bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hospital CEO Turnover: Modelling More or Less Durable Places to Work
Authors: Weil Peter , Timmerberg John 
Published: January 2017

This study documents the rising rate of hospital CEO turnovers between 1978 and 1988, a trend that has accelerated since the introduction of Medicare's prospective payment system. Using data from the American Hospital Association, we identify characteristics of hospitals experiencing rapid CEO turnover. Results show that full utilization along with a positive operating margin can prolong the CEO's tenure but ownership and system membership specify the findings. For example, CEO turnover is higher in investor-owned, multihospital systems hospitals if they are small, if their costs are high and if they have recently joined a multi-hospital system. By contrast, in not-for-profit multihospital systems, turnover is higher if they have low occupancy and low operating margins. CEO turnover in not-for-profit, freestanding hospitals is higher in metropolitan areas and in the Western region of the US as well as in hospitals with low occupancy, low operating margins and lower costs per patient day. Governmental hospitals experiencing higher CEO turnover are small, metropolitan and tend to be located in any region except the Midwest. Many have recently joined a multi-hospital system and have experienced low operating margins.
A Study to Estimate the Prevalence of Upper Respiratory Tract Papillomatosis in Patients with Genital Warts
Authors: Clarke Janette , Terry R M , Lacey C J N 
Published: January 2017

Respiratory tract papillomas are associated with human papillomavirus (HPV) types 6 and 11; these HPV types are also commonly associated with genital warts (condyloma acuminata). Although most commonly seen in young children, the incidence of respiratory tract papillomas in young adults is increasing. It has been postulated that orogenital contact is the means of transmission in this age group. We performed a survey of adults with genital warts to assess the prevalence of respiratory tract papillomatosis in relation to sexual behaviour and other factors. Fifty-three adult patients (35 male, 18 female) with genital warts attending a genitourinary medicine clinic agreed to examination of the mouth and throat, including indirect laryngoscopy. Seventy per cent of the group had participated in oral sex. Two patients (3.8%) had lesions attributable to HPV infection of the oropharynx and larynx (one with laryngeal keratosis, one with papilloma of the pharynx). There was no specific risk factor identified to predict respiratory tract disease. In view of the high infectivity of genital warts, it is interesting to note the low prevalence of oropharyngeal warts in adults indulging in orogenital contact. Since malignant transformation is known in respiratory tract papillomas, we would recommend that any patient with genital warts who develops unexplained hoarseness has a specialist examination of the upper respiratory tract.
Temporal Changes in the Sensitivity of Neisseria Gonorrhoeae to Penicillin in Edinburgh, Scotland
Authors: Ross J D C , Moyes A , McMillan A , Young H 
Published: January 2017

Increased resistance of Neisseria gonorrhoeae to penicillin has been reported from many centres around the world since the introduction of antibiotic therapy in the 1940s. This study reports the temporal changes in gonococcal penicillin sensitivity over a 3-year period. All patients with a diagnosis of gonorrhoea in the city of Edinburgh, Scotland between 1990 and 1992 were included in the study. Penicillin sensitivity of isolates was analysed in relation to the sex and sexual orientation of the patient and the antibiotic therapy given. Four hundred and twenty-seven new patient episodes of infection occurred of which penicillin sensitivities were available in 426. Eleven episodes of PPNG infection occurred. Chromosomally mediated penicillin resistance did not increase over the study period. No differences were evident in the sensitivity of isolates from homosexual and heterosexual patients. Unlike many other areas the relative resistance of N. gonorrhoeae is not increasing in Edinburgh at present. This may relate to local antibiotic policies combined with intrinsic characteristics of N. gonorrhoeae itself. Unlike previous reports there did not appear to be any increased resistance- to penicillin in isolates from gay men.
Maternal Serum Screening in Ontario Using the Triple Marker Test
Authors: Summers A M , Farrell S A , Huang T , Meier C , Wyatt P R 
Published: January 2017

