bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Forced Use on Arm Function in the Subacute Phase After Stroke: A Randomized, Clinical Pilot Study
Authors: Hammer Ann M. , Lindmark Birgitta 
Published: April 2009

Background and Objective: Following stroke, it is common to exhibit motor impairments and decreased use of the upper limb. The objective of the present study was to evaluate forced use on arm function during the subacute phase after stroke.Design: A comparison of standard rehabilitation only and standard rehabilitation together with a restraining sling was made through a randomized, nonblinded, clinical pilot trial with assessments before intervention, after intervention, and at 1- and 3-month follow-ups.Setting: The present study took place at the departments of rehabilitation medicine, geriatrics, and neurology at a university hospital.Participants: A convenience sample of 30 people 1 to 6 months (mean, 2.4 mo) after stroke was randomized into 2 groups (forced-use group and standard training group) of 15 people each. Twenty-six participants completed the 3-month follow-up.Intervention: All participants received their standard rehabilitation program with training 5 days per week for 2 weeks as inpatients or outpatients. The forced-use group also wore a restraining sling on the nonparetic arm with a target of 6 hours per day.Measurements: The Fugl-Meyer (FM) test, the Action Research Arm Test, the Motor Assessment Scale (MAS) (sum of scores for the upper limb), a 16-hole peg test (16HPT), a grip strength ratio (paretic hand to nonparetic hand), and the Modified Ashworth Scale were used to obtain measurements.Results: The changes in the forced-use group did not differ from the changes in the standard training group for any of the outcome measures. Both groups improved over time, with statistically significant changes in the FM test (mean score changed from 52 to 57), MAS (mean score changed from 10.1 to 12.4), 16HPT (mean time changed from &gt;92 seconds to 60 seconds), and grip strength ratio (mean changed from 0.40 to 0.55).Limitations: The limitations of this pilot study include an extended study time, a nonblinded assessor, a lack of control of treatment content, and a small sample size.Conclusions: The results of the present pilot study did not support forced use as a reinforcement of standard rehabilitation in the subacute phase after stroke. Forced use did not generate greater improvements with regard to motor impairment and capacity than standard rehabilitation alone. The findings of this effectiveness study will be used to help design future clinical trials with the aim of revealing a definitive conclusion regarding the clinical implementation of forced use for upper-limb rehabilitation.
Physical Therapists’ Experiences Updating the Clinical Management of Walking Rehabilitation After Stroke: A Qualitative Study
Authors: Salbach Nancy M. , Veinot Paula , Rappolt Susan , Bayley Mark , Burnett Dawn , Judd Maria , Jaglal Susan B. 
Published: April 2009

Background: Little is known about physical therapists’ experiences using research evidence to improve the delivery of stroke rehabilitation.Objectives: The purpose of this study was to explore how physical therapists use research evidence to update the clinical management of walking rehabilitation after stroke. Specific objectives were to identify physical therapists’ clinical questions related to walking rehabilitation, sources of information sought to address these questions, and factors influencing the incorporation of research evidence into practice.Design and Methods: Two authors conducted in-depth telephone interviews with 23 physical therapists who treat people with stroke and who had participated in a previous survey on evidence-based practice. Data were analyzed with a constant comparative approach to identify emerging themes.Results: Therapists commonly raised questions about the selection of treatments or outcome measures. Therapists relied foremost on peers for information because of their availability, ease of access, and minimal cost. Participants sought information from research literature themselves or with the help of librarians or students. Research syntheses (eg, systematic reviews) enabled access to a body of research. Older therapists described insufficient computer and search skills. Most participants considered appraisal and application of research findings challenging and identified insufficient time and peer isolation as organizational barriers to the use of research.Conclusions: Physical therapists require efficient access to research syntheses primarily to inform the measurement and treatment of walking limitation after stroke. Continuing education is needed to enhance skills in appraising research findings and applying them to practice. Older therapists require additional training to develop computer and search skills. Peer networks and student internships may optimize the exchange of new knowledge for therapists working in isolation.
Isolated hepatic tuberculosis
Authors: Jayakumar J 
Published: April 2009

We report a case of carcinoma stomach who had fever of three weeks duration. On evaluation he was detected to have hepatic nodules. It was initially presumed to be due to metastasis. The biopsy of the nodules showed it to be of tubercular in origin. He was treated with antitubercular treatment (ATT) and the fever resolved. Key words: hepatic isolated tuberculosis doi: 10.3126/kumj.v6i3.1721 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 391-392
Stress among medical students of Gorgan (South East of Caspian Sea), Iran
Authors: Marjani A , Gharavi AM , Jahanshahi M , Vahidirad A , Alizadeh F 
Published: April 2009

