bluuebunny/crossref_metadata_2025_split huggingface dataset:
Feasibility of Pilates exercise to decrease falls risk: a pilot randomized controlled trial in community-dwelling older people
Authors: Barker Anna L , Talevski Jason , Bohensky Megan A , Brand Caroline A , Cameron Peter A , Morello Renata T 
Published: September 2015

Objective: To evaluate the feasibility of Pilates exercise in older people to decrease falls risk and inform a larger trial. Design: Pilot Randomized controlled trial. Setting: Community physiotherapy clinic. Participants: A total of 53 community-dwelling people aged ⩾60 years (mean age, 69.3 years; age range, 61–84). Interventions: A 60-minute Pilates class incorporating best practice guidelines for exercise to prevent falls, performed twice weekly for 12 weeks. All participants received a letter to their general practitioner with falls risk information, fall and fracture prevention education and home exercises. Main outcome measure(s): Indicators of feasibility included: acceptability (recruitment, retention, intervention adherence and participant experience survey); safety (adverse events); and potential effectiveness (fall, fall injury and injurious fall rates; standing balance; lower limb strength; and flexibility) measured at 12 and 24 weeks. Results: Recruitment was achievable but control group drop-outs were high (23%). Of the 20 participants who completed the intervention, 19 (95%) attended ⩾75% of the classes and reported classes were enjoyable and would recommend them to others. The rate of fall injuries at 24 weeks was 42% lower and injurious fall rates 64% lower in the Pilates group, however, was not statistically significant ( P = 0.347 and P = 0.136). Standing balance, lower-limb strength and flexibility improved in the Pilates group relative to the control group ( P < 0.05). Estimates suggest a future definitive study would require 804 participants to detect a difference in fall injury rates. Conclusion: A definitive randomized controlled trial analysing the effect of Pilates in older people would be feasible and is warranted given the acceptability and potential positive effects of Pilates on fall injuries and fall risk factors. Trial Registration: The protocol for this study is registered with the Australian and New Zealand Clinical Trials Registry (ACTRN1262000224820).
HIV risk and awareness and interest in pre-exposure and post-exposure prophylaxis among sheltered women in Miami
Authors: Doblecki-Lewis Susanne , Lester Larissa , Schwartz Bryanna , Collins Constance , Johnson Rai , Kobetz Erin 
Published: September 2015

Summary Pre- and non-occupational post-exposure prophylaxis for the prevention of HIV infection are recommended for adults at substantial risk of HIV. Women experiencing homelessness have increased risk of HIV infection compared with stably-housed women. We conducted a survey of 74 sheltered women at Lotus House Women's Shelter (Lotus House) in Miami to assess risk behaviour as well as knowledge and perception of pre- and non-occupational post-exposure prophylaxis in this population. Of surveyed women, 58.1% engaged in vaginal and/or anal sex while sheltered, and of sexually-active women 55.4% reported inconsistent condom use. 83.8% of women reported no concern regarding HIV acquisition due to their behaviour. Few women surveyed (20.8%) had previously heard of pre- or non-occupational post-exposure prophylaxis. The majority (58.3%) of respondents indicated receptiveness to these prevention methods when introduced. Those indicating that they would consider pre- or non-occupational post-exposure prophylaxis were significantly younger than those indicating that they would not consider these prevention strategies (p = 0.004). Education and referral for pre- and non-occupational post-exposure prophylaxis should be considered for sheltered women at risk of HIV infection. Additional research to optimise implementation of biomedical prevention strategies in this population is needed.
Elevated BLyS levels in patients with systemic lupus erythematosus: Associated factors and responses to belimumab
Authors: Roth D A , Thompson A , Tang Y , Hammer A E , Molta C T , Gordon D 
Published: September 2015

