bluuebunny/crossref_metadata_2025_split huggingface dataset:
Late reoperations after acute aortic dissection repair: Single-center experience
Authors: Luciani Nicola , De Geest Raphael , Lauria Giuseppe , Farina Piero , Luciani Marco , Glieca Franco , Massetti Massimo 
Published: May 2015

Background After repair of acute type A aortic dissection, aortic complications can develop, and reoperations might be necessary. In our retrospective study, we wanted to assess early and late outcomes in this cohort of patients. Methods From September 2005 to July 2012, 21 consecutive patients previously operated on for acute type A aortic dissection underwent 27 redo aortic surgical procedures. Indications for redo procedures were: enlargement of the false lumen in the residual aorta (18 events), severe aortic regurgitation with or without aortic root dilatation (8 events), suture dehiscence and pseudoaneurysm at the proximal or distal aortic graft anastomosis (5 events) or at the coronary button anastomosis in patients who previously underwent a Bentall procedure (1 patient). In all cases, total or partial cardiopulmonary bypass was used. Hypothermic cardiocirculatory arrest was needed in 22 (81%) procedures. Results Hospital mortality was 3.7% (1/27), reexploration for bleeding and paraplegia rates were 7.4% and 7.4%, respectively. Marfan patients received 3.2 procedures per patient vs. 1.5 in non-Marfan patients ( p < 0.01). At a mean follow-up of 6.5 years, 2 aortic events occurred: 1 aortic death, and 1 additional aortic redo surgery. Conclusions When procedures are carried out on elective basis, redo aortic surgery can be performed in all segments of the aorta with good early and late outcomes. Close lifelong clinical and radiological follow-up is mandatory. After repair of acute type A aortic dissection, Marfan patients are more prone to develop late complications, with a more rapid evolution.
Early postoperative arrhythmias after pediatric cardiac surgery
Authors: Talwar Sachin , Patel Kartik , Juneja Rajnish , Choudhary Shiv Kumar , Airan Balram 
Published: May 2015

Background This prospective study proposed to determine the incidence, risk factors, and management protocols for early postoperative arrhythmias after pediatric cardiac surgery, with focus on outcomes, using a uniform protocol, and also to see if children operated on at a later age have different issues from those operated on earlier. Methods Of 224 consecutive pediatric patients undergoing cardiac surgery from September 2013 to July 2014, 24 were excluded because their procedures were performed without cardiopulmonary bypass. Results The median age was 24 months (mean 50.1 ± 62.4 months, range 0.5–216 months). Fifteen (7.5%) patients developed arrhythmia, the most common was junctional ectopic tachycardia ( n = 7, 46.6%) followed by supraventricular tachycardia ( n = 5, 33.3%). All junctional ectopic tachycardias occurred within 24 h of intensive care unit admission. Of the 7 patients with junctional ectopic tachycardia, 5 responded to conventional measures and 2 required amiodarone infusion. There was a significant longer cardiopulmonary bypass time in patients with arrhythmias compared to those without arrhythmias. Conclusion We observed a very low incidence of arrhythmias, particularly junctional ectopic tachycardia, after open heart surgery in children. Other than a longer cardiopulmonary bypass time, no specific predictors were identified. It appears that the cause of arrhythmias following pediatric cardiac surgery is multifactorial and needs further study with a greater number of patients.
The impact of colorectal cancer on leisure participation: A narrative study
Authors: Shipp Sarah , McKinstry Carol , Pearson Elizabeth 
Published: May 2015

Introduction The prevalence of cancer is increasing and, with enhanced early detection and treatment, survival rates have also improved. During cancer treatment and survivorship, occupational participation is significantly impacted, with leisure affected. This field has attracted limited research interest however, particularly involving men with colorectal cancer. Symptoms including cancer-related fatigue and pain may reduce ability to engage in usual leisure occupations. Method A qualitative narrative study was conducted to enhance understanding of leisure participation during and following cancer treatment. In-depth interviews were undertaken with four men with colorectal cancer attending for review at a specialist cancer centre. Audio-recorded interview data were transcribed verbatim and thematically analysed. Results All men interviewed reported significant disruption to their usual leisure occupations. Participants described participating in passive leisure occupations during treatment over more active or community-based occupations due to challenges such as having a colostomy bag and fatigue. The men described generally returning to their chosen leisure occupations and the significance this held for their wellbeing. Conclusion Given the impact of colorectal cancer on participation in leisure occupations for men, occupational therapists can assist these men to either resume previous leisure occupations or commence alternative leisure occupations to improve their quality of life.
Implications of DSM-5 for recognising adults with developmental coordination disorder (DCD)
Authors: Purcell Catherine , Scott-Roberts Sally , Kirby Amanda 
Published: May 2015

