bluuebunny/crossref_metadata_2025_split huggingface dataset:
Therapy of Sustained Ventricular Arrhythmias With Amiodarone: Prediction of Efficacy With Serial Electrophysiologic Studies
Authors: Nasir Nadim , Swarna Udaya S. , Boahene Kwabena A. , Doyle Timothy K. , Pacifico Antonio 
Published: January 2017

Background: Programmed electrical stimulation early during amiodarone therapy has poor prognostic capabilities; and persistent inducibility has been associated with a favorable outcome in a majority of patients. These observations result from studies that differed significantly in methodology. Methods and Results: The authors prospectively enrolled 121 patients in a standardized amiodarone dosing protocol in which amiodarone was the only antiarrhythmic agent. Electrophysiologic testing was done after 2 and 6 weeks to determine noninducibility, predictive value, and the significance of drug-induced prolongation of tachycardia cycle length. The mean age of the patients in the study was 63.2 ± 11.5 years, and their ejection fraction was 32.8 ± 11.9%. Coronary artery disease was present in 103 (85%). At 2 weeks 17 patients (14%) were no longer inducible, whereas 101 patients (86%) remained inducible. Patients in these groups were similar in age and ejection fraction. During follow-up evaluation, recurrences (35% vs 24%; P =.44) and sudden death (12% vs 13.5%) were similar in the two groups. Thirty-five of 95 patients (32%) with sustained monomorphic ventricular tachycardia had more than 100 ms prolongation of their cycle length, which was hemodynamically well tolerated (partial response), but 60 did not (nonresponse). Patients with a partial response were older (66.5 vs 61.1 years; P =.02) and had longer QRS durations (143.2 vs 129.4 ms; P =.03). They also had increased recurrences (37% vs 17%; P =.01) and more sudden deaths (23% vs 8%; P =.02). At 6 weeks 11 of 76 patients studied were noninducible. They had a lower recurrence rate than those who remained inducible (8% vs 27%; P =.02) but a similar number of sudden deaths (8% vs 16%; P =.27). Thirty-two patients partially responded, and 31 patients did not respond. During follow-up examination these two groups had a similar number of recurrences (25% vs 29%; P =.76) and sudden deaths (16% vs 16%). Conclusions: Noninducibility at 2 or 6 weeks of amiodarone therapy did not identify patients at low risk of sudden death. In inducible patients, tachycardia cycle length prolongation, even when well tolerated, was not a marker for favorable outcome. Electrophysiologically guided therapy. therefore. offers little benefit over empiric amiodarone. Conclusions: Noninducibility at 2 or 6 weeks of amiodarone therapy did not identify patients at low risk of sudden death. In inducible patients, tachycardia cycle length prolongation, even when well tolerated, was not a marker for favorable outcome. Electrophysiologically guided therapy. therefore. offers little benefit over empiric amiodarone.
Differential Electrophysiologic Effects of Chronically Administered Amiodarone on Canine Purkinje Fibers versus Ventricular Muscle
Authors: Papp Julius Gy. , Németh Mikós , Krassói Irén , Mester Lajos , Hála Ottó , Varró András 
Published: January 2017

Background: Acute and chronic treatment with amiodarone has been reported to cause different electrocardiographic changes in patients. The cellular electrophysiologic effects of chronic administration (50 mg/kg/day orally for 6 weeks) and acute superfusion (5 μM in the tissue bath) of amiodarone were therefore studied in dog cardiac ventricular muscle and Purkinje fibers using conventional microelectrode techniques. Methods and Results: During stimulation at 1 Hz, chronic amiodarone treatment lengthened the ventricular muscle action potential duration (APD) (from 227.8 ± 6.3 ms (n = 20) to 262.3 ± 5.2 ms (n = 21; P < .01), but shortened that of Purkinje fibers from 337.6 ± 9.2 (n = 21) to 308.3 ± 7.1 (n = 19; P < .05). Acute superfusion of 5 μM amiodarone in cardiac tissue obtained from chronically treated dogs did not change ventricular muscle APD but shortened Purkinje fiber AP from 309.7 ± 13.6 ms to 281.9 ± 11.9 ms (n = 8; P < −05). Neither the chronic nor the acute amiodarone exposure prevented the APD shortening in ventricular muscle evoked by 10 μM pinacidil, suggesting that amiodarone does not interfere with the ATP-dependent potassium channels. The normal difference in APD between ventricular muscle and Purkinje fibers in untreated, control preparations was 110 ms but decreased to 46 ms in fibers obtained from dogs chronically treated with amiodarone and increased to 185 ms in the presence of 30 μM sotalol, a class III antiarrhythmic drug used for comparison. Amiodarone (5 μM) applied directly abolished early afterdepolarizations (EADs) (induced by 1 μM dofetilide + 20 μM BaCl2 + 2 mM CsCI) in 5 of 6 experiments and caused strong use-dependent Vmax block with relatively fast onset kinetics (nte constant = 1.23 ± 0.13 AP-1, n = 5) and offset (time constant = 364 ± 62.5 ms, n = 5). After chronic amiodarone treatment, in contrast with acute sotalol application (30 μM), no reverse use-dependent effect was observed on the APD in Purkinje fibers. Conclusions: These results provide further evidence that amiodarone differs from other recognized class III antiarrhythmic drugs (ie, it is a mixed type agent with acute fast kinetic class I [type B] and a unique class III antiarrhythmic action characterized by decreased dispersion of APDs between ventricular muscle and Purkinje fibers). Amiodarone can abolish EADs unlike other class III agents that are usually associated to induction of EADs. These features might be responsible not only for the antiarrhythmic efficacy, but also for the relative safety (low incidence of torsade de pointes) of amiodarone in clinical settings.
Effect of Dofetilide and d-Sotalol on the ATP-Sensitive Potassium Channel of Rabbit Ventricular Myocytes
Authors: West Paul D. , Bursill Jane A. , Wyse Kenneth R. , Martin Donald K. , Campbell Terence J. 
Published: January 2017

Background: The ability of dofetilide and d-sotalol to maintain their class III action during ischemia is uncertain. We investigated the effect of these two drugs on the ATP-sensitive potassium channel (IKATP), which plays a major role in ischemia-induced action potential duration shortening. Methods and Results: The activity of (IKATP) channels was studied in excised membrane patches of single ventricular myocytes, obtained by standard enzymatic dissociation techniques from New Zealand white rabbits. Dofetilide demonstrated a dose-dependent block of (IKATP) with an EC50 of 51 ± 1 μM in inside-out patches. Its ability to block the channel was substantially less when applied to the external membrane surface. d-Sotalol significantly blocked (IKATP) (42% reduction) at a concentration of 10 μM but not at 1 μM. As with dofetilide, its ability to block (IKATP) was reduced when applied externally. Conclusions: We conclude that dofetilide and d-sotalol block the ATP-sensitive potassium channel. but dofetilide does so only at concentrations much greater than those rcquired for block of the delayed rectifier potassium channel. d-Sotalol in contrast shows modest blockade of (IKATP) at concentrations in the tipper range of those seen during its clinical use.
Staffing of Inpatient Psychiatric Units and Assault by Patients
Authors: Lanza Marilyn Lewis , Kayne Herbert L. , Gulliford Dorothy , Hicks Carol , Islam Shaheen 
Published: January 2017

BACKGROUND: Assault by a patient is a serious problem for patients, staff, and hospitals. There is disagreement in the literature about the relationship between the number of staff on psychiatric units and the assault rate. OBJECTIVE: The purpose of this study was to determine the relationship between the number of and characteristics of nursing staff and the occurrence of assault on inpatient psychiatric units. STUDY DESIGN: This was a comparative study of assaults over a 6-month time period. The primary unit of analysis was the unit shift. RESULTS: When comparing shifts with an assault to shifts without an assault, the statistical resultsfor each of thefour dependent variables (number of registered nurses, number of staff patient/staff ratio, and staff gender) were not significant. There was a significant (p < .001) interaction among three factors: assault status, unit, and time. Although the number of registered nurses (RNs) was not significantly related to assault occurrence, examination of individual units by time of day (shift) revealed surprising and important results. Some units had more assaults when there were fewer RNs, and some units had more assaults when there were more RNs. CONCLUSION: The difference between shifts with an assault and shifts without an assault depended on the particular unit and the particular time of day. The findings cannot be generalized across units and must be examined in detail at the unit level A most importantfinding in need offurther investigation is the inconsistent pattern of number of RNs related to assault occurrence both among units and within each unit.
The Relationship Between Medication Noncompliance and Cognitive Function in Patients With Schizophrenia
Authors: Jarboe Kathleen S. , Schwartz Sarah K. 
Published: January 2017

BACKGROUND:The relatively high rate of medication noncompliance in patients with schizophrenia may be in part the result of cognitive impairments frequently associated with the disorder. OBJECTIVE: The purpose of this study was to determine whether baseline performance on specific neurocognitive tests predicts a patient's level of medication compliance. The question of whether improvement on these same tests after 3 months of antipsychotic treatment would correlate with medication compliance was also examined in this study. DESCRIPTVE CORRELATIONAL DESIGN: Patients' medication compliance (on a percentage basis) was correlated with their baseline and 3-month posttreatment scores on four neurocognitive tests. RESULTS: A statistically significant relationship exists between medication compliance and patients'performance on tests of attention and immediate visual recall CONCLUSION: The results of this study support the implementation of interventions that ameliorate specific neurocognitive deficits that, in turn may facilitate improved medication compliance.
Purse-String Suture for Round and Oval Defects: A Useful Technique in Dermatologic Surgery
Authors: Zhu Jian-Wei , Wu Xian-Jie , Lu Zhong-Fa , Cai Sui-Qing , Zheng Min 
Published: January 2017

Background: Round and oval skin wounds, like facial pigmented nevi after excision, are traditionally sutured linearly for closure, leaving significant scars, which greatly influences their appearance. Objective: This article provides an overview of our experience using intradermal purse-string suture for round and oval defects in the faciocervical region to ascertain whether purse-string suture closure for such defects can result in good functional and cosmetic outcomes. Methods and Results: We present 63 cases with different skin lesions in the faciocervical area. The defects of the lesions after excision were closed using intradermal purse-string suture. The wounds showed good final healing without obvious adverse events postoperatively. The result of scar assessment using the Vancouver Scar Scale was satisfying, with a total score of only 1.11. The final cosmetic appearance of the healed wounds seemed to be excellent and acceptable as they were always smaller than the original defects, with minimal scarring. Conclusion: Purse-string suture enabled us to repair small, circular wounds easily after excision of skin lesions. It is an excellent alternative to other reconstructions and a rapid, simple method to close skin defects with minimal scarring, achieving an excellent long-term cosmetic and functional outcome.
Comparative Study of IQ-Ultra and Finn Chambers Test Methodologies in Detecting 10 Common Standard Allergens that Cause Allergic Contact Dermatitis
Authors: Doumit Joseph , Pratt Melanie 
Published: January 2017

Background: Patch testing is routinely used in contact dermatitis clinics because it is the gold standard for the evaluation of potential allergic contact dermatitis. Objective: The study was undertaken to evaluate possible differences in reactivity between the Finn Chamber and IQ-Ultra patch-testing methodologies. Methods: Patients were patch-tested simultaneously with the Finn Chamber and IQ-Ultra patch tests. Ten standard allergens set by the North American Contact Dermatitis Group were used for both techniques. Results: Both patch tests had a significant agreement in detecting all of the allergens. An “almost perfect agreement” was noted for ethylenediamine dihydrochloride, quaternium-15, mercapto mix, black rubber mix, balsam of Peru, and nickel sulfate; “substantial agreement” for formaldehyde, bisphenol A epoxy resin, and 4-tert-butylphenol formaldehyde resin; and “moderate agreement” for potassium dichromate. Conclusion: The Finn Chamber and IQ-Ultra patch tests had a good agreement in the detection of the 10 standard allergens that were tested.
Local Side Effects Caused by Hair Dye Use in Females: Cross-sectional Survey
Authors: Alghamdi Khalid M. , Moussa Noura A. 
Published: January 2017