Introduction Patients with systemic lupus erythematosus (SLE) with B-lymphocyte stimulator (BLyS) levels ≥ 2 ng/mL are at increased risk of flare. A regression analysis was undertaken to identify routine clinical measures that correlate with BLyS ≥ 2 ng/mL. Efficacy and safety of belimumab 10 mg/kg were examined in patients with BLyS ≥ 2 ng/mL and < 2 ng/mL. Methods Data from BLISS-52 and -76 ( N = 1684) were pooled post hoc. A univariate logistic regression was employed to identify factors predictive of baseline BLyS ≥ 2 ng/mL. Factors significant at the 0.05 level then entered a stepwise logistic regression as covariates. Efficacy endpoints included SLE responder index (SRI), ≥ 4-point reduction in Safety of Estrogens in Lupus National Assessment–Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) and risk of severe flare over 52 weeks. Adverse events (AEs) were analyzed for each treatment arm and BLyS subgroup. Results Baseline predictors of BLyS ≥ 2 ng/mL included positive anti-Smith (≥ 15 U/mL), low complement (C) 3 (< 900 mg/L), anti-double-stranded DNA (anti-dsDNA) 80–200 and ≥ 200 IU/mL, immunosuppressant usage, proteinuria, elevated C-reactive protein (CRP), and low total lymphocyte count for all patients. Belimumab 10 mg/kg led to significantly greater SRI responses over 52 weeks versus placebo in both BLyS subgroups, though treatment differences were numerically greater at Week 52 in the BLyS ≥ 2 ng/mL group (24.1%, p < 0.0001) compared with BLyS < 2 ng/mL (8.2%, p = 0.0158). Results were similar for ≥ 4-point reduction in SELENA-SLEDAI. Risk of severe flare over 52 weeks was significantly reduced with belimumab 10 mg/kg versus placebo in the BLyS ≥ 2 ng/mL group ( p = 0.0002). AEs were similar across treatment arms and BLyS subgroups. Conclusions Positive anti-Smith, low C3, anti-dsDNA ≥ 80 IU/mL, immunosuppressant usage, proteinuria, elevated CRP, and low total lymphocyte count were predictors of BLyS ≥ 2 ng/mL. Monitoring these factors could identify patients with BLyS ≥ 2 ng/mL who are at risk of flare.
A good death
Authors: Hold Judith L 
Published: September 2015

Background: On a day to day basis, nurses are facing more ethical dilemmas during end-of-life care resulting in not being able to actualize a good death for patients. Research objective: The purpose of this study was to explore how experienced hospice nurses resolve day to day ethical dilemmas during end-of-life care. Research design: The study used a qualitative narrative approach. Participants: Through purposeful sampling, a total of six experienced hospice nurse participated. Ethical considerations: Approval from the researcher’s university Institutional Review Board for ethical review was obtained. Findings: Using core story creation, several different ethical dilemmas were identified divulging struggles with key stakeholders including family members and providers. Thematic analysis generated three main themes: Ethics within Practice, Ethical Knowledge, and Ethical Solutions. Discussion: The participants told their stories depicting a keen awareness of ethical conflicts situated by contextual factors including social, political, and personal issues. The nurses’ deliberations were informed through formal, experiential, and intuitive knowledge. Ethical predicaments were resolved by either following rules or choosing acts of resistance. Conclusion: A better understanding was obtained on how experienced hospice nurses successfully resolve ethical dilemmas culminating in better deaths for patients.
Access to services for young adults with medical complexity
Authors: Joly Elizabeth 
Published: September 2015

Background: With the number of young people with medical complexity increasing, an increasing number must navigate the transition to adulthood. This transition, in part, involves a situational transition in which young people and their families must access new services in the adult system. Objectives: To explore how societal ideologies, communities, and organizations represent the foundation of barriers to access to services. Research Design: The discussion in this paper, framed within a social justice perspective, outlines barriers to access to services at the societal and community levels including societal ideologies, differences in philosophies of care in pediatric and adult care, physical environments, and availability of services. Ethical Considerations: Since this is an exploratory discussion paper, no ethical approval was required. Findings and Conclusion: Based on analysis of the literature from a social justice perspective, it is suggested that the adult health care and social service systems do not provide the supports and services necessary to empower young people and their families to achieve their goals and maintain their health and quality of life. It is, thus, an ethical issue that the transfer from pediatric to adult services is occurring in the absence of appropriate services. Recommendations at the individual, community and policy levels highlight how nurses can address this ethical issue to promote more equitable access to services.
Clear conscience grounded in relations: Expressions of Persian-speaking nurses in Sweden
Authors: Mazaheri Monir , Ericson-Lidman Eva , Zargham-Boroujeni Ali , Öhlén Joakim , Norberg Astrid 
Published: September 2015

