bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mycophenolate Mofetil for the Treatment of Autoimmune Hepatitis in Patients Refractory or Intolerant to Conventional Therapy
Authors: Sharzehi Kaveh , Huang Mary Ann , Schreibman Ian R , Brown Kimberly A 
Published: March 2016

BACKGROUND: Autoimmune hepatitis is characterized by hepatocellular inflammation often progressing to cirrhosis. Standard treatment consists of corticosteroids and azathioprine. For the 20% of patients with refractory disease or those who are intolerant to medication, there is no standardized treatment.OBJECTIVE: To evaluate mycophenolate mofetil (MMF) as an alternative therapy for autoimmune hepatitis.METHODS: The present retrospective study identified all patients with autoimmune hepatitis who were treated with MMF over a 10-year period at the Henry Ford Hospital (Michigan, USA). These patients were evaluated for tolerance and response.RESULTS: Of the 90 patients participating in the study, 48% had a complete response, 32% experienced relapses and 21% were refractory. MMF was initiated in 21 patients – 12 (57%) for refractory disease and nine (43%) for medication intolerance. Of the 12 patients converted for refractory disease, all showed biochemical improvement but none had a complete response. Of the patients converted due to intolerance, 88% maintained complete remission. For all patients converted to MMF, there was a mean decrease in steroid dose from 18.9 mg/day to 7.8 mg/day (P=0.01).CONCLUSIONS: In patients with autoimmune hepatitis who were intolerant to conventional therapy, MMF was well tolerated, with 88% of patients maintained in remission. MMF did not induce remission in those refractory to conventional therapy; however, it resulted in a significant decrease in steroid use. Prospective studies are needed to better assess the role of MMF as an alternative therapy.
Ankaferd Blood Stopper for Controlling Gastrointestinal Bleeding due to Distinct Benign Lesions Refractory to Conventional Antihemorrhagic Measures
Authors: Kurt Mevlut , Onal Ibrahim Koral , Akdogan Meral , Kekilli Murat , Arhan Mehmet , Sayilir Abdurrahim , Oztas Erkin , Haznedaroglu Ibrahim Celalettin 
Published: March 2016

OBJECTIVE: To assess the hemostatic efficacy of the Ankaferd Blood Stopper (ABS, Ankaferd Health Products Ltd, Turkey) hemostatic agent for controlling gastrointestinal bleeding associated with various benign lesions refractory to conventional antihemorrhagic measures.METHODS: The records of all patients who underwent upper and lower endoscopy procedures at the Turkiye Yuksek Ihtisas Teaching and Research Hospital (Ankara, Turkey) between April 2008 and June 2009 were reviewed. Patients in whom ABS was used as a primary or adjuvant hemostatic agent were included in the study. Rates of bleeding control and postprocedural complications were documented.RESULTS: Hemostasis with no immediate complications was achieved in all patients within seconds of endoscopic application of ABS.CONCLUSIONS: ABS may have a role as a primary treatment or as an adjuvant to conventional modalities used to control gastrointestinal bleeding. Prospective controlled studies are needed to help establish its efficacy and, perhaps, offer a comparison with conventional hemostatic interventions.
How Well Does the Internet Answer Patients’ Questions about Inflammatory Bowel Disease?
Authors: Promislow Steven , Walker John R , Taheri Mohammad , Bernstein Charles N 
Published: March 2016

