bluuebunny/crossref_metadata_2025_split huggingface dataset:
The treatment of open femoral fractures with bone loss
Authors: Mitchell S. E. , Keating J. F. , Robinson C. M. 
Published: December 2010

The results of the treatment of 31 open femoral fractures (29 patients) with significant bone loss in a single trauma unit were reviewed. A protocol of early soft-tissue and bony debridement was followed by skeletal stabilisation using a locked intramedullary nail or a dynamic condylar plate for diaphyseal and metaphyseal fractures respectively. Soft-tissue closure was obtained within 48 hours then followed, if required, by elective bone grafting with or without exchange nailing. The mean time to union was 51 weeks (20 to 156). The time to union and functional outcome were largely dependent upon the location and extent of the bone loss. It was achieved more rapidly in fractures with wedge defects than in those with segmental bone loss. Fractures with metaphyseal defects healed more rapidly than those of comparable size in the diaphysis. Complications were more common in fractures with greater bone loss, and included stiffness of the knee, malunion and limb-length discrepancy. Based on our findings, we have produced an algorithm for the treatment of these injuries. We conclude that satisfactory results can be achieved in most femoral fractures with bone loss using initial debridement and skeletal stabilisation to maintain length, with further procedures as required.
A critique of revision rate as an outcome measure
Authors: Goodfellow J. W. , O’Connor J. J. , Murray D. W. 
Published: December 2010

National registers compare implants by their revision rates, but the validity of the method has never been assessed. The New Zealand Joint Registry publishes clinical outcomes (Oxford knee scores, OKS) alongside revision rates, allowing comparison of the two measurements. In the two types of knee replacement, unicompartmental (UKR) had a better knee score than total replacement (TKR), but the revision rate of the former was nearly three times higher than that of the latter. This was because the sensitivity of the revision rate to clinical failure was different for the two implants. For example, of knees with a very poor outcome (OKS < 20 points), only about 12% of TKRs were revised compared with about 63% of UKRs with similar scores. Revision therefore is not an objective measurement and should not be used to compare these two types of implant. Furthermore, revision is much less sensitive than the OKS to clinical failure in both types and therefore exaggerates the success of knee replacements, particularly of TKR.
Vastus lateralis muscle flap for infected hips after resection arthroplasty
Authors: Suda A. J. , Heppert V. 
Published: December 2010

We evaluated the potential of a vastus lateralis muscle flap in controlling infection after resection arthroplasty of the hip. We retrospectively reviewed 119 patients with 120 chronic infections after resection arthroplasty treated with this procedure. The flap was fixed with Mitek anchors in the acetabular cavity. The mean duration of infection after resection before the muscle flap procedure was 6.5 months (2 to 13). The patients had previously undergone a mean of 4.9 operations (2 to 25). In all patients the infected cavity was the origin of the persistent infection. The mean follow-up was for 2.6 years (1.0 to 4.7). No patient had recurrent infection post-operatively and all had an improvement in the pain and better quality of life.
Four-limb compartment syndrome associated with the systemic capillary leak syndrome
Authors: Simon D. A. , Taylor T.-L. , Bayley G. , Lalonde K.-A. 
Published: December 2010

Systemic capillary leak syndrome, or the Clarkson syndrome, is an extremely rare condition in which increased capillary permeability results in a massive shift of fluid into the extravascular space. This is followed rapidly by hypotensive shock, haemoconcentration, and, potentially, substantial oedema of the limbs resulting in an acute compartment syndrome. It is important for orthopaedic surgeons to be aware of this syndrome as our medical colleagues, who initially care for these patients, are less familiar with the diagnosis and the need for emergency management of the associated compartment syndrome should it develop. There have been fewer than 100 cases of this entity reported. This case report is the first to describe the subsequent development of a compartment syndrome in all four limbs. Clinical vigilance and continuous monitoring of intracompartmental pressure is necessary in these patients in order to help reduce limb-threatening complications.
Coccydynia
Authors: Nathan S. T. , Fisher B. E. , Roberts C. S. 
Published: December 2010