Background: Conscience is an important concept in ethics, having various meanings in different cultures. Because a growing number of healthcare professionals are of immigrant background, particularly within the care of older people, demanding multiple ethical positions, it is important to explore the meaning of conscience among care providers within different cultural contexts. Research objective: The study aimed to illuminate the meaning of conscience by enrolled nurses with an Iranian background working in residential care for Persian-speaking people with dementia. Research design: A phenomenological hermeneutical method guided the study. Participants and research context: A total of 10 enrolled nurses with Iranian background, aged 33–46 years, participated in the study. All worked full time in residential care settings for Persian-speaking people with dementia in a large city, in Sweden. Ethical considerations: The study was approved by the Regional Ethical Review Board for ethical vetting of research involving humans. Participants were given verbal and written study information and assured that their participation was voluntary and confidential. Findings: Three themes were constructed including perception of conscience, clear conscience grounded in relations and striving to keep a clear conscience. The conscience was perceived as an inner guide grounded in feelings, which is dynamic and subject to changes throughout life. Having a clear conscience meant being able to form a bond with others, to respect them and to get their confirmation that one does well. To have a clear conscience demanded listening to the voice of the conscience. The enrolled nurses strived to keep their conscience clear by being generous in helping others, accomplishing daily tasks well and behaving nicely in the hope of being treated the same way one day. Conclusion: Cultural frameworks and the context of practice needed to be considered in interpreting the meaning of conscience and clear conscience.
Moberg Osteotomy Shifts Contact Pressure Plantarly in the First Metatarsophalangeal Joint in a Biomechanical Model
Authors: Kim Paul Hyon-Uk , Chen Xiang , Hillstrom Howard , Ellis Scott J. , Baxter Josh R. , Deland Jonathan T. 
Published: September 2015

Background: A proximal phalangeal dorsiflexion osteotomy (Moberg osteotomy) is commonly used to treat hallux rigidus, but the mechanical explanation for its effectiveness is unclear. The purpose of our study was to test the effect of a Moberg osteotomy on first metatarsophalangeal joint contact mechanics. Methods: Ten cadaveric first ray specimens were dissected, with the medial band of the plantar aponeurosis preserved at its origin, and placed in a custom testing apparatus. Forefoot loads during mid-stance with the first metatarsal positioned at 10 degrees were simulated using a custom-made loading jig while contact mechanics were acquired with a thin pressure-sensitive sensor. A Moberg osteotomy was performed starting 9 mm distal to the proximal phalanx with excision of a 3-mm wedge of bone and fixated with a 2-mm Kirschner wire. The effect of the Moberg osteotomy was tested by reapplying the forefoot loads and acquiring the joint pressures. The center of pressure, peak pressure, and contact area were calculated. Paired t tests were performed to determine if the Moberg osteotomy affected joint contact mechanics. Results: The Moberg osteotomy shifted the center of contact pressure on the proximal phalanx surface more plantarly ( P < .01). However, the Moberg osteotomy did not affect the peak pressure ( P = .62) or the joint contact area ( P = .96). Conclusions: There were no differences in peak pressure or first MTPJ contact area, but a plantar shift in the center of pressure occurred after the Moberg osteotomy. Clinical Relevance: The plantar cartilage, which is often spared from arthritic changes, may be preferentially loaded and the potential edge loading following cheilectomy may be avoided with the Moberg osteotomy secondary to the plantar shift of center of pressure.
Outcomes and Return to Activity After Operative Repair of Chronic Latent Syndesmotic Instability
Authors: Ryan Paul M. , Rodriguez Ryan M. 
Published: September 2015

