bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Family Disagreement Affect Donation Decisions by Next of Kin?
Authors: Rodrigue James R. , Cornell Danielle L. , Howard Richard J. 
Published: January 2017

Context Information about the relationship between family disagreement and donation decisions may facilitate development of strategies to help families resolve conflict and possibly increase donation consent rates. Objective To assess how family interactions influence next-of-kin decisions about organ donation. Design Semistructured survey. Setting and Participants Next of kin of potential donors (147 donors, 138 non-donors) from 1 organ procurement organization participated in a semistructured telephone interview, answering questions about the presence and influence of others during decision making related to organ donation. Results When others were actively involved in the donation decision (68%), disagreement about the donation decision occurred in 32% of cases. Compared with families initially in agreement, families not in agreement were less likely to donate ( P <.001), took longer to make a decision ( P <.001), and were less likely to make the same decision now ( P <.001). Family disagreement was significantly associated with having more family members involved in the discussion, characteristics of the deceased (younger age, not married, nonwhite race, fewer days in the hospital, trauma-related death), next-of-kin characteristics (less education, less favorable organ donation beliefs), not knowing the deceased's donation intentions, less satisfaction with the health care team, and perceptions of a less compassionate donation requester. Conclusions Family disagreement occurred in one-third of donation approaches when other family members were present. Such disagreement is most likely to contribute to donation refusal when the deceased's donation intentions are unknown. Recognizing and assessing the nature of family disagreement may increase donation consent.
The Relationship between the Sick Role and Functional Ability: One Center's Experience
Authors: Cerrato Annette , Avitable Matthew , Hayman Laura L. 
Published: January 2017

Objective To determine the impact of the sick role on posttransplant functional ability. Methods A convenience sample of 97 kidney transplant recipients (mean age, 45.8 years; SD, 12.8 years; 47% female; 68% African American) participated in this exploratory cross-sectional study. Self-report data were collected during a posttransplant clinic visit via the Response to Illness Questionnaire used to measure sick-role perceptions, the Functional Status Questionnaire used to measure functional ability, and an investigator-developed Demographic Data Sheet used to measure sociodemographic data and comorbidities. Results Factor analysis of the Response to Illness Questionnaire yielded 7 distinct factors that accounted for 62.2% of total score variance. Multiple regression analysis indicated a significant relationship between those 7 factors and the 5 factors revealed by the Functional Status Questionnaire. Demographic factors that also correlated with the functional status factors included type of work, gender, age, education, and donor source. Coping with illness and Resentment of illness were the strongest predictors of functional status in this sample. Patients with the strongest coping skills and the least resentment of illness consistently showed more advanced functional abilities. Conclusions Results suggest that individuals who have the strongest coping skills and the least resentment toward their illness seem best able to gain strength and reject the sick role as a permanent identity. Health care providers must acknowledge patients' illness perceptions and design interventions focused on optimizing functional ability in vulnerable transplant recipients.
One Kidney Transplant Center's Experience: Linking Process Improvements and Medicare/Medicaid Conditions of Participation
Authors: Escobedo Wendy , Hosseinpour Peter , Abe Marlene , Cecka J. Michael , Ruzics Ervin P. 
Published: January 2017

Context An institutional priority toward transplantation, dedicated team dynamics, aggressive clinical growth, and optimal care practices are essential for delivering exceptional care to transplant patients. The importance of multidisciplinary integration of these priorities throughout the continuum of patient care is widely recognized in the transplant arena as well as by the Centers for Medicare and Medicaid Services (CMS). In fact, it is the collaboration within these aspects of care that is necessary for certification by CMS. Objectives To establish institution-wide practices, systems, and mechanisms to optimize performance of transplant centers through the use of evidence-based protocols, clinical innovation, and data-driven quality improvements. To develop training programs and competency based orientation addressing the topics needed for transplant nurses, multidisciplinary caregivers, and clinical transplant coordinators who provide care to transplant patients. To comply with the CMS conditions of participation for transplant centers. Methods Formation of a renal transplant council and multidisciplinary care team. Flow chart of hospital course from admission to discharge, carefully examining patients' progression through the continuum of care, assessing for barriers to care and knowledge deficits of transplant practitioners. Results Development of multiple clinical process improvements resulting in the creation of an environment for continuous learning, optimal transplant care, and exceptional outcomes in transplantation as well as compliance with CMS conditions of participation for transplant centers.
Induction Immunosuppression for Orthotopic Heart Transplantation: A Review
Authors: Ensor Christopher R. , Cahoon William D. , Hess Michael L. , Kasirajan Vigneshwar , Cooke Richard H. 
Published: January 2017

