bluuebunny/crossref_metadata_2025_split huggingface dataset:
Variability in discharge instructions and activity restrictions for patients evaluated in a children's emergency department following concussion
Authors: De Maio Valerie J , Joseph Damilola O , Tibbo-Valeriote Holly , Lanier Brian , Register-Mihalik Johna 
Published: March 2013

ObjectiveTo describe discharge instructions given to school-aged patients evaluated in a children's emergency department (ED) following concussion.DesignRetrospective cohort.SettingDedicated children's ED (Level I Trauma Center).PatientsAll children 6–18 years evaluated in 2008 following head trauma regardless of mechanism, identified by any of 16 ICD-9 diagnostic codes for head injury, concussion, or skull fracture (n=350). Included (n=218): presentations consistent with 2008 Zurich consensus definition for concussion. Excluded (n=132): hospital admission, death, intoxication, structural neuroimaging abnormality.Assessment of Risk FactorsAge, gender, mechanism, signs/symptoms.Main Outcome MeasurementsUnivariate and multivariate analyses determined adjusted ORs for receipt ofconcussion-specific discharge instructionsandactivity restrictions.ResultsPatients were mostly male (68%) with mean age 12.8 years (sd=3.4). Injury characteristics included: sport-related 42%, fall 23%, loss of consciousness (LOC) 33%, headache 75%, dizziness 29%, amnesia 25%, vomiting 19%, imaging ordered 81%. Discharge characteristics included: concussion stated in final diagnosis 31%, concussion-specific instructions 62%, activity restrictions 34% (sport-related 42%, non-sport 29%). Concussion-specific instructions were more likely for LOC (OR 1.7, 95% CI 1.22 to 2.36) and activity restrictions more likely for amnesia (OR 1.42, 95% CI 1.01 to 1.98) and sport-related injury (OR 1.31, 95% CI 1.02 to 1.76).ConclusionsMost children meeting diagnostic criteria for concussion were discharged without concussion-specific diagnoses or activity restrictions, even when the injury was sport-related. Given the risks associated with untimely return to both physical and cognitive activity after concussion, improved awareness and standardisation of discharge instructions is imperative for the management of these young patients in the ED.AcknowledgementsWe would like to confirm that none of the authors have any financial or commercial interest in this material.
Concussion and concurrent cognitive and sport-specific task performance in youth ice hockey players: a pilot study
Authors: Reed Nick , Fait Philippe , Perez Olinda Habib , Zabjek Karl , Keightley Michelle L 
Published: March 2013

ObjectiveTo determine the influence of concussion on cognitive performance while completing concurrent sport-specific tasks to further inform return to play protocols for youth athletes.DesignThis descriptive case pilot study compared the performance of youth ice hockey players who had experienced a concussion in the last ice hockey season to non-injured controls.SettingYouth athletes were assessed while performing ice hockey skills in an ice hockey arena.ParticipantsFour male youth ice hockey players who experienced a concussion during the previous ice hockey season (mean age=11.7±0.29 years; mean time since injury=92.5±49.0 days) and nine non-injured control subjects (mean age=11.4±1.0 years).InterventionParticipants completed a randomised combination of four tasks (unobstructed skating, visual interference task, avoiding a fixed obstacle, stickhandling an ice hockey puck).Outcome MeasuresResponse errors and response reaction time dual-task costs during visual interference task (modified Stroop task).ResultsParticipants who experienced a concussion within the past ice hockey season and were ≤58 days post-injury demonstrated significantly poorer cognitive performance (increased dual task cost) across all conditions when performing concurrent sport-specific skills (based on 95% CI).ConclusionsYouth ice hockey players with a more recent concussion demonstrated greater cognitive deficits compared to controls. This study acts as an initial step towards the development of an ecologically valid, sport-specific assessment of functional performance following concussion in youth ice hockey players.AcknowledgementsOntario Neurotrauma Foundation, Quebec Rehabilitation Research Network (ONF-REPAR).Competing interestsNone.
Head impact biomechanics in ski related accident
Authors: Kleiven Svein , Halldin Peter 
Published: March 2013

