bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antimicrobial Agents and Catheter-Related Interventions to Prevent Peritonitis in Peritoneal Dialysis: Using Evidence in the Context of Clinical Practice
Authors: Bonifati C. , Pansini F. , Torres D.D. , Navaneethan S.D. , Craig J.C. , Strippoli G.F.M. 
Published: January 2018

Background Peritonitis still represents a common and major complication of peritoneal dialysis. The broader adoption of several strategies, including antimicrobial and catheter related interventions, has been advocated to prevent or reduce the risk of peritonitis in peritoneal dialysis. Methods In this article we start with the presentation of a clinical case where concern exists about the strategies for preventing peritoneal dialysis peritonitis. We then look at the available evidence in the form of systematic reviews of randomized trials and individual randomized trials of interventions to prevent peritonitis in peritoneal dialysis. A summary of the evidence is provided and then put in context with the clinical case scenario. Results Nineteen eligible trials (1949 patients) of antimicrobial agents and 37 (2822 patients) of catheter related interventions to prevent peritonitis in peritoneal dialysis were identified. Nasal mupirocin compared with placebo significantly reduced the exit-site and tunnel infection rate (1 trial, 2716 patient months, RR 0.58, 95% CI 0.40 to 0.85) but not peritonitis rate (1 trial, 2716 patient months, RR 0.84, 95% CI 0.44 to 1.60). As for antimicrobial strategies, perioperative intravenous antibiotics compared with no treatment significantly reduced the risk of early peritonitis (4 trials, 335 patients, RR 0.35, 95% CI 0.15 to 0.80) but not exit site and tunnel infection (3 trials, 114 patients, RR 0.32, 95% CI 0.02 to 4.81). As for catheter related strategies, Y-set and twin-bag systems were superior to conventional spike systems (7 trials, 485 patients, RR 0.64, 95% CI 0.53 to 0.77) and no other catheter-related intervention was demonstrated to prevent peritonitis in PD. Conclusions Evidence exists to support the use of perioperative intravenous antibiotic prophylaxis at the time of catheter placement, the twin-bag and Y-set system, as well as prophylaxis with mupirocin in Staphylococcus aureus nasal carriers. Despite lack of evidence, several other agents are used and recommended in major international guidelines, which is reasonable but requires further investigation.
The Toronto Western Hospital Catheter: One Center's Experience and Review of the Literature
Authors: Sikaneta T. , Cheung K.M. , Abdolell M. , Tam P. , Ting R. , Fung J. , Roscoe J. , Woods E. , Le Blanc D. , Oreopoulos D. 
Published: January 2018

Background We report our center's experience with the Toronto Western Hospital (TWH) catheter, and discuss our catheter survival and complication rates. Methods Retrospective chart review of patients receiving peritoneal dialysis therapy via a TWH catheter. Catheter complication rates of peritonitis, exit site infection, obstruction, leak, and malfunction were assessed. A catheter was considered failed if removed because of exit site infection, obstruction, or malfunction. All other catheters, even if removed for other reasons, were considered censured. Survival was defined as the period from insertion to failure or censure date, and reported using Kaplan Meier analysis. Results 192 patients with a total of 208 TWH catheters (4,845.3 catheter months) were analyzed. Our overall 1- and 3-year catheter survival rates were identical at 0.9182. Our catheter complication rates (expressed as number of catheter months per event) were 31.3 for peritonitis, 42.9 for exit site infection, 72.3 for obstruction, 538.4 for malfunction, and 969.1 for catheter leak. Our findings were similar to those reported in the literature for TWH and other peritoneal catheters.
Behavior of Gaseous Microemboli in Extracorporeal Circuits: Air versus Co2
Authors: Martens S. , Dietrich M. , Doss M. , Deschka H. , Keller H. , Moritz A. 
Published: January 2018