Objectives To describe the appropriateness and safety of induction immunosuppression for patients at risk for fatal rejection, and to describe the safety and effectiveness profiles of the induction regimens available in the United States. Data Sources MEDLINE/PubMed database, EMBASE database, Google Scholar; references from pertinent articles were also reviewed to identify additional data. Study Selection A systematic literature review from January 1, 1980, through June 30, 2008, was performed. Included articles ranged from case series to prospective randomized controlled double-blind placebo-controlled trials that detailed the following topics with respect to induction immunosuppression: risk of fatal rejection, renal sparing, malignancy, OKT3, rabbit or equine antithymocyte globulin, daclizumab, basiliximab, and alemtuzumab. Results Patients at highest risk for fatal rejection experienced a survival benefit from induction immunosuppression, whereas all other patients experienced no benefit or harm. Most of the early data detail positive experiences with polyclonal antibody regimens. Several newer trials compare the use of polyclonal strategies with the use of anti-CD25 targeted monoclonal antibodies. Few researchers have assessed the usefulness of an anti-CD52 approach. Overall, induction therapy remains a poorly studied and widely variable practice among the major US heart transplant centers. Conclusion At present, the unrestricted use of induction for all patients does not seem prudent. Induction should be individualized for each patient on the basis of a well-designed protocol, careful analysis of the transplant center's demographics, and the effectiveness and safety profiles of the regimens used.
Stability of Levothyroxine Sodium 0.4 μg/mL in 0.9% Sodium Chloride Injection
Authors: Stadalman Kelli A. , Kelner Michael J. , Box Kevin , Dominguez Alex , Rigby Joseph F. 
Published: January 2017

Context Intravenous levothyroxine therapy decreases vasopressor requirements and prevents cardiovascular collapse in hemodynamically unstable patients eligible for organ donation. The stability of levothyroxine when used in this manner is unknown. Objective To determine the stability of levothyroxine solution for intravenous use at a concentration of 0.4 μg/mL diluted in 0.9% sodium chloride. Design Triplicate sample sets were prepared by reconstituting levothyroxine 200 μg for injection with 5 mL of 0.9% sodium chloride with further dilution in 500 mL of 0.9% sodium chloride. One sample set was protected from light and the other was left unprotected. Both sample sets were stored at room temperature, and samples from each were analyzed for initial concentration and 4, 8, 12, and 24 hours later. Conclusions Levothyroxine sodium 0.4 μg/mL in 500 mL 0.9% sodium chloride is stable for 24 hours at room temperature when protected from light.
Education Before Kidney Transplantation
Authors: Rosaasen Nicola , Mainra Rahul , Shoker Ahmed , Wilson Jay , Blackburn David , Mansell Holly 
Published: January 2017

Context: Poor knowledge about immunosuppressive (IS) medications remains a major problem for patients in the posttransplant setting. Therefore, more effective educational strategies in the pretransplant setting are being considered as a possible method to improve knowledge and readiness for the challenges of posttransplant care. However, the most effective/relevant content of a pretransplant educational program is yet to be determined. Objective: To identify pretransplant education topics from the posttransplant patient perspective. Design: A focus group meeting was conducted among 7 high-functioning, stable adult kidney transplant recipients recruited from the Saskatchewan Transplant Program. Demographic information including age, gender, occupation, background/ethnicity, and time since transplant were recorded. A moderator, assistant moderator, and research assistant facilitated the 90-minute focus group meeting using a predetermined semistructured interview guide. The session was audio recorded and transcribed verbatim. Nvivo software was used to code the data and identify emerging themes exploring views of participants relating to the educational information required for pretransplant patients. Results: Patients were satisfied with the education they had received. Ideas were classified into the following major themes—patient satisfaction, transplant waitlist, surgery, medications, posttransplant complications, lifestyle and monitoring, knowledge acquisition, illusion of control, and life changes posttransplant. Knowledge gaps were identified in all areas of the transplantation process and were not exclusive to IS medications. Conclusion: Misconceptions regarding transplantation were identified by a group of high-functioning, stable adult recipients who were satisfied with their clinical care. Future educational strategies should aim to address the entire transplantation process and not be limited to medications.
Practical Protective Tools for Occupational Exposure: 1) Double Focus Spectacles for the Aged with Highly Refracted Glass Lens 2) Remodeled Barrier for Radiation Protection
Authors: Kurokawa S. , Yabe S. , Takamura A. , Ishizaki H. , Aizawa S. 
Published: January 2017

