bluuebunny/crossref_metadata_2025_split huggingface dataset:
The significance of radiolucent zones surrounding pedicle screws
Authors: Sandén B. , Olerud C. , Petrén-Mallmin M. , Johansson C. , Larsson S. 
Published: April 2004

We examined the radiographs from a prospective clinical study of fixation by pedicle screws and those from an experimental study in a sheep model. In the clinical study, instruments were removed from 21 patients after implantation for 11 to 16 months and the extraction torques of the screws were recorded. A structured protocol was used for the radiological examinations. In the experimental study, loaded pedicle screw instrumentations were implanted in the sheep for six or 12 weeks. After radiological examination the pull-out resistance and the histological characteristics were studied. In the clinical study, all screws with radiolucent zones had a significantly reduced mean extraction torque compared with screws without radiolucent zones (16 ± 10 Ncm v 403 ± 220 Ncm; p < 0.0001). In the experimental study the mean maximum pull-out resistance for the screws with radiolucent zones was significantly lower than for those with no radiolucency (243 ± 156 N v 2214 ± 578 N; p = 0.0006) and the mean bone-to-screw contact was reduced for screws with zones compared with those without zones (8 ± 9% v 55 ± 29%; p = 0.0002). Our findings showed that all screws with radiolucent zones had low extraction torques or low pull-out resistance. A radiolucent zone is a good indicator of loosening of a pedicle screw.
Complex fracture-dislocation of the proximal interphalangeal joint of the hand
Authors: Deshmukh S. C. , Kumar D. , Mathur K. , Thomas B. 
Published: April 2004

We reviewed 13 patients with a complex fracture-dislocation of the proximal interphalangeal joint of a finger and one patient with a complex fracture-dislocation of the interphalangeal joint of thumb. We had treated these injuries using a pins and rubbers traction system which had been modified to avoid friction of the pins against the bone during mobilisation of the joint in order to minimise the risk of osteolysis. A Michigan hand outcome questionnaire was used for subjective assessment. The active range of movement (AROM) of the proximal and distal interphalangeal joints and the grip strength were used for objective assessment. The mean follow-up was 34 months (12 to 49). The mean normalised Michigan hand outcome score was 84. The mean AROM of the proximal interphalangeal joint was 85° and that of the distal interphalangeal joint 48°. The mean grip strength was 92% of the uninvolved hand. Twelve patients have returned to their original occupations. There has been no radiological osteolysis or clinical osteomyelitis. This modified traction system has given acceptable results with a low rate of complications. It is light, cheap, effective and easy to apply.
Curved intertrochanteric varus osteotomy for osteonecrosis of the femoral head
Authors: Sakano S. , Hasegawa Y. , Torii Y. , Kawasaki M. , Ishiguro N. 
Published: April 2004

We reviewed the outcome of curved intertrochanteric varus osteotomy in the treatment of osteonecrosis of the femoral head in 20 hips. A mean varus angulation of 31° was obtained by the osteotomy. The ratio of intact area on the weight-bearing portion increased from 19% to 61%. The mean elevation and lateral displacement of the greater trochanter were 1.2 cm and 0.5 cm, respectively. These changes in the position of the greater trochanter were very small when compared with those after conventional varus wedge osteotomy. Nonunion or delayed union was not observed. Quantitative analyses showed aggressive bone remodelling in the medial intertrochanteric region. Eighteen hips survived without collapse after a mean follow-up of 48 months. We conclude that curved varus osteotomy can be used to preserve the hip joint in patients with osteonecrosis of the femoral head.
A three-dimensional classification for fractures of the proximal humerus
Authors: Edelson G. , Kelly I. , Vigder F. , Reis N. D. 
Published: April 2004

