bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparison of the reliability of two gene targets in loop-mediated isothermal amplification assays for detecting leptospiral DNA in canine urine
Authors: Gentilini Fabio , Zanoni Renato Giulio , Zambon Elisa , Turba Maria Elena
Published: January 2017

We compared 2 novel loop-mediated isothermal amplification (LAMP) assays that target either the 16S ribosomal RNA ( rrs) gene or the gene encoding a 32-kDa leptospiral lipoprotein ( lipL32) in order to assess the effect of the target on the accuracy of the LAMP assays. The most sensitive assay was the rrs assay with a limit of detection (LOD) of 1.2 × 101 genome equivalents per reaction. The novel lipL32 assay showed an LOD of 1.2 × 102 genome equivalents per reaction. Both assays showed adequate specificity when tested against a collection of bacteria commonly found in voided canine urine. However, when field samples were assayed, the rrs assays gave many false-positive results and a poor positive predictive value of 8.33%. In conclusion, even if the LAMP assay is used in low prevalence areas, the lipL32 assay would be preferable. Conversely, the higher analytical sensitivity of the rrs assay could be effectively used as a screening test in endemic areas with high disease prevalence, followed by confirmation of the positive results using the lipL32 assay.
Canine spinal cord glioma
Authors: Rissi Daniel R. , Barber Renee , Burnum Annabelle , Miller Andrew D.
Published: January 2017

Spinal cord glioma is uncommonly reported in dogs. We describe the clinicopathologic and diagnostic features of 7 cases of canine spinal cord glioma and briefly review the veterinary literature on this topic. The median age at presentation was 7.2 y. Six females and 1 male were affected and 4 dogs were brachycephalic. The clinical course lasted from 3 d to 12 wk, and clinical signs were progressive and associated with multiple suspected neuroanatomic locations in the spinal cord. Magnetic resonance imaging of 6 cases revealed T2-weighted hyperintense lesions with variable contrast enhancement in the spinal cord. All dogs had a presumptive clinical diagnosis of intraparenchymal neoplasia or myelitis based on history, advanced imaging, and cerebrospinal fluid analysis. Euthanasia was elected in all cases because of poor outcome despite anti-inflammatory or immunosuppressive treatment or because of poor prognosis at the time of diagnosis. Tumor location during autopsy ranged from C1 to L6, with no clear predilection for a specific spinal cord segment. The diagnosis was based on histopathology and the immunohistochemistry expression of glial fibrillary acidic protein, oligodendrocyte lineage transcription factor 2, 2′,3′-cyclic-nucleotide 3′-phosphodiesterase, neuron-specific enolase, synaptophysin, and Ki-67. Diagnoses consisted of 4 cases of oligodendroglioma, 2 cases of gliomatosis cerebri, and 1 astrocytoma. This case series further defines the clinicopathologic features of canine spinal glioma and highlights the need for comprehensive immunohistochemistry in addition to routine histopathology to confirm the diagnosis of these tumors.
Use of Family Management Styles in Family Intervention Research
Authors: Alderfer Melissa A.
Published: January 2017

Family management styles (FMSs) explain some of the complexities embedded in a family with a child who has chronic illness. The FMS typologies provide descriptions of family adjustment and management of care. These 5 distinct patterns may be valuable in tailoring and evaluating family interventions in research.
The (Modified) In Game: An Experimental Paradigm for Manipulating Interpersonal Rejection
Authors: Betts Kevin R. , Hinsz Verlin B.
Published: January 2017

We offer a unique paradigm for manipulating interpersonal rejection that models the complexities of real-life rejection, allows for significant participant immersion in the rejection experience, and requires limited materials. Our approach modifies an existing paradigm, the In Game, to encourage the development of coalitions whereby two individuals are included and one is rejected. The original In Game was developed to reflect real-life situations that involve the exchange of resources or use of power, legitimacy, and obligation. We fuse these elements with new features involving coalition formation to produce a powerful rejection manipulation. Results demonstrate that the modified In Game effectively and reliably produces coalitions that result in one randomly assigned individual being rejected. Moreover, rejection in this paradigm is linked to thwarted psychological need fulfillment and reduced positive affect. Implications of this unique paradigm for studying interpersonal rejection are considered along with suggestions for its successful implementation in other research.
Unfolding Meaning From Memories: An Integrative Meaning Reconstruction Method for Counseling the Bereaved
Authors: Payàs Puigarnau Alba , Chaurand Morales Adrián
Published: January 2017

This conceptual article describes a specific bereavement counseling intervention method for elaborating relational memories. Based in an integrative meaning reconstruction process of change, we show in a practical way how by promoting the display of the continuing bonds with the deceased and favoring the activation of memories about the lost relationship, the bereaved is able to engage in a process of attributing meaning, from which a new personal worldview emerges as a therapeutic outcome of personal posttraumatic growth. Using a case example to explain how the specific set of procedures of the method are implemented in clinical practice, the article focuses on the description of the client’s process of change, and how its components reflect the complementarity and interrelation of these theoretical constructs.
Pattern Versus Change: Community-Based Dyadic Heart Failure Self-Care
Authors: Buck Harleah G. , Hupcey Judith , Watach Alexa
Published: January 2017

