bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Randomized Preference Trial Comparing Cognitive-Behavioral Therapy and Yoga for the Treatment of Late-Life Worry: Examination of Impact on Depression, Generalized Anxiety, Fatigue, Pain, Social Participation, and Physical Function
Authors: Danhauer Suzanne C. , Miller Michael E. , Divers Jasmin , Anderson Andrea , Hargis Gena , Brenes Gretchen A. 
Published: May 2022

Background Depression, generalized anxiety, fatigue, diminished physical function, reduced social participation, and pain are common for many older adults and negatively impact quality of life. The purpose of the overall trial was to compare the effects of cognitive-behavioral therapy (CBT) and yoga on late-life worry, anxiety, and sleep; and examine preference and selection effects on these outcomes. Objective The present analyses compared effects of the 2 interventions on additional outcomes (depressive symptoms, generalized anxiety symptoms, fatigue, pain interference/intensity, physical function, social participation); and examined whether there are preference and selection effects for these treatments. Methods A randomized preference trial of CBT and yoga was conducted in adults ≥60 years who scored ≥26 on the Penn State Worry Questionnaire-Abbreviated (PSWQ-A), recruited from outpatient medical clinics, mailings, and advertisements. Cognitive-behavioral therapy consisted of 10 weekly telephone sessions. Yoga consisted of 20 bi-weekly group yoga classes. Participants were randomized to(1): a randomized controlled trial (RCT) of CBT or yoga (n = 250); or (2) a preference trial in which they selected their treatment (CBT or yoga; n = 250). Outcomes were measured at baseline and post-intervention. Results Within the RCT, there were significant between-group differences for both pain interference and intensity. The pain interference score improved more for the CBT group compared with the yoga group [intervention effect of (mean (95% CI) = 2.5 (.5, 4.6), P = .02]. For the pain intensity score, the intervention effect also favored CBT over yoga [.7 (.2, 1.3), P < .01]. Depressive symptoms, generalized anxiety, and fatigue showed clinically meaningful within-group changes in both groups. There were no changes in or difference between physical function or social participation for either group. No preference or selection effects were found. Conclusion Both CBT and yoga may be useful for older adults for improving psychological symptoms and fatigue. Cognitive-behavioral therapy may offer even greater benefit than yoga for decreasing pain.
Efficacy of unloader knee orthosis and lateral wedge insole on static balance in medial knee osteoarthritis
Authors: Dwarakanathan Raagavi , Mohanty Rajesh Kumar , Sahoo Swapna , Prasad Sakti 
Published: May 2022

Background Medial knee osteoarthritis can contribute to pain and stiffness, interfere with balance and limit functional activities of daily living. Unloader knee orthosis or lateral wedged insoles are current conservative approaches used to treat these conditions. The aim of this study was to identify and compare the effects of them on the balance parameters. Methods 66 subjects with mild to moderate medial knee osteoarthritis were randomly assigned to wear unloader knee brace or full-length 6° lateral wedge insole. Primary outcome balance parameters were stability %, path length and average velocity of center of pressure and mobility score which were investigated by HUMAC® Balance and Tilt system. Secondary outcome measures were knee function score using Knee Injury and Osteoarthritis Outcome Score scale. Assessment was performed at baseline and six months post orthotic intervention period. Findings Both orthoses improved all parameters compared to the baseline condition (p < 0.05). Unloader knee orthosis showed a significant improvement in all balance parameters compared to lateral wedged insoles (p < 0.001) except mobility scores (p = 0.527). Except activities of daily living (p = 0.752) and sports and recreational activities (p = 0.437), unloader knee orthosis had a greater effect on the pain (p = 0.002) and symptoms (p < 0.001) sub scales than lateral wedged insoles. However, quality of life sub-scale scores for insoles were more effective than the knee orthosis. Interpretation Unloader knee orthosis improved balance and knee function scores more than lateral wedged insole, though both orthoses produced significantly improved results compared to baseline assessment.
Outcomes of Anterior Cruciate Ligament Reconstruction in Patients Older Than 50 Years and Younger Than 30 Years
Authors: Weng Chun-Jui , Yang Cheng-Pang , Yeh Wen-Ling , Hsu Kuo-Yao , Chang Shih-Sheng , Chiu Chih-hao , Chen Alvin Chao-yu , Chan Yi-Sheng 
Published: May 2022