Existing classifications of fractures of the head of the humerus are inadequate in terms of interobserver reliability and the predictability of the clinical outcome. From a combined study of 73 fracture specimens in museums and 84 CT-three-dimensional reconstructions in patients, we have devised a classification which appears to be more useful clinically. Common patterns of fracture and a plausible mechanism of injury were observed. In 3-D most proximal humeral fractures can be organised into five basic types. These correspond in some degree to the Codman/Neer classification, but differ significantly in regard to the more complex patterns of fracture. We observed a logical progression from simple to complex fractures. An interobserver reliability study was carried out which indicated the improved usefulness of this new 3-D concept in providing a common language among clinicians for classifying these injuries. When surgery is indicated, the 3-D concept is also invaluable in guiding the restitution of anatomy through either open or percutaneous means.
Heterotopic ossification of the elbow in patients with burns
Authors: Tsionos I. , Leclercq C. , Rochet J-M. 
Published: April 2004

Heterotopic ossification which may develop around the elbow in patients with burns may lead to severe functional impairment. We describe the outcome of early excision of such heterotopic ossification in 28 patients (35 elbows), undertaken as soon as the patient’s general and local condition allowed. The mean age at operation was 42 years. The mean area of burnt body surface was 49%. The mean pre-operative range of movement was 22° in flexion/extension and 94° in pronation/supination. The mean time between the burn and operation was 12 months with the median being 9.5. The mean follow-up period was for 21 months. At the last review, the mean range of movement was 123° in flexion/extension and 160° in pronation/supination. Clinical evidence of recurrence was seen in four patients, occurring within the first two months after operation. Nevertheless, three of these elbows gained 60° or more in flexion/extension and in pronation/supination. Based on this experience, we recommend early surgical treatment of heterotopic ossification of the elbow in patients with severe burns.
A comparison of polyethylene wear rates between cemented and cementless cups
Authors: McCombe P. , Williams S. A. 
Published: April 2004

We selected randomly a consecutive series of 162 patients requiring hip replacement to receive either a cementless, hemispherical, modular, titanium acetabular cup or a cemented, all-polyethylene cup. These replacements were performed by two surgeons in four general hospitals. The same surgical technique was used and a 26 mm metal-head femoral component was used in every case. After exclusions, 115 hips were studied for differences in rates of wear and osteolysis. The mean clinical follow-up was eight years and the mean radiological follow-up, 6.5 years. The cementless cups wore at a mean rate of 0.15 mm per year and the cemented cups at 0.07 mm per year. This difference was significant (p < 0.0001). Our findings in this mid-term study suggest that cementless cups wear more than cemented cups.
Computer-assisted knee arthroplasty versus a conventional jig-based technique
Authors: Chauhan S. K. , Scott R. G. , Breidahl W. , Beaver R. J. 
Published: April 2004

We have compared a new technique of computer-assisted knee arthroplasty with the current conventional jig-based technique in 70 patients randomly allocated to receive either of the methods. Post-operative CT was performed according to the Perth CT Knee Arthroplasty protocol and pre- and post-operative Maquet views of the limb were taken. Intra-operative and peri-operative morbidity data were collected and blood loss measured. Post-operative CT showed a significant improvement in the alignment of the components using computer-assisted surgery in regard to femoral varus/valgus (p = 0.032), femoral rotation (p = 0.001), tibial varus/valgus (p = 0.047) tibial posterior slope (p = 0.0001), tibial rotation (p = 0.011) and femorotibial mismatch (p = 0.037). Standing alignment was also improved (p = 0.004) and blood loss was less (p = 0.0001). Computer-assisted surgery took longer with a mean increase of 13 minutes (p = 0.0001).
Weakness of extensor hallucis longus after removal of non-vascularised fibula as an autograft
Authors: Shingade V. U. , Jagtap S. M. , Ranade A. B. 
Published: April 2004

The upper three-quarters of the fibula is commonly used as a non-vascularised autograft. Subsequent to this isolated weakness of extensor hallucis longus may occur. We have studied 26 patients in whom the upper and middle thirds of the fibula had been harvested as a graft through Henry’s posterolateral approach. Isolated weakness of extensor hallucis longus was found after operation in ten patients but not in the remainder. EMG and nerve-conduction studies confirmed injury of the nerve to extensor hallucis longus in those with weakness. We dissected 40 cadaver limbs and found that those in which the nerve to extensor hallucis longus ran close to the fibular periosteum were at risk. The injury is mostly incomplete and recovery occurs within four to six months.
Whatever happened to local government?: local labour market policy in the UK and Denmark
Authors: Etherington David , Jones Martin 
Published: April 2004