Background Open heart surgery is associated with serious risk of cerebral and peripheral organ dysfunction, attributed in part to air microbubbles generated in or not eliminated from the extracorporeal circuit (ECC). Venous air leakage leads to increased arterial bubble load. CO2 replacing air in cardiac chambers show faster resorption times, reducing possible cerebral or peripheral organ damage after heart valve interventions. In two models of ECC the effect of air entering closed circuits was demonstrated and compared to the effect of CO2 entry. Methods Fragmentation and dissolution of gas (0.5 mL) was evaluated in an in vitro model of ECC, using ultrasonic bubble detection. Air leakage (10 mL) in the venous line of the ECC was simulated and compared to the effect of the same quantity of CO2 entering the circuit. Both models used whole blood priming and physiological conditions, verified with blood gas analyses. Results Fragmentation and dissolution of gas bubbles injected into a closed ECC could be demonstrated, complete resorption of CO2 bubbles was observed earlier than complete resorption of room air (5.0±0.6 vs. 14.4±5.9 min, p=0.0009). CO2 entering the venous line lead to 40% less arterial bubble load as compared to the same amount of room air entering the circuit (2099±991 vs. 3555±632, p=0.005). Conclusions Current ECC systems fail to eliminate gas entering the circuit, leading rather to microbubble dispersion. CO2 is much faster resorbed within the circuit than room air. In open heart surgery as valvular operations, CO2 insufflation into the operative field is protective, as we have demonstrated in our models.
Confirmation of High Cytokine Clearance by Hemofiltration with a Cellulose Triacetate Membrane with Large Pores: An in vivo Study
Authors: Delanaye P. , Lambermont B. , Dogné J.-M. , Dubois B. , Ghuysen A. , Janssen N. , Desaive T. , Kolh P. , D'Orio V. , Krzesinski J.-M. 
Published: January 2018

Objective To confirm in vivo the hypothesis that hemofiltration with a large pore membrane can achieve significant cytokine clearance. Method We used a well-known animal model of endotoxinic shock (0.5 mg/kg of lipopolysaccharide from Escherichia Coli over a period of 30 mins). Six pigs were hemofiltrated for 3 hours with a large pore membrane (78 Å pore, 80 kDa cut off) (Sureflux FH 70, Nipro, Osaka, Japan). The ultrafiltration rate was 45 ml/kg/min. Samples were taken from arterial, venous line and in the ultrafiltrate at T120 and T240. We measured concentrations of interleukin 6, interleukin 10 and albumin. Results At T120 and T240, the IL-6 clearances were 22 ± 7 and 15 ± 3 ml/min, respectively. The IL-6 sieving coefficients were 0.97 and 0.7 at T120 and T240, respectively. At T120 and T240, the IL-10 clearances were 14 ± 4 and 10 ± 7 ml/min, respectively. The sieving coefficients were 0.63 and 0.45 at T120 and T240, respectively. The concentrations of IL-6 and IL-10 were the same at T0 and T240. At T60 and T240, the plasmatic albumin concentrations were 24 ± 4 g/L and 23 ± 4 g/L, respectively (p = 0.13). Conclusions In this animal model of endotoxinic shock, we confirm the high cytokine clearance observed when hemofiltration is applied to a large pore membrane. The loss of albumin seems negligible. The impact of such clearances on hemodynamic stability and survival remains to be proved.
Practice Pattern of Hemodialysis Vascular Access in Maiduguri, Nigeria
Authors: Nwankwo E.A. , Wudiri W.W. , Bassi A. 
Published: January 2018

Background Despite available evidence based recommendations and guidelines there are differences in the preferred type of vascular access in use in different localities and geographical regions. This one center study on the practice pattern of vascular access was carried out in Maiduguri, Nigeria covering a period of the first 5 years of renal care in the area. Methods We analysed the dialysis and hospital records of consecutive patients that received hemodialysis in the renal center during the period between January 2000 and December 2004. Data comprised patients' demographics, vascular access used, complications encountered during the treatment period. Clinical and laboratory features of the patients were also recorded and analysed. Results The study involved one hundred and seventy-nine patients (M:F=2:1) who suffered kidney failure whose cause was clinically determined to be mainly due to chronic glomerulonephritis, hypertension, obstructive nephropathy and interstitial nephritis. Majority presented as late referrals to the nephrologist. Overall 9 % of the study population used AVFs while 91 % used catheters inserted into the femoral or internal jugular veins. Conclusion The use of catheters for vascular access was the practice in the majority of the patients and this is possibly related to the poor survival of the patients on hemodialysis. Socioeconomic circumstances of the patients in turn largely influenced the rate of AVF use.
Weight Gains and Increased Blood Pressure in Outpatient Hemodialysis Patients Due to Change in Acid Dialysate Concentrate Supplier
Authors: Sandhu Eleanor , Crawford Colley , Davenport Andrew 
Published: January 2018