Background: Few studies have compared the outcomes of anterior cruciate ligament (ACL) reconstruction between older patients and younger patients. Purpose: To evaluate the clinical and functional outcomes of ACL reconstruction with autologous hamstring tendon in patients >50 years and <30 years. It was hypothesized that the outcomes would be comparable between these age groups. Study Design: Cohort study; Level of evidence, 3. Methods: Patients >50 years (older group) or <30 years (younger group) who underwent ACL reconstruction surgery with autologous hamstring tendon between 2012 and 2015 at the authors’ hospital were retrospectively enrolled in this study. All patients had a minimum of 2 years of follow-up. Intraoperative findings, including cartilage and meniscal injury, were recorded, and clinical and functional outcomes were evaluated using the International Knee Documentation Committee (IKDC), Lysholm, and Tegner activity scores. We used the paired-samples t test for statistical analysis between the 2 age groups. Results: A total of 67 patients and 459 patients were included in the older and younger groups, respectively. Both groups achieved significant preoperative to postoperative improvement in IKDC (older group, from 41.4 to 88.9; younger group, from 49 to 91.2), Lysholm (older group, from 49.8 to 86.1; younger group, from 50.2 to 91.8), and Tegner (older group, from 2.7 to 4.4; younger group, from 4.6 to 6.9) ( P < .05 for all) scores. The change in Tegner score from preinjury to postoperatively was not statistically significant in the older group (from 4.5 to 4.4; P = .471), although it was significant in the younger group (from 7.5 to 6.9; P < .05). No between-group differences were noted in preoperative or postoperative IKDC or Lysholm scores. Both age groups reached a high rate of return to sports activity, and no major complications or ACL retears were noted in either group. Conclusion: Comparable results after ACL reconstruction were achieved in patients >50 years compared with patients <30 years, with a high rate of return to sports activity and a low rate of complications at the 2-year follow-up. The younger group returned to a higher Tegner score, while the older group did not.
Cryoneurolysis for Digital Neuralgia in Professional Baseball Players: A Case Series
Authors: Shaffer Johnathon P. , Williams Vernon B. , Shin Steven S. 
Published: May 2022

Background: Thumb injuries are common in baseball players and can sometimes be challenging to effectively manage. A subset of patients experience failed nonoperative management yet do not have a clear indication for surgery. Cryoneurolysis or cryoanalgesia is a form of neuromodulation for pain that has been approved by the US Food and Drug Administration; it has been used safely and effectively on a variety of peripheral nerves. The mechanism of action involves percutaneous introduction of a small probe under local anesthetic to nerve tissue using ultrasound guidance. The probe is then cooled to –88°C using nitrous oxide, which results in secondary Wallerian degeneration. Axonal and myelin regeneration occurs completely in 3 to 6 months. Purpose: To describe a nonsurgical approach to refractory digital neuralgia using cryoneurolysis in a series of professional baseball players. Study Design: Case series; Level of evidence, 4. Methods: Included were 3 professional baseball players, each presenting with thumb pain in his top batting hand refractory to nonoperative modalities. Visualization of the superficial radial sensory and ulnar digital nerves was obtained using ultrasound. The skin was prepared in sterile fashion. A 22-gauge, 1.5-inch (3.8-cm) needle was then advanced using ultrasound guidance, and local anesthetic was applied. Both treatment sites were marked using a skin marker. Cryoneurolysis was performed using a 5-mm tip, and 60-second treatment cycles were performed at each site. Each of the cycles resulted in a roughly 5 × 7–mm lesion visible as hypoechoic signal. Results: All 3 players endorsed significant and prolonged relief and were able to return to an elite level of play. Conclusion: Study findings indicated marked efficacy and safety of using cryoneurolysis of the ulnar digital nerve and the superficial radial sensory nerve in a small group of elite baseball players with refractory digital neuralgia.
Biomechanical Testing of Scapular Spine Autograft for Anterior Glenoid Bone Augmentation
Authors: Mittelsteadt Marcus , Nelson Bradley J. , Rohman Eric M. , Arciero Robert A. , Tompkins Marc A. 
Published: May 2022