Introduction The latest edition of the Diagnostic and Statistical Manual of Mental Disorders has attempted to recognise the pervasiveness of developmental coordination disorder across the lifespan. However, it falls short at describing the non-motoric symptomology such as executive functioning, social, emotional and psychiatric difficulties commonly reported in adults. Consequently, at the point of entry the self-reported functional difficulties of an adult with developmental coordination disorder may not be immediately associated with an underlying deficit within a motor domain, potentially resulting in inappropriate referrals. Method This study aimed to explore the reasons why 16 adults without a previous diagnosis of developmental coordination disorder referred themselves for a clinical assessment and consider whether their significant motor difficulties would be apparent. Results The primary self-reported concerns related to executive functioning difficulties, activities of daily living, changes in routine and social interaction and engagement. The least common self-reported concerns included gross motor skills. Conclusion Practitioners at the point of entry need to be mindful that adults with significant motor difficulties may not identify motor difficulties as their primary concern. It is, therefore, important to include screening for motor difficulties and for a future clinical landscape to comprise a referral pathway to adult neurodevelopmental clinics incorporating multidisciplinary teams.
Implementing evidence-based supported employment in Sussex for people with severe mental illness
Authors: van Veggel Rhonda , Waghorn Geoffrey , Dias Shannon 
Published: May 2015

Introduction The aim of this research was to evaluate a large-scale implementation of evidence-based supported employment for people with severe mental illness, at 17 locations throughout Sussex, England. Method A parallel group observational design was used to evaluate an implementation of the individual placement and support approach to supported employment. Three sites provided both a comparison pre-individual placement and support cohort ( n = 140), and a new post-individual placement and support cohort ( n = 107) as part of the individual placement and support implementation ( n = 446). All individual placement and support sites involved community mental health teams forming partnerships with Southdown Supported Employment to co-locate an employment specialist into each mental health team. The primary outcome was the proportion of participants commencing competitive employment during the follow-up period. Results The new individual placement and support sites attained higher fidelity with respect to individual placement and support principles and practices (mean 97 of 125) than the pre-individual placement and support sites (mean 77 of 125). Significantly more individual placement and support participants commenced competitive employment than pre-individual placement and support participants (24.9% vs 14.3%). Individual placement and support participants experienced less delay before commencing their first job (153 vs 371 days), and when employed, worked more hours per week (24.3 vs 15.4 hours). Conclusion This implementation of individual placement and support in Sussex improved on the previous vocational services. Although progress is encouraging there is much room for improvement. More resources appear needed to support programme development, specifically to strengthen site-level management, training, technical support, fidelity assessment, programme monitoring, and outcome evaluation.
Optimising occupational performance through sensory modulation interventions: Case reports of two young adults diagnosed with juvenile Huntington's disease
Authors: Brown Anahita , Fisher Caroline 
Published: May 2015

Statement of context People with juvenile Huntington's disease often experience difficulty engaging in occupations due to neuropsychiatric sequelae, such as impulse control difficulties, agitation and aggression. Occupational therapy using sensory modulation intervention strategies may be utilised to assuage behavioural symptoms in this population. Critical reflection on practice Through case reports, this practice analysis explores changes in occupational performance for two young adults diagnosed with juvenile Huntington's disease who received sensory modulation treatment. Implications for practice These inspiring reports could encourage occupational therapists to consider sensory modulation intervention to decrease psychiatric disturbance, thus optimising performance capacity among this rare population.
Systematic review of the behavioural assessment of pain in cats
Authors: Merola Isabella , Mills Daniel S 
Published: May 2015

Objectives The objectives were to review systematically the range of assessment tools used in cats to detect the behavioural expression of pain and the evidence of their quality; and to examine behavioural metrics (considering both the sensory and affective domains) used to assess pain. Methods A search of PubMed and ScienceDirect, alongside articles known to the authors, from 2000 onwards, for papers in English was performed. This was followed by a manual search of the references within the primary data sources. Only peer-reviewed publications that provided information on the assessment tool used to evaluate the behavioural expression of pain in cats, in conscious animals (not anaesthetised cats), were included. Results No previous systematic reviews were identified. One hundred papers were included in the final assessment. Studies were primarily related to the assessment of pain in relation to surgical procedures, and no clear distinction was made concerning the onset of acute and chronic pain. Ten broad types of instrument to assess pain were identified, and generally the quality of evidence to support the use of the various instruments was poor. Only one specific instrument (UNESP-Botucatu scale) had published evidence of validity, reliability and sensitivity at the level of a randomised control trial, but with a positive rather than placebo control, and limited to its use in the ovariohysterectomy situation. The metrics used within the tools appeared to focus primarily on the sensory aspect of pain, with no study clearly discriminating between the sensory and affective components of pain. Conclusions and relevance Further studies are required to provide a higher quality of evidence for methods used to assess pain in cats. Furthermore, a consistent definition for acute and chronic pain is needed. Tools need to be validated that can detect pain in a range of conditions and by different evaluators (veterinary surgeons and owners), which consider both the sensory and emotional aspects of pain.
Components separation technique is feasible for assisting delayed primary fascial closure of open abdomen
Authors: Rasilainen S. K. , Mentula P. J. , Leppäniemi A. K. 
Published: May 2015

