bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stability of Human Recombinant Epoetin Alfa in Commonly used Neonatal Intravenous Solutions
Authors: Ohls Robin K , Christensen Robert D 
Published: January 2017

OBJECTIVE: TO measure epoetin alfa concentrations after adding it to a variety of commonly used neonatal intravenous fluids to determine the stability of epoetin alfa over time. DESIGN: Epoetin alfa was added to the following fluids: sterile water; NaCl 0.9%; dextrose 10% in water; dextrose 10% with albumin at concentrations of 0.01 %, 0.05%, and 0.1 %; and total parenteral nutrition solution containing either 0.5% or 2.25% amino acids. The fluid was administered through intravenous tubing, a T-connector, and catheter, and samples were collected at 0,2,4, 8, and 24 hours. MAIN OUTCOME MEASURES: Epoetin alfa concentrations were compared with the measured original preinfusion concentration and recorded as the percentage recovered. RESULTS: Concentrations declined significantly in all fluids containing less than 0.05% protein, but remained stable over 24 hours in fluids containing 0.05% or more protein. CONCLUSIONS: We conclude that epoetin alfa should be mixed in intravenous fluids containing at least 0.05% protein.
Acute Management of Cancer-Related Hypercalcemia
Authors: Chisholm Marie A , Mulloy Anthony L , Taylor A Thomas 
Published: January 2017

OBJECTIVE: TO review the pathogenesis and pharmacologic treatment of acute hypercalcemia associated with malignancy. DATA SOURCES: A MEDLINE search (1966 to 1995) of the English-language literature pertaining to acute hypercalcemia was performed. Additional literature was obtained from reference lists of articles identified through the search. STUDY SELECTION AND DATA EXTRACTION: All articles discussing the etiology and medical management of cancer-related acute hypercalcemia were considered in the review. Clinical trials reporting efficacy and safety of antihypercalcemic agents were also included. Information selected in the review was based on the discretion of the authors. DATA SYNTHESIS: Hypercalcemia is a life-threatening disorder associated with malignancy. It occurs in approximately 10–20% of patients with cancer. A variety of medications have been used in the management of hypercalcemia including bisphosphonates, calcitonin, furosemide, gallium nitrate, glucocorticoids, NaCl 0.9%, and plicamycin. Each of these agents has been reviewed with consideration of pharmacologic mechanism of action, evaluation of clinical trials, recommended dosages, efficacy, safety, cost, and role in treating cancer-related acute hypercalcemia. CONCLUSIONS: Immediate management of cancer-related acute hypercalcemia to prevent death and provide symptomatic relief is warranted. Severity determined by symptoms, calcium concentrations, and the overall status of the patient are important considerations in selecting appropriate therapy. Although the specific role of individual agents may vary, hydration remains the cornerstone of therapy. NaCl 0.9%, calcitonin, and Pamidronate disodium have established roles as dominant first-line agents for the management of acute hypercalcemia associated with malignancy.
Amphotericin B Enzyme-Linked Immunoassay for Clinical Use: Comparison with Bioassay and HPLC
Authors: Cleary John D , Chapman Stanley W , Hardin Thomas C , Rinaldi Michael G , Lee Spencer J , Deng Jie , Pennick Gennethel J , Lobb Craig J 
Published: January 2017