It is imperative that dyadic heart failure (HF) self-care be carefully examined so we can develop interventions which improve patient outcomes. The purpose of this study was to qualitatively examine how patient/informal caregiver dyads mutually engage in managing the patient’s HF at home. Twenty-seven dyads were interviewed using a theoretically derived interview guide. All interviews were digitally recorded and professionally transcribed, and iterative thematic analysis was conducted. Three descriptive themes emerged—Mutual engagement in self-care involves maintaining established patterns of engagement across the life course of the relationship, changing patterns according to whether it is day-to-day care or symptom management, and mobilizing the help of a third party as consultant. These themes reveal the dyadic conundrum—whether to change or remain the same in the face of a dynamic and progressive condition like HF. The themes suggest potential targets for intervention—interventions focused on the relationship or caregiver activation.
Inquiring Into Appreciative Inquiry: A Conversation With David Cooperrider and Ronald Fry
Authors: Grieten Styn , Lambrechts Frank , Bouwen René , Huybrechts Jolien , Fry Ronald , Cooperrider David
Published: January 2017

David Cooperrider and Ronald Fry are professors of organizational behavior at the Weatherhead School of Management, Case Western Reserve University (CWRU). CWRU’s Department of Organizational Behavior is consistently acknowledged as one of the best in the world by the Financial Times. Together with their mentor, Suresh Srivastva, they created Appreciative Inquiry (AI) over 30 years ago. Since then, AI has been extensively applied worldwide, and many exciting results have been achieved and published. This article is grounded in an in-depth conversation with David and Ron at the World Appreciative Inquiry Conference 2012, and subsequent discussions between 2012 and 2016. It focuses on how AI has been contributing to a generative scholarship and what new possibilities are on the horizon to strengthen these efforts. In the epilogue, we highlight contributions to current debates around generative scholarship, and offer recommendations to heighten the generative potential of AI and our field.
Comparative Studies on the in Vitro Drug Dissolution Profiles for Hydroxyzine Hydrochloride Tablets
Authors: Loucas Spiro P. , Maager Paul , Mehl Bernard
Published: January 2017

OBJECTIVE:

A significant practical problem in the standardization of dissolution testing is addressed. In vitro releasing characteristics of hydroxyzine hydrochloride tablets are presented to further the documentation of bioequivalency criteria.

DESIGN:

The assessment model compares the official United States Pharmacopeia disintegration approach for dissolution analysis with that of the Food and Drug Administration's recommended rotating paddle technique for inducing aqueous disruption of the solid oral dosage form.

RESULTS:

The rationale and significance of the study focuses attention on the variation in release of the active ingredient observed relative to the four formulation strengths. With differences in the extent of dissolution noted and official standards in mind, emphasis is placed on the development of an alternate test protocol.

CONCLUSIONS:

Dissolution data derived via ultraviolet spectrophotometry revealed statistically significant differences in the amount of hydroxyzine hydrochloride being released from its coated structure, the extent of which was found to be dependent on the acid nature of the simulated gastric dissolution medium used and intensity of mixing action employed.
Meperidine-Related Seizures Associated with Patient-Controlled Analgesia Pumps
Authors: Hagmeyer Kathleen O. , Mauro Laurie S. , Mauro Vincent F.
Published: January 2017

OBJECTIVE:

To report three cases of meperidine-related seizures when meperidine was administered via patient-controlled analgesia pump (PCAP) and to review literature related to meperidine-associated seizures.

DATA SOURCES:

Case reports and review articles identified by a computerized search (MEDLINE) and manual search ( Index Medicus).

DATA SYNTHESIS:

PCAPs are being used frequently to relieve the pain of sickle cell crisis as well as pain from many other etiologies. We report three cases of meperidine-related seizures associated with its administration via PCAP. Each of the patients received either relatively high doses, long-term therapy, or both. Meperidine has been associated with seizure activity when administered via traditional routes. Previously identified risk factors for the development of meperidine-related seizures include renal failure, high meperidine dosages, and coadministration of hepatic enzyme-inducing medications or phenothiazines.

CONCLUSIONS:

Meperidine administered via PCAP may be associated with seizures. Optimally, an alternative analgesic should be administered when this route is used.
Ceftriaxone-Induced Acute Pancreatitis
Authors: Zimmermann Anthony E. , Katona Brian G. , Jodhka Joginder S. , Williams Richard B.
Published: January 2017

OBJECTIVE:

To report a case of probable ceftriaxone-induced acute pancreatitis.

CASE SUMMARY:

A patient with a history of short-bowel syndrome on home total parenteral nutrition developed fever, chills, and right flank pain. She was diagnosed with gram-negative catheter sepsis and prescribed antibiotic therapy to be administered for four weeks. After completion of the first week of therapy, the antibiotic regimen was changed to intravenous injections of ceftriaxone to be given daily at home. Prior to discharge the patient developed acute abdominal pain, leukocytosis, jaundice, and markedly elevated lipase and amylase concentrations consistent with acute pancreatitis. The patient's condition improved upon discontinuation of the ceftriaxone and the remainder of her stay was uneventful.

DISCUSSION:

There is only one other case report in the literature of probable ceftriaxone-induced pancreatitis. Multiple other medications have been implicated in causing acute pancreatitis. The exact mechanism of this uncommon adverse effect of ceftriaxone is unknown.