BACKGROUND: The Internet is an increasingly important source of health information.OBJECTIVE: To assess how well common websites answered patients’ questions regarding inflammatory bowel disease (IBD).METHODS: Thirty websites were identified and evaluated. Based on a previous survey of patient information needs, a comprehensive question list was developed in the three following areas: medical information (seven items), medical treatment (six items) and self‐management (eight items). The websites were evaluated for the amount of information they provided to answer each question using two standard measures of information quality – the DISCERN and the Ensuring Quality Information for Patients scales.RESULTS: Four particularly strong websites, scoring highest (on a scale from 1 to 5) in terms of IBD information, were the Crohn’s and Colitis Foundation of America (mean information score 4.3), About.com (4.2), HealthCentral (3.8) and WebMD (3.8). These websites also scored well on the DISCERN and the Ensuring Quality Information for Patients quality scales. Most websites provided at least adequate information on common symptoms, complications, treatments and what is known (or not known) about the causes of IBD. However, many web‐sites did not provide adequate information about prognosis, possible side effects of treatment and risks of developing cancer. Information regarding self‐management was covered to a very limited extent.CONCLUSION: Websites could be strengthened by providing more of the information patients deem to be important, and by more clearly identifying sources of information and the date the information was updated. Most websites would benefit from more attention given to reducing the reading level and improving the organization of material.
A 10‐Year Retrospective Review of Salmonella Infections at the Children’s Hospital in London, Ontario
Authors: Cellucci Tania , Seabrook Jamie A , Chagla Yasmine , Bannister Susan L , Salvadori Marina I 
Published: March 2016

OBJECTIVES: To describe Salmonella infections in children presenting to the Children’s Hospital (London Health Sciences Centre, London, Ontario), to assess risk factors for infection and to examine whether younger children, particularly infants younger than 12 weeks of age, experience higher morbidity than older children.METHODS: A 10‐year retrospective review of children with Salmonella infections at the Children’s Hospital was conducted. Patient demographics, risk factors for infection, clinical characteristics, bacteriology and outcome were collected from the hospital charts and laboratory records. Data were separated into groups based on age and recent use of antibiotics to analyze differences in outcomes.RESULTS: Sixty‐six children with Salmonella infections presented to the Children’s Hospital over a 10‐year period. Common risk factors for Salmonella infection included having sick contacts, living in a rural area, recent travel, contact with pets (especially reptiles) and exposure to local water. Younger age was associated with an increased likelihood of admission to hospital, treatment with antibiotics and a longer course of antibiotic therapy. This was true when comparing older infants with those younger than 12 weeks of age. Patients recently treated with antibiotics and those with significant underlying medical conditions were more likely to be admitted.CONCLUSIONS: A wider knowledge of the epidemiological risk factors for Salmonella infection may improve diagnosis. Higher admission rates were expected in children younger than 12 weeks of age, those recently treated with antibiotics and those who had a significant underlying medical condition. A prospective, multicentre study is needed to further address questions regarding increased illness severity and appropriate management of Salmonella infections in children younger than 12 weeks of age.
Transition from Intravenous Epoprostenol to Oral or Subcutaneous Therapy in Pulmonary Arterial Hypertension: A Retrospective Case Series and Systematic Literature Review
Authors: Park Kirily , Ostrow David , Levy Robert D , Swiston John 
Published: March 2016

BACKGROUND: Intravenous epoprostenol, a prostaglandin analogue, has been a mainstay of therapy for patients with advanced pulmonary arterial hypertension (PAH) since the early 1990s. This medication has multiple side effects, and sudden discontinuation is potentially associated with severe sequelae. Several recent case series have described the transition from intravenous to newer oral or subcutaneous therapies. A case series detailing the authors’ experience with such transitions, and a systematic lierature review is presented.METHODS: All consecutive PAH patients seen at the Vancouver Pulmonary Hypertension Clinic (Vancouver, British Columbia) between June 1995 and July 2009 were reviewed for cases in which weaning or transition from intravenous epoprostenol was attempted. The Cochrane Collaboration, Cochrane Register of Controlled Trials, Journals@Ovid, MEDLINE, EMBASE and Papers First were searched using predefined key words for publications describing transition of PAH patients from parenteral prostanoids to oral or subcutaneous agents.RESULTS: Of the six patients who attempted, all transitioned successfully to oral or subcutaneous agents, having been on intravenous epoprostenol for a mean of 3.8 years (range 1.8 to 9.75 years). Five are living, surviving a mean of 5.5 years after transition. The literature search yielded nine studies and, of 127 patients described, 82 transitioned successfully. The length of pretransition prostanoid treatment (range 1.7 to 7.6 years) and the post‐transition follow‐up period (range two months to 70 months) were shorter than for patients described in the present study.CONCLUSIONS: Given the rarity of PAH, the absolute numbers of patients transitioned from intravenous epoprostenol are still low. With the advent of new therapies, these numbers will hopefully increase; continued study is necessary to identify factors that are predictive of success.
Health‐Related Quality of Life and 6 Min Walk Distance in Patients with Idiopathic Pulmonary Fibrosis
Authors: Verma Geetika , Marras Theodore , Chowdhury Noori , Singer Lianne 
Published: March 2016

