bluuebunny/crossref_metadata_2025_split huggingface dataset:
Highly Cross-Linked Polyethylene Reduces Wear and Revision Rates in Total Hip Arthroplasty
Authors: Monem Mohammed , Sugand Kapil , Pearse Michael 
Published: June 2024

Abstract
Aseptic loosening is the most common reason for revision of total hip replacements (THRs). Understanding which type of liners to use to reduce debris-related osteolysis and loosening is important and should lead to better clinical outcomes. This double-blinded study compares the clinical and radiological outcomes of two different liners, Marathon highly cross-linked polyethylene (XLPE) vs. Enduron ultra-high-molecular-weight polyethylene (UHMWPE), in THRs followed up for at least a decade. The stem and acetabular shells used in the study were the same design and from the same manufacturer. The results of this study will help to inform the surgeon’s decision-making in choosing their acetabular liners for both primary and revision THRs.
Hemiarthroplasty or Total Hip Arthroplasty for the Treatment of a Displaced Intracapsular Fracture in Active Elderly Patients
Authors: Janahan Thayaparan Anthony , Singh Ashok , Al-Obaidi Bilal , Strachan Robin K. , Spicer Dominic 
Published: June 2024

Abstract
The treatment of displaced intracapsular neck of femur fractures in elderly patients with hemiarthroplasty or total hip arthroplasty has been contended over the years with advantages and disadvantages for each operation in the immediate instance and the subsequent months to years. However, debates arise as to which procedure is superior in the longer term. This chapter presents data suggesting that at twelve years postoperatively there is no significance between the two procedures in modified Harris Hip Scores (for functionality), mortality, rate of revision surgery, and complications in the two studied groups. Limitations consisted of the only complications recorded after discharge were dislocation and revision surgery. Only 20% of the patients were included in the final analysis at final follow-up. Consequently, the authors concluded that patients over the age of 70 years should be considered for a faster cemented hip hemiarthroplasty rather than a total hip replacement.
Should Acute Scaphoid Fractures Be Fixed?
Authors: Panagiotidou Anna , Elvey Mike 
Published: June 2024

Abstract
This is a prospective randomized controlled trial reporting on outcomes of eighty-eight minimally displaced or undisplaced waist of scaphoid fractures treated with either early surgical fixation or cast immobilization. The authors looked at the rate of union and the effects of treatment on pain, tenderness, grip strength, range of motion, and Patient Evaluation Measure scores at different time intervals spanning over a year. The results of the study suggest that apart from better union rates, all other potential benefits of surgery are transient, and nonunions can be successfully fixed at a later date. Cast immobilization is effective in achieving union, and therefore early fixation could lead to overtreatment of a large proportion of fractures.
A Controlled Trial of Arthroscopic Knee Surgery versus Placebo for Osteoarthritis
Authors: Maheswaran Tim , Sugand Kapil , Sarraf Khaled M. 
Published: June 2024

Abstract
Arthroscopic knee surgery for osteoarthritis has been commonplace for several decades, and what this study aimed to do was to determine the efficacy of arthroscopic knee surgery against a sham surgery (placebo) by means of a randomized controlled trial. One hundred and eighty patients and the assessors were blinded to the group they were assigned to, and the patients were followed up at regular intervals for up to 2 years. At each time point, the patients were assessed for pain and function. The results demonstrated no significant improvement in pain or function between the treatment and placebo group. Thus, the results of this study proved to be both significant and controversial at the time.
Long-Term Survivorship of the Hip Following Operatively Treated Acetabular Fracture
Authors: Martin Alexander , Abdul-Jabar Hani B. 
Published: June 2024