Background: Despite its association with a number of side effects, hair dye use is common worldwide. Objective: To explore the local side effects of hair dye use and to relate these effects to features of hair dyeing. Methods: A questionnaire about hair dye use was distributed to a random sample of 650 female patients at various outpatient clinics in 2008. Results: A total of 567 females returned the questionnaire (87.2% response rate). Of these respondents, 82.6% (464 of 562) had used hair dye products in the past. The mean age at first use was 22.23 ± 7.05 years, and the median time between two consecutive dyes was 6 months. Of these respondents, 76.8% (354 of 461) used permanent dyes. Participants reported that they suffered skin redness caused by hair dyes (15.1%, 65 of 431), had scaling (14.4%, 60 of 417), or had itchiness (31.3%, 134 of 428). In addition, 74% (262 of 354) of the participants reported that they had issues with the texture or condition of hair following hair dye use; 77.7% (314 of 404) reported split ends, whereas 69.6% (273 of 392) reported hair dryness, 69.4% (256 of 369) lusterless hair, 77.2% (308 of 399) excessive hair loss, and 53.6% (210 of 392) excessive hair graying. Furthermore, 55.1% (196 of 356) of the participants reported a slowing of hair growth. The total number of hair dyeing events was associated with increased hair loss (p = .04) and excessive graying (p < .001) after controlling for all relevant variables. Conclusion: Hair dye is associated with local side effects to the skin and hair. Increased public awareness of these risks could help inform consumer choices and reduce excessive use.
Mycophenolate Mofetil and Erythromycin for Bullous Lupus Erythematosus of Childhood
Authors: Pehr Kevin 
Published: January 2017

Background: Bullous lupus erythematosus is a rare disease that is extremely rare in childhood (with only seven previous reports) and difficult to control. Objective: Herein is presented the youngest patient reported with this condition, and a novel, safe, and effective treatment regimen is described. Methods: Through study, perseverance, serendipity, and creativity, a safe and effective regimen was developed. Results: The combination of mycophenolate mofetil and erythromycin (plus sun protection) was found to be efficacious. Conclusion: It is proposed that the two medications act synergistically, with the “antibiotic” acting as a antiinflammatory agent, but at a different point in the inflammatory cascade than mycophenolate mofetil. This suggests the approach of using common, inexpensive, and benign antibiotics to potentiate, and perhaps decrease the use of, immunomodulatory agents in autoimmune and autoinflammatory diseases.
Do Clinical Practice Guidelines Reflect Research Evidence?
Authors: Savoie Isabelle , Kazanjian Arminée , Bassett Ken 
Published: January 2017

Objectives: To examine whether existing clinical practice guidelines (CPGs) for cholesterol testing reflect research evidence and hence may control or reduce costs while maintaining or improving the quality of care. Methods: A systematic search for published and unpublished cholesterol testing CPGs and independent critical appraisal of the CPGs by two researchers using a standard checklist. Results: In four of the five CPGs analysed, the link between the research evidence and the recommendations was not maintained. The appraisal, local experience and the literature all suggest that panel composition is an important explanation, in that the greater the involvement of clinical experts in the development process of the CPGs, the less the recommendations reflected the research evidence. Even though their participation is important for CPG uptake, clinical expert panels appear to have difficulty limiting CPGs to research-based recommendations. Conclusions: Existing cholesterol testing CPGs are unlikely to improve the quality of care while controlling or reducing costs. The problem lies not with guideline implementation but with the guidelines themselves. It is unclear how best to ensure that recommendations reflect research evidence but this is likely to require significant and progressive changes to the current guideline development process, including a redefinition of the clinical experts' role.
Weights for Waits: Lessons from Salisbury
Authors: Lack Alastair , Edwards Rhiannon Tudor , Boland Angela 
Published: January 2017