CONCLUSIONS:

There was a temporal relationship between the development of this patient's signs and symptoms and the administration of ceftriaxone. We could not identify any other factors that may have been responsible for the development of her acute pancreatitis. Ceftriaxone should be considered as a possible etiologic agent in patients who present with acute abdominal pain and elevated lipase and amylase concentrations.
High-Dose Ciprofloxacin in the Treatment of a Renal Cyst Infection
Authors: Rossi Stephen J. , Healy Daniel P. , Savani Dora V. , Deepe George
Published: January 2017

OBJECTIVE:

To report a case of renal cyst infection successfully treated with ciprofloxacin.

CASE SUMMARY:

The clinical course of a 33-year-old woman with radiologic and symptomatic evidence of a renal cyst infection continued to worsen after 7 days of apparently adequate antibiotic therapy for Escherichia coli isolated from her urine. Antibiotic therapy with intravenous ciprofloxacin 600 mg every 12 hours was administered for 7 days and then given as oral therapy (750 mg q12h) for another 14 days. The patient's clinical condition rapidly improved on ciprofloxacin and follow-up 28 days later showed no evidence of infection.

DISCUSSION:

Renal cyst infections are a serious complication of polycystic kidney disease and are often refractory to standard antimicrobial therapy. Ciprofloxacin has the chemical properties and antimicrobial activity needed to treat these infections. Previously reported concentrations of ciprofloxacin in renal cyst fluid are therapeutic for the common pathogens associated with renal cyst infections.

CONCLUSIONS:

Ciprofloxacin appears to be a safe and effective option for treating renal cyst infections. Further controlled studies evaluating its clinical efficacy are warranted.
Fatal Seizures after Flumazenil Administration in a Patient with Mixed Overdose
Authors: Haverkos Gregory P. , DiSalvo Raymond P. , Imhoff Thomas E.
Published: January 2017

OBJECTIVE:

To report a fatal case of refractory status epilepticus precipitated by flumazenil use in a mixed benzodiazepine—tricyclic antidepressant overdose.

CASE SUMMARY:

A 39-year-old woman was brought to the emergency room (ER) in a stupor from a suspected suicidal overdose of an unknown mixture of drugs. Past medical history included seizures and psychiatric disorders managed with benzodiazepine and tricyclic antidepressants. Initial ER electrocardiogram showed a QRS interval of 136 milliseconds. The patient developed refractory seizures after being given flumazenil. Lorazepam, phenytoin, and phenobarbital were administered; however, seizures persisted for 4 hours, resulting in rhabdomyolysis, acute renal failure, severe brain damage, and death.

DISCUSSION:

Flumazenil should be used with caution in patients with chronic benzodiazepine use, prior seizure history, or when a mixed overdose is suspected. Flumazenil may unmask tricyclic antidepressant—induced seizures by antagonizing the antiepileptic effect of concomitantly ingested benzodiazepine. In this patient seizures occurred within two minutes of flumazenil administration. As benzodiazepine-induced central nervous system depression is rarely life-threatening, the use of flumazenil must be balanced against potential risk.

CONCLUSIONS:

Seizure risk factors should be assessed in all patients in whom flumazenil use is considered. If risk factors are present, the benefit of flumazenil use is outweighed by the potential risk. If flumazenil is used, resulting seizures may require larger doses of benzodiazepine.
Selective Serotonin Reuptake Inhibitors: Pharmacologic Profiles and Potential Therapeutic Distinctions
Authors: Finley Patrick R.
Published: January 2017

OBJECTIVE:

To review the respective pharmacologic profiles of the selective serotonin reuptake inhibitors (SSRIs), with particular emphasis placed on clinically relevant distinctions.

DATA SOURCES:

A MEDLINE search was conducted to identify English language literature published within the last five years on the four SSRIs (fluoxetine, sertraline, paroxetine, fluvoxamine). Previous review articles were scrutinized for additional citations, and manufacturers provided a contemporary bibliography of more recent material.

STUDY SELECTION/DATA EXTRACTION:

Studies were selected for specific citation on the basis of comparative research merit and the contribution of this original literature to the pharmacologic profile(s) described.

DATA SYNTHESIS:

All SSRIs appear to be more efficacious than placebo for the acute treatment of major depressive disorder (MDD). Short-term (six-week) efficacy was comparable with that of tricyclic antidepressants for the amelioration of MDD regarded as moderate in severity. Further comparative trials are clearly indicated to demonstrate the therapeutic benefits of SSRIs in specific populations (e.g., geriatric, severely ill) and to demonstrate sustained benefit with long-term prophylaxis. Other potential indications for SSRIs include obsessive-compulsive disorder, panic disorder, bulimia, and chronic pain syndromes. Pharmacokinetic profiles of the four SSRIs reveal similar parametric values, and most quantitative differences are of limited clinical significance. Adverse effects are common but ordinarily mild and transient, primarily restricted to the gastrointestinal tract and central nervous system. Important differences in the prevalence or severity of these adverse effects await the accumulation of further clinical experience and the completion of additional comparative trials. Similarly, the relative propensity of SSRIs to inhibit the metabolism of other medications is currently under investigation.

CONCLUSIONS:

The four SSRIs studied appear to be more similar than they are different. Slowly, important distinctions are beginning to emerge with regard to adverse effect profiles and potential drug interactions. Given that the costs of these respective medications are comparable, such differences may ultimately serve to establish the preferential selection of individual agents in specific clinical situations.
Effects of Intravenous Famotidine on Gastric Acid Secretion in Patients Undergoing Cardiac Surgery
Authors: Wagner Bertil KJ , Amory David W , Majcher Claudine M , DiFazio Louis T , Scott Gregory E , Spotnitz Alan J
Published: January 2017

Objective:

To determine the effects of cardiopulmonary bypass and famotidine on gastric acid secretion in adults undergoing cardiac surgery.

Design:

Prospective, randomized, double-blind, placebo-controlled study.

Setting:

University teaching hospital.

Participants:

Eighteen patients undergoing elective cardiac surgery with cardiopulmonary bypass.

Main Outcome Measures:

Famotidine 20 mg or NaCl 0.9% placebo was administered intravenously following induction of anesthesia and placement of a nasogastric pH probe. A second dose was given 12 hours after surgery in the intensive care unit. Gastric pH was measured continuously and gastric volume was measured every 4 hours for up to 24 hours after cardiopulmonary bypass.

Results:

Following famotidine administration, pH increased by 43% within 45 minutes and remained above 5.5 throughout the study period (p < 0.05 vs placebo and baseline). The gastric pH did not increase, but remained above 4.0 in most patients in the placebo group for up to 12 hours after cardiopulmonary bypass. Gastric volumes were on average 24% lower in the famotidine group (p > 0.05).

Conclusions:

Gastric acid secretion is decreased during and for 12 hours after cardiopulmonary bypass. Perioperative administration of famotidine suppresses gastric secretion in cardiac surgery patients.
Medication Taking Behaviors in the High- and Low-Functioning Elderly: Macarthur Field Studies of Successful Aging
Authors: Wallsten Sharon M , Sullivan Robert J , Hanlon Joseph T , Blazer Dan G , Tyrey Mary J , Westlund Ronald
Published: January 2017

Objective:

To describe and compare medication-taking behaviors in the high- and low-functioning elderly living in the community.

Design:

A cross-sectional design with data collected by interview.

Setting:

The study included 5 counties in the southern Piedmont area of North Carolina.

Participants:

Respondents included 242 elderly aged 70-79 years selected from the Piedmont Health Survey of the Elderly and the MacArthur Research Program on Successful Aging.

Main Outcome Measures:

Outcome measures included strategies used to remember to take drugs, reasons given for skipping medications, factors associated with understanding of drugs, the number of over-the-counter and prescribed drugs used, and the number of drugs used in therapeutic categories.

Results:

Low-functioning elderly white respondents took greater numbers of prescribed drugs than did blacks or high-functioning whites. Respondents had a better understanding of prescribed than of over-the-counter drugs, with the poorest understanding of nutritional supplements. Men and blacks had poorer understanding of drugs than women and whites. The strategies subjects used to remember to take drugs included (from most to least frequently used): making it a routine activity, reading labels, a self-devised memory aid, a habit, being reminded by someone else, sorting, and noticing symptoms.

Conclusions:

Clinicians should provide their patients with information about over-the-counter agents as well as prescribed drugs, be alert to cues that blacks and men give indicating their need for additional explanation about a drug's purposes, and be sensitive to differential prescribing patterns with respect to race. When planning a regimen for multiple doses of a drug, clinicians should account for their patients' tendencies to use routine activities as memory prompts.
Treatment of Extravasation of both Doxorubicin and Vincristine Administration in a Y-Site Infusion
Authors: Comas Dolors , Mateu Javier
Published: January 2017

OBJECTIVE:

To describe a patient treated with vincristine, doxorubicin, and dexamethasone who experienced extravasation of both doxorubicin and vincristine during a Y-site infusion.

CASE SUMMARY:

A 74-year-old white woman was diagnosed with multiple myeloma IgA kappa in stage IIA. One year after a complete remission she relapsed. Her treatment included daily doxorubicin 16 mg in 500 mL of dextrose 5% and vincristine 0.4 mg in 500 mL of dextrose 5% administered in a Y-site continuous infusion into a peripheral vein of her left forearm. Extravasation occurred during administration of these drugs. Immediately, chondroitinsulfatase, a mucopolysaccharidase similar to hyaluronidase, was administered subcutaneously around the extravasation area and repeated 24 hours later. Furthermore, dimethyl sulfoxide 90% v/v was applied topically on the area four times daily for 2 weeks. All inflammatory signs resolved and no necrosis developed.

DISCUSSION:

This is the first report of an extravasation of two cytotoxic drugs. Doxorubicin and vincristine have different antidotes and opposite physical treatments for their extravasation. The antidotes dimethyl sulfoxide and chondroitinsulfatase have different mechanisms of action, but both cause uptake of the cytotoxic agent from the tissue and are likely to be administered together. No warming or cooling was performed.