Two practical protective tools for occupational exposure for neurointerventional radiologists are presented. The first purpose of this study was to investigate the effectiveness of double focus spectacles for the aged with a highly refracted glass lens (special spectacles for the aged) for radiation protection of the crystalline lens of the eye in comparison with other spectacles on the market, based on the measurement of film density which was obtained by exposure of X-ray through those spectacles. As a result of the film densitometry mentioned above, the effectiveness of special spectacles for the aged in radiation protection was nearly equal to the effectiveness of a goggle type shield which is made with a 0.07 mm lead-equivalent plastic lens. The second purpose of this study was to investigate the effectiveness of the protective barrier, which we remodeled for cerebral angiography or neuroendovascular therapy, for radiation exposure, based on the measurement in a simulated study with a head phantom, and on the measurement of radiation exposure in operaters during procedures of clinical cases. In the experimental study radiation exposure in supposed position of the crystalline lens was reduced to about one third and radiation exposure in supposed position of the gonadal glands was reduced to about one seventh, compared to radiation exposure without employing the barrier. The radiation exposure was monitored at the left breast of three radiologists, in 215 cases of cerebral angiography. Employing the barrier in cerebral angiography, average equivalent dose at the left breast measured 1.49μ Sv during 10 min of fluoroscopy. In three kinds of neuroendovascular therapy in 40 cases, radiation exposure in an operator was monitored in the same fashion and the dose was recorded less than the result reported in previous papers in which any protective barrier have not been employed in the procedure1,2. As a result, the two above mentioned protective tools are considered practical in clinical usage and very effective to reduce radiation exposure in an operator of interventional neuroradiolgy which may sometimes require many hours to complete the therapy under extended fluoroscopic time.
Intraaneurysmal GDC Embolization for Ruptured Aneurysm in the Acute Stage
Authors: Ezura M. , Takahashi A. , Yoshimoto T. 
Published: January 2017

This report focused on our treatment protcol and results on the intraaneurysmal GDC embolization for ruptured aneurysm in the acute stage. Clinical materials of this study consist of 39 patients who were treated with intraaneurysmal GDC embolization within 72 hours after the onset of subarachnoid hemorrhage from March 1997 to May 1999. Patients with cerebral aneurysms are always examined as a possible candidate for neurosurgical clipping. If the patient had any difficulties and/or problems on neurosurgical clipping (high age 24, poor grade 12, surgically difficult location 11, systemic disease 2), the patient was treated by intraaneurysmal GDC embolization. GDCs were inserted as tight as possible. Then, spinal drainage was set in patients with thick subarachnoid hemorrhage. Tissue plasminogen activator was administered via the drainage in patients with thicker subarachnoid hemorrhage. Two patients experienced rerupture during peritherapeutic period. Symptomatic vasospasm was observed in 2 patients (5.1%). Good outcome was obtained in 31 out of 34 surviving patients. Symptomatic complication caused by distal embolism occurred in 1 patient, parent artey occlusion in 3 patients. In conclusion, intraaneurysmal GDC embolization is thought to be sufficient regarding prevention of rerup tu re, incidence of vasospasm, and clinical outcome.
Superselective Arterial Chemotherapy for Inoperable Metastases in the Dura Mater and Cranium
Authors: Suzuki S. , Kurata A. , Takagi H. , Nakahara K. , Oka H. , Miyasaka Y. , Fujii K. 
Published: January 2017

Diffuse metastases to the cranium and dura mater of the bilateral hemisphere do not allow surgical intervention. We describe an excellent case which was treated by intra-arterial chemotherapy using Epirubicine (Farumorbicine). A 58-year-old woman treated for breast cancer ten years ago was admitted to our hospital with headache and frontal mass lesions. Magnetic resonance (MR) imaging on admission revealed a remarkable enhanced lesion of the bilateral dura mater and cranium, and bilateral brain edema in the frontal lobe. Angiography disclosed a vascular rich tumour supplied by bilateral external carotid artery branches. We successfully treated the lesion using superselective intra-arterial chemotherapy with a minimal dose of Epirubicine followed by embolization of bilateral external carotid artery branches. Follow-up MR imaging two years after the endovascular treatment showed disappearance of the enhanced lesion and remodeling of the skull bone. The patient is neurologically free of symptoms.
Percutaneous Transluminal Cerebral Angioplasty and Stenting in Acute Vertebrobasilar Ischemic Stroke
Authors: Nistri M. , Mangiafico S. , Cellerini M. , Villa G. , Mennonna P. , Ammannati F. , Giordano G. P. 
Published: January 2017

Reports of cerebral transluminal angioplasty and stenting in patients with vertebrobasilar ischemic stroke are scanty. Herein we report on the use of “monorail” coronary balloon angioplasty and stent balloon mounted catheters in two patients with acute vