time of instability and number of instability events. Methods: A total of 140 patients with recurrent anterior instability underwent an analysis of computed tomography (CT) three-dimensional imaging to assess GBL. The glenoid bone fragment was digitally analyzed (Osirix, Adobe) to qualitatively and quantitatively stratifyeach patient based upon attrition into- Type I “minimal atrittional” (no attrition -33%), Type II “partial attritional” (34 - 66%), and Type III “severe attritional” (67% - complete attrition). Additionally, demographic variables of age, total time of instability, and number of instability events were correlated to type of bone loss. Results: Patients had a mean age of 30.6 (range: 20 - 54) with a demonstrated mean GBL of 16.5% (range 5.1 - 62.3). Furthermore, the mean size of the remaining glenoid bone fragment was 27.8% of the full fragment size. Of 140 participants, 12 had attritional bone loss classified as Type I (12/140 = 8.6% of patients), 45 as Type II (45/140 = 32.1%), and 83 as Type III (83/140 = 59.3%). The mean percent loss for these three categories was 22.2%, 54.4%, and 88.5% respectively. Longer time of instability and more dislocations were associated with type III bone loss, and higher attrition of bone loss. Conclusion: This study highlights that GBL presents in a highly attritional nature and one should be cognizant that the remaining bone fragment does not come close to reconstituting glenoid bone stock. Patients with recurrent instability are predominantly severe attritional (Type III).