ObjectiveThe objective of this study was to investigate the need for an updated specification for improved Downhill and Super-G helmet. One important aspect was to understand if the impact situations in the ski slope can generate high rotational accelerations and if so, how can the helmets be designed to absorb both translational and rotational energy.DesignTV footage from 11 accidents during 2008–2010 has been collected by NIH, Oslo. Video analysis of the accidents has been conducted by KTH to quantify the kinematics of the helmeted head during the accidents. The head kinematics from the video analysis was then applied to perform accidents reconstructions by use of the detailed KTH numerical head model, a helmet model and a new model of the impacted ski slope.ResultsThe preliminary results show that impact speeds are higher compared to the velocities used in the current test standard (5.4 m/s). It is also shown that the impact angle is very steep (Around 20° s) compared to the pure vertical impacts (90° impact angle) used in helmet standards. The simulations of the helmeted head impact do show that the rotational forces to the head is large and that the material properties of the snow is important to take into consideration when designing a new helmet standard.Conclusion▸ The test speed should be increased from 5.4 m/s.▸ The rotational accelerations in the simulations are high.▸ The ongoing project aim to answer if the specification of ski helmets needs to take the rotation into account.
Streptococcal pharyngitis in children: a meta-analysis of clinical decision rules and their clinical variables
Authors: Le Marechal Flore , Martinot Alain , Duhamel Alain , Pruvost Isabelle , Dubos François 
Published: March 2013

ObjectiveTo identify the best clinical decision rules (CDRs) for diagnosing group A streptococcal (GAS) pharyngitis in children. A combination of symptoms could help clinicians exclude GAS infection in children with pharyngitis.DesignSystematic review and meta-analysis of original articles involving CDRs in children. The Pubmed, OVID, Institute for Scientific and Technical Information and Cochrane databases from 1975 to 2010 were screened for articles that derived or validated a CDR on a paediatric population: 171 references were identified.SettingAny reference including primary care for children with pharyngitis.Data extractionThe methodological quality of the articles selected was analysed according to published quality standards. A meta-analysis was performed to assess the statistical performance of the CDRs and their variables for the diagnosis of GAS pharyngitis.Primary outcome measureThe main criterion was a false-negative rate in the whole population not any worse than that of a rapid diagnostic test strategy for all patients (high sensitivity and low negative likelihood ratio).Results4 derived and 12 validated CDRs for this diagnosis in children. These articles involved 10 523 children (mean age, 7 years; mean prevalence of GAS pharyngitis, 34%). No single variable was sufficient for diagnosis. Among the CDRs, that of Joachimet alhad a negative likelihood ratio of 0.3 (95% CI 0.2 to 0.5), resulting in a post-test probability of 13%, which leads to 3.6% false-negative rate among low-risk patients and 10.8% overall, equivalent to rapid diagnostic tests in some studies.ConclusionsThe rule of Joachimet alcould be useful for clinicians who do not use rapid diagnostic tests and should allow avoiding antibiotic treatment for the 35% of children identified by the rule as not having GAS pharyngitis. Owing to its poor specificity, such CDR should be used to focus rapid diagnostic tests to children with high risk of GAS pharyngitis to reduce the antibiotic consumption.
The contribution of stress to the comorbidity of migraine and major depression: results from a prospective cohort study
Authors: Swanson Sonja A , Zeng Yiye , Weeks Murray , Colman Ian 
Published: March 2013

ObjectivesTo assess how much the association between migraine and depression may be explained by various measures of stress.DesignNational Population Health Survey is a prospective cohort study representative of the Canadian population. Eight years of follow-up time were used in the present analyses.SettingCanadian adult population ages 18–64.Participants9288 participants.OutcomeIncident migraine and major depression.ResultsAdjusting for sex and age, depression was predictive of incident migraine (HR: 1.62; 95% CI 1.03 to 2.53) and migraine was predictive of incident depression (HR: 1.55; 95% CI 1.15 to 2.08). However, adjusting for each assessed stressor (childhood trauma, recent marital problems, recent unemployment, recent household financial problems, work stress, chronic stress and change in social support) decreased this association, with chronic stress being a particularly strong predictor of outcomes. When adjusting for all stressors simultaneously, both associations were largely attenuated (depression–migraine HR: 1.30; 95% CI 0.80 to 2.10; migraine–depression HR: 1.19; 95% CI 0.86 to 1.66).ConclusionsMuch of the apparent association between migraine and depression may be explained by stress.
DoesCandidaand/orStaphylococcusplay a role in nipple and breast pain in lactation? A cohort study in Melbourne, Australia
Authors: Amir Lisa H , Donath Susan M , Garland Suzanne M , Tabrizi Sepehr N , Bennett Catherine M , Cullinane Meabh , Payne Matthew S 
Published: March 2013