Introduction Sodium balance during hemodialysis is predominantly achieved by ultrafiltration. The additional effect of diffusional sodium losses and gains remains unclear. We recently changed our dialysate acid concentrate supplier, and although both concentrates were instructed to be diluted 1:44, we audited the practical effects of this change. Methods Review of electronic dialysis and laboratory records of patients attending a satellite dialysis center. Results 91 adult hemodialysis patients, mean age 61.4 ± 1.7 years, 65% male, 52% diabetic, median dialysate sodium machine setting at 137 mmol/l (137–138), following change in acid dialysate patients dialyzed against a mean measured dialysate sodium of 4.8 (95%cCL 3.6–6.1) mmol/l higher than setting. After six weeks, pre-dialysis weight increased from 75.5 ± 1.9 kg to 76.6 ± 1.9 kg, p<0.001, with increased mean weight loss on dialysis from 2.38 ± 0.1% to 3.28 ± 0.13%, p<0.001, and increase in pre-dialysis mean arterial blood pressure from 91.2 ± 1.5 mm Hg to 95.4 ± 1.5 mm Hg, p<0.001. Post-dialysis serum sodium increased from 0 (–3 to +3) mmol/l to +3 (1 to 5.5) mmol/l compared to pre-dialysis value, p<0.001. Monthly symptomatic episodes of intradialytic hypotension fell from 69 to 46. After correcting the dialysate sodium setting, blood pressure and weight gains resolved over 4 weeks. Conclusions Changing dialysate acid concentrates, both labeled 1:44 dilution, led to the delivery of a higher dialysate sodium, resulting in weight gains, increased pre-dialysis blood pressure, but less symptomatic intradialytic hypotension. Following readjustment of volumetric dialysate mixing, excess weight gains and increased blood pressure resolved over 4 weeks, highlighting the importance of checking the delivered dialysate sodium following a change in dialysate acid concentrate.
Increment of Cerebral Blood Flow by LDL-Apheresis in Dialysis Patients with Arteriosclerosis Obliterans: A Pilot Study
Authors: Nakajima Fumitaka , Morimoto Satoshi , Yurugi Takatomi , Amari Yoshihumi , Kasuno Yuko , Fukui Masayoshi , Furumatsu Yoshiyuki , Kitamura Tetsuya 
Published: January 2018

Objective The prevalence of thrombotic cerebral infarction is higher in dialysis than in general patients. Changes in cerebral blood flow (CBF) during low-density lipoprotein cholesterol-apheresis (LDL-A) in dialysis patients with arteriosclerosis obliterans (ASO) were evaluated employing xenon-CT (Xe-CT) to investigate the possibility of CBF improvement. Subjects and Methods Xe-CT was performed before LDL-A in 4 dialysis patients with ASO (3 males and 1 female). LDL-A was then performed once a week 10 times. After the completion of LDL-A treatment, Xe-CT was performed again to observe changes in CBF. Results Before treatment, CBF in the 4 patients was lower than that in the general population in the same age group. After LDL-A treatment, CBF was improved. The improvement was observed in the cerebral cortex rather than the basal ganglia. The grade of improvement and improved cerebral region varied among the patients. Conclusion It was suggested that LDL-A may improve not only lower limb blood flow but also CBF. However, further investigation is necessary with regard to the influence of CBF improvement on the brain function and clinical application. The reported results need to be confirmed in larger studies.
Late de Novo Aortic Regurgitation with the Jarvik 2000 Flowmaker® left ventricular assist device
Authors: Rossi Michele , Serraino Giuseppe Filiberto , Jiritano Federica , Renzulli Attilio 
Published: January 2018