Background: This study is a retrospective review of prospectively gathered data determining the postoperative outcomes of patients who underwent operative treatment to address chronic syndesmotic instability. Methods: The cohort is composed of 19 individuals who elected to undergo operative treatment of chronic syndesmotic instability. The operative repair consisted of arthroscopic debridement in all cases with reduction and suture button fixation of those patients who had greater than 4 mm of syndesmotic diastasis on arthroscopic evaluation. All patients had a minimum of 24 months follow-up. This study retrospectively examined the prospectively gathered preoperative and postoperative outcome scores to include a Visual Analog Scale (VAS) pain score and an American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. In addition, patients were questioned on their ability to return to their preinjury level of activity and their ability to continue running sports. Fourteen patients returned their postoperative surveys. Results: Mean AOFAS scores improved significantly from 48 to 82.7 ( P = .014). Mean VAS scores improved from 6.1 to 1.0 ( P = .002). Overall, 86% (12/14) of patients were able to return to running and 79% (11/14) of patients were able to return to their preinjury level of sport. Preoperative and postoperative weight-bearing ankle radiographs were reviewed to evaluate the tibiofibular clear space and overlap. The clear space measured on anteroposterior (AP) radiographs decreased from 5.4 mm to 4.6 mm ( P = .005), the clear space evaluated on the mortise radiograph decreased from 4.5 mm to 3.6 mm ( P = .006), and the overlap measured on the AP radiograph increased from 5.7 mm to 6.9 mm ( P = .019). All radiographs were measured by a board-certified musculoskeletal radiologist. Conclusion: This study presents a treatment method that can be instituted at the time of diagnosis for syndesmotic injuries with greater than 4 mm of diastasis that were treated with debridement and stabilization. The results of this treatment technique are promising, with significant improvements in subjective outcome scores and a high rate of return to running sports. Level of Evidence: Level IV, retrospective case series.
Transocular ultrasound measurement of the optic nerve sheath diameter can identify elevated intracranial pressure in trauma patients
Authors: Nash Joshua E , O’Rourke Colin , Moorman Matthew L 
Published: September 2015

Background Prompt identification of elevated intracranial pressure (eICP) is life-saving. Physical exam alone often fails to identify this problem and invasive monitoring is not always utilized appropriately. A non-invasive, rapid, reliable technique to detect eICP is needed and optic nerve sheath diameter (ONSD) is known to be a valid surrogate. Historically, ONSD in patients with eICP above 20 mmHg varied from 0.5 to 0.7 cm. Receiver operator curves predict that diameters below 0.5 to 0.58 cm correspond to normal pressures. Interobserver variability is low (0.01--0.03 cm). The learning curve was 25 and 10 procedures for novice and experienced sonographers, respectively. We report our initial experience using ultrasound to measure ONSD during initial trauma evaluation. Study design Transocular ultrasound was used to determine ONSD after traumatic brain injury. Data were correlated with CT and exam findings or measured ICP. Measurements were performed by a single trauma surgeon. Time to perform the measurement was recorded. Relevant literature from the past 15 years was reviewed. Results Physical exam was not a reliable indicator of eICP. In patients with eICP requiring surgery, ONSD averaged 0.62 cm. Normal pressures were ensured if the ONDS was <0.50 cm (95% CI 0.469–0.540 cm, p < 0.001). Intraobserver variability was low (0.01--0.02 cm). Average time to perform the exam was less than 2 min. Conclusions Determining ONSD with ultrasound is easy to learn, precise, and inexpensive. An ONSD of less than 5 mm ensures no eICP. This procedure can be added to the evaluation of trauma patients with no delay in care. Future prospective studies may validate and incorporate this technique into the trauma surgeon's armamentarium.
Junk in the joint: A trend for arthroscopic debridement to improve outcomes following closed reduction of traumatic hip dislocation
Authors: Keil Lukas G , Vorburger Michael S , Dahners Laurence E 
Published: September 2015