English
This article builds on the emerging body of work concerned with local state restructuring under New Labour. Set within the context of labour market and welfare state restructuring, we suggest that there is an emerging consensus for a more robust and proactive involvement by local government. The article argues that initiatives for reactivating the local state have been deployed and tested in Denmark, with local government playing a central role in socioeconomic governance. The article unpacks what we term Denmark's ‘welfare-through-work’ model – a policy-making system built around negotiated and inclusive systems of regulation and governance – and then highlights some lessons for re-engaging local authorities in the UK.
State modernisation and local strategic selectivity after Local Agenda 21: evidence from three northern English localities
Authors: Jonas Andrew E.G. , Gibbs David C. , While Aidan 
Published: April 2004

English
Over the last decade all English local authorities have developed strategies for a sustainable local environment in line with Local Agenda 21 (LA21) principles. Under New Labour, local government is being modernised, creating opportunities to advance LA21 from process to strategy. The article examines local environmental governance after LA21 in three local authority areas in northern England: Manchester, Leeds and Lancashire. Drawing on neo-Gramscian state theory and its concept of the spatial selectivity of the national state, emphasis is placed on an actual local politics of environmental policy making vis-à-vis the ideal of ecological modernisation. Local environmental strategies are not only linked to changing national priorities but also reflect the particular economic, environmental and political challenges impacting on decision making in each locality. The concept of local state strategic selectivity is proposed.
Democratic governance and bureaucratic politics: a case of pension reform in Korea
Authors: Yang Jae-jin 
Published: April 2004

English
Governance theories have two theoretical tendencies: downplaying the role of the state and overemphasis on cooperative relationships among participants in the policy-making process. This article seeks to redress the balance by paying more attention to bureaucratic politics and conflicting policy networks, using the case study of Korean pension reform. This orientation enables us to understand the effect of governance not only on relations between the state and civil society, but also on the relative power among state bureaucracies. The Korean case demonstrates that the establishment of democratic governance under the leadership of President Kim Dae Jung reinforces social bureaucrats’ power over the social policy domain, which had long been within the power of economic bureaucrats in the heyday of the Korean developmental state.
The micropolitics of clinical guidelines: an empirical study
Authors: McDonald Ruth , Harrison Stephen 
Published: April 2004

English
This article analyses data from a participant observation study of decision making in local National Health Service institutions, focusing on the construction of local clinical guidelines. We found that guideline construction departed significantly from the ‘bureaucratic-scientific’ model. Although clinical guidelines are often seen as constraining the practice of medicine, our study suggests that there is nothing intrinsically corrosive of professional autonomy about guidelines. It is not likely to be guidelines per se which diminish physician autonomy but rather the manner in which they are implemented. Participation in the guidelines process functioned primarily as a device by which actors hoped to pursue their existing opinions, either through imposing them on others, or by creating a framework of legitimation for themselves.
Charities, civil society and the charity law reviews on the island of Ireland
Authors: O'Halloran Kerry 
Published: April 2004

English
This article considers the opportunity, presented by the coincidence of simultaneous charity law reviews in the two jurisdictions on the island of Ireland, for an adjustment of charity law frameworks to maximise appropriate and effective charitable activity within each jurisdiction, while also facilitating the coordination of some such activity between both. It examines the nature of civil society and charity law, and the relationship between them. The article argues that a creative legislative response to this opportunity could address themes of social inclusion common to both jurisdictions and thereby contribute to the consolidation of civil society on this island.
ELA-max: A New Topical Lidocaine Formulation
Authors: Goldman Ran D 
Published: April 2004