BACKGROUND: Few studies have investigated the relationship between physiological outcomes and quality of life in patients with idiopathic pulmonary fibrosis (IPF). Health‐related quality of life (HRQL) data may provide a valuable patient‐centred outcome for the evaluation of interventions. Determination of which physiological and functional variables are associated with HRQL may facilitate interpretation of disease progression and impacts of therapy.OBJECTIVES: To determine whether an association between Medical Outcomes Short‐Form 36 and St George’s Respiratory Questionnaire scores and other markers of disease severity exist, and to identify which physiological and functional variables are independently associated with HRQL.METHODS: In a cross‐sectional study, 137 patients with IPF completed HRQL surveys and underwent clinical assessment. Multiple linear regression analysis was used to determine the relationship between age, forced vital capacity, diffusing capacity of carbon monoxide, 6 min walk distance (6MWD) and oxygen requirement, and HRQL scores.RESULTS: 6MWD was the only functional measure of disease severity significantly associated with all domain scores of the St George’s Respiratory Questionnaire and the Medical Outcomes Short‐Form 36 physical component summary score.CONCLUSIONS: 6MWD was associated with HRQL among patients with IPF. This highlights the importance of 6MWD not only as a prognostic indicator in IPF, but also a predictor of HRQL and a meaningful outcome for patients.
Azathioprine Metabolite Measurements Are not Useful for Following Treatment of Autoimmune Hepatitis in Alaska Native and other Non-Caucasian People
Authors: Ferucci Elizabeth D , Hurlburt Kathy J , Mayo Marlyn J , Livingston Stephen , Deubner Heike , Gove James , Plotnik Julia , McMahon Brian J 
Published: March 2016

BACKGROUND: In autoimmune hepatitis (AIH) patients treated with azathioprine, the utility of measuring thiopurine methyltransferase (TPMT) and azathioprine metabolites has been limited.OBJECTIVE: To evaluate the association between TPMT genotype and enzyme activity, and the impact of TPMT enzyme activity on levels of azathioprine metabolites and leukopenia to assess the clinical utility of monitoring azathioprine metabolites in Alaska Native and other non-Caucasian AIH patients.METHODS: Individuals with AIH were recruited at the Alaska Native Medical Center (Alaska, USA) and the University of Texas Southwestern Medical Center (Texas, USA). Identification of TPMT genotype and measurement of enzyme activity were performed. The metabolites 6-thioguanine nucleotides (6-TGN) and 6-methylmercaptopurine (6-MMP) were measured in participants who were on azathioprine, and the associations with disease remission and leukopenia were assessed.RESULTS: Seventy-one patients with AIH were included. The distribution of TPMT genotypes was similar to that reported in other population-based studies. TPMT genotype and phenotype were strongly associated (P<0.0001). Levels of 6-TGN and 6-MMP correlated with azathioprine dose only in individuals with normal TPMT enzyme activity. Patients with leukopenia due to azathioprine were no more likely to have abnormal TPMT enzyme levels than those without leukopenia (P=1.0). No specific level of 6-TGN metabolites was associated with remission or leukopenia.DISCUSSION: Results of the present study were consistent with previous studies in Caucasian populations. TPMT genotype and phenotype correlated well, and levels of 6-TGN and 6-MMP metabolites were not associated with remission of AIH or toxicity of azathioprine.CONCLUSIONS: The present study confirmed the limited utility of monitoring levels of azathioprine metabolites in AIH patients.
Health Care Resource Use and Costs for Crohn’s Disease before and after Infliximab Therapy
Authors: Loomes Dustin E , Teshima Christopher , Jacobs Philip , Fedorak Richard 
Published: March 2016