Objectives: This paper describes a waiting list patients' points scheme under development in Salisbury, UK, for the fair management of elective inpatient and day case waiting lists. The paper illustrates how points can be assigned to patients on a waiting list to indicate their relative unmet need, and illustrates the impact on case mix and resource use of the implementations of the points system versus ‘first come, first served’. The paper explores a range of philosophical and technical questions raised by the points system. Methods: The Salisbury Priority Scoring System enables surgeons to assign relative priority to patients at the time they are placed on a waiting list for elective health care. Points are assigned to patients to reflect the rate of progress of their disease, pain or distress, disability or dependence on others, loss of usual occupation and time already waited. In recognition of the need for resource planning alongside the prioritisation of elective inpatients and day case waiting lists, a range of iso-resource groups has been developed for all procedures on these lists. These categorise procedures in terms of their resource use (i.e. bed days and theatre time required). Results: In a modelling exercise, application of the Salisbury Points Scheme to a ‘first come, first served' orthopaedic waiting list produced considerable changes in the order of patients to be treated. Only seven patients appeared in the first 20 patients to be treated under both regimes. The Salisbury Scheme required fewer resources to treat its first 20 patients than ‘first come, first served' and met more Salisbury-defined ‘need’;, but eliminated fewer days of waiting from the list. Conclusions: Development of a points scheme and iso-resource groupings opens up opportunities for more sophisticated purchasing, based on treating patients in order of unmet need rather than according to arbitrary maximum waiting time guarantees, as has been the dominant policy on waiting lists pursued in the UK, Australia, and Sweden, to date. However, such schemes raise three issues: first, the necessity of defining need as a composite of clinical and social factors; second the necessity to determine the acceptability of explicit prioritisation to both health care professionals and patients; third, the thorny issue of whether such prioritisation schemes will lead to ‘gaming’ by well-meaning general practitioners and specialists, aiming to secure the priority of their own patients and clinical specialty. Rigorous piloting of schemes, such as that developed at Salisbury, will be required to identify their dynamic effect over time on case mix, waiting time and resource use.
Cost Containment of Pharmaceutical Use in Iceland: The Impact of Liberalisation and User Charges
Authors: Almarsdóttir Anna Birna , Morgall Janine Marie , Grímsson Almar 
Published: January 2017

Objectives: Iceland was the first Nordic country to liberalise its drug distribution system, in March 1996. Subsequent regulation in January 1997 increased patients' share of drug costs. The objectives of this study were to test the assumptions that liberalising community pharmacy ownership would lower reimbursement costs for the state's Social Security Institute and that increasing patient charges would reduce use and, therefore, lower the cost to the Institute. Methods: Based on the assumptions, we built and tested two models using interrupted time series designs that contrast the monthly reimbursement costs before and after the legislation and regulation took effect. A control variable (the number of office visits to general practitioners) was tested to assess other events in the health care arena. Monthly data on these variables were provided by the Icelandic State Social Security Institute for January 1993 to August 1998 for reimbursement costs and to December 1998 for office visits to general practitioners. Results: Reimbursement costs have risen steadily throughout the period under study. The interrupted time series analysis did not show a substantial effect from the legislative change in March 1996 or from the regulatory intervention in January 1997. Conclusions: The main argument used for liberalising community pharmacy ownership in Iceland was built on false assumptions regarding the effect on drug reimbursement costs to the state. It will be necessary to find more promising interventions to halt the rapidly increasing cost of drugs.
Quantifying Patient Preferences for Out-of-Hours Primary Care
Authors: Morgan Anne , Shackley Phil , Pickin Mark , Brazier John 
Published: January 2017

Objective: To quantify public preferences for different attributes of out-of-hours primary medical care. Methods This study applies a technique called conjoint analysis. A focus group was convened to identify the most important attributes for inclusion in the study, followed by a postal questionnaire asking people to choose between hypothetical services containing different mixes of these attributes. Multi-variate regression analysis estimated the relative importance of different attributes to respondents. The respondents were 436 adults who were among respondents to an earlier postal survey of 25 090 randomly selected Sheffield residents. Results: The doctor's manner (whether the doctor takes time to listen), the type of consultation (whether the patient receives a home visit, telephone advice, sees an accident and emergency doctor or attends a primary care treatment centre) and waiting time for consultation best predicted the public's preferences for out-of-hours care. Another three attributes - ease of access; seeing a familiar doctor; and the doctor's shift arrangements - were not statistically significant. Conclusions: By asking people to make simple choices between hypothetical services, it is possible to quantify their strength of preference for different aspects of a service. This has important implications for the planning of services. Specifically, for out-of-hours services, more consideration should be given to the doctor's manner and waiting times rather than familiarity of doctor.