Abstract
This seminal study from one of the godfathers of hip surgery represents the largest and longest series of patients demonstrating the likelihood of a successful outcome following open reduction and internal fixation of a displaced acetabular fracture. It highlights that with appropriate and skilled management, patients can expect a “survival” of their native hip joint in 79% at 20 years without progressing to THR. It also highlights the fact that 50% of all treatment failures occurred within the first 2 years postinjury. The publication provides valuable prognostic information to help guide decision-making using the normogram, postoperative follow-up, and patient counseling regarding their long-term outlook. The inclusion of a novel tool to help predict the likelihood of early treatment failure will be of great interest and value to clinicians treating these complex injuries. This is a level two study from California, USA.
Cemented or Uncemented Hemiarthroplasty for Displaced Intracapsular Fractures of the Hip
Authors: Ghafur Asim , Osborne Andrew , Holloway Ian 
Published: June 2024

Abstract
This study compares treatment options for displaced intracapsular neck of femur fractures. A randomized controlled trial of 400 patients was undertaken to determine whether there was any difference in the outcome between cemented polished tapered or uncemented Furlong hydroxyapatite-coated hemiarthroplasty techniques. There were 273 women and 127 men with a mean age of 84.2 years (60–102) in the cemented group and 85.3 years (58–98) in the uncemented group. They were assessed for functional outcome, hip movements, limb shortening, and pain scores at two, three, six, nine, and twelve months after the injury. The main finding was better recovery with respect to mobility in patients treated with a cemented prosthesis. There was no difference in residual pain or mortality.
Comparison of Adverse Outcomes after Total Knee versus Unicompartmental Knee Replacements
Authors: Popat Ravi , Ghosh Subhajit , Nathwani Dinesh 
Published: June 2024

Abstract
The aim of this study was to compare the rates of adverse outcomes after total knee replacement (TKR) and unicompartmental/unicondylar knee replacement (UKR) with large data sets. The outcomes from the National Joint Registry for England and Wales, Hospital Episode Statistics, and the Office for National Statistics were reviewed. There were 25 334 UKR episodes identified, which were matched to 75 996 TKRs on the basis of propensity score. UKRs had a higher rate of revision and reoperation than TKRs at eight years. Length of stay, complications, and rates of readmission were all higher for TKR than for UKR.
Randomized Trial of Reamed and Unreamed Intramedullary Nailing of Tibial Shaft Fractures
Authors: Kwok Iris H. Y. , Bates Peter 
Published: June 2024

Abstract
A multicenter randomized controlled trial of 1226 patients with tibial shaft fractures was conducted across 29 centers in Canada, comparing reoperation and complication rates between reamed and unreamed intramedullary nailing. It showed that reoperation rates were lower in the reamed group for closed fractures. In open fractures, there was no significant difference between reamed and unreamed groups. The overall reoperation rate in this study was 4.6%. There were significantly more deaths in the reamed compared to the unreamed group; however, the deaths were unrelated to the intramedullary nailing procedure itself.
Isolated Medial Patellofemoral Repair Does Not Improve Patient Outcomes or Decrease the Rate of Patella Redislocation
Authors: Boutong Sara , Sugand Kapil , Ahmad Mudassar 
Published: June 2024

Abstract
The purpose of this study was to evaluate the effect of surgical repair of the medial patellofemoral ligament (MPFL) onto the adductor tubercle in patients with primary dislocation of the patella. Eighty patients underwent diagnostic arthroscopy before being randomized to surgical repair of the MPFL or nonoperative management. Patients were monitored for recurrent patella dislocation. Their scores from the Kujala score and Knee injury and Osteoarthritis Outcome Score were recorded. The redislocation rate and outcome scores showed no significant difference between both groups. Therefore, delayed isolated primary repair of the MPFL using anchor-based reattachment does not decrease the risk of redislocation, nor does it improve clinical outcomes.
Arthroscopic Subacromial Decompression for Subacromial Shoulder Pain (CSAW)
Authors: Nabil Fanous Rafik , Gooding Ben 
Published: June 2024