ObjectiveTo investigateCandidaspecies andStaphylococcus aureusand the development of ‘nipple and breast thrush’ among breastfeeding women.DesignProspective longitudinal cohort study.SettingTwo hospitals in Melbourne, Australia (one public, one private) with follow-up in the community.Participants360 nulliparous women recruited at ≥36 weeks’ gestation from November 2009 to June 2011. Participants were followed up six times: in hospital, at home weekly until 4 weeks postpartum and by telephone at 8 weeks.Main outcome measuresCase definition ‘nipple and breast thrush’: burning nipple pain and breast pain (not related to mastitis); detection ofCandidaspp (using culture and PCR) in the mother's vagina, nipple or breast milk or in the baby's mouth; detection ofS aureusin the mother's nipple or breast milk.ResultsWomen with the case definition of nipple/breast thrush were more likely to haveCandidaspp in nipple/breast milk/baby oral samples (54%) compared to other women (36%, p=0.014).S aureuswas common in nipple/breast milk/baby samples of women with these symptoms as well as women without these symptoms (82% vs 79%) (p=0.597). Time-to-event analysis examined predictors of nipple/breast thrush up to and including the time of data collection. Candida in nipple/breast milk/baby predicted incidence of the case definition (rate ratio (RR) 1.87 (95% CI 1.10 to 3.16, p=0.018). We do not have evidence thatS aureuscolonisation was a predictor of these symptoms (RR 1.53, 95% CI 0.88 to 2.64, p=0.13). Nipple damage was also a predictor of these symptoms, RR 2.30 (95% CI 1.19 to 4.43, p=0.012). In the multivariate model, with all three predictors, the RRs were very similar to the univariate RRs. This indicates thatCandidaand nipple damage are independent predictors of our case definition.
Finnish Degenerative Meniscal Lesion Study (FIDELITY): a protocol for a randomised, placebo surgery controlled trial on the efficacy of arthroscopic partial meniscectomy for patients with degenerative meniscus injury with a novel ‘RCT within-a-cohort’ study design
Authors: Sihvonen Raine , Paavola Mika , Malmivaara Antti , Järvinen Teppo L N 
Published: March 2013

IntroductionArthroscopic partial meniscectomy (APM) to treat degenerative meniscus injury is the most common orthopaedic procedure. However, valid evidence of the efficacy of APM is lacking. Controlling for the placebo effect of any medical intervention is important, but seems particularly pertinent for the assessment of APM, as the symptoms commonly attributed to a degenerative meniscal injury (medial joint line symptoms and perceived disability) are subjective and display considerable fluctuation, and accordingly difficult to gauge objectively.Methods and analysisA multicentre, parallel randomised, placebo surgery controlled trial is being carried out to assess the efficacy of APM for patients from 35 to 65 years of age with a degenerative meniscus injury. Patients with degenerative medial meniscus tear and medial joint line symptoms, without clinical or radiographic osteoarthritis of the index knee, were enrolled and then randomly assigned (1 : 1) to either APM or diagnostic arthroscopy (placebo surgery). Patients are followed up for 12 months. According to the prior power calculation, 140 patients were randomised. The two randomised patient groups will be compared at 12 months with intention-to-treat analysis. To safeguard against bias, patients, healthcare providers, data collectors, data analysts, outcome adjudicators and the researchers interpreting the findings will be blind to the patients’ interventions (APM/placebo). Primary outcomes are Lysholm knee score (a generic knee instrument), knee pain (using a numerical rating scale), and WOMET score (a disease-specific, health-related quality of life index). The secondary outcome is 15D (a generic quality of life instrument). Further, in one of the five centres recruiting patients for the randomised controlled trial (RCT), all patients scheduled for knee arthroscopy due to a degenerative meniscus injury are prospectively followed up using the same protocol as in the RCT to provide an external validation cohort. In this article, we present and discuss our study design, focusing particularly on the internal and external validity of our trial and the ethics of carrying out a placebo surgery controlled trial.Ethics and disseminationThe protocol has been approved by the institutional review board of the Pirkanmaa Hospital District and the trial has been duly registered at ClinicalTrials.gov. The findings of this study will be disseminated widely through peer-reviewed publications and conference presentations.Trial registrationClinicalTrials.gov, numberNCT00549172.
Construction of tissue microarrays using pre-existing slides as source of tissue when paraffin blocks are unavailable
Authors: Deng Fang-Ming , Zhao Yan , Kong Xiantian , Lee Peng , Melamed Jonathan 
Published: March 2013