CONCLUSIONS:

Topical dimethyl sulfoxide four times daily for 14 days plus subcutaneous chondroitinsulfatase in one or two applications effectively treated an extravasation of both doxorubicin and vincristine in our patient.
Effects of Serotonin Reuptake Inhibitors on Hemostasis
Authors: Alderman Christopher P , Seshadri Prabha , Ben-Tovim David I
Published: January 2017

OBJECTIVE:

To examine the hematologic safety profile of the selective serotonin reuptake inhibitors (SSRIs), with particular emphasis on the effects of these drugs on platelet aggregation.

METHODS:

Platelet aggregation studies were undertaken at baseline, and repeated 2 and 4 weeks after the initiation of treatment with an SSRI. Other investigations undertaken included analysis of serum electrolyte and liver enzyme concentrations, complete blood count, and coagulation studies. Patients were also assessed for clinical signs of bleeding. Eight patients (7 treated with fluoxetine, 1 with paroxetine) completed the study protocol.

RESULTS:

Repeated ANOVA revealed no abnormalities in platelet aggregation, hematopoiesis, or coagulation profile. No patient developed clinical signs of abnormal hemostasis during the study period. A statistically significant elevation in the mean serum bilirubin concentration was detected, but this was not of clinical significance.

CONCLUSIONS:

Although the SSRIs may cause abnormal hemostasis, this effect is probably rare. Another possibility is that abnormal hemostasis is more likely to occur when high doses of SSRIs are administered.
Anesthetic Efficacy of Eutectic Prilocalne-Lidocaine Cream in Pediatric Oncology Patients Undergoing Lumbar Puncture
Authors: Jiménez Juan Carlos Juárez , Oliveras María , Hidalgo Eduardo , Cabañas Ma José , Barroso Concepcion , Moraga Fernando Antonio , Gallego Soledad , de Toledo José Sánchez
Published: January 2017

OBJECTIVE:

To evaluate the efficacy of eutectic mixture of local anesthetics 5% (Emla) in reducing pain associated with lumbar punctures in children.

DESIGN:

Prospective, double-blind, randomized, placebo-controlled trial.

SETTING:

University pediatric hospital.

PATIENTS:

Eleven pediatric oncology patients (mean age 6.6 y, range 4–16) who underwent 31 lumbar punctures.

MAIN OUTCOME MEASURES:

The analgesic effect was measured by using two methods. The first was a 10-point visual analog scale reported by the patient and the second was an 8-point behavioral pain scale assessed by the nurse who applied the cream.

RESULTS:

Emla cream was associated with significantly lower pain scores than those with placebo as measured by the patient when the puncture was successful on the first attempt (2.0 +1.6 Emla group, 3.8 +1.9 placebo group; p < 0.05).

CONCLUSIONS:

The use of Emla cream may reduce pain substantially only in patients who undergo a successful lumbar puncture on the first attempt.
Phenoxybenzameve Placental Transfer during the Third Trimester
Authors: Santeiro Maria L , Stromquist Carine , Wyble Lance
Published: January 2017

OBJECTIVE:

To report phenoxybenzamine placental transfer in the treatment of maternal hypertension secondary to pheochromocytoma.

CASE SUMMARY:

A 22-year-old woman diagnosed with pheochromocytoma was medically managed at 33 weeks gestation with oral phenoxybenzamine and labetalol until delivery 26 days later. To determine phenoxybenzamine placental passage, at the time of cesarean section simultaneous samples were obtained from the cord blood, maternal blood, and amniotic fluid. Additional blood samples were obtained from the newborn at 32 and 80 hours of life. Mean concentrations of phenoxybenzamine from cord and maternal plasma and in amniotic fluid were 103.3,66, and 79.3 ng/mL, respectively; the newborn's plasma concentration at 32 hours of life was 22.3 ng/mL. At the time of delivery, the 2475-g male infant exhibited perinatal depression; mild transient hypotension was also noted for the first few days of life.

DISCUSSION:

The fetal—maternal plasma accumulation ratio of 1.6:1 indicates that at this gestational age after 26 days of therapy, the placental transfer of phenoxybenzamine occurs and is accompanied by accumulation in the fetal blood.

CONCLUSIONS:

Because of the placental transfer of phenoxybenzamine, mild perinatal depression and transient hypotension may occur in newborns of mothers receiving this medication. These newborns must be closely monitored during the first few days of life for respiratory depression and hypotension.
Corticosteroids in Tuberculosis
Authors: Cisneros Jennifer R , Murray Kim M
Published: January 2017

OBJECTIVE:

TO examine the effects of corticosteroids used for concomitant disease states in patients with latent or active tuberculosis (TB). The role of corticosteroids in the treatment of extrapulmonary TB is also discussed.

DATA SOURCES:

A MEDLINE search was conducted for the years 1953-1995. The International Pharmaceutical Abstracts service was also used to conduct an extensive literature review. In addition, relevant articles were cross-referenced to screen for additional information.

STUDY SELECTION/DATA EXTRACTION:

During the literature review, emphasis was placed on human studies and individual case reports.

DATA SYNTHESIS:

The resurgence of TB in this decade has affected many populations, especially immunocompromised patients. These patients may need corticosteroid therapy for various concomitant diseases that might predispose a patient to develop primary TB infection or reactivate latent TB infection. In appropriate patients, prophylaxis with isoniazid is recommended. Corticosteroid therapy may benefit patients with some forms of extrapulmonary TB. After steroid therapy, improved survival and more rapid reduction of tuberculous symptoms have been noted in cases of tuberculous pleurisy, endobronchial TB, tuberculous meningitis, and tuberculous pericarditis. Corticosteroids may also be useful in controlling both fever and hypersensitivity reactions in pulmonary and extrapulmonary TB, although not routinely used for this purpose.

CONCLUSIONS:

Corticosteroids may play an important role in TB infection by promoting reactivation of latent infection. Corticosteroids may modify symptoms of some forms of extrapulmonary TB, although randomized, placebo-controlled studies are needed before corticosteroids will have a definitive place in the standard therapy of TB.
Anticoagulation with Warfarin in Infants and Children
Authors: Buck Marcia L
Published: January 2017

OBJECTIVE:

TO provide a comprehensive review of warfarin use in infants and children, including recommendations for appropriate dosage and monitoring parameters.

DATA SOURCES:

A MEDLINE search (1966-1995) was used to identify pertinent English-language articles in the medical literature. The key search term was warfarin. Additional material was obtained from references cited in articles retrieved through MEDLINE.

STUDY SELECTION:

All articles involving children younger than 18 years were evaluated. In addition, articles on the pharmacokinetics and pharmacodynamics in adults, adverse effects, and drug interactions were included.

DATA EXTRACTION:

Material selected for review included clinical trials, case reports, and surveys of practice.

DATA SYNTHESIS:

Warfarin has been used as prophylactic therapy in children with prosthetic cardiac valves as well as for prevention of thromboembolic complications associated with autoimmune disorders and protein C or protein S deficiency. Warfarin also has been used to prevent embolization in children with deep-vein thrombosis or clots in central venous catheters. According to the literature, an initial dosage of 0.1 mg/kg/d should provide anticoagulation without significant adverse effects. As in adults, dosing should be adjusted to achieve a target international normalized ratio (INR). Although the target range in children is not well established, INR values of 1.5–3 are recommended for most patients. Higher values have been used in children with prosthetic cardiac valves and hereditary clotting disorders.

CONCLUSIONS:

Due to its infrequent use, there is limited information on the effects of warfarin in children. Basic guidelines for initiating and monitoring warfarin were developed by using data gathered from clinical trials, retrospective reviews, case series, and surveys of practice.
Associated Injuries Found in Chronic Lateral Ankle Instability
Authors: DiGiovanni Benedict F. , Fraga Carlos J. , Cohen Bruce E. , Shereff Michael J.
Published: January 2017

Sixty-one patients underwent a primary ankle lateral ligament reconstruction for chronic instability between 1989 and 1996. In addition to the ligament reconstruction, all patients had evaluation of the peroneal retinaculum, peroneal tendon inspection by routine opening of the tendon sheath, and ankle joint inspection by arthrotomy. A retrospective review of the clinical history, physical exam, MRI examination, and intraoperative findings was conducted on these 61 patients. The purpose was to determine the type and frequency of associated injuries found at surgery and during the preoperative evaluation. At surgery no patients were found to have isolated lateral ligament injury. Fifteen different associated injuries were noted. The injuries found most often by direct inspection included: peroneal tenosynovitis, 47/61 patients (77%); anterolateral impingement lesion, 41/61 (67%); attenuated peroneal retinaculum, 33/61 (54%); and ankle synovitis, 30/61 (49%). Other less common but significant associated injuries included: intra-articular loose body, 16/61 (26%); peroneus brevis tear, 15/61 (25%); talus osteochondral lesion, 14/61 (23%); medial ankle tendon tenosynovitis, 3/61 (5%). The findings of this study indicate there is a high frequency of associated injuries in patients with chronic lateral ankle instability. Peroneal tendon and retinacular pathology, as well as anterolateral impingement lesions, occur most often. A high index of suspicion for possible associated injuries may result in more consistent outcomes with nonoperative and operative treatment of patients with chronic lateral ankle instability.
Direct adaptive algorithm for seismic control of damaged structures with faulty sensors
Authors: Hosseini Amin , Taghikhany Touraj , Yeganeh Fallah Arash
Published: January 2017

In recent decades, the application of semi-active control strategies has gained much attention as a way to reduce the seismic response of civil infrastructures. However, uncertainty in the modeling process of systems with possible partial or total failure during an earthquake is the main concern of engineers about the reliability of this strategy. In this regard, adaptive control algorithms are known as an effective solution to adjust control parameters with different uncertainties. In the current study, the efficiency of the simple adaptive control method (SACM) is investigated to control the seismic response of building structures in the presence of unknown structural damage and fault in the sensors. The method is evaluated in 20-story steel moment resisting frames with different arrangement of smart dampers and sensors with various damage and fault scenarios. The results show that the SACM control system can effectively reduce the maximum inter-story drift of the structure in all different assumed magnetorheological damper arrangements. Furthermore, combination of a Kalman–Bucy filter with the SACM improves robustness of the controller to the uncertainties of sensors faults and damages of structural elements.
Are Managed Care Plans Organizing for Quality?
Authors: Scanlon Dennis P. , Rolph Elizabeth , Darby Charles , Doty Hilary E.
Published: January 2017