Background: Augmentation of anterior glenoid defects with bone graft can improve shoulder stability and reduce the risk of redislocation. Several characteristics of the scapular spine may make it a suitable harvest site, avoiding the disadvantages associated with other glenoid augmentation procedures. Purpose: To evaluate the capacity of scapular spine autograft to restore the stabilizing joint-reaction forces of the shoulder in simulated scenarios of bony anterior shoulder instability. Study Design: Controlled laboratory study. Methods: We obtained 6 matched pairs of fresh-frozen cadaveric shoulders. Skin, subcutaneous tissues, and non–rotator cuff muscles were removed from the specimens, leaving intact the rotator cuff musculature and shoulder capsule. A customized testing device was used to translate the humerus 1 cm anteriorly on the glenoid under 25 N of axial compression force. The peak joint-reaction force of the glenohumeral joint was then measured under 3 conditions: (1) specimen with intact glenoid, (2) specimen after a bone defect measuring 25% of the maximal width of the glenoid was made in the anteroinferior glenoid, and (3) specimen after size-matched glenoid augmentation with a scapular spine tricortical autograft. The primary outcome was the change in peak joint-reaction forces between the defect state and augmented state. Results: One matched pair was removed from final analysis secondary to anatomic concerns that undermined the accuracy of test results. Among the 10 remaining specimens, all showed a significant decrease in peak joint-reaction force after the glenoid defect was created compared with the intact state ( P < .001). All remaining specimens showed an increase in peak joint-reaction force in the augmented state compared with the defect state ( P < .001). On average, the augmented state restored 81% of the peak reaction force of the glenohumeral joint compared with the intact state, a nonsignificant difference ( P = .07). Conclusion: The study findings indicated that autograft harvested from the scapular spine increased the bony restraint to anterior shoulder dislocation in shoulders with glenoid bone loss. Clinical Relevance: The scapular spine is an alternative for bony augmentation of glenoid defects in shoulder instability.
Prevalence of Computer Use among Geriatric In- and Outpatients
Authors: Jørgensen Bodil B. , Damsgaard Else Marie , Simonsen Mia M. , Gregersen Merete 
Published: May 2022

Objective: Despite its many benefits, tele-rehabilitation is not widely used by the older generations. This study aimed to investigate the opportunity to offer tele-rehabilitation in a geriatric population by determining the prevalence of computer use and to examine whether the patients’ characteristics affect computer use. Design: Cross-sectional study. Patients: Cognitive well-functioning in- and outpatients aged 65 years or older. Methods: Patients were consecutively included and surveyed. Results: A total of 249 patients participated in the survey. Among them, 124 were computer users. Four of these never went online. Compared to non-users, computer users were younger OR: 0.91 (95% CI: 0.87; 0.94) p = 0.001, less frail OR: 0.37 (95% CI: 0.25;0.55) p = 0.001, had a higher functional capacity OR: 1.02 (95% CI 1.01; 1.03) p = 0.001 and more often had an education at high school level or higher OR: 1.7 (95% CI: 1.41; 2.40). Conclusion: Only half of the geriatric patients are computer users. If tele-rehabilitation is to be adopted by a wider geriatric population challenged by reduced mobility, long transportation times, or frailty, computer training, user friendly devices and computer support should be considered beforehand.
Midwives Experiences of Managing Clients with Eclampsia in a low Resource Setting: A Qualitative Descriptive Study
Authors: Dartey Anita Fafa , Dzansi Gladys , Lotse Comfort Worna , Obuobisa Racheal , Afua Bosu Celestine Emefa , Afaya Agani 
Published: May 2022

Objective Eclampsia remains a public health issue, especially in low-resource countries worldwide. Midwives are the backbone of the pregnancy and delivery process. Midwives trained in the necessary knowledge and skills are more likely to notice early warning signals of preeclampsia and immediately help clients in such emergencies. This study explored midwives’ experiences in managing patients with eclampsia in Ghana. Methods This study was conducted among eight registered midwives at maternity units of two district hospitals in the Eastern Region of Ghana, using an exploratory, descriptive qualitative research design. A purposive sampling technique was adopted to select and interview participants. Interviews were audio-recorded, transcribed, and analyzed using qualitative thematic analysis. The right of participation and withdrawal from the study was respected. Findings The three emerged overriding themes are: 1. Midwives have knowledge (warning signs, regimens, and prevention of complications) about the management of eclampsia. 2. Challenges in managing clients included inadequate equipment, staffing, and access to drugs. 3. Strategies for mitigating barriers to care for women with eclampsia (adherence to protocols, teamwork, peer mentoring and supervision, midwives’ attitude, and client education. Conclusion Midwives working in underserved facilities have the knowledge and skill to monitor and manage pregnant women experiencing eclampsia. However, they need to be supported with appropriate resources and advanced equipment to ensure adherence to protocols on managing eclampsia promptly referred. Continuous training and workshops for midwives in the management of hypertension in pregnancy are recommended and the public educated on the dangers of eclampsia.
Determining the Impact of an Alarm Management Program on Alarm Fatigue among ICU and Telemetry RNs: An Evidence Based Research Project
Authors: Dee Stacie A. , Tucciarone Jessica , Plotkin Gary , Mallilo Christina 
Published: May 2022