OBJECTIVE To evaluate the role of a new formulation of lidocaine (ELA-max) in local anesthesia in children and compare it with the eutectic mixture of local anesthetics (EMLA). DATA SOURCES Relevant literature was identified by a MEDLINE search (1966—November 2003) using the search terms ELA-max and EMLA. Bibliographies of selected articles were also examined to include all relevant investigations. The product manufacturer was contacted for inclusion of the most recent data available. DATA SYNTHESIS Topical anesthesia in children is clinically challenging. ELA-max has been shown to be as effective as EMLA for venipuncture in children, but with faster onset. Adverse effects, such as transient blanching with redness and erythema, have been reported. CONCLUSIONS Further investigation is needed to determine the effectiveness of ELA-max on other painful procedures in children, as well as its safety.
Drug-Related Problem Classification Systems
Authors: van Mil JW Foppe , Westerlund LO Tommy , Hersberger Kurt E , Schaefer Marion A 
Published: April 2004

OBJECTIVE To provide an overview of and critically appraise classifications of drug-related problems (DRPs) for use during the pharmaceutical care process and research in pharmacy. DATA SOURCES A literature search was conducted using MEDLINE and Yahoo (January 2003) and manually. The search terms included DRP, drug-related problem, drug-therapy problem, and medicine-related problem. STUDY SELECTION AND DATA EXTRACTION English- and German-language articles on pharmaceutical care and DRPs were reviewed. DATA SYNTHESIS Most classifications of DRPs were identified through searching publications on pharmaceutical care and DRPs. Fourteen classifications with different focuses were found. Some classifications were hierarchical, categorized into main groups and subgroups. Various terminologies and definitions for DRPs were revealed, as well as guidelines for an optimal DRP classification. Classifications were assessed according to a clear definition, published validation method, and results reflecting process and outcomes, usability in pharmaceutical care practice, and a hierarchical structure with main groups and subgroups. CONCLUSIONS Finding DRP classifications by computerized search of the biomedical literature with the help of PubMed proved to be difficult. No classification could be found that met all of our criteria for an optimal system. Few classifications have been validated. Three have been tested as to their usability in practice and internal consistency. The Pharmaceutical Care Network Europe system Version 4 comes closest to the defined requirements.
Home Blood Pressure Monitoring: Point-of-Care Testing
Authors: Lopez Larry M , Taylor James R 
Published: April 2004

OBJECTIVE To review the literature regarding point-of-care blood pressure monitoring and describe its role in pharmacy practice. DATA SOURCES Primary articles were identified by a MEDLINE search (1966—May 2003); references cited in these articles provided additional resources. STUDY SELECTION AND DATA EXTRACTION All articles identified from this search were reviewed and all information deemed relevant was included in this article. DATA SYNTHESIS Hypertension is a well-established risk factor for coronary heart disease, the leading cause of death in the US. The use of at-home blood pressure monitors may help improve identification and management of this disorder. Pharmacists may use many of these devices in their practice and are also in an ideal position to provide patient education on the selection and use of these monitors, as well as interpretation of results. CONCLUSIONS The availability of at-home blood pressure devices has considerably increased in recent years and likely will continue to do so. Based on currently available but limited data, fully automated or semiautomated upper-arm devices are preferred over wrist- or finger-cuff devices. These devices are best suited for screening and monitoring only and should not be used for diagnosis. Although such devices are potentially cost-effective, there is presently insufficient evidence to support the notion that their use can replace routine office monitoring.
Compliance with Dosing Guidelines in Patients with Chronic Kidney Disease
Authors: Long Charron L , Raebel Marsha A , Price David W , Magid David J 
Published: April 2004

OBJECTIVE To assess the level of reported compliance with renal dosing guidelines in inpatient, long-term care, and ambulatory settings. DATA SOURCES Available databases (MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness, ACP Journal Club) were searched (1966-December 2002) to identify published literature pertaining to renal dosing guideline compliance in patients with chronic kidney disease. STUDY SELECTION AND DATA EXTRACTION All articles addressing renal dosing guideline compliance in inpatient, long-term care or ambulatory settings were included. Six articles matching our inclusion criteria were reviewed. DATA SYNTHESIS Patients with chronic kidney disease require appropriate medication dosing for disease severity and level of renal function for avoiding adverse drug events, preventing additional renal injury, and optimizing patient outcomes. Consensus-based medication dosing guidelines are readily available and provide initial dose estimations, which can be further individualized based on disease severity and therapeutic response. Studies conducted in hospitals found renal dosing guideline noncompliance rates ranged from 19% to 67%. Limited data in long-term care reported a noncompliance rate of 34%. While published studies concerning compliance to renal dosing recommendations in ambulatory settings are not available, an abstract indicated 69% noncompliance. CONCLUSIONS Based on limited published data, improvements in renal dosing guideline compliance are needed in all settings where data are available. Research is needed to further assess the appropriateness of renal dosing in ambulatory settings and inform quality improvement efforts in all settings.
Proenzyme Forms of Prostate-Specific Antigen in Serum Improve the Detection of Prostate Cancer
Authors: Mikolajczyk Stephen D , Catalona William J , Evans Cindy L , Linton Harry J , Millar Lisa S , Marker Kathy M , Katir Diksha , Amirkhan Anna , Rittenhouse Harry G 
Published: April 2004

