bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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 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.
Postoperative Physical Training following Colorectal Surgery: A Randomised, Placebo-Controlled Study
Authors: Houborg K. B. , Jensen M. B. , Rasmussen P. , Gandrup P. , Schroll M. , Laurberg S. 
Published: January 2017

Background and Aims: Major surgery is often followed by fatigue and reduced physical function. We wished to study if postoperative physical training reduced fatigue and improved physical function. Material and Methods: Randomised, placebo-controlled, single-blinded study. Participants were unselected patients ≥ 60 years undergoing elective colorectal surgery without disseminated cancer or inflammatory bowel disease. Group A trained muscular strength and work capacity. Group B performed relaxation exercises and received hot wrappings and massage. Main outcome measures were: fatigue (visual analogue scale), muscular strength, walking speed, physical performance test, and physical function questions (SF-36). Results: Preoperatively the two groups were similar except that A was more fatigued than B. By postoperative day seven fatigue had increased compared to preoperatively, more in B than A, but by day 30 and 90 there were no significant differences between groups. All indices of physical function decreased postoperative day seven and were at the preoperative level day 90 with no significant differences between groups in change in function. Day seven the change in knee extension strength tended to be lower in B than A but by day 30 changes were similar in both groups. Conclusion: Postoperative training did not improve physical function, but reduced fatigue in hospital.
Stoma Care Problems after Stoma Surgery in Northern Finland
Authors: Mäkelä J. T. , Niskasaari M. 
Published: January 2017

Background and Aims: Stoma-related complications and problems in stoma care are common after gastrointestinal surgery requiring the construction of a stoma. The frequency and types of such complications and problems were evaluated in a patient cohort operated on in Oulu University Hospital. Material and Methods: A detailed questionnaire concerning clinical problems and stoma care was mailed to 163 stoma patients operated on during the years from 1995 to 2001 in Oulu University Hospital. One hundred and nineteen patients (70 percent) answered the questions adequately. The clinical variables concerning stoma complications and the patients' symptoms, problems with stoma care and adaptation to the situation were recorded. Special attention was paid to the patients' general wellbeing and social problems. Results: Thirty-five patients (30%) had stoma complications, most commonly parastomal hernias (18 cases). Patients with an ileostomy had more difficulties with stoma handling more often than the patients with a colostomy. Seventy-eight patients (66%) were well adapted to their stoma, including 49 (72%) of the patients with a colostomy and 25 (56%) of the patients with an ileostomy. Of the 41 non-adapted patients, 12 did not accept their altered body image, ten had problems in social life and nine had difficulties because of faecal leakage. The quality of life analysis of 114 patients showed that their physical condition was better than before the operation in 55 cases (48%), unchanged in 16 (14%) and worse in 43 (38%). General mental health was better than before the operation in 52 cases (46%), unchanged in 23 (20%) and worse in 39 (34%) patients. Social functioning had improved after stoma surgery in 38 cases (34%), remained unchanged in 27 (24%) and deteriorated in 46 (42%) patients after stoma surgery. Patients with a colostomy reported worse subjective physical condition, mental health and social functioning than the patients with an ileostomy. Conclusions: Two-thirds of the patients had adapted to their stoma. The patients with an ileostomy had difficulties in stoma handling and the patients with a colostomy reported their physical, mental and social wellbeing to be affected.
Red Blood Cell Transfusions in Patients Undergoing Lower Extremity Artery Bypass Surgery
Authors: Niemi T. T. , Kuitunen A. H. , Haukka J. , Lepäntalo M. 
Published: January 2017

Background and Aims: The purpose of this study was to search predictors of red blood cell transfusions in peripheral vascular surgical patients. Material and Methods: All the patients who undergone infrainguinal bypass surgery at Helsinki University Hospital in the year 2000 were included. Of 266 records 261 (98%) were available for data review. Multiple stepwise regression model was created to identify independent predictors of blood use. Results and Conclusions: 174 (67%) of the patients received red blood cell transfusion. The lowest measured mean (SD) haemoglobin was 94 (11) g/l intraoperatively and 92 (± 10) g/l on the first two postoperative days. The median (range) number of units was 3 (1–19). Multivariate analysis showed that high age (p = 0.019), small body surface area (p = 0.017), low preoperative haemoglobin (p<0.001), blood loss (p<0.001), long lasting surgery (p<0.001), reoperation (p = 0.018), femoro-distal reconstruction (p = 0.048) and chronic obstructive pulmonary disease (p = 0.023) increased the risk to receive red blood cell transfusion. The frequent use of antithrombotic medication (72% of the patients) did not significantly increase red blood cell administration. The generous use of red blood cells despite relative safe haemoglobin levels indicates a need for a standardized multidisciplinary transfusion strategy in this patient population. Otherwise, most of the predictors for red blood cell administration were nonmodifiable.
Low Local Recurrence Rates after Rectal Cancer Resection with Limited Use of Preoperative Radiotherapy
Authors: Wasmuth H. H. , Nestvold T. , Røkke O. 
Published: January 2017

Background: Local recurrence rates after curative rectal resection for rectal cancer have decreased after introduction of TME. In order to achieve even further reduction in local recurrence rates, several hospitals increase the use of preoperative radiotherapy. Thus, radiotherapy-related side effects will increase. The aim of the study was to evaluate the results of the TME-technique with minimal use of radiotherapy. Materials and Methods: A prospective observational study from 1993 to 2000 of 137 consecutive patients treated for rectal cancer at the Department of Surgery, Nordland Hospital HF, Bodø, Norway. Results: 115 patients underwent curative resections (84%). Eight patients (6.4 %) received peri-operative radiotherapy: three preoperatively (2.4%) because of clinically fixed tumours and five patients (4%) postoperatively; four with pR1-resections and one patient after perforation of the rectum. The local recurrence rate was 3.4 % with an observation time of 5 years. The total survival rate was 74% in curative group. In 22 patients the treatment was palliative. Only one of these patient survived 5 years. Conclusion: With TME-technique it is possible to achieve low recurrence rates and high survival rates with a high curative rate with minimal use of additional radiotherapy.