Background and aims: The goal after open abdomen treatment is to reach primary fascial closure. Modern negative pressure wound therapy systems are sometimes inefficient for this purpose. This retrospective chart analysis describes the use of the ‘components separation’ method in facilitating primary fascial closure after open abdomen. Material and methods: A total of 16 consecutive critically ill surgical patients treated with components separation during open abdomen management were analyzed. No patients were excluded. Results: Primary fascial closure was achieved in 75% (12/16). Components separation was performed during ongoing open abdomen treatment in 7 patients and at the time of delayed primary fascial closure in 9 patients. Of the former, 3/7 (43%) patients reached primary fascial closure, whereas all 9 patients in the latter group had successful fascial closure without major complications (p = 0.019). Conclusion: Components separation is a useful method in contributing to successful primary fascial closure in patients treated for open abdomen. Best results were obtained when components separation was performed simultaneously with primary fascial closure at the end of the open abdomen treatment.
Hybrid, Y-configured, dual stent-assisted coil embolization in the treatment of wide-necked bifurcation aneurysms
Authors: Akgul Erol , Balli Tugsan , Aksungur Erol H 
Published: May 2015

In Y-stenting, stabilization of the first stent may be problematic as in some cases it migrates during second stent insertion. This report evaluates the safety and effectiveness of the technique and presents the long-term results of hybrid, Y-configured, dual stent-assisted coil embolization in the treatment of wide-necked bifurcation aneurysms. We retrospectively evaluated the patients treated endovascularly due to cerebral aneurysms. Twenty patients treated with hybrid Y-stent-assisted coil embolization were enrolled in the study. In hybrid stenting, an open-cell intracranial stent (Neuroform) was used as a first stent to prevent stent migration. A closed-cell stent (Enterprise or Acclino) was used as a second stent and the aneurysm was embolized with coils between the stent struts. In all patients, hybrid Y-stenting and coil embolization were accomplished successfully. No stent migration occurred. Clinically, neither symptomatic neurologic complication nor death was seen. Of 20 wide-necked bifurcation aneurysms, nine were at the basilar tip, while seven were at the middle cerebral artery and three at the anterior communicating artery. In one patient, the aneurysm was at the A2-3 junction of the anterior cerebral artery. One of the patients had a subarachnoid hemorrhage. The mean angiographic follow-up was 25.6 months. No in-stent stenosis was seen in any of the patients and recanalization in only one. Hybrid, Y-configured, dual stent-assisted coil embolization is a safe and effective method in the treatment of wide-necked bifurcation aneurysms to prevent stent migration and aneurysm recanalization, and is a viable alternative to microsurgery.
Effect of flow diversion with silk on aneurysm size: A single center experience
Authors: Slater Lee-Anne , Soufan Cathy , Holt Michael , Chong Winston 
Published: May 2015

Alterations in aneurysm size and mass effect can result in alleviation or aggravation of symptoms. We assessed the effects of flow diversion with SILK stents on aneurysm sac size and associated factors. A retrospective evaluation of 14 aneurysms treated with SILK stents alone with MRI follow-up was performed. Aneurysm sac size was measured using the sequence best demonstrating the sac. Aneurysm characteristics and flow-related enhancement on time of flight images were documented. Clinical histories were reviewed for evolution of symptoms. Complete collapse of the aneurysm sac was demonstrated at three and 18 months in 2/14 aneurysms. Increase in size was observed in 2/14 aneurysms with associated persistent flow on time of flight MRA. Blister formation with aggravation of symptoms was observed in one aneurysm, and subsequent decrease in size occurred after treatment with a second SILK. The other aneurysm which increased in size initially continued to enlarge asymptomatically despite retreatment with a second SILK, however at 24 months thrombosis of the sac and decrease in size was observed. The remaining 10/14 aneurysms decreased in size. Nine had corresponding MRA occlusion and the tenth demonstrated decreased but persistent flow on the time of flight MRA. No aneurysm with MRA occlusion increased in size. Decrease in sac size was associated with MRA occlusion in our study. Persistence of flow and blistering were associated with increased sac size. As previously demonstrated flow diversion may be effective in the treatment of large aneurysms presenting with mass effect, however rates of sac obliteration in this small series were not as high as previously reported.
Using a covered stent for large cerebral aneurysms treated with stent-assisted coiling
Authors: Fang Chun , Liu Chuan-Sen , Xiao Ya-ping , Zhao Mei , Zhang Jian-Min , Li Ming-Hua , Zhu Yue-Qi 
Published: May 2015