OBJECTIVE: To evaluate a new enzyme-linked immunosorbent assay (ELISA) for amphotericin B in serum samples. Results are compared with those obtained by HPLC and bioassay. DESIGN: Comparison of results obtained by ELISA, HPLC, and bioassay. METHODS: We developed a new ELISA using a polyclonal rabbit antibody to measure serum amphotericin B concentrations. Blinded samples of amphotericin B in concentrations of 0.15–78 μg/mL were prepared in human serum and assayed simultaneously by the ELISA, HPLC, and bioassay. The results of each assay were derived from standard curves and evaluated by using the Table Curve 2D computer program. These data were compared by using correlation analysis with evaluation of Pearson's correlation coefficient by Student's t-est. RESULTS: ELISA and bioassay compared favorably at amphotericin B concentrations of 0.3–20 μg/mL with a correlation coefficient of r = 0.993, while ELISA and HPLC compared with a correlation coefficient of r = 0.944. The average coefficient of variation over the range 0.3–20.0 μg/mL was 28% ± 7% for HPLC, 26% ± 9% for ELISA, and 13% ± 4% for bioassay. Comparison of all three assays revealed the highest correlation with the ELISA assay (r = 0.998) for the range of concentrations (0.3–20 μg/mL) routinely achieved. Samples containing concentrations in excess of 20 μg/mL could be diluted. Desiccation for concentrations less than 0.3 μg/mL was not tested. CONCLUSIONS: The determination of serum amphotericin B concentrations by ELISA gave results similar to those obtained by a bioassay and HPLC technique. Although variability appears greater with ELISA, the ease of performing this assay expedites the evaluation of many samples. Finally, this assay may allow the determination of amphotericin B concentrations from lipid formulations without interference from coadministered antibacterials or azole antifungals.
Endoscopic Plantar Fascia Release: A Case Series
Authors: Boyle R.A. , Slater G.L. 
Published: January 2017

Plantar fasciitis is a common disabling condition that can be recalcitrant to treatment. Endoscopic Plantar Fascia Release (EPFR) has received greater attention in recent years as a viable, and possibly superior, alternative to established open procedures for the treatment of plantar fasciitis. In a series of 17 patients (17 feet) with follow-up over an average of 16 months, we report a two portal endoscopic technique of partial release of the plantar fascia, as a successful, safe and reliable procedure for the treatment of plantar fasciitis in the patient group selected. The surgical results of 17 EPFR's performed by the same surgeon were reviewed. All patients had preoperative symptoms of subcalcaneal heel pain for greater than 12 months, all having undergone nonsurgical measures for at least 12 months. Of 17 feet, all reported marked improvement of preoperative symptoms within two months. Patients' subjective assessment of the procedure was strongly supportive, 100% totally satisfied or satisfied with only minor restrictions. Postoperatively, 82.4% reported mild or no pain, and 100% had improvement in walking distance. Complications all resolved within two to six months; there were no re-operations and no infections.
Hallux Metatarsophalangeal Joint Arthrodesis Using Dome-Shaped Reamers and Dorsal Plate Fixation: A Prospective Study
Authors: Goucher Nicholas R. , Coughlin Michael J. 
Published: January 2017

Background: Many techniques exist for arthrodesis of the first metatarsophalangeal (MTP) joint, as well as, indications for each method. The purpose of this study was to determine the results of one method using dome-shaped reamers to prepare the joint surfaces and a low-profile dorsal titanium plate for internal fixation. To date, no prospective studies have reported patient outcomes of arthrodesis of the first MTP joint using this technique. Methods: Fifty patients (54 feet) had first MTP joint arthrodesis from January, 2004, through January, 2005. All patients were evaluated preoperatively for underlying pathology, pain, function, and radiographic findings. First MTP joint arthrodesis was fixed with a dorsal titanium plate with preset valgus and dorsiflexion after the joint surfaces were prepared with matching male and female dome-shaped power reamers to achieve congruous cancellous bone surfaces. At a minimum of 1-year followup, patients returned for postoperative evaluation. In addition to evaluation of pain, function, and radiographic findings, patients were asked how long they remained off work, how long swelling persisted, and whether the hardware caused symptoms. Results: Forty-nine of 53 patients returned for followup at an average of 16 months after surgery. American Orthopaedic Foot and Ankle Society (AOFAS) scores improved significantly (z = −6.301, p > 0.01) from an average of 51 points preoperatively (range 24 to 97) to 82 points postoperatively (range 47 to 90). Pain scores at final followup demonstrated a significant improvement (z = −6.154, p > 0.01) from a mean of 6.3 to a mean of less than 1 point on the visual analog pain scale. Time off work averaged 3 weeks, while swelling persisted for an average of 11 weeks. Thirty-five feet in 32 patients (66%) were rated as excellent, 16 feet in 16 patients (30%) were rated as good, and two feet (4%) in one patient were rated as fair, with none reporting a poor result. There were four nonunions (8%), with one being a fibrous union having no progression of deformity. Three of four patients with a nonunion reported a good result subjectively with the fourth reporting a fair result. Conclusions: The 96% satisfaction rate in 49 patients indicates that first MTP joint arthrodesis with a low-profile contoured dorsal titanium plate and crossed lag screws after joint preparation with dome-shaped reamers is both reliable and reproducible. The union rate was high (92%), and the revision rate was low (4%).
Relationship Between Glycosylated Hemoglobin Level and Sciatic Nerve Block Performance in Diabetic Patients
Authors: Sertoz Nezih , Deniz Mustafa N. , Ayanoglu Hilmi O. 
Published: January 2017

Background: The objective of the present study was to explore the effects of deficiencies in glucose regulation on the onset, regression, and block performance times in a group of patients with diabetes-related foot problems. Methods: Forty-eight patients with American Society of Anesthetists physical status 2-4 undergoing foot and ankle surgery with a popliteal fossa block were prospectively studied. Patients were stratified into cohorts based on 3 groups according to their HbA1c levels: group 1 (n = 15), HbA1c 5%-6%; group 2 (n = 16), HbA1c 7%-8%; group 3 (n = 17), HbA1c 9%-10%. A standardized local anesthetic mixture containing 10 mL of 2% prilocaine and 10 mL of 0.5% levobupivacaine was used in all study groups. The primary outcome of the study was the time for regression of the sensory block. Results: The onset times of sensory and motor blocks in group 3 were significantly longer than those in groups 2 and 1. Motor block regression time differed significantly between groups ( P = .04), being longer in group 3 compared with group 1. In group 3, the sensory block regression time and the time of first analgesic use were significantly longer than the times in groups 1 and 2. Conclusions: We found that sensory block regression time was longer in diabetic patients with poor glycemic control than in the patients with better glycemic control. Longer block performance time, probably due to reduction in sensory and motor conduction velocity in diabetic patients with poor glycemic control, should be taken into consideration when peripheral nerve blocks are used. Level of Evidence: Level II, prospective comparative study.
Propranolol in the Management of Infantile Hemangiomas: Clinical Response and Predictors
Authors: Balma-Mena Alexandra , Chakkittakandiyil Ajith , Weinstein Miriam , Lansang Perla , Ho Nhung , Cammisuli Salvatore , Pope Elena 
Published: January 2017

Background: Recent data suggest that propranolol is an effective treatment for infantile hemangiomas (IHs). Data on the optimal dose, duration of therapy, and predictors of response are currently lacking. Objective: To assess the clinical response to and predictors of propranolol use in the treatment of IH. Methods: Retrospective cohort study of 44 patients. Two independent assessors evaluated improvement by comparing serial digital photographs using a 100 mm visual analogue scale (VAS), where 5 mm change represented 10% change in the size or appearance of the IH. Results: Propranolol was started at a mean age of 7.8 (SD 8.21) months and was used for 7.3 (SD 4.8) months before weaning. The mean percent improvement compared to baseline (as measured by the VAS) was 78% (SD 23%). Minor adverse events were noted in 32% of patients. The most significant predictor of regrowth after weaning was a IH > 5 cm in size ( p = .017). Conclusions: Propranolol is effective in IH, but the side effects and the possibility of regrowth should be considered.
Safety and Efficacy of Adalimumab for the Treatment of Severe Alopecia Areata: Case Series of Three Patients
Authors: Bolduc Chantal , Bissonnette Robert 
Published: January 2017

Background: Current therapeutic options for extensive alopecia areata (AA) often lead to disappointing results. Objective: To study the efficacy and safety of adalimumab in patients with severe AA. Methods: This was a prospective, open-label, single-center, pilot study. Three subjects of the planned 10 were enrolled and received two weekly subcutaneous (SC) loading doses of adalimumab 80 mg followed by 40 mg SC every week for 6 months. Patients were evaluated for efficacy and safety on a monthly basis. Results: Enrolment in this trial was stopped following publication of studies showing no improvement in patients with AA treated with tumor necrosis factor α antagonists. One patient had a favorable response to adalimumab, whereas the two other patients had no benefit from the therapy. Adalimumab was well tolerated by patients with AA. Conclusion: Adalimumab was well tolerated in patients with AA but did not induce clinically significant hair regrowth.
Effective Treatment of Chronic Hand Dermatitis with 36 Continuous Months of Alitretinoin Administration: Report of Three Cases
Authors: Gulliver Wayne P. , Baker Kenneth A. 
Published: January 2017