Coccydynia is a painful disorder characterised by coccygeal pain which is typically exaggerated by pressure. It remains an unsolved mystery because of the perceived unpredictability of the origin of the pain, some psychological traits that may be associated with the disorder, the presence of diverse treatment options, and varied outcomes. A more detailed classification based on the aetiology and pathoanatomy of coccydynia helps to identify patients who may benefit from conservative and surgical management. This review focuses on the pathoanatomy, aetiology, clinical features, radiology, treatment and outcome of coccydynia.
Treatment of Meningitis Caused by Vancomycin-Resistant Enterococcus faecium: High-Dose and Combination Daptomycin Therapy
Authors: Le Jennifer , Bookstaver P Brandon , Rudisill Celeste N , Hashem Mohamed G , Iqbal Raza , James Charles L , Sakoulas George 
Published: December 2010

Objective: To report 3 successful treatments of vancomycin-resistant Enterococcus faecium meningitis in adults using daptomycin and either linezolid or gentamicin. Case Summary: Three case reports involving males (aged 58-78 years) are presented; in each case (trigeminal nerve microvascular decompression and subdural hygroma; paraspinal abscess; and hydrocephalus with subsequent craniotomy and ventriculo-peritoneal shunt placement) CSF examination revealed vancomycin-resistant Enterococcus (VRE) susceptible to daptomycin, gentamicin, and/or linezolid. Three- to four-week treatment regimens with daptomycin 6-12 mg/kg and either gentamicin or linezolid led to clinical resolution and microbiological clearance of infection. Discussion: Daptomycin has previously been shown to be successful in treating methicillin-resistant Staphylococcus aureus–associated meningitis and other serious VRE and enterococcal infections. Higher than approved doses of daptomycin were used in 2 cases where in theory higher CSF concentrations would thus be obtained. Gentamicin and linezolid were added to daptomycin therapy based on in vitro data synergy results and because of documented successful treatment for VRE meningitis, respectively. Conclusions: The difficulty in treating VRE CSF infections involves both drug kinetics and microbial resistance factors, as well as external factors such as foreign bodies like shunts. This report highlighted 3 cases where daptomycin use in concert with either gentamicin or linezolid was successful in treating this infection. Additional controlled trials will be helpful in identifying the best strategies when using daptomycin to treat CSF infections.
Drug Use Practices at Pediatric Hospitals of Khartoum State, Sudan
Authors: Ahmed Anas M , Awad Abdelmoneim I 
Published: December 2010

Background: Irrational drug utilization is a major concern in developing countries. The World Health Organization (WHO) has developed first-level informative indicators in assessing drug use practices and encouraging improvement in the quality of patient care. Objective: To assess the current drug use practices in 4 pediatric teaching hospitals in Khartoum State, and to compare the results with studies conducted in Sudan and other developing countries. Methods: A descriptive, quantitative, and cross-sectional study using the WHO drug use indicators methodology was conducted in the outpatient settings of 4 pediatric hospitals. The study sample was selected using systematic random sampling. In each hospital, prescribing was assessed through a collection of 150 prescriptions, determination of consultation time and dispensing time for 150 patients, and by interview of 150 patients for the evaluation of dispensing practices and parents' knowledge. Results: The mean number of drugs prescribed per prescription was 2.0 (95% CI 1.9 to 2.1); 49.3% (95% CI 46.3 to 52.4) were prescribed by generic name, 81.3% (95% CI 77.9 to 84.3) of prescriptions involved an antibiotic, and 3.5% (95% CI 2.2 to 5.4) of prescriptions were in injection form. The mean consultation and dispensing times were 4.7 minutes (95% CI 4.4 to 5.1) and 28.2 seconds (95% CI 26.5 to 29.9), respectively. The percentage of drugs actually dispensed was 80.1% (95% CI 77.9 to 82.2), 55.7% (95% CI 52.0 to 59.4) of drugs were adequately labeled, and 83.5% (95% CI 80.2 to 86.3) of parents knew the correct dosage of all drugs dispensed for their children. The percentage of availability of key drugs was 81.3% (95% CI 77.1 to 84.9). The essential medicines list was not available at the 4 hospitals. Conclusions: Our findings reveal problem areas in prescribing and dispensing practices in pediatric hospitals. Further in-depth quantitative research to answer the shortcomings of this study and cost-effective multifaceted interventions to improve current drug use practices are highly needed to secure the quality of medical care in pediatric hospitals.
Genetics of Type 2 Diabetes
Authors: Ahlqvist Emma , Ahluwalia Tarunveer Singh , Groop Leif 
Published: December 2010

BACKGROUND
Type 2 diabetes (T2D) is a complex disorder that is affected by multiple genetic and environmental factors. Extensive efforts have been made to identify the disease-affecting genes to better understand the disease pathogenesis, find new targets for clinical therapy, and allow prediction of disease.