Purpose To determine whether arthroscopic debridement following closed reduction of traumatic hip dislocation is associated with less persistent pain and functional impairment than closed reduction alone. Methods Retrospective comparative study, consisting of telephone interview, 2–14 years postinjury. Subjects were 15 patients aged 18 years or older at time of injury who received closed reduction of traumatic hip dislocation with arthroscopy (seven patients) or without arthroscopy (eight patients) at a level 1 trauma center between 2000 and 2012. The exposure was arthroscopic removal of intra-articular loose bodies following closed reduction. The primary outcome was the American Academy of Orthopaedic Surgeons® Hip & Knee Outcomes Questionnaire. Results Among the patients who received arthroscopy, the mean Hip & Knee Core Scale standardized score (0–100) was 98 (SD 2), as compared to 86 (SD 29) among patients who did not. These scores showed a statistical trend toward less pain and improved function in the arthroscopy group (p = 0.069). No patients in the arthroscopy group had scores below the average among healthy people, as compared to three of eight (38%) in the control group. Conclusions Patients who underwent arthroscopic debridement in addition to closed reduction had nonsignificant improvements in pain, stiffness, swelling, and functional impairment as compared to those who received closed reduction alone. Though not significant, these results warrant further study to determine whether arthroscopy is indicated for all patients suffering traumatic hip dislocation. Level of Evidence IV
A biomechanical study of the effects of simulated ulnar deviation on silicone finger joint implant failure
Authors: Drayton P. , Morgan B. W. , Davies M. C. , Giddins G. E. B. , Miles A. W. 
Published: September 2015

Silicone finger arthroplasties are used widely, especially for metacarpophalangeal joint replacement in patients with inflammatory arthritis. Implant failure is well recognized. The rates of failure in vivo differ substantially from experience in vivo. One cause of failure is felt to be post-operative ulnar deviation. The aim of our study was to test the effect of ulnar deviation testing on silicone finger implants. We tested 12 implants in three groups of four implants. The implants were submerged in a bath of Ringer’s solution at 370 °C throughout the experiment and tested in a rig held in 0°, 10° and 20° deviation. The rig was cycled at 1.5 Hz from 0°–90°. The implants were inspected every 500,000 cycles until a total of 4 million cycles. There was consistently increased wear and supination plastic deformity in going from 0°–20° deviation. This study confirms the adverse effects of ulnar deviation on silicone finger implant wear. It is likely that this combines with lateral pinch forces and sharp bone edges to cause catastrophic silicone implant failure. Level of evidence: III
Patterns of HIV-1 Drug-Resistance Mutations among Patients Failing First-Line Antiretroviral Treatment in South India
Authors: Thirunavukarasu Dharmalingam , Udhaya Visvanathan , Iqbal Hussain Syed , Umaarasu Thirunavukarasu 
Published: September 2015

Background: Although highly active antiretroviral therapy has improved the quality of life among HIV-infected people in India, the emergence of drug resistance along with the limited access and affordability to routine monitoring continues to be a challenge worldwide. Methods: The frequency and patterns of HIV-1 drug-resistance mutations among the first-line failing HIV-infected patients attending a hospital in Salem, Tamil Nadu, India, were genotypically analyzed using the online Stanford HIV Database. Results: Of the study patients followed up for 6 months, 23 patients failed first-line therapy and the mutation of I135R/T/V/X, L178 I/M, M184V/I, D67N, K70R, and K103N was most common. Phylogenetic analysis revealed that most of these patients belonged to HIV subtype C. Conclusion: The study documents the frequency of nucleoside reverse transcriptase inhibitor and nonnucleoside reverse transcriptase inhibitor mutations that are prevalent in the first-line failing HIV-infected patients of South Indian region and adds up to the data for developing future algorithms to study the drug-resistance mutations of HIV subtype C. Thus, the results of the study call for the need for rational approach for selecting and for frequent viral monitoring to be performed to detect failure, followed by genotyping.