Purpose The purpose of this article is to evaluate the efficacy and safety of covered stent implantation for large intracranial aneurysms treated with stent-assisted coiling. Materials and methods Seven patients with a cerebral aneurysm were selected for this study. The aneurysms were located at the cavernous segment of the internal carotid artery in three cases, the supraclinoid segment in two and the vertebrobasilar junction in one. Aneurysm diameter was 10–25 mm. Mass effect symptoms occurred in six patients, epistaxis in one and subarachnoid hemorrhage in one. All patients underwent endovascular reconstruction with stent-assisted coiling and a covered stent. Five had undergone conventional endovascular embolization with stent-assisted coiling three to six months previously; the covered stent was then navigated through the existing stent and deployed to cover the aneurysm neck. In two cases, the covered stent was deployed after stent-assisted coiling in a single procedure. Results Angiography showed that all aneurysms were excluded from the circulation and parent arteries were preserved. No technical adverse events occurred. At the one- to two-year follow-up, complete resolution of clinical symptom had occurred in six patients and partial resolution in one. No recurrent aneurysm filling and no hemodynamic stenosis was observed. Conclusion Endovascular reconstruction combining a covered stent with stent-assisted coiling could be an effective and safe strategy for the treatment of large cerebral aneurysms.
Long-term outcomes and factors influencing late survival following elective abdominal aortic aneurysm repair: A 24-year experience
Authors: Khashram Manar , Jenkins Julie S , Jenkins Jason , Kruger Allan J , Boyne Nicholas S , Foster Wallace J , Walker Philip J 
Published: May 2015

Background Abdominal aortic aneurysms can be either treated by an open abdominal aortic aneurysm repair or an endovascular repair. Comparing clinical predictors of outcomes and those which influence survival rates in the long term is important in determining the choice of treatment offered and the decision-making process with patients. Aims To determine the influence of pre-existing clinical predictors and perioperative determinants on late survival of elective open abdominal aortic aneurysm repair and endovascular repair at a tertiary hospital. Methods Consecutive patients undergoing elective abdominal aortic aneurysm repair from 1990 to 2013 were included. Data were collected from a prospectively acquired database and death data were gathered from the Queensland state death registry. Pre-existing risks and perioperative factors were assessed independently. Kaplan–Meier and Cox regression modeling were performed. Results During the study period, 1340 abdominal aortic aneurysms were repaired electively, of which 982 were open abdominal aortic aneurysm repair. The average age was 72.4 years old and 81.7% were males. The cumulative percentage survival rates for open abdominal aortic aneurysms repair at 5, 10, 15 and 20 years were 79, 49, 31 and 22, respectively. The corresponding 5-, 10- and 15-year survival rates for endovascular repair were not significantly different at 75, 49 and 33%, respectively (P = 0.75). Predictors of reduced survival were advanced age, American Society of Anaesthesiology scores, chronic obstructive pulmonary disease, renal impairment, bifurcated grafts, peripheral vascular disease and congestive heart failure. Conclusions Open repair offers a good long-term treatment option for patients with an abdominal aortic aneurysm and in our experience there is no significant difference in late survival between open abdominal aortic aneurysms repair and endovascular repair. Consideration of the factors identified in this study that predict reduced long-term survival for open abdominal aortic aneurysms repair and endovascular repair should be considered when deciding repair of abdominal aortic aneurysm.
Ultrasound determination of rotator cuff tear repairability
Authors: Tse Andrew K , Lam Patrick H , Walton Judie R , Hackett Lisa , Murrell George AC 
Published: May 2015

Background Rotator cuff repair aims to reattach the torn tendon to the greater tuberosity footprint with suture anchors. The present study aimed to assess the diagnostic accuracy of ultrasound in predicting rotator cuff tear repairability and to assess which sonographic and pre-operative features are strongest in predicting repairability. Methods The study was a retrospective analysis of measurements made prospectively in a cohort of 373 patients who had ultrasounds of their shoulder and underwent rotator cuff repair. Measurements of rotator cuff tear size and muscle atrophy were made pre-operatively by ultrasound to enable prediction of rotator cuff repairability. Tears were classified following ultrasound as repairable or irreparable, and were correlated with intra-operative repairability. Results Ultrasound assessment of rotator cuff tear repairability has a sensitivity of 86% ( p < 0.0001) and a specificity of 67% ( p < 0.0001). The strongest predictors of rotator cuff repairability were tear size ( p < 0.001) and age ( p = 0.004). Sonographic assessments of tear size ≥4 cm2 or anteroposterior tear length ≥25 mm indicated an irreparable rotator cuff tear. Conclusions Ultrasound assessment is accurate in predicting rotator cuff tear repairability. Tear size or anteroposterior tear length and age were the best predictors of repairability.