Objective: This study aims to estimate the prevalence of psychological stress and association between the levels of stress and study variables among Gorgan medical students. Materials and methods: All three year medical students (129 basic sciences students) in Gorgan Faculty of Medicine, Golestan University of medical Sciences, were asked to complete the Kessler 10 questionnaire. Results: The findings showed mild, moderate and severe stress among 26.22%, 20.50% and 14.75% study subjects. 39.35% of medical students had no stress. There was statistically significant association between year of study and stress levels (p= 0.040). Conclusion: The results indicate that there is a decrease in the psychological health of first year medical students. Provided that stress management courses are organised by medical schools, when the students arrive, they will cope up with the stress in coming years. These courses may reduce the negative effects of stress on medical students. By providing such courses and reducing stress level, medical students may improve their medical education. Key words: Medical students, stress, Gorgan doi: 10.3126/kumj.v6i3.1726 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 421-425
Retrospective analysis of management of patients presenting with acute urinary retention due to benign prostatic hyperplasia: A hospital based study
Authors: Pandit RK , Agrawal CS , Chalise PR , Sapkota G 
Published: April 2009

Objectives: To analyze current practice of management of acute urinary retention (AUR) in men above 40 years of age at B.P.Koirala Institute of Health Sciences, Nepal. Materials and methods: A total of 68 patients (aged 50-91 years) presenting with indwelling catheter for AUR were included in the study. Because of lack of clear guideline and limited health care facility in our setup trial without catheter (TWOC) was given selectively depending mainly on preexisting symptoms. AUR presumed to be due to urinary tract infection received only antibiotic and others diagnosed of benign prostatic hyperplasia (BPH) received alfa1 blocker prior to TWOC. TWOC was given 3-15 days after such treatment. Those satisfied without catheter for at least a week were considered successful TWOC. Results: The data was available for 68 patients (mean age 66.1 years). Of 15 patients treated with antibiotic alone, 11 (73.3 %) had successful TWOC. Of 57 with presumptive diagnosis of BPH, 68.9% (31 of 45) had successful TWOC. Mean age, symptom score and prostate volume were higher for patients with unsuccessful TWOC. Conclusion: Selective TWOC may be imperative to minimize unnecessary suffering from AUR in less easily accessible health care facilities like ours. It may also reduce total cost of treatment. Key words: Acute urinary retention, benign prostatic hyperplasia, trial without catheter doi: 10.3126/kumj.v6i4.1733 Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 448-452
Chondrolipoma of tongue
Authors: Goel G , Khadilkar UN , Kumar S 
Published: April 2009

Although lipomas can occur in any part of the body, they are found infrequently in the oral cavity. Variants of lipoma have been described according to the type of tissue present; a lipoma with cartilaginous metaplasia is a chondrolipoma which is a rare variant. We describe a chondrolipoma of tongue in a 36 year old lady. Key words: Tongue, Chondrolipoma doi: 10.3126/kumj.v6i4.1745 Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 505-507
Are we progressing towards elimination of diphtheria, pertusis, tetanus from Nepal?
Authors: Jha N , Kumar S 
Published: April 2009

Diphtheria, Pertussis and Tetanus (DPT) are the vaccine preventable diseases of childhood. The published literatures and reports related to DPT immunization coverage are relatively more than DPT diseases. The striking reduction in deaths and in the incidence of these diseases has been closely associated with the introduction of specific vaccination program. Expanded Program on Immunization (EPI) is a priority program in the country. Nepal has been running country-wide immunization program since 1989. However, there is no doubt that the program has contributed significantly towards reduction of infants and child mortality. Effective and efficient surveillance system and strengthening the routine immunization against DPT are the key steps for elimination of DPT diseases. Key words: DPT, Diphtheria, Pertussis, Tetanus, Immunization, DPT Vaccine, surveillance, vaccine coverage, Nepal. doi: 10.3126/kumj.v6i4.1749 Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 520-525
Risk of neonatal hyperbilirubinemia in babies born to ‘O’ positive mothers: A prospective cohort study
Authors: Kalakheti BK , Singh R , Bhatta NK , Karki A , Baral N 
Published: April 2009