AbstractIntroduction: Pro or precursor forms of prostate-specific antigen (PSA) have emerged as potentially important diagnostic serum markers for prostate cancer detection. Immunoassays were developed to measure specific proPSA forms containing propeptides of 2, 4, and 7 amino acids [(-2)proPSA, (-4)proPSA, and (-7)proPSA, respectively].Methods: Research-use dual monoclonal antibody immunoassays using europium-labeled detection monoclonal antibodies were developed for each form of proPSA. Sera from patients with prostate cancer or benign prostate disease containing 4–10 μg/L PSA were assayed and analyzed by area under the ROC curve (AUC) for specificity and sensitivity.Results: The proPSA forms had quantification limits of 0.015–0.025 μg/L in serum, with cross-reactivities &lt;1% with PSA. The sum of the proPSA forms divided by free PSA (percentage proPSA) had a higher AUC than did percentage of (-2)proPSA, free PSA, and complexed PSA with AUC (95% confidence intervals) of 0.69 (0.64–0.74), 0.64 (0.58–0.68), 0.63 (0.58–0.68), and 0.57 (0.51–0.62), respectively. The proPSA comprised a median of 33% of the free PSA in cancer and 25% in noncancer sera (P &lt;0.0001). One-third (33%) of cancer samples had &gt;40% proPSA, whereas only 8% of noncancer samples did (P &lt;0.0001). In men with cancer and &gt;25% free PSA, the (-2)proPSA had an AUC of 0.77 (0.66–0.86), with 90% sensitivity and 36% specificity at 0.04 μg/L.Conclusions: The percentage of proPSA gave better cancer detection in the 4–10 μg/L range than did percentage of free PSA and complexed PSA. (-2)proPSA significantly discriminated cancer in men whose serum had &gt;25% free PSA, for whom there is currently no good marker for cancer detection.
Cationic Van-der-Waals Complexes: Theoretical Study of Ar2H+ Structure and Stability
Authors: Ritschel Thomas , Zülicke Lutz , Kuntz Philip J. 
Published: April 2004

Abstract
The electronic and geometric structure, stability and molecular properties of the cationic van-der-Waals complex Ar2H+ in its ground electronic state are studied by means of two ab-initio quantum-chemical approaches: conventional configuration interaction (multi-reference and coupled-cluster methods) and a diatomics-in-molecules model with ab-initio input data. To ensure consistency between the two approaches, one and the same one-electron atomic basis set (aug-cc-pVTZ by Dunning) is employed in both. The topography of the ground-state potential-energy surface is examined with respect to the nature of the binding and the stability of structures corresponding to stationary points. In accordance with most earlier theoretical work, there are two local minima at linear arrangements: a strongly bound centro-symmetric moiety, (Ar–H–Ar)+, and a weakly bound van-der-Waals complex, Ar···ArH+. These are separated by a low barrier. Only the centro-symmetric molecule is significantly stable (D
e = 0.68eV) against fragmentation into Ar + ArH+ and should have structural and dynamical relevance. A fairly simple diatomics-in-molecules model taking into account only the few lowest electronic fragment states yields a qualitatively correct description of the ground state but shows quantitative deviations from the more accurate configuration-interaction data in detail. Nevertheless, it should provide a good starting point for the treatment of larger complexes Ar
n
H+ with n > 2.