Background: Moderate to severe chronic hand dermatitis (CHD) is not well controlled by current medical strategies; however, recent studies have shown significant improvement in patients treated with up to 6 months of oral alitretinoin (9- cis-retinoic acid). The results of longer-term continuous treatment are lacking. Objective: To evaluate the long-term safety and efficacy of alitretinoin for the treatment of CHD. Methods: The Physician's Global Assessment (PGA) and Modified Total Lesion Symptom Score (MTLSS) were used to assess CHD improvement in three patients treated with alitretinoin (10–30 mg/d). Patients had routine bloodwork and were monitored for adverse events. Results: Significant improvement in MTLSS scores (≈ 76%) was seen at 2 months ( p < .002) and maintained for the 3-year treatment period with occasional dosage adjustments. No significant adverse events developed that necessitated treatment withdrawal. Conclusion: Alitretinoin was well tolerated in the treatment of these three CHD patients who were carefully monitored over this prolonged treatment period.
Orthovoltage X-rays for Postoperative Treatment of Resected Basal Cell Carcinoma in the Head and Neck Area
Authors: Duinkerken Charlotte W. , Lohuis Peter J.F.M. , Crijns Marianne B. , Navran Arash , Haas Rick L.M. , Hamming-Vrieze Olga , Klop W. Martin C. , van den Brekel Michiel W.M. , Al-Mamgani Abrahim 
Published: January 2017

Background: Surgery is the golden standard for treating basal cell carcinomas. In case of positive tumor margins or recurrent disease, postoperative adjuvant or salvaging therapy is suggested to achieve good local control. Objective: To retrospectively report on local control and toxicity of postoperative radiotherapy by means of orthovoltage X-rays for residual or recurrent basal cell carcinoma after surgery in the head and neck area. Methods: Sixty-six surgically resected residual or recurrent basal cell carcinomas of the head and neck region were irradiated postoperatively by means of orthovoltage X-rays at the Netherlands Cancer Institute between January 2000 and February 2015. Results: After a median follow-up duration of 30.5 months, only 5 recurrences were reported. The 5-year local control rates at 1, 3, and 5 years were 100%, 87%, and 87%, respectively. The 5-year local control rate was 92% for immediate postoperative radiotherapy of incompletely resected basal cell carcinomas, 90% for recurrences after 1 previously performed excision, and 71% for multiple recurrences, namely, a history of more than 1 excision ( P = .437). Acute toxicity healed spontaneously within 3 months. Late toxicities were mild. Conclusion: Radiotherapy by means of orthovoltage X-ray is an excellent alternative for re-excision in case of incompletely resected or recurrent basal cell carcinomas that are at risk of serious functional and cosmetic impairments after re-excision, with a 5-year local control rate of 87% and a low toxicity profile.
Adapting a National Guideline for Local Use: A Comparative Case Study in a US and an Israeli Health Maintenance Organization
Authors: Shye Diana , Porath Avi , Browne Jonathan Betz 
Published: January 2017

Objectives: We compared the way a US and an Israeli health maintenance organization (HMO) used the Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (the JNG V) in developing a hypertension guideline. Methods: Comparative case study. We describe and contrast the two HMOs, the social contexts in which they function, their motivations for creating a local guideline and their guideline development processes. We then compare the two HMO guidelines with each other and with the JNC-V. Based on this analysis, we offer provisional answers to some key concerns raised by local adaptations of national or international guidelines. These include whether adaptations will reflect local cost-containment concerns in ways that could threaten quality of care, whether guidelines constitute a threat to physician autonomy and the relationship between local adaptations and the evolution of national or international guidelines. Results: The HMO guidelines differed substantially, and in similar ways, from the JNC-V in format, coverage and emphasis of topics. They differed from it minimally, but also in similar ways, in the content of their recommendations. Each HMO guideline ‘improvised’ on the JNC-V in ways that differed to reflect local needs and objectives but did not significantly distort the original. Quality of care considerations appeared to predominate over cost considerations, and we found no evidence that guidelines threatened physician autonomy. Conclusions: Local adaptations may function as part of the iterative process through which national or international guidelines evolve in ways more suitable for potential local use.
Best Place of Care for Older People after Acute and during Subacute Illness: A Systematic Review
Authors: Parker Gillian , Bhakta Padma , Katbamna Savita , Lovett Caroline , Paisley Suzy , Parker Stuart , Phelps Kay , Baker Richard , Jagger Carol , Lindesay James , Shepperdson Billie , Wilson Andrew 
Published: January 2017

Objectives: To assess the evaluative research literature on the costs, quality and effectiveness of different locations of care for older patients. Methods: A systematic review of evaluative research from 1988 using CRD4 guidelines. Twenty-five databases were searched, using processes developed specially for this review. Library OPACS, the Internet and research registers were also searched for relevant material. The final stage of the review was confined to randomised and pseudo-randomised trials. Studies were selected for review by pairs of researchers working independently who then met to reach a decision. Analysis was predominantly descriptive; simple pooled odds ratios were used to explore some outcomes. Results: Eighty-four papers from 45 trials were included. Firm conclusions were difficult to draw, except in relation to some outcomes for stroke units, early discharge schemes and geriatric assessment units. Few trials in this area have adequately addressed issues of patients' quality of life and costs to health services, social care providers, patients and their families. Conclusions: Despite considerable recent development of different forms of care for older patients, evidence about effectiveness and costs is weak. However, evidence is also weak for longer-standing care models. A substantial service evaluation agenda emerges from this review. This study also raises questions about the usefulness of systematic review techniques in the area of service delivery and organisation.
Does Ageism Affect the Management of Ischaemic Heart Disease?
Authors: Bond Matthew , Bowling Ann , McKee Dorothy , Kennelly Marian , Banning Adrian P , Dudley Nigel , Elder Andrew , Martin Anthony 
Published: January 2017

Objectives: To analyse access by age to exercise testing, coronary angiography, revascularisation (percutaneous transluminal coronary angioplasty/stent insertion and coronary artery bypass graft surgery) and receipt of thrombolysis, where indicated, for hospital patients with diagnosed cardiovascular disease. Method: Retrospective case note analysis, tracking each case backwards and forwards by 12 months from the patient's date of entry to the study. The setting was a district hospital in the eastern part of outer London. The case notes eligible for inclusion were those of elective and emergency in-patients with an in-patient ICD-10 code of ischaemic heart disease, angina pectoris or acute myocardial infarction and a consecutive 20% sample of new cardiac outpatients with these diagnoses. Results: Analysis of 712 case notes showed that older hospital patients with ischaemic heart disease, and with indications for further investigation, were less likely than younger people to be referred for exercise tolerance tests and cardiac catheterisation and angiography. This was independent of both gender and severity of condition. Older patients did not appear to be discriminated against in relation to receipt of indicated treatments (revascularisation or thrombolysis), although, in the case of revascularisation, older patients were more likely to have been filtered out at the investigation stage (catheterisation and angiography), so selection bias partly explains this finding. Conclusions: The current findings from a single hospital are comparable with the results from a broader study of equity of access by age to cardiological interventions in another district hospital in the same region. Although only two hospitals were analysed, the similarity of findings enhances the generalisability of the results presented here. It appears that age per se causes older cardiac hospital patients to be treated differently.
Not a ‘proper’ solution? The Gap between Professional Guidelines and Users' Views about the Safety of Using Emergency Contraception
Authors: Ziebland Sue , Maxwell Krista 
Published: January 2017

Objectives: As a form of contraception which is used after sex, emergency contraception occupies a singular place in the birth control repertoire. The relatively high UK incidence of pregnancy terminations and of teenage pregnancy, combined with the recognition that much early sex remains unplanned and unprotected, has led to calls for better access to emergency contraceptive methods. In this study a combination of self-completion questionnaires and semi-structured interviews was used to explore views of emergency contraception among women who were using the method. Methods: Five hundred and ten women attending two family planning clinics in Oxford and London completed a questionnaire in the waiting room and 53 women who were attending for emergency contraception took part in semi-structured interviews. Results: The view, presented in recently published UK guidelines, that emergency contraception is a reliable method and not dangerous to repeat, was not shared by the respondents. The rationale for and sources of women's concerns about the strength of the dose of hormonal emergency contraception and the nature of side-effects are explored.