CONTENT
Our knowledge about the genes involved in disease pathogenesis has increased substantially in recent years, thanks to genomewide association studies and international collaborations joining efforts to collect the huge numbers of individuals needed to study complex diseases on a population level. We have summarized what we have learned so far about the genes that affect T2D risk and their functions. Although more than 40 loci associated with T2D or glycemic traits have been reported and reproduced, only a minor part of the genetic component of the disease has been explained, and the causative variants and affected genes are unknown for many of the loci.

SUMMARY
Great advances have recently occurred in our understanding of the genetics of T2D, but much remains to be learned about the disease etiology. The genetics of T2D has so far been driven by technology, and we now hope that next-generation sequencing will provide important information on rare variants with stronger effects. Even when variants are known, however, great effort will be required to discover how they affect disease risk.
Supportive Leadership: Improving Organisational Health and Preventing Burnout in Pastoral Care Managers and Staff
Authors: Stebbins Peter , Lees Danielle , Ham David , Karabitsios Joanne 
Published: December 2010

AbstractThis study examined the efficacy of an evidence based supportive leadership program to address psychosocial hazards identified in an organisational health review of a pastoral care organisation. Participants were employees and volunteers identified as having supervisory or management roles (N= 24;M= 11,F= 13; Age Range = 24 to 68), including the Senior Leadership Team (SLT;n= 7). The supportive leadership program was implemented over a 12-month period with follow-up over another 12-month period. Organisational health was measured through the use of the Health and Safety Executive Indicator Tool (HSE, 2004b) and qualitative interview data at pre-intervention and at 12- and 24-month follow-up. The results of the HSE Tool were compared over time, utilising the comparison benchmarks provided by the HSE (2004b). Results indicated notable improvements in organisational health within the SLT with reductions in risk status at 24-month follow-up across the domains of Control, Managerial Support, Peer Support, Relationships, Role and Change. Supportive leadership is a key predictor in organisational health and burnout, and importance in improving organisational health across managers.
The quality of the extra-analytical phase of laboratory practice in some developing European countries and Mexico – a multicentric study
Authors: Simundic Ana-Maria , Bilic-Zulle Lidija , Nikolac Nora , Supak-Smolcic Vesna , Honovic Lorena , Avram Sanja , Beregovaja Elena , Dobreanu Minodora , Guimaraes Joao-Tiago , Kovacs Gabor L. , Singh Nada Majkic , Sierra-Amor Rosa Isabel , Sypniewska Grazyna , Zima Tomas 
Published: December 2010

Abstract

Background: This cross-sectional multicentric survey study aimed to assess the quality of the extra-analytical phase of laboratory activities in some developing European countries and Mexico. We assessed the quality of the extra-analytical practices in participating laboratories regarding the: a) sample acceptance criteria; b) phlebotomy procedures; c) test results reporting and d) recording non-conformities.

Methods: A survey was performed during the April–May 2009. A total of 15 clinical laboratories from the following countries were included: Bosnia, Croatia, Czech Republic, Hungary, Mexico, Poland, Portugal, Romania, Serbia and Ukraine. Questions were scored (scores from 1–4) and average scores was calculated for each category.

Results: The overall score for all respondents (n=443) was 3.10±0.33. The average score was 3.11±0.56 for sample acceptance criteria, 2.76±0.58 for phlebotomy and 3.34± 0.53, for test results reporting (F=116.49; p<0.001). Laboratory accreditation was associated with better practices and higher overall quality of the extra-analytical procedures (F=16.62; p<0.001). Moreover, the highest scores for sample acceptance criteria (F=8.32; p<0.001), phlebotomy procedures (F=13.28; p<0.001) and for reporting non-conformities (F=33.62; p<0.001) were observed for accredited laboratories or laboratories under preparation for accreditation.

Conclusions: The overall quality of the extra-analytical practices in countries in this survey is not satisfactory. Phlebotomy practices are the most critical extra-analytical activity. Since laboratory accreditation was associated with better practices and higher overall quality of the extra-analytical procedures, we believe that the most significant improvement could be made by implementing the total quality management system and standardizing laboratory procedures.
The Toll-Like Receptor-3 Agonist Polyinosinic:Polycytidylic Acid Triggers Nigrostriatal Dopaminergic Degeneration
Authors: Deleidi Michela , Hallett Penelope J. , Koprich James B. , Chung Chee-Yeun , Isacson Ole 
Published: December 2010

In Parkinson's disease (PD), loss of striatal dopaminergic (DA) terminals and degeneration of DA neurons in the substantia nigra (SN) are associated with glial reactions. Such inflammatory processes are commonly considered an epiphenomenon of neuronal degeneration. However, there is increasing recognition of the role of neuroinflammation as an initiation factor of DA neuron degeneration. To investigate this issue, we established a new model of brain inflammation by injecting the Toll-like receptor 3 (TLR-3) agonist polyinosinic:polycytidylic acid [poly(I:C)] in the SN of adult rats. Poly(I:C) injection induced a sustained inflammatory reaction in the SN and in the dorsolateral striatum. Significant changes were detected in proteins relevant to synaptic transmission and axonal transport. In addition, cytoplasmic mislocalization of neuronal TAR DNA binding protein TDP-43 was observed. Poly(I:C) injection increased the susceptibility of midbrain DA neurons to a subsequent neurotoxic trigger (low-dose 6-hydroxydopamine). Systemic delivery of interleukin-1 receptor antagonist protected SN DA neurons exposed to combined poly(I:C) induced inflammatory and neurotoxic oxidative stress.These data indicate that viral-like neuroinflammation induces predegenerative changes in the DA system, which lowers the set point toward neuronal dysfunction and degeneration. New powerful neuroprotective therapies for PD might be considered by targeting critical inflammatory mechanisms, including cytokine-induced neurotoxicity.
Health Inequity in Children and Youth With Chronic Health Conditions
Authors: Berry Jay G. , Bloom Sheila , Foley Susan , Palfrey Judith S. 
Published: December 2010

BACKGROUND:Over the last decades, there have been great advances in health care delivered to children with chronic conditions, but not all children have benefitted equally from them.OBJECTIVES:To describe health inequities experienced by children with chronic health conditions.METHODS:We performed a literature review of English-language studies identified from the Medline, Centers for Disease Control and Prevention, National Cancer Institute, and Cystic Fibrosis Foundation Web sites that were published between January 1985 and May 2009, included children aged 0 to 18 years, and contained the key words “incidence,” “prevalence,” “survival,” “mortality,” or “disparity” in the title or abstract for the following health conditions: acute leukemia, asthma, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders, cerebral palsy, cystic fibrosis, diabetes mellitus, Down syndrome, HIV/AIDS, major congenital heart defects, major depressive disorder, sickle cell anemia, spina bifida, and traumatic brain injury.RESULTS:Black children had higher rates of cerebral palsy and HIV/AIDS, were less likely to be diagnosed with ADHD, had more emergency department visits, hospitalizations, and had higher mortality rates associated with asthma; and survived less often with Down syndrome, type 1 diabetes, and traumatic brain injury when compared with white children. Hispanic children had higher rates of spina bifida from Mexico-born mothers, had higher rates of HIV/AIDS and depression, were less likely to be diagnosed with ADHD, had poorer glycemic control with type 1 diabetes, and survived less often with acute leukemia compared with white children.CONCLUSIONS:Serious racial and ethnic health and health care inequities persist for children with chronic health conditions.
Hispanic Children With Special Health Care Needs From Spanish-Language Households
Authors: Blumberg Stephen J. , Read Debra , Avila Rosa M. , Bethell Christina D. 
Published: December 2010

OBJECTIVES:
We examined the specific health care needs of Hispanic children with special health care needs (CSHCN) from Spanish-language households, and we compared the needs for children in this group to those for Hispanic and non-Hispanic white CSHCN from English-language households.

METHODS:
We estimated the prevalence of parent-reported health care needs, health conditions, and functional characteristics by using data from the 2001 and 2005–2006 National Survey of Children With Special Health Care Needs. We used bivariate and multivariate methods to describe the relationship between ethnicity, language, and the demographic, socioeconomic, and health characteristics of CSHCN.

RESULTS:
Between 2001 and 2005–2006, the prevalence of special health care needs increased significantly among Hispanic and non-Hispanic white children from English-language households but not among Hispanic children from Spanish-language households. In 2005–2006, Hispanic children from Spanish-language households were only one-third as likely as other children to be identified as CSHCN. Relative to both Hispanic and non-Hispanic white CSHCN from English-language households, Hispanic CSHCN from Spanish-language households had a higher prevalence of several developmentally related conditions and of functional difficulties related to gross and fine motor coordination, self-care, speech, and communication but had a lower prevalence of attention-deficit/hyperactivity disorder. Lower use of prescription medications was significantly associated with Hispanic ethnicity (regardless of household language) even after we controlled for demographic and socioeconomic differences.

CONCLUSIONS:
Hispanic CSHCN from Spanish-language households are distinct from other CSHCN, and stratifying the Hispanic population by using primary household language can reveal important differences in the health and functioning characteristics of Hispanic CSHCN.
Transition Planning for Youth With Sickle Cell Disease: Embedding Neuropsychological Assessment Into Comprehensive Care
Authors: Wills Karen E. , Nelson Stephen C. , Hennessy Jane , Nwaneri M. Osita , Miskowiec Joyce , McDonough Elizabeth , Moquist Kristin 
Published: December 2010

OBJECTIVE:
Sickle cell disease (SCD) conveys a high risk of neuropsychological impairment due to chronic anemia, hypoxemia, cerebrovascular ischemia and stroke, in addition to causing pain and other biomedical complications. Few families accessed neuropsychological testing via the traditional referral system. In this paper, we describe a successful alternative strategy for addressing cognitive and behavioral needs of youth with SCD.

METHOD:
The Sickle Cell Disease Program for Learning and Neuropsychological Evaluation (SCD-PLANE) was embedded in 2007 into the SCD Comprehensive Clinic of Children's Hospitals and Clinics of Minnesota. SCD-PLANE includes brief neuropsychological testing, individualized recommendations, patient education and advocacy, interdisciplinary collaboration, and follow-through to assure patients' access to recommended resources. The purpose of SCD-PLANE is to identify and recommend interventions for cognitive, academic, emotional, behavioral, or social problems affecting child development and transition to adulthood.

RESULTS:
Access to neuropsychological testing improved dramatically and is well accepted by SCD patients and families. Test results reveal increased risk of problems with executive function, speed of processing, graphomotor function, academic achievement, and parent-reported anxious/depressed symptoms, despite normal intelligence and language abilities. Patients' needs had not been previously identified or served by schools or other community agencies.

CONCLUSIONS:
The SCD-PLANE, providing brief neuropsychological testing embedded within routine annual visits to SCD Comprehensive Clinic, is an effective approach to detect unmet developmental, educational, and behavioral needs within an underserved high-risk population. As youth move towards adulthood, considering cognitive, academic, and mental health status facilitates successful health care transitions.
Residency Training in Transition of Youth With Childhood-Onset Chronic Disease
Authors: Patel Manisha S. , O'Hare Kitty 
Published: December 2010

OBJECTIVE:
To assess the current medical school training of internal medicine and pediatric residents in transitioning youth with special health care needs from child-oriented to adult-oriented health care.

METHODS:
We surveyed internal medicine and pediatric residents to assess their preparedness to transition youth with special health care needs to adult-oriented health care.

RESULTS:
The survey results demonstrated that internal medicine residents felt unprepared to care for most patients with chronic childhood-onset illness; however, most pediatric residents were comfortable caring for such patients.

CONCLUSION:
Training in chronic childhood-onset illness should be included in internal medicine training programs.