AimTo develop and validate a technique for construction of intermediate density tissue microarray (TMA) slides based on the transfer of tissue from pre-existing routine slides provided for pathology diagnosis with validation to show preservation of morphology and antigenicity of the transferred tissue.MethodsProstate cancer patch TMAs were constructed using 20 cores acquired from radical prostatectomy histology slides. The preservation of morphology and antigenicity of these patch TMAs were tested with immunohistochemistry (IHC) in comparison to a traditional TMA.ResultsAfter IHC staining, 35 of 39 cores (89.7%) on the patch TMA were intact compared with 39 of 40 cores (97.5%) on the traditional TMA. Expression patterns and density of the antigens (34BE12, p63 and AMACR) on the patch TMA were almost identical to the traditional TMA.ConclusionsPatch TMA represents a viable alternative for tissue-based IHC studies when paraffin blocks are unavailable. This may be a valuable tool for allowing use of archival slide material for IHC and enable a standardized TMA platform to be used when the slides sent for review from other institutions are the only source of tissue available.
Novel Therapeutic Strategy to Prevent Chemotherapy-Induced Persistent Sensory Neuropathy By TRPA1 Blockade
Authors: Trevisan Gabriela , Materazzi Serena , Fusi Camilla , Altomare Alessandra , Aldini Giancarlo , Lodovici Maura , Patacchini Riccardo , Geppetti Pierangelo , Nassini Romina 
Published: March 2013

Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a severe and painful adverse reaction of cancer treatment in patients that is little understood or treated. Cytotoxic drugs that cause CIPN exert their effects by increasing oxidative stress, which activates the ion channel TRPA1 expressed by nociceptors. In this study, we evaluated whether TRPA1 acted as a critical mediator of CIPN by bortezomib or oxaliplatin in a mouse model system. Bortezomib evoked a prolonged mechanical, cold, and selective chemical hypersensitivity (the latter against the TRPA1 agonist allyl isothiocyanate). This CIPN hypersensitivity phenotype that was stably established by bortezomib could be transiently reverted by systemic or local treatment with the TRPA1 antagonist HC-030031. A similar effect was produced by the oxidative stress scavenger α-lipoic acid. Notably, the CIPN phenotype was abolished completely in mice that were genetically deficient in TRPA1, highlighting its essential role. Administration of bortezomib or oxaliplatin, which also elicits TRPA1-dependent hypersensitivity, produced a rapid, transient increase in plasma of carboxy-methyl-lysine, a by-product of oxidative stress. Short-term systemic treatment with either HC-030031 or α-lipoic acid could completely prevent hypersensitivity if administered before the cytotoxic drug. Our findings highlight a key role for early activation/sensitization of TRPA1 by oxidative stress by-products in producing CIPN. Furthermore, they suggest prevention strategies for CIPN in patients through the use of early, short-term treatments with TRPA1 antagonists. Cancer Res; 73(10); 3120–31. ©2013 AACR.
Temporal Trends in Treatment and Outcomes for Advanced Heart Failure With Reduced Ejection Fraction From 1993–2010
Authors: Loh John C. , Creaser Julie , Rourke Darlene A. , Livingston Nancy , Harrison Tamara K. , Vandenbogaart Elizabeth , Moriguchi Jaime , Hamilton Michele A. , Tseng Chi-Hong , Fonarow Gregg C. , Horwich Tamara B. 
Published: March 2013

Background—
Randomized trials have demonstrated the efficacy of several new therapies for heart failure (HF) with reduced ejection fraction over the preceding 2 decades. This study investigates whether these therapeutic advances have translated into improvement in outcomes for patients with advanced HF referred to a heart transplant center.

Methods and Results—
Patients with HF (n=2507) referred to a single university center were analyzed in three 6-year eras during which medical and device therapies were evolving: 1993 to 1998 (era 1), 1999 to 2004 (era 2), and 2005 to 2010 (era 3). Impaired hemodynamics and comorbidities were more frequent at time of referral in later eras, whereas other HF severity parameters where similar or improved. Successive eras had greater usage of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, aldosterone antagonists, implantable cardioverter defibrillators, and cardiac resynchronization therapy, consistent with evolving evidence and guideline recommendations over the study period. All-cause mortality and sudden death were significantly lower in era 2 and 3 compared with era 1. After multivariable risk adjustment, era 3 had significantly decreased 2- and 3-year all-cause mortality risk and significantly decreased 1- and 3-year sudden death risk compared with era 1. However, progressive HF death and the combined outcome of mortality/urgent transplant/ventricular assist device were modestly increased in the latter eras.