Introduction: Hyperbilirubinemia in a neonate is one of the most common problems that may occur in 60-70 % of term and 80% of preterm babies. It is known to be associated with significant morbidity like neonatal bilirubin encephalopathy and even death. Clinically, and almost exclusively ABO incompatibility occur in ‘A' and ‘B' blood group babies of O ‘+ve' mothers. These babies are reported to be at high risk of severe hyperbilirubinemia (serum bilirubin level more than 16 mg/dl). Objectives: To find out the incidence of hyperbilirubinemia in babies born to ‘O' positive mothers. To estimate the risk of ABO incompatibility in babies born to ‘O' positive mothers. Materials and methods: A prospective cohort study conducted in B. P. Koirala institute of Health Science (Department of Pediatrics and Dept. of Gynae and Obstetric) from July 2002 to June 2003. A total of 199 women having ‘O' positive blood group admitted to the Department of Gynae and Obstetric were included in the study. A piloted proforma was used to collect information. The blood group of neonates was tested by tile and slide method and serum bilirubin was estimated by diazo method in the Central Laboratory Services and Emergency laboratory of BPKIHS. The data was observed and analysis was carried out using statistical software SPSS-10. Results: Total 37 (18.5%) babies had developed hyperbilirubinemia and among them 14 (38%) were from group of babies having ‘O' Positive blood group and 23 (62%) were from group of babies having other than ‘O' Positive blood group. There was 2.6 times higher chance of having hyperbilirubinemia in the babies with ABO incompatibility than ‘O' Positive babies after adjusting other significant variables. Conclusion: Among different significantly associated variables, ABO incompatibility was found to be a major risk factor for neonatal hyperbilirubinemia.It was seen that neonate with ABO incompatibility had two times higher chances of having hyperbilirubinemia than those babies with O ‘+ve' blood group. This finding in BPKIHS suggests that there is a need of screening cord blood bilirubin and continuous monitoring of bilirubin level in the hospital especially among ABO incompatible neonates. Key words: Hyperbilirubinemia, Neonatal Jaundice, ABO-incompatibility doi: 10.3126/kumj.v7i1.1758 Kathmandu University Medical Journal (2009), Vol. 7, No. 1, Issue 25, 11-15
Evaluation of predictive factors for conversion of laparoscopic cholecystectomy
Authors: Gabriel R , Kumar S , Shrestha A 
Published: April 2009

Background: Laparoscopic cholecystectomy has now replaced open cholecystectomy for the treatment of gallbladder diseases. However, certain cases still require conversion to open procedures. This study identifies and evaluates risk factors that may predict conversion from laparoscopic to an open procedure. Objectives: To identify and evaluate the predictive factors for conversion of laparoscopic to open cholecystectomy. Materials and methods: A total of 234 Laparoscopic cholecystectomies were attempted at the Kasturba Medical College Hospital, Manipal, from January 2003 to July 2005. Of these, 61 had to be converted to open cholecystectomy. A retro and prospective analysis of different parameters, including Patient factors, Intra-operative factors and Surgeon factors were performed. Results: Sixty one (26.1%) laparoscopic cholecystectomies required conversion. Factors contributing to conversion included male sex, age group of 31-40 years, over weight and history of biliary pain within last two to four months, ultrasonography findings of multiple calculi and gall bladder wall thickness of more than 3 mm. Intraoperative gall bladder perforation with spillage of its contents in abdominal cavity and dense adhesions with difficult anatomy resulted in higher conversion rates. Surgery performed by surgeons in learning phase of laparoscopic surgery was more prone to conversion. Conclusion: Patient factors, presentation, preoperative ultrasonography findings and surgeon's experience, all contribute to the possibility of conversion of laparoscopic cholecystectomy. Knowledge of these factors may help in preinformation to patient for psychological preparations for conversion and an experienced surgeon can plan to operate on these patients. Key words: Cholecystectomy, laparoscopy, conversion. doi: 10.3126/kumj.v7i1.1761 Kathmandu University Medical Journal (2009), Vol. 7, No. 1, Issue 25, 26-30
Dynamic imaging of a model of intracranial saccular aneurysms using ultra-high-resolution flat-panel volumetric computed tomography
Authors: Mitha Alim P. , Reichardt Benjamin , Grasruck Michael , Macklin Eric , Bartling Soenke , Leidecker Christianne , Schmidt Bernhard , Flohr Thomas , Brady Thomas J. , Ogilvy Christopher S. , Gupta Rajiv 
Published: April 2009

Object
Imaging of intracranial aneurysms using conventional multidetector CT (MDCT) is limited because of nonvisualization of features such as perforating vessels, pulsatile blebs, and neck remnants after clip placement or coil embolization. In this study, a model of intracranial saccular aneurysms in rabbits was used to assess the ultra-high resolution and dynamic scanning capabilities of a prototype flat-panel volumetric CT (fpVCT) scanner in demonstrating these features.

Methods
Ten New Zealand white rabbits underwent imaging before and after clipping or coil embolization of surgically created aneurysms in the proximal right carotid artery. Imaging was performed using a prototype fpVCT scanner, a 64-slice MDCT scanner, and traditional catheter angiography. In addition to the slice data and 3D views, 4D dynamic views, a capability unique to fpVCT, were also created and reviewed. The images were subjectively compared on 1) 4 image quality metrics (spatial resolution, noise, motion artifacts, and aneurysm surface features); 2) 4 posttreatment features reflecting the metal artifact profile of the various imaging modalities (visualization of clip or coil placement, perianeurysmal clip/coil anatomy, neck remnant, and white-collar sign); and 3) 2 dynamic features (blood flow pattern and aneurysm pulsation).