This article examines the degree to which managed care organizations (MCOs) are reorganizing to take responsibility for the quality of care and service they provide. Specifically, factors prompting plans to focus on quality improvement (QI) and how they may be building the capacity to improve quality are considered. The authors’ analysis is based on executive interviews with the plan medical directors, QI directors, and chief executive officers (CEOs) in a sample of 24 health plans. The overall response rate was 58.3 percent (medical director = 62.5 percent, QI director = 79.2 percent, CEO = 33.3 percent). The authors queried respondents about (1) perceived drivers and obstacles to the development of an effective QI program, (2) plan organizational structure for QI, and (3) technical capacities for data collection, management, and performance measurement. The results suggest that MCOs are responding to outside pressures to engage in QI. They are reorganizing their management structures and more slowly and tentatively are building technical capacity for QI.
Assessing the Relationship between Quality of Care and the Characteristics of Health Care Organizations
Authors: Dudley R. Adams , Landon Bruce E. , Rubin Haya R. , Keating Nancy L. , Medlin Carol A. , Luft Harold S.
Published: January 2017

In the past two decades, relationships among health plans, medical groups, and providers have grown more complex and the number of clinical management strategies has increased. In this context, determining the independent effect of a particular organizational strategy on quality of care has become more difficult. The authors review some of the issues a researcher must address when studying the relationship between organizational characteristics and quality of care. They offer criteria for selecting a research question, list organizational characteristics that may influence quality, and suggest sampling and study design techniques to reduce confounding. Since this type of research often requires a health care organization as collaborator, the authors discuss strategies for developing research partnerships and collecting data from the partner organization. Finally, they offer suggestions for translating research into policy.
Quality Measures for Mental Health Care: Results from a National Inventory
Authors: Hermann Richard C. , Leff H. Stephen , Palmer R. Heather , Yang Dawei , Teller Terri , Provost Scott , Jakubiak Chet , Chan Jeff
Published: January 2017

The National Inventory of Mental Health Quality Measures was funded by the Agency for Healthcare Research and Quality to (1) inventory process measures for assessing the quality of mental health care; (2) identify clinical, administrative, and quality domains where measures have been developed; and (3) identify areas where further research and development is needed. Among the 86 measures identified, most evaluated treatment of major mental disorders, for example, schizophrenia (24 percent) and major depression (21 percent). A small proportion focused on children (8 percent) or the elderly (9 percent). Domains of quality included treatment appropriateness (65 percent), continuity (26 percent), access (26 percent), coordination (13 percent), detection (12 percent), and prevention (6 percent). Few measures were evaluated for reliability (12 percent) or validity (3 percent). Measures imposing a lower burden were more likely to be in use (σ 2 = 4.41, p = .036). Further measures are needed to assess care for several priority clinical and demographic groups. Research should focus on measure validity, reliability, and implementation costs. In order to foster quality improvement activities and use of common measures and specifications for mental health care, the inventory of quality measures will be made available at www.challiance.org/cqaimh.
Deleuze, Concept Formation, and the Habit of Shorthand Inquiry
Authors: Schulte Christopher M.
Published: January 2017

Informed by Deleuze and Guattari’s philosophical sense of the concept, this article challenges the tendency to desire for, rationalize, and use qualitative research methodology as a day-to-day concept—a readymade habit that gets legitimized as a form of shorthand for the experience of thinking and doing methodological work. Specifically, this article purposes to (a) provide an orientation to both everyday and philosophical concepts; (b) consider the distinct usage and interplay of these conceptual practices in relation to qualitative research methodology; (c) introduce and discuss the three ages of Deleuze and Guattari’s philosophical sense of the concept (i.e., the encyclopedia, pedagogical, and commercial professional training) as a means to encounter, think, and do research methodology as a problematic form; and (d) draw on personal memory and existing research and theory, as well as the performative sculptures of Charles Garoian, as a means to activate research methodology as a conceptual practice, one that must be continually created.
Association of time to antibiotics and clinical outcomes in adult hematologic malignancy patients with febrile neutropenia
Authors: Butts Allison R , Bachmeier Christina Carracedo , Dressler Emily V , Liu Meng , Cowden Ann , Talbert Jeff , Adams Val R
Published: January 2017

Objective

The objective of this study was to determine the clinical impact of time to antibiotic administration in adult inpatients who have hematologic malignancies and develop febrile neutropenia.

Methods

A retrospective chart review was conducted to screen for all febrile neutropenia events amongst adult hematologic malignancy patients between 1 January 2010 and 1 September 2014. All included patients were admitted to the hospital at the time of fever onset, having been admitted for a diagnosis other than febrile neutropenia. Descriptive statistics and logistic generalized estimated equations were used to analyze the data.

Results

Two hundred forty-four neutropenic fever events met inclusion criteria. Thirty-five events (14.34%) led to negative clinical outcomes (in-hospital mortality, intensive care unit transfer, or vasopressor requirement), with an in-house mortality rate of 7.4%. The time to antibiotics ranged from 10 min to 1495 min. The median time to antibiotics in the events that led to negative outcomes was 120 min compared to 102 min in the events that did not lead to the negative outcome ( p = 0.93). Conditional order sets were used to order empiric antibiotics in 176 events (72.1%) and significantly reduced time to antibiotics from 287 min to 143 min ( p = 0.0019).