BACKGROUND: Infliximab therapy in patients with Crohn’s disease decreases resource use; however, the overall impact on health-related expenditures is unclear, especially beyond one year of study.METHODS: A retrospective analysis of economic data one and two years before and after infliximab therapy was performed using patients who served as their own controls. Total health care resource use and direct health care costs were compared for patients with or without fistulae.RESULTS: Patients with one (n=66) and two (n=39) years of economic data before and after infliximab treatment had their resource use and direct health care costs estimated. In the year following initiation of infliximab therapy, there were significant decreases in health care use, reflected in total hospital days (495 to 155 [P<0.05]), inpatient colonoscopies (46 to 24 [P<0.05]), outpatient colonoscopies (58 to 33 [P<0.05]) and major surgeries (10 to 2 [P<0.05]). Direct health care costs of inpatient costs for luminal (−$1,747 [P<0.05]) and fistulizing disease (−$2,530 [P<0.05]), major surgeries (−$1240 [P<0.05]) and outpatient colonoscopies (−$184 [P<0.05]) were also significantly reduced before and after infliximab therapy. Total direct health care costs, including the drug cost of infliximab, increased ($21,416 [P<0.05]). In general, the trends in health care costs analyzed over four consecutive years paralleled the two consecutive-year analysis.CONCLUSIONS: Infliximab therapy in patients with Crohn’s disease resulted in a significant decrease in both resource use and health care costs, but an increase in total direct health care costs once the cost of infliximab was added.
Examining Nurse Empathy for Infant Procedural Pain: Testing a New Video Measure
Authors: Latimer Margot , Jackson Philip , Johnston Celeste , Vine Jocelyn 
Published: March 2016

BACKGROUND: Research reporting effective pain care strategies exists, yet it is not translated to care. Little is known about how repeated pain exposure has affected nurses’ ability to be empathetic and use their knowledge to provide evidence‐based care. Concerns have been raised regarding the validity of self‐report empathy instruments; therefore, a novel video program was developed for testing. It was hypothesized that those who viewed infants in painful and nonpainful states would have a measureable empathy (pain rating) response correlating to the level of pain expressed by the infants.OBJECTIVE: To validate the newly developed Empathy for Infant Pain video program (EIPvp) by determining whether nurse and non‐nurse control groups’ pain scores of 24 video clips showing infants undergoing real medical procedures were equal.DESIGN: A descriptive cross‐sectional video judgement study.METHODS: Fifty female participants (25 nurses and 25 allied health controls) were asked to score the infant procedural pain level displayed in the EIPvp using a visual analogue scale and a composite score of known infant pain cues. Participants also scored their own sensitivity to painful events.RESULTS: Participants rated the videos contained in the EIPvp similarly in three categories (no, low or high pain); however, there were consistent differences between groups within the categories. Nurses scored facial cues for all categories higher than the control group. Nurses scored their own pain in hypothetical situations and that of the infants consistently higher than the control group.CONCLUSION: The EIPvp yielded predictable responses from both the nurse and non‐nurse control groups when scoring the pain expressed in the video clips. Nurses’ detection of pain more often than controls may have been an indication that they have greater knowledge of pain cues, or their empathy levels may have been different as a result of their exposure to, or their perceived relationship with, patients. The EIPvp was validated and has promising potential for training and research purposes.
Evaluation of Influenza‐Specific Humoral Response by Microbead Array Analysis
Authors: Keynan Yoav , Bodnarchuk Tavis , Wayne Stephen , Li Yan , Fowke Keith R. 
Published: March 2016