Abstract
Shoulder pain is a significant burden on the healthcare system, of which the most common presentation is impingement syndrome. Arthroscopic subacromial decompression to free the passage of the rotator cuff tendons in the subacromial space is a commonly performed orthopaedic procedure to address this. This large randomized study assessed the effectiveness of this procedure and has suggested that there is no benefit over diagnostic arthroscopy alone or no treatment. It would seem, therefore, that some patients may improve without surgical intervention. However, there remains contention as to the role for subacromial decompression in some cases.
Compartment Monitoring in Tibial Fractures
Authors: Merchant Irfan , Sugand Kapil , Paul Murphy John 
Published: June 2024

Abstract
The study observing for compartment monitoring of tibial fractures was designed to test the hypothesis of whether decompression should be performed when compartmental tissue pressure rises to within 30 mmHg of diastolic blood pressure. This study reviewed 116 patients with tibial diaphyseal fractures over two years and seven months. Continuous monitoring on anterior compartment pressures was performed over a twenty-four-hour period. The results of this study showed that no cases of compartment syndrome were missed when using a differential pressure of 30 mmHg. It was recommended that fasciotomies should be performed at this pressure limit.
Pain in People with Substance Use Disorder
Authors: Hetherington Lucy , Farnham Christopher 
Published: June 2024

Abstract
This case describes a person, Lydia, with substance use disorder and severe multiple disadvantages. The case discusses the role of palliative care services (hospital, community, and hospice inpatient care) in addressing Lydia’s symptoms and supporting her complex needs. Methadone medication-assisted treatment (MAT) and buprenorphine MAT use alongside other opioids is explained. Managing the prescription and storage of controlled drugs for people with substance use disorder is explored. The palliative care community has evolved over the last 50 years to support the symptom control needs of people with non-malignant life limiting or life-threatening conditions. People who use substances are no different in this respect—however, the hidden nature of their ‘needs’ and often challenging circumstances, make it easy for them to be forgotten.
Cancer Cachexia
Authors: Ison Lucy , Laird Barry , Skipworth Richard 
Published: June 2024

Abstract
This case examines the diagnosis and management of cachexia in patients with cancer. It explores the nature of cachexia and effects on the patient’s nutrition and function mediated by inflammation. The definition, diagnosis, and multimodal and multidisciplinary management of cachexia will be reviewed. Prehabilitation prior to definitive oncological treatment, nutritional, and pharmacological interventions will be discussed. Changes in management when a person is reaching the end of their life will be explored. This information is illustrated via a case discussion of a patient with a pancreatic malignancy and includes input from experts in the field.
Depression in Life-limiting Illness
Authors: Wood Felicity , Price Annabel 
Published: June 2024

Abstract
This case examines the importance of recognizing, assessing, and effectively managing depression at the end of life. Depression is common in palliative populations, yet it is frequently underdetected and undertreated. Identifying depression is important because effective management can improve quality of life and relationships with others. Screening tools can be useful to recognize depressive symptoms amongst feelings of grief, sadness, and the biological symptoms relating to poor physical health. A bio-psycho-social approach is important for management. Medication and non-pharmacological treatments have been shown to be effective. When starting antidepressants, it is important to review frequently for side effects and effectiveness and titrate to a therapeutic dose as quickly as is safely possible.
Hoarding and Associated Disorders
Authors: Bhamra Manraj , Ismail Khalida 
Published: June 2024

Abstract
This case outlines a case of hoarding in a woman with a new cancer diagnosis and depressive illness. The case considers the differential between hoarding as part of the presentation of underlying psychiatric illness and primary hoarding disorder, the importance of comprehensive assessment and the challenges of effective management, particularly as older people are more resistant to treatment. Whilst cognitive and behavioural techniques (CBT) have been shown to be effective in hoarding, current treatments are not as robust as for other psychiatric disorders. Technology-supported hoarding interventions, cognitive rehabilitation treatment, compassion-focused therapy, motivational interviewing, and harm reduction have all shown promise. Treatment effects with antidepressants may not be sufficient. The use of novel agents, such as stimulants and cognitive enhancers, or augmentation of psychological therapies with medications, may be future options. Further studies and more effective treatments are required for this disabling condition.
Frailty and Multiple Long-Term Conditions
Authors: Dewhurst Felicity , Nicholson Caroline 
Published: June 2024