Conclusion

Prolonged time to antibiotic administration in hematologic malignancy patients who develop neutropenic fever was not shown to be associated with negative clinical outcomes.
The Relationship Between Psychosocial Adjustment and Coping Strategies Among Patients With Multiple Sclerosis in Turkey
Authors: Okanli Ayse , Tanriverdi Derya , Ipek Coban Gülay , Asi Karakaş Sibel
Published: January 2017

BACKGROUND: Multiple sclerosis (MS) is a disease with significant psychosocial adjustment challenges. OBJECTIVE: The objective of the study was to assess the psychosocial adjustment and coping strategies in patients with MS and to put forth the relationships between them. DESIGN: The sample group comprised 85 outpatients with MS who were admitted to the Neurology Clinic of a university hospital for treatment between October 2007 and July 2008. Data were acquired via an information form and the Psychosocial Adjustment to Illness Scale and Coping Strategy Indicator. RESULTS: It was determined that 55% of the patients had poor psychosocial adjustment levels. Statistically significant relationship was found between Psychosocial Adjustment to Illness Scale–Self-Report and problem solving as well as seeking social support coping strategies ( p < .01). Psychosocial adjustment got worse with decreasing problem-solving and seeking–social support coping strategies of patients. CONCLUSIONS: The psychosocial adjustment to MS of patients is closely related with effective coping strategies. The results have emphasized the significant role of mental health and social services and coping strategies regarding the comprehensive care needs of these patients.
Parent and Family Processes Related to ADHD Management in Ethnically Diverse Youth
Authors: Paidipati Cynthia P. , Brawner Bridgette , Eiraldi Ricardo , Deatrick Janet A.
Published: January 2017

BACKGROUND: Previous research has shown major disparities in attention deficit hyperactivity disorder (ADHD) for diverse youth across America. We do not fully understand, however, how parent and family processes are related to the identification, care-seeking approaches, treatment preferences, and engagement with care systems and services for youth with ADHD. OBJECTIVES: The present study aimed to explore parent and family processes related to the management of ADHD in racially and ethnically diverse youth. DESIGN: This integrative review was structured with the methodology proposed by Whittemore and Knafl. RESULTS: Three major electronic databases yielded a final sample of 32 articles (24 quantitative, 6 qualitative, and 2 mixed methods). Nine themes emerged within three overarching meta-themes. CONCLUSIONS: Understanding the unique perspectives of families from diverse backgrounds is essential for clinicians, researchers, and policymakers, who are dedicated to understanding racial and ethnic perspectives and developing ecologically appropriate and family-based interventions for youth with ADHD.
The Successful Immediate Neonatal Transition to Extrauterine Life
Authors: Michel Alexandra , Lowe Nancy K.
Published: January 2017

Purpose:

To define and describe the processes underlying the successful neonatal transition to extrauterine life and methods to assess the transition.

Method:

Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Web of Science, and Google Scholar were searched using a combination of the key words neonate, neonatal, newborn, transition, respiratory OR pulmonary, cardiac, metabolic, pH, umbilical cord, and assessment. Articles in English and German were reviewed. The final sample of articles consisted of one randomized controlled trial, 30 observational studies using human neonates, one observational study using rabbit pups, one secondary analysis, three systematic reviews, and 23 review articles.

Major Findings:

The pertinent findings in regard to normal events in the respiratory, cardiovascular, and metabolic transitions are reviewed and summarized. We address the underlying factors necessary for the transition to extrauterine life, specify the consequences of a successful transition, and review common assessment approaches.

Conclusion:

Available evidence indicates that the successful immediate transition to extrauterine life should be completed within 1–3 hr after birth, though some adaptive processes can fail as late as 24–48 hr after birth. Further research is necessary to identify a feasible, easily used, noninvasive method to assess the status of a neonate’s transition to extrauterine life.
Dying in hospital: socioeconomic inequality trends in England
Authors: Barratt Helen , Asaria Miqdad , Sheringham Jessica , Stone Patrick , Raine Rosalind , Cookson Richard
Published: January 2017

Objective

To describe trends in socioeconomic inequality in the proportion of deaths occurring in hospital, during a period of sustained effort by the NHS in England to improve end of life care.

Methods

Whole-population, small area longitudinal study involving 5,260,871 patients of all ages who died in England from 2001/2002 to 2011/2012. Our primary measure of inequality was the slope index of inequality. This represents the estimated gap between the most and least deprived neighbourhood in England, allowing for the gradient in between. Neighbourhoods were geographic Lower Layer Super Output Areas containing about 1500 people each.

Results

The overall proportion of patients dying in hospital decreased from 49.5% to 43.6% during the study period, after initially increasing to 52.0% in 2004/2005. There was substantial ‘pro-rich’ inequality, with an estimated difference of 5.95 percentage points in the proportion of people dying in hospital (confidence interval 5.26 to 6.63), comparing the most and least deprived neighbourhoods in 2011/2012. There was no significant reduction in this gap over time, either in absolute terms or relative to the mean, despite the overall reduction in the proportion of patients dying in hospital.

Conclusions

Efforts to reduce the proportion of patients dying in hospital in England have been successful overall but did not reduce inequality. Greater understanding of the reasons for such inequality is required before policy changes can be determined.