Objectives: To summarise the experience and evaluate the performance of the Ontario maternal serum screening (MSS) programme. Methods: This study used information collected in the Ontario MSS database, which contains data on each screened pregnancy. In the Ontario MSS programme, women are screened between 15 and 20 weeks of gestation. The risk cut-off for Down's syndrome was ≥1 in 385 at term and women with a serum alpha-fetoprotein ≥2.2 multiples of the unaffected population median were defined as screen-positive for open neural tube defects. Results: Between 1 October 1993 and 30 September 2000, 428,410 women residing in Ontario were screened for open neural tube defects, and 423,895 women were screened for Down's syndrome and trisomy 18. Approximately 48% of all pregnant women in the province had MSS. The uptake rate of amniocentesis following a positive Down's syndrome screening was 67%. Of 717 cases of Down's syndrome ascertained in the screened population, 531 were detected by MSS, giving a term detection rate (DR) of 70.6%, with a false-positive rate (FPR) of 7.2%. For neural tube defects, the DRwas 72.7%, with a FPR of 2.0%. The screen also detected 50% of cases of trisomy 18 at term, with a FPR of 0.2%. Coincidentally, 113 cases of chromosome aneuploidies other than Down's syndrome and trisomy 18 were detected Discussion: In the Ontario MSS programme, MSS performed as expected in the detection of Down's syndrome, open neural tube defects and trisomy 18. MSS is an effective and practical method for large- scale second ttrriimester screeni.ng for Down's syndrome, open neuraI tube defects and ttrriisomy 18, and the MSS database is an extremely useful tool in monitoring the performance of this screen.
A Rational Approach to Radiological Screening in Von Hippel-Lindau Disease
Authors: Harries R W J 
Published: January 2017

Objectives— To optimise radiological screening in von Hippel-Lindau disease (VHL) while minimising cost and morbidity. Methods— A model of VHL was based on retrospective studies, and Bayes's theorem used to calculate the probability of the gene's presence and the likelihood of further lesions in affected families. A six year follow up was conducted to test the validity of the model. Results— Follow up confirmed the accuracy and validity of the model. Posterior fossa haemangioblastomas occur in 79·2% of VHL cases, supratentorial, retinal and spinal haemangioblastomas in 6·9%, 42·8%, and 22·0%, phaeochromocytomas in 5·2%, and renal carcinomas in 14·5%. Population incidences are 1:15 700 live births (posterior fossa), 1:780 000 (supratentorial), and 1:116 000 (spinal). The birth rate of subjects with VHL is 1:43 000; new mutations occur in 1:178 000 live births. Penetrance is 90%; 40% present with multiple lesions and 6·4% die within two years after diagnosis. Conclusions— For most patients presenting with a VHL-type lesion, with sufficient clinical and pedigree data, the presence or absence of the VHL gene, and the probability of further lesions occurring, can be assessed with a high degree of accuracy using the method described in this paper. Those cases in the non-VHL group do not require long term radiological follow up, nor do their relatives require radiological screening. Subjects in the VHL group should be screened for renal carcinoma indefinitely from the age of 20 years, and all clinically unaffected relatives should be screened genetically for the VHL gene. (Those found negative for the gene do not require further screening, but those found positive should be screened.)
Seeking asylum
Authors: Velakoulis Dennis , Pantelis Chris 
Published: January 2017

Objective: To highlight our duty of care for patients with persistent and treatment-resistant chronic schizophrenia, some of whom remain homeless. Conclusions: That schizophrenia as an illness has not changed, nor has the efficacy of our treatments. A minority of patients have and will continue to develop persistent and chronic illness. Asylum can offer the time and structure required for the maximisation of function and symptom treatment.
An initiative in primary care psychiatry in South Australia
Authors: Paterson Tom , Seiboth Christopher , Magin Barbara , Nagesh Rajan , Lloyd Cyndy , Williams Helena 
Published: January 2017

Objective: To describe a joint mental health project involving the Adelaide Northern Division of General Practice (ANDGP) and the North West Adelaide Mental Health Service (NWAMHS). Conclusions: This project has been developed to explore alternative strategies to facilitate the identification and management of patients with mental illness in the primary care setting. The project has also endeavoured to explore alternative types of psychiatrist/general practitioner interactions other than the conventional ‘general practitioner referred psychiatrist consultation’. The development of adequate and clinically relevant evaluation methods, both quantitative and qualitative, has also been an explicit objective of the project. While the project provides an exciting stimulus for ongoing development of models of Primary Psychiatric Care, it is evident that such models can only evolve in the context of significant service and systemic change. It is hoped that the experiences in the northern suburbs of Adelaide can stimulate others to explore the ongoing collaborations between psychiatric services and general practitioners in ways that can produce better mental health outcomes in our patients.
Emergency Department Asthma Treatment Protocol
Authors: Joe Ronald H. , Kellermann Arthur , Arheart Kristopher , Ellis Robert , Self Timothy 
Published: January 2017

OBJECTIVE: The purpose of this study was to determine if a brief educational intervention (INT) on the treatment of acute asthma improved prescribing patterns of internal medicine residents in an emergency department (ED). Additional objectives were to determine if optimal therapy reduced length of stay (LOS) in the ED and to determine if discharge prescribing patterns could be improved. DESIGN: Nonrandomized, single-blind INT study. SETTING: A large, urban, county-owned, university-affiliated ED. PATIENTS AND OTHER PARTICIPANTS: Eight internal medicine residents in each of three study periods; numbers of adult asthmatics for each period were: control group, 129 (Nov—Dec 1989); INT group A, 82 (Jan—Feb 1990); and INT group B, 139 (Nov—Dec 1990). INTERVENTIONS: INT consisted of a ten-minute verbal presentation, a three-page summary of the literature, and a posted protocol in the ED. Control data were collected prior to any INT. Prescribing patterns were covertly evaluated in each of the three study periods. Because discharge prescribing of long-term antiinflammatory therapy with inhaled corticosteroids was not improved in group A, emphasis on this point was added for group B. MAIN OUTCOME MEASURES: Percentage of patients who received desired acute and discharge therapies and LOS for each study period. RESULTS: Increased prescribing of desired acute therapy in the ED was seen in both INT groups. For discharge prescribing, the INT was partially successful. Reduced LOS was not found for the INT groups. CONCLUSIONS: A brief INT effectively improves prescribing of optimal acute therapy of asthma in the ED, yet does not appear to reduce LOS. Further strategies are needed to impact on therapy prescribed at discharge from the ED.
Mitomycin-Induced Pulmonary Toxicity: Case Report and Review of the Literature
Authors: Linette Donna C. , McGee Karen H. , McFarland James A. 
Published: January 2017

OBJECTIVE: This report describes a case of mitomycin-induced pulmonary toxicity and reviews the incidence of this adverse effect, reported patterns of toxicity and associated dosages of the drug, and the use of corticosteroids in the management of pulmonary toxicity. DATA SOURCES: Information about our patient was obtained in part from the medical chart; we had also treated him personally in the past. We conducted a MEDLINE search of the English language literature (restricted to human studies) from 1966 to 1991 and manually searched Index Medicus for current information. STUDY SELECTION: All case reports that described pulmonary toxicity possibly associated with mitomycin were reviewed. DATA EXTRACTION: Studies were evaluated for the dosages of mitomycin given to patients, the nature and onset of symptoms, management course, and corticosteroid use. DATA SYNTHESIS: Our case is similar to others described in the literature. The incidence of mitomycin-induced pulmonary toxicity has been reported to range from 2 to 38 percent. Concurrent vinca alkaloid administration may potentiate the risk of an acute pulmonary insult secondary to mitomycin use. The toxicity is usually of slow onset and the average total dosage of drug implicated is 78 mg. A formal evaluation of corticosteroid treatment has not been performed, but various authors have reported success with different regimens. CONCLUSIONS: The incidence of pulmonary toxicity associated with mitomycin is unpredictable, but more likely to occur at higher dosages. Treatment with corticosteroids is encouraged to improve pulmonary response.
Inadequate Adrenergic Response to Disopyramide-Induced Hypoglycemia
Authors: Smith Richard C. , Sullivan Michael , Geller Jack 
Published: January 2017

OBJECTIVE: To report a case of disopyramide-induced hypoglycemia and to discuss the observed inadequate adrenergic response in this patient. Risk factors, possible etiologies, and preventive measures are also discussed. DATA SOURCES: References from case reports and review articles as identified by MEDLINE. DATA SYNTHESIS: A wide variety of drugs has been implicated as causing hypoglycemia. The mechanism for drug-induced hypoglycemia is known for the majority of these agents. Case reports of disopyramide-induced hypoglycemia have been reported in the literature, but the mechanism of action is unclear. We report a case of disopyramide-induced hypoglycemia in which counterregulatory hormones, serum insulin, and C-peptide concentrations were obtained. From these data, it appears that disopyramide-induced hypoglycemia results from endogenous insulin secretion, with concomitant inadequate counterregulatory response. CONCLUSIONS: Although a rare occurrence, disopyramide-induced hypoglycemia is potentially life-threatening. Patients at risk for this reaction need to be identified prior to the institution of disopyramide therapy. Patients at risk for hypoglycemia should be monitored while on disopyramide and disopyramide blood concentrations should be maintained at the lower end of the therapeutic range, or alternative agents should be considered.
Postmortem Changes and Pharmacokinetics: Review of the Literature and Case Report
Authors: Shepherd Michele F. , Lake Kathleen D. , Kamps Melissa A. 
Published: January 2017

OBJECTIVE: To review the mechanisms and sequence of events that occur during ischemia and cell death and following death of the human body. The impact of these postmortem events on the distribution and pharmacokinetic behavior of drugs is described. The case study presented illustrates a possible situation where such postmortem changes could have affected the pharmacokinetics of procainamide. DATA SOURCES: English-language journal articles and reference texts identified from pertinent data sources. DATA SYNTHESIS: Postmortem changes in the human body begin at the cellular level with the onset of ischemia. As the length of time of ischemia increases and death ensues, more changes occur and lead to deterioration in tissue and organ function. These changes may affect the pharmacokinetic and distribution behavior of certain drugs. Drugs particularly affected are those whose distribution is dependent on molecular size, lipophilicity, pH, energy-dependent transport, and tissue binding. Such drugs include the tricyclic antidepressants, digoxin, and cimetidine. Other drugs with similar characteristics, such as procainamide, may also demonstrate like changes in distribution and pharmacokinetics. CONCLUSIONS: When measuring drug concentrations after death, it is important to consider the phenomenon of postmortem redistribution. Postmortem drug concentrations may not be a true reflection of antemortem concentrations and as a result, wrong conclusions could be made about the cause of death. More studies characterizing the postmortem distribution and pharmacokinetic characteristics of specific drugs are necessary.
Taurine: An Essential Amino Acid to Prevent Cholestasis in Neonates?
Authors: Howard Denise , Thompson Dennis F. 
Published: January 2017

OBJECTIVE: To review the evidence that taurine can prevent cholestasis in neonates. DATA SOURCES: MEDLINE and EMBASE searches were conducted to identify both animal and human data regarding taurine's role in bile acid conjugation and liver disease (key terms: taurine, children less than two years old). STUDY SELECTION: Emphasis was placed on human data supplemented by relevant animal data. DATA SYNTHESIS: Taurine appears to more effectively conjugate bile acids than glycine, and the end-products of conjugation are more soluble. Taurine deficiency may increase glyco-conjugates of bile acids and result in cholestasis. Although the cause of neonatal cholestasis probably is multifactorial, there are data indicating that adequate taurine may prevent cholestasis in neonates. CONCLUSIONS: Taurine should be considered an essential amino acid for neonates and should be included in total parenteral nutrition solutions for these patients.
Transdermal Fentanyl
Authors: Yee Lisa Y. , Lopez Julio R. 
Published: January 2017

OBJECTIVE: To review the use of transdermal fentanyl for the treatment of moderate to severe chronic pain. The article provides background on the pharmacology and pharmacokinetics of the drug, as well as the properties of the transdermal system. In addition, clinical trials, adverse effects, and therapeutic considerations and recommendations are presented. DATA SOURCES: Clinical trials, review articles, and reference texts. STUDY SELECTION: Comparative clinical trials involving the use of transdermal fentanyl on postoperative and chronic pain patients. DATA EXTRACTION: Data from clinical human trials published in the English language were reviewed. Trials were assessed by sample size, opioid dosage regimen, and therapeutic outcome. DATA SYNTHESIS: Transdermal fentanyl was found to be effective in the control of chronic and postoperative pain. In one trial the overall patient satisfaction with pain control was 79 percent for the transdermal fentanyl group and 44 percent for the placebo group. In another trial, the amount of additional parenteral morphine was significantly lower for the group receiving transdermal fentanyl than for the placebo group (49.9 ± 4.9 vs. 77.0 ± 6.3 mg, respectively, p<0.01). The most common adverse effects recorded were nausea (45–85 percent), pruritus (14–60 percent), and sedation (40–59 percent). The cost of analgesic therapy with this delivery system is higher than that of parenteral opioid analgesia, but less than patient-controlled analgesia. CONCLUSIONS: The transdermal fentanyl formulation offers some minor advantages over other forms of conventional pain management. Results of early clinical trials are promising, but more studies are needed to evaluate its long-term effectiveness and adverse effects. Specifically, comparisons with standard parenteral and patient-controlled opioid analgesia in chronic malignant and nonmalignant pain are necessary for adequate evaluation of transdermal fentanyl.
Intravenous-to-Oral Stepdown Program: Four Years of Experience in a Large Teaching Hospital
Authors: Frighetto Luciana , Nickoloff Donna , Martinusen Shelagh M. , Mamdani Fatima S. , Jewesson Peter J. 
Published: January 2017

OBJECTIVE: To assess the impact of an intravenous-to-oral (iv-po) stepdown program on the relative use of oral and parenteral dosage forms of select antimicrobials. DESIGN: A retrospective review of drug utilization records before and after a trial comparing metronidazole and clindamycin prescribing trends from a 12-month baseline period to a four-year follow-up period. SETTING: One thousand-bed Canadian tertiary care referral teaching center. INTERVENTION: An authorized iv-po stepdown program was developed to promote the oral route of drug administration. Reminders of iv-po stepdown were produced for metronidazole and clindamycin and these notes were sent to nursing units with the parenteral dosage form. The notes then were attached to the front of the health record to serve as a reminder to prescribers that an equally effective, well-tolerated, and less-expensive oral dosage form was available for use. RESULTS: A 44 percent relative increase in the use of oral metronidazole and a 79 percent relative increase in the use of oral clindamycin occurred. When acquisition and delivery costs were considered, cumulative cost savings from 1988 to 1991 resulted for metronidazole ($31920) and clindamycin ($53880). CONCLUSIONS: This intervention represents a simple yet effective method of promoting a process of stepdown from parenteral to oral antibiotic therapy.
Aspirin for the Prevention of Vascular Death in Women
Authors: McAnally Laura Engles , Corn Carolyn R. , Hamilton Stephen F. 
Published: January 2017

OBJECTIVE: To review current information relevant to the use of aspirin for preventing vascular death in women, and to provide recommendations based on this information. DATA SOURCES: References from pertinent articles are identified throughout the text. DATA SYNTHESIS: Based on current information, low-dose aspirin is not recommended as primary prevention for cardiovascular death in women; efforts are better focused at promoting risk-factor reduction. Low-dose aspirin is recommended for reducing further cardiovascular morbidity and mortality in women with known cardiovascular disease. Women presenting with unstable angina or myocardial infarction should receive aspirin 325 mg as soon as the diagnosis is confirmed, and this dosage should be continued on a chronic basis. Women who have experienced transient ischemic attacks or ischemic stroke should receive aspirin 1000 mg/d, with a subsequent dosage reduction to 325 mg/d in patients who do not tolerate the higher dose. CONCLUSIONS: Current recommendations are based on the results of studies that involved few women. Further investigation of antiplatelet agents for primary and secondary prevention of vascular death in women is needed.