Conclusions—
Over the past 2 decades, patients with advanced HF referred to and managed at a tertiary university referral center have benefited from advances in HF medications and devices, as evidenced by improvements in overall survival and sudden death risk.
Plantar Medial Wounds Associated With Calcaneal Fractures
Authors: Firoozabadi Reza , Kramer Patricia Ann , Benirschke Stephen Kurt 
Published: March 2013

Background: Calcaneal fractures with open wounds are prone to soft tissue complications. We describe a particular subclass of open injury that occurs on the plantar surface of the foot, medial to the anterior process of the calcaneus, the plantar medial wound (PMW). The purpose of this study was to evaluate soft tissue healing and potential complications in open calcaneal fractures that have a PMW. Methods: We established the time to soft tissue healing and the status of the injured limb of 11 adults with 12 calcaneal fractures with a PMW. This was a retrospective review of prospectively gathered data at a Level I trauma center. Results: Five fractures developed an infection requiring intravenous antibiotics. Two patients required split thickness skin grafts and 1 patient required a free gracilis flap 10 months after injury to treat a chronic open PMW with resolving osteomyelitis and required a below-knee amputation secondary to flap failure. The most commonly associated bony injury with a PMW was a transcalcaneal-talonavicular fracture dislocation (8/13 injuries). Nonunion of the calcaneal fracture occurred in 3 patients. Conclusion: Patients with this type of injury—even those with Gustilo Type I open fractures—need to be apprised that their injury is associated with long-term sequelae, including complications with wound healing, high infection rates, and a higher potential for subsequent amputation than other open hind foot wounds. The Tscherne classification of open wounds should be used in the future. Level of Evidence: Level IV, retrospective case series.
A phase II single-arm study of induction chemotherapy with cisplatin and gemcitabine followed by concurrent cisplatin and gemcitabine with thoracic radiation for unresectable locally advanced non-small cell lung cancer
Authors: Driesen Peter , Lambrechts Marc , Kraaij Kees , Soldatenkova Victoria , Chouaki Nadia , Colinet Benoit 
Published: March 2013

Objectives: The aim of this study was to evaluate the efficacy and tolerability of the combination of cisplatin–gemcitabine with concurrent thoracic radiotherapy for locally advanced non-small cell lung cancer (LA-NSCLC). Methods: This was a phase II, multicenter, open-label, single-arm trial in treatment-naïve patients with stage IIIA and IIIB LA-NSCLC. After three induction cycles with gemcitabine 1250 mg/m2 plus cisplatin 80 mg/m2, two concurrent chemoradiotherapy cycles with gemcitabine 300 mg/m2, cisplatin 80 mg/m2, and radiotherapy (63 Gy) were administered. The primary endpoint was response rate after induction chemotherapy followed by concurrent chemoradiotherapy. Secondary endpoints included time to progressive disease (TtPD), overall survival (OS), and safety. Results: Overall, 49 patients (median age 63.4 years; 73.5% male; Karnofsky performance status scores of 80, 85, 90, and 100 [16.3%, 2.0%, 49.0%, and 32.7%, respectively]; disease stage IIIA or IIIB 28.6% and 71.4%, respectively) were enrolled and treated. Response rate was 38.8% (95% confidence interval [CI] 25.2–53.8%). Median TtPD was 11.4 months (95% CI 9.4–12.9). Median OS was 21.8 months (95% CI 17.5–26.0), with 1- and 2-year survival rates of 70.8% and 43.7%, respectively. Overall, six patients discontinued from study treatment due to adverse events (AEs), of which two were serious AEs. The most relevant grade 3/4 AEs were neutropenia and thrombocytopenia in induction chemotherapy and chemoradiotherapy, and grade 3 events related to radiation in acute chemoradiotherapy, e.g. dysphagia, radiation pneumonitis, and radiation esophagitis. Conclusions: Induction chemotherapy followed by concurrent chemoradiotherapy with gemcitabine (300 mg/m2) and cisplatin was associated with acceptable toxicity. The observed median OS time was 21.8 months. Response evaluation was difficult as in many cases it was not possible to differentiate tumor progression from local radiofibrosis.