This evidence-based research project provides an appraisal of current research on how an alarm management program impacts alarm fatigue among registered nurses (RNs) in both intensive care units (ICUs) and telemetry units. Alarm fatigue is a major problem recognized by both the American Association of Critical-Care Nurses (AACN) and the Joint Commission. RNs are the primary caretakers of critically ill patients in ICUs and telemetry units and therefore are at the greatest risk for alarm fatigue. The researchers performed an evidence synthesis to determine the impact of an alarm management program on alarm fatigue among ICU and telemetry RNs. A literature search was conducted using scientific databases such as PubMed, CINAHL, Trip, Cochrane Review, and Google Scholar. Our search strategy included the following terms: adult registered nurse, inpatient registered nurse, ICU registered nurses, RNs, Nurse Practitioners, alarm fatigue, alarm management strategy, education, cardiac monitor alarm, alarm strategies, alarm bundle, telemetry alarm, and cardiac monitor. Any studies involving the pediatric population, pulse oximeter alarms, and ventilator alarms were excluded. Due to the lack of available randomized control trials and cohort studies, the authors included two quality improvement (QI) projects. Finally, six studies were taken into consideration for review. The authors appraised each of the six articles using the Critical Appraisal Skills Programme Checklist (CASP) Tool. This tool allowed the authors to synthesize information based on the outcomes and determine the level of the evidence of each article in order to make evidence-based practice recommendations on implementing alarm management programs. Conclusion: Despite extensive literature highlighting the astronomical prevalence of alarm fatigue in RNs, there was a lack of current high-quality data related to implementing alarm management programs. Therefore, more research is needed to support the utilization of alarm management programs in ICUs and telemetry units to improve alarm fatigue among RNs.
Cardiac CT for intra-cardiac thrombus detection in embolic stroke of undetermined source (ESUS)
Authors: Barnea Rani , Agmon Inbar Nardi , Shafir Gideon , Peretz Shlomi , Mendel Rom , Naftali Jonathan , Shiyovich Arthur , Kornowski Ran , Auriel Eitan , Hamdan Ashraf ,   Cardiac CT for Undetermined Source of Embolic Stroke (CaCTUSES) Working Group
Published: May 2022

Introduction: Embolic stroke of undetermined source (ESUS) is a common medical challenge regarding secondary prevention strategy. Cardiac imaging is the cornerstone of embolic stroke workup, in an effort to diagnose high risk cardio-embolic sources. Cardiac computed tomography angiography (CCTA) is an emerging imaging modality with high diagnostic performance for intra-cardiac thrombus detection. The yield of CCTA implementation in addition to standard care in ESUS workup is unknown. Thus, the aim of this study was to assess the utility of CCTA in detecting intra-cardiac thrombi in the routine ESUS workup. Patients and methods: This is a retrospective observational analysis of ESUS cases managed in vascular neurology unit between 2019 and 2021. Within this ESUS registry, consecutive patients undergoing CCTA were included and carefully analyzed. Results: During the study period 1066 Ischemic stroke (IS) cases were treated and evaluated. 266/1066 (25%) met ESUS criteria and 129/266 (48%) underwent CCTA. Intra-cardiac thrombus was detected by CCTA in 22/129 (17%; 95% CI, 11.5%−23.5%) patients: left ventricular thrombus (LVT) in 13 (10.1%) patients, left atrial appendage (LAA) thrombus in 8 (6.2%) patients, and left atrial (LA) thrombus in 1 (0.8%) patient. Only 5/22 (23%) of these thrombi were suspected, but could not be confirmed, in trans-thoracic echocardiogram (TTE). Among CCTA-undergoing patients, 27/129 (21%; 95% CI, 14%−28%) were found to have an indication (including pulmonary embolism) for commencing anticoagulation (AC) treatment, rather than anti-platelets. In favor of CCTA implementation, 22/266 (8.2%; 95% CI, 4.9%−11.5%) patients within the entire ESUS cohort were diagnosed with intra-cardiac thrombus, otherwise missed. Conclusion: CCTA improves the detection of intra-cardiac thrombi in addition to standard care in ESUS patients. The implementation of CCTA in routine ESUS workup can change secondary prevention strategy in a considerable proportion of patients.
Bilateral Exudative Retinal Detachments, Chemosis, and Impaired Ocular Motility in the Setting of Preeclampsia and HELLP Syndrome
Authors: Govindaraju Viren K. , Schimmel Olivia C. , Trese Matthew G. J. , Garretson Bruce R. , Faia Lisa J. 
Published: May 2022