Abstract
‘Frailty and Multiple Long-term Conditions’ examines a case of an older woman with complex health and social needs relating to multiple long-term conditions and her personal circumstances. The ageing population, together with associated high rates of frailty and MLTC, is arguably the biggest problem currently facing the health system. People with frailty and MLTC have high rates of morbidity, mortality and poor quality of life. Despite their high levels of need, which frequently escalate as the end-of-life approaches, people with MLTC and frailty often have poor access to palliative care. Family members are left to care for relatives without adequate support. Appropriate models of palliative care are urgently required; ensure realistic medicine provision, reduce non-beneficial hospital visits and admissions, and ensure the appropriate coordination of care. Multidisciplinary interspecialty-working (including palliative, geriatric, and primary care services) is key.
Diabetes Management at the End of Life
Authors: Mann Jaspal Kaur , Lumb Alastair 
Published: June 2024

Abstract
This case considers the case of a 44-year-old man with type 1 diabetes with adenocarcinoma of the distal sigmoid colon and explores the complexities of safe diabetes management in the context of life-limiting illness. In this case, the patient stopped his insulin treatment prior to admission to hospital for symptom relief, as his glucose readings had been in range at home without it and there were no further systemic anticancer treatment options available. His insulin was reinstated due to concerns about the risk of diabetic ketoacidosis, then withdrawn again after hypoglycaemia developed. The relationship between diabetes and cancer is discussed, as are the reasons for the change in his insulin requirement. Current guidelines for the treatment of diabetes at the end of life are presented.
Spiritual Care
Authors: Maan Sarah , Gray Alice , Goodhead Andrew 
Published: June 2024

Abstract
Spiritual care explores how to address spiritual needs at the end of life, which may include religious needs, and the value of doing this in palliative care. It is an essential part of a holistic assessment and impacts significantly on the patient’s experience. Looking beyond the scope of organized religion, spiritual care examines the different ways patients perceive and experience spirituality. It looks at how our own spirituality can influence the rapport and connections made with our patients and how we can help them meet their spiritual needs and manage any spiritual pain or distress. Listening to our patients and engaging with those important to them is crucial in ensuring this aspect of their care has been addressed.
Supportive Care and Survivorship
Authors: Datta-Paulin Lara , Warren Mark , Berman Richard 
Published: June 2024

Abstract
‘Supportive care and survivorship’ examines a case of narcotic bowel syndrome in the context of a patient who has had curative cancer treatment. It reviews specific short- and long-term effects of cancer treatments, including post-chemotherapy rheumatism and side effects from pelvic radiotherapy. It also considers both the immediate and long-term effects of opioid therapy such as endocrine and immune dysfunction, opioid-induced hyperalgesia, and opioid-induced bowel dysfunction (OIBD). The evidence base for the management of OIBD is examined. It reviews the pathophysiology and management of narcotic bowel syndrome. Lastly, it considers the role that supportive care can have in managing patients throughout their cancer journey and outlines the future development of supportive care within the UK.
Treatment Escalation Plans
Authors: Lewis-Williams Gemma , Taubert Mark 
Published: June 2024

Abstract
This case explores the current literature surrounding the use of Treatment Escalation Plans (TEPs) and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) discussions and decision-making in clinical practice. Paper-based forms carry significant risks. Therefore, it is important to plan for central electronic patient records and repositories, that hold information about DNACPR forms and other advance or future care planning statements and can highlight where a person has a lasting power of attorney for health and welfare. The electronic records need to be available as read versions for all providers, including paramedics, hospital staff, 999 or 111 call handlers, primary care, out-of-hours services, etc. They need to be editable, when, for instance, a patient’s situation changes, or when a decision is revoked or temporarily suspended. The ability to audit records is essential.
Withdrawal of Treatment
Authors: Senders-Galloway Simeon , Gorringe Anna 
Published: June 2024