Introduction There is a worldwide trend towards a more liberal use of ventricular assist devices (VADs) as a definitive treatment for patients in end-stage heart failure. This has also led to a new set of complications related to the prolonged interaction between the native heart and the device. Methods We report a case of, late, de novo aortic regurgitation (AR), leading to acute pulmonary edema in a 56-year-old man, 20 months after the implantation of a left ventricular assist device (LVAD), the Jarvik 2000 Flowmaker®, as destination therapy for end-stage heart failure. Results The Jarvik 2000 was working well at check up at level 3 of assistance, i.e. generating a flow between 3–5 l/min at 10,000 rpm. The only new finding was a moderate, de novo, AR at trans-thoracic echocardiogram (TTE). The patient was assisted in intensive care with inotropic and diuretic support and made a good recovery. He remains under close follow up in NYHA class II with the same level of mechanical assistance and a more intensive diuretic therapy. Conclusions This case shows how dramatic the onset of de novo AR in patients with LVAD can be. The AR occurred despite the presence of the ILS (intermittent low speed) that allows the opening of the native aortic valve for 8 seconds every 64 and should, theoretically, preserve the native aortic valve. To our knowledge, this is the first report of de novo AR in a patient with the Jarvik 2000 axial flow device.
Media Literacy and Education in India During Times of Communication Abundance
Authors: Jayachandran Jesna 
Published: January 2018

Media literacy has been a persistent, but under-engaged concern in India despite its media explosion.This commentary examines media literacy against various dimensions like the public sphere, market, technology and access, civil society and citizen activism to identify the limitations and possibilities. In the process, it proposes inclusive, multi-pronged continuous approaches to build critical awareness, autonomies and empowered action.
Triangulation in action
Authors: Piggot-Irvine Eileen 
Published: January 2018

This article presents a summary review of the design and results of an independently conducted evaluation of a national New Zealand (NZ) Ministry of Education funded contract for professional development of staff of students with special education needs in 49 schools. The evaluation was conducted as a mixed method design (Johnson & Onwuegbuzie 2004) in the following three phases: a broad questionnaire issued to all participants associated with the development; eight focus groups with a sample of participants; and success case studies (Brinkerhoff, 2003) with four schools. The most significant overall finding was that regardless of the approach to development engaged in (either action research, AR, or action learning, AL), there was an outstanding recurring characteristic of staff and supporters wanting to see the students excel. Other key participant self-report impacts from the small-scale projects on adaptation of the curriculum fell under the headings of improved social interaction and academic achievement for students, changes in values and attitudes (for students and teachers), and changes in teaching practice. Participants referred to the importance of school context factors (inclusive planning, management support) and internal and external experts as enablers towards the effectiveness of development. Barriers to effectiveness were noted as associated with initial national contract administration, the number of development initiatives involved in and lack of alignment between these varied initiatives. Maintaining and sustaining the effective impact of projects was seen as dependent on: ongoing commitment and follow-through by school management, governors and program teachers; having ongoing funding and support (internal and external); and bringing other staff on board. The Phase Three success case evaluation revealed an important element that distinguished projects perceived to be highly successful by both the participants and Ministry of Education personnel. In this small proportion of projects the participant action researchers/learners utilised ‘informed’ decision-making. Although many participants in Phases One and Two justified their limited use of informed decision-making by noting that it was either too early to validate project outcome changes, or it was difficult to show causal effect (changes could be attributed to the development program), a hallmark of the four success cases was the use of strong data in the reconnaissance and evaluation phases of the AR and AL and improvement initiatives that were informed by both this data and relevant previous literature.
An examination of the value of the Victorian Government's investment logic map as a tool for front-end evaluation of investment proposals
Authors: Doty Aaron 
Published: January 2018

This article considers a tool called an ‘investment logic map’ which was developed by the Victorian Government Department of Treasury and Finance to assist in testing the rationale for proceeding with investment proposals (particularly information and communications technology investments) while they are still at an early stage of development. The article views this tool through the lens of evaluation theory and practice, and situates the investment logic map within the practice of front-end evaluation. From this perspective, the article considers some of the drawbacks of the investment logic map as an example of program logic. The article argues that, because of the pivotal role the investment logic map plays in the management and review of investments through their lifecycle (as part of the government's broader Investment Management Standard), it needs to be underpinned by more robust evaluation practice. The article concludes by suggesting a way in which the strengths of the investment logic map can be retained, while reducing the risks inherent in its current use.
Invisible Mechanisms
Authors: Pawson Ray 
Published: January 2018

The mandate for evaluators to ‘look inside the black box’ of an intervention has become a familiar and heeded cry. So whether it is process evaluators with their logic maps, or theories-of-change researchers with their intervention stepping stones, or realists with their context, mechanism outcome configurations, searchlights have been aimed into the gloom. So much so that a contemporary sounding riposte, ‘been in there, done for that’ might be deemed to reflect the current state of play in evaluation research. This article, nonetheless, warns against complacency. It peers even further into the darkest reaches of the inky blackness, and urges other researchers to follow. It throws light on the presence of an overlooked set of program mechanisms, so deeply buried that they are almost invisible. The processes I have in mind are missed because they are tacit, mundane, over-familiar, and taken for granted and, as result, they often overlooked. And yet they are often responsible for a goodly part of impact of a goodly number of interventions. As such, they deserve a sustained program of research and this article sets out a brief agenda for such inquiries.
Participatory Research in Challenging Circumstances Lessons with a Rural Aboriginal Program
Authors: Spooner Catherine , Flaxman Saul , Murray Colleen 
Published: January 2018

The evaluation of a crime prevention program for Aboriginal boys in a rural setting (Tirkandi Inaburra Cultural and Development Centre) faced a number of challenges, such as geographic distance, a modest budget, and the need for culturally appropriate and sustainable methods that capture a multitude of program effects while minimising the burden of data collection. Literature suggests the value of participatory methods. However, would this approach work in these circumstances? Would it threaten the probity of the evaluation? This article describes a case study of participatory methodology used in challenging circumstances and considers the factors that contributed to its successful implementation. These included mutual respect, willingness to work together, high capacity within Tirkandi Inaburra, funding-body support for a participatory approach, a common concern for the program's mission, and strategies for ensuring probity. It is recommended that funding bodies accommodate the resource implications involved in developing relationships and accommodate changes to research plans that can be necessary for genuine participation.
Evaluating Contracted Domestic Violence Programs
Authors: Carson Ed , Chung Donna , Day Andrew 
Published: January 2018

The growing significance of domestic violence programs run by the state and contracted nongovernment agencies in Australia over the past decade has not been matched by a commensurate growth in evaluation of those programs. A number of evaluations have been conducted, but only a few have been long-term and large-scale, due to funding and other constraints. The promotion of evidence-based practice and policy encourages practitioners and scholars to aim for comprehensive and systematic review of initiatives, but achieving that is no mean feat since both the service delivery and governance of these programs are often complex and multi-stranded. In this article we reflect on theoretical and practical issues of evaluation by reporting on the experience of undertaking an evaluation of domestic violence perpetrator and victim support programs delivered for an Australian state government by contracted community service agencies. The experience was not as we had expected on the basis of social policy debates. In this situation, there were difficulties in generating sufficiently robust data on offenders in group programs that delayed and limited the scope of a quasi-experimental assessment of intervention, although that strand continues to date. At the same time, however, this strengthened the importance of evaluating service delivery and governance issues within a ‘realist evaluation’ paradigm. Since contemporary domestic violence programs often typically combine coordinated support for women and children and behaviour change intervention with offenders, evaluation needs multi-stranded approaches that may draw on paradigms more commonly thought of as being in tension.
The Political Inherency of Evaluation: The Impact of Politics on the Outcome of 10 Years of Evaluative Scrutiny of Australia's Mandatory Detention Policy
Authors: Slattery David 
Published: January 2018

The primary objective of evaluation is to provide information that can provide a basis for developing or revising policies and programs, and is an inherently political activity. This article reflects on 10 years of scrutiny by evaluators of a contested policy in Australia—that of the mandatory detention of asylum seekers—and explores how evaluation informs political decisions, and how politics shapes the use of evaluation results. The evidence presented shows that evaluators need to be aware of, and manage, the political forces that shape the scope and outcomes of evaluations. Otherwise, evaluation may be little more than a tool for reinforcing existing power relations rather than a neutral and objective means of improving social policies or programs. Some strategies are suggested to help evaluators safeguard their neutrality and maximise the effectiveness of their contributions to political debates.