RATIONALE: Quantitation and determination of antigen specificity of systemic and mucosal immune responses to influenza vaccination is beneficial for future vaccine development. Previous methods to acquire this information were costly, time consuming and sample exhaustive. The benefits of suspension microbead array (MBA) analysis are numerous. The multiplex capabilities of the system conserve time, money and sample, while generating statistically powerful data.OBJECTIVE: To demonstrate the use of the assay by comparing the humoral influenza‐specific responses of two cohorts from two countries that differed in circulating influenza strains and rates of influenza vaccination.METHODS: Influenza hemagglutinin (HA) from different strains were coated on microbeads and incubated with serum samples to capture immunoglobulin (Ig) A1 and IgG1 host antibodies.RESULTS: Statistically significant differences in IgA1 and IgG1 exist between the serum samples from Winnipeg (Manitoba) donors and those from Kenyan (Africa) donors. Data were compared using Mann‐Whitney nonparametric tests. The Winnipeg donors had higher mean fluorescence intensity values, with significant P values for anti‐HA IgA1 to A/Wyoming/3/2003 (P=0.044), A/Vietnam/1203/2004 (P=0.0179), A/New Caledonia/20/99 (P<0.0001) and B/Tokyo/53/99 (P=0.0002). No differences were seen between the groups in their response to B/Jilin/20/2003. The Winnipeg donors had higher mean fluorescence intensity values, with significant P values for anti‐HA IgG1 to A/Wyoming/3/2003 (P=0.0135), B/Tokyo/53/99 (P=0.006) and B/Jilin20/2003 (P=0.026).CONCLUSION: Influenza‐specific IgA1 and IgG1 antibodies were successfully detected using MBA technology. A significant difference in antibody response was observed between Winnipeg and Kenyan donor serums. MBA analysis is a relatively quick and cost‐effective method for serum antibody analysis. The potential to simultaneously assay small sample volumes for a multitude of antigens makes this method invaluable for future vaccine response monitoring.
Antimicrobial Resistance Surveillance Systems: Are Potential Biases Taken into Account?
Authors: Rempel Olivia , Pitout Johann DD. , Laupland Kevin B. 
Published: March 2016

The objective of this study was to assess potential biases that may influence the validity of contemporary antimicrobial‐resistant (AMR) pathogen surveillance systems. Although surveillance data have been widely published and used by researchers and decision makers, little attention has been devoted to the assessment of their validity. A Medline search was used to identify reports, in 2008, of laboratory‐based AMR surveillance systems. Identified surveillance systems were appraised for six different types of bias. Scores were assigned as ‘2’ (good), ‘1’ (fair) and ‘0’ (poor) for each bias. The results of this assessment indicate that there are several potential biases that can influence the validity of AMR surveillance information and, therefore, the potential for bias should be considered in the interpretation and use of AMR surveillance data.BACKGROUND: The validity of surveillance systems has rarely been a topic of investigation.OBJECTIVE: To assess potential biases that may influence the validity of contemporary antimicrobial‐resistant (AMR) pathogen surveillance systems.METHODS: In 2008, reports of laboratory‐based AMR surveillance systems were identified by searching Medline. Surveillance systems were appraised for six different types of bias. Scores were assigned as ‘2’ (good), ‘1’ (fair) and ‘0’ (poor) for each bias.RESULTS: A total of 22 surveillance systems were included. All studies used appropriate denominator data and case definitions (score of 2). Most (n=18) studies adequately protected against case ascertainment bias (score = 2), with three studies and one study scoring 1 and 0, respectively. Only four studies were deemed to be free of significant sampling bias (score = 2), with 17 studies classified as fair, and one as poor. Eight studies had explicitly removed duplicates (score = 2). Seven studies removed duplicates, but lacked adequate definitions (score = 1). Seven studies did not report duplicate removal (score = 0). Eighteen of the studies were considered to have good laboratory methodology, three had some concerns (score = 1), and one was considered to be poor (score = 0).CONCLUSION: Contemporary AMR surveillance systems commonly have methodological limitations with respect to sampling and multiple counting and, to a lesser degree, case ascertainment and laboratory practices. The potential for bias should be considered in the interpretation of surveillance data.