Abstract
This case examines the key clinical, ethical, legal considerations in withdrawing life-sustaining treatment in patients having or lacking capacity. The case explores the withdrawal of clinically assisted nutrition and hydration (CANH) in a community patient with a prolonged disorder of consciousness (PDOC). The core principles apply to the withdrawal of any life-sustaining treatment in any clinical scenario and are outlined in a stepwise structure. Learning points explored in detail include justifications for withdrawing treatment, legal case precedent, ethical considerations, and key medicolegal principles such as advance decision to refuse treatment (ADRT), independent mental capacity advocate (IMCA), and lasting power of attorney (LPA).
Kidney Transplantation with Transplant Phases
Authors: Puttarajappa Chethan M. , Mohan Sumit 
Published: June 2024

Abstract
Kidney transplantation offers a great opportunity to improve an end-stage kidney disease (ESKD) patient’s quality of life and mortality risk. Long-term success however requires overcoming several challenges along the post-transplant journey. These challenges vary with time after transplant and often require a multifaceted approach to ensure that recipients obtain optimal care leading to substantial benefit from their transplantation. This chapter will highlight key challenges faced by patients and healthcare providers as they navigate these different post-transplant phases, which we have demarcated here as early, middle, and late phases. The chapter will highlight immunological, medical, and social factors that pose a risk for poor graft and patient outcomes and discuss opportunities for mitigating these risks and thus improving long-term outcome.
Immunological and Nonimmunological Factors Affecting Kidney Transplant Outcomes
Authors: Sood Puneet , Gill John 
Published: June 2024

Abstract
Allograft failure adds significant health and financial burden to the patient and healthcare system and is the fifth leading cause of dialysis initiation in the United States. Patients who initiate dialysis after transplant failure have high morbidity and mortality. Repeat transplantation is clearly the best treatment, but is available to only a minority of patients who suffer allograft failure. Repeat transplant recipients have inferior outcomes compared to primary transplant recipients, in part due to higher levels of. Patient death with a functioning allograft is often premature, and only a minority of transplant recipients live a normal life expectancy. Traditionally allosensitization factors contributing to allograft failure have been separated from factors contributing to patient death. However, because these factors are often intertwined, this chapter provides a holistic overview of the nonimmunological and immunologic factors contributing to both allograft failure and patient death.
Short-Term and Late T-Cell-Mediated Rejection after Kidney Transplantation
Authors: Mehta Rajil B. , Naesens Maarten 
Published: June 2024

Abstract
Alloimmune T cell responses are central in the pathogenesis of rejection. T cells are activated by exposure to alloantigens followed by expansion of T cell clones, differentiation into effector cells, and migration into the graft, leading to tissue destruction. From the early days of kidney transplantation, this immune infiltration into the graft was recognized as rejection, even prior to the development of a classification system of rejection. Over the years, this understanding has evolved as has the recognition of the prognostic implications of varying severity of rejection. This chapter provides details of T-cell-medicated rejection (TCMR) including historical perspective, classification, clinical features, current management and its shortcomings, as well as future directions.
Cardiovascular Disease and Metabolic Complications after Kidney Transplantation
Authors: Lin Chien-Jung , Lentine Krista L. , Sharif Adnan 
Published: June 2024

Abstract
Cardiovascular disease (CVD) remains the leading cause of death for people with chronic kidney disease with or without kidney transplant and accounts for 30% of post-transplant hospitalizations and one-third of deaths in kidney transplant recipients. Among all renal replacement therapy options, kidney transplantation is the best option to reduce long-term cardiovascular risk in comparison to remaining on dialysis. However, death with a functioning graft is the leading cause of late allograft loss and CVD remains one of the leading causes of death post-transplantation. This may relate to progression of pretransplantation CVD or development of de novo disease post-transplantation, influenced by the milieu of immunosuppression contributing to cardiometabolic risk burden. To improve long-term outcomes further after kidney transplantation, reducing the morbidity and/or mortality associated with CVD is a priority for transplant professionals. This chapter reviews the range of metabolic complications and CVD observed for kidney transplant candidates and recipients.