Purpose: We present a complication of preeclampsia and hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome including bilateral exudative retinal detachments, bullous chemosis, and impaired ocular motility. Methods: The patient was followed in the inpatient and outpatient setting with clinical examinations, optical coherence tomography, widefield fundus photography, neuroimaging including magnetic resonance imaging of the brain/orbits, as well as carotid artery ultrasonography. Results: Our patient was admitted with bilateral vision changes in the setting of preeclampsia and HELLP syndrome and was found to have bilateral exudative detachments, retinal exudation, severe bullous chemosis, and impaired motility. She was started on intravenous dexamethasone followed by an extended prednisone taper with resolution of her ocular findings and return of her vision to baseline. Conclusions: There is evidence that HELLP syndrome and preeclampsia are proinflammatory syndromes. Aggressive blood pressure control, corticosteroids, and a multidisciplinary approach might accelerate visual and systemic recovery in these complex cases.
Tailored Fundoplication for GERD With Impedance Planimetry (EndoFLIP™)
Authors: Wu Hoover , Ungerleider Sara , Attaar Mikhail , Wong Harry J. , Kuchta Kristine , Denham Woody , Linn John , Ujiki Michael B. 
Published: May 2022

Introduction: Impedance planimetry with the endoluminal functional lumen imaging probe (FLIP) has been used to measure the gastroesophageal junction (GEJ) tightness, the distensibility index (DI), during anti-reflux surgery. We describe our institutional experience of a tailored fundoplication algorithm utilizing FLIP to select whether patients should have Laparoscopic Nissen Fundoplication (LNF) or Toupet Fundoplication (LTF) for treatment of gastroesophageal reflux disease (GERD). Methods and procedures: A prospectively maintained quality database was queried. Patients who underwent laparoscopic fundoplication for GERD from 2008 to June 2021 were analyzed. Multiple patient factors and intraoperative FLIP measurements were used to guide decision making from 2017 to 2021. Outcomes included quality of life surveys, Reflux Symptom Index, Gastroesophageal Reflux Disease-Health Related Quality of Life (GERDHRQL), and Dysphagia score. Results: A total of 357 patients were reviewed, 2008-December 2016 (N = 248, 81% LNF) and January 2017 to June 2021 (N = 109, 32% LNF). In the FLIP group, LNF patients had a larger DI compared to LTF patients, 6.5 ± 2.4 mm2/mmHg at hernia reduction ( P < .01). Upon 2-year follow-up, FLIP patients reported lower gas-bloat scores, 0.9 ± 1.1 versus 1.8 ± 1.4 in non-FLIP patients ( P < .01). Patients with normal esophageal motility in the FLIP group had less gas-bloat syndrome than the non-FLIP group (0.9 ± 1.1 vs 1.9 ± 1.4, P < .01). Conclusions: Incorporating FLIP into a tailored fundoplication algorithm led to less gas bloat. Careful selection of which patients can tolerate a Nissen fundoplication may optimize outcomes. Continued exploration with intraoperative impedance planimetry can impact the postoperative quality of life after anti-reflux surgery.
A 3-decade multicenter European experience with cladribine as upfront treatment in 384 patients with hairy cell leukemia
Authors: Broccoli Alessandro , Argnani Lisa , Cross Matthew , Janus Agnieszka , Maitre Elsa , Troussard Xavier , Robak Tadeusz , Dearden Claire , Else Monica , Catovsky Daniel , Zinzani Pier Luigi 
Published: May 2022

Key Points
Cladribine is regarded as the first treatment of choice for symptomatic hairy cell leukemia. This large international study reports a complete response in 72% of cases and a continuous complete response in 20% of patients.