Results
Flat-panel volumetric CT provided better image resolution than MDCT and was comparable to traditional catheter angiography. The surface features of aneurysms were demonstrated with much higher resolution, detail, and clarity by fpVCT compared with MDCT and angiography. Flat-panel volumetric CT was inferior to both MDCT and angiography in terms of image noise and motion artifacts. In fpVCT images, the metallic artifacts from clips and coils were significantly fewer than those in MDCT images. As a result, clinically important information about posttreatment aneurysm neck remnants could be derived from fpVCT images but not from MDCT images. Time-resolved dynamic sequences were judged slightly inferior to conventional angiography but superior to static MDCT images.

Conclusions
The spatial resolution, surface anatomy visualization, metal artifact profile, and 4D dynamic images from fpVCT are superior to those from MDCT. Flat-panel volumetric CT demonstrates aneurysm surface features to better advantage than angiography and is comparable to angiography in metal artifact profile. Even though the temporal resolution of fpVCT is not quite as good as that of angiography, fpVCT images yield clinically important anatomical information about aneurysm surface features and posttreatment neck remnants not attainable with either angiography or MDCT images.
Emergency transorbital ventricular puncture: refinement of external landmarks
Authors: Tubbs R. Shane , Loukas Marios , Shoja Mohammadali M. , Cohen-Gadol Aaron A. 
Published: April 2009

Object
Emergency access to the ventricular system is sometimes necessary for the treatment of raised intracranial pressure with ensuing herniation. One procedure described in the literature is a transorbital approach performed using a spinal needle. Because past publications have been case reports with minimal definition of external landmarks, the present study was performed.

Methods
Five adult cadavers (10 sides) underwent transorbital puncture of the lateral ventricles. This approach was performed following an axial section through the cranium that exposed the lateral ventricular system. Landmarks for the ideal placement of catheters into the ventricular system were then evaluated.

Results
The authors found that the lateral ventricular system was consistently entered just superior to the level of the foramen of Monro by puncturing the roof of the orbit just medial to a midpupillary line, with the trajectory of the perforation aimed 45° from a horizontal line and 15–20° medial to a vertical line.

Conclusions
Although it is uncommon, transorbital ventriculostomy may be used in emergency cases of raised intracranial pressure. Such refined landmarks as described in the present study may be of use to the neurosurgeon.
Withdrawal of life support in critically ill neurosurgical patients and in-hospital death after discharge from the neurosurgical intensive care unit
Authors: Varelas Panayiotis N. , Hacein-Bey Lotfi , Schultz Lonni , Conti Mary , Spanaki Marianna V. , Gennarelli Thomas A. 
Published: April 2009

Object
The aim of this study was to examine the variables influencing the mode and location of death in patients admitted to a neurosurgical intensive care unit (NICU), including the participation of a newly appointed neurointensivist (NI).

Methods
Data from all patients admitted to a university hospital NICU were prospectively collected and compared between 2 consecutive 19-month periods before and after the appointment of an NI.

Results
One thousand eighty-seven patients were admitted before and 1279 after the NI's appointment. The withdrawal of life support (WOLS) occurred in 52% of all cases of death. Death following WOLS compared with survival was independently associated with an older patient age (OR 1.04/year, 95% CI 1.03–1.05), a higher University Hospitals Consortium (UHC) expected mortality rate (OR 1.05/%, 95% CI 1.04–1.07), transfer from another hospital (OR 3.7, 95% CI 1.6–8.4) or admission through the emergency department (OR 5.3, 95% CI 2.4–12), admission to the neurosurgery service (OR 7.5, 95% CI 3.2–17.6), and diagnosis of an ischemic stroke (OR 5.4, 95% CI 1.4–20.8) or intracerebral hemorrhage (OR 5.7, 95% CI 1.9–16.7). On discharge from the NICU, 54 patients died on the hospital ward (2.7% mortality rate). A younger patient age (OR 0.94/year, 95% CI 0.92–0.96), higher UHC-expected mortality rate (OR 1.01/%, 95% CI 1–1.03), and admission to the neurosurgery service (OR 9.35, 95% CI 1.83–47.7) were associated with death in the NICU rather than the ward. There was no association between the participation of an NI and WOLS or ward mortality rate.

Conclusions
The mode and location of death in NICU-admitted patients did not change after the appointment of an NI. Factors other than the participation of an NI—including patient age and the severity and type of neurological injury—play a significant role in the decision to withdraw life support in the NICU or dying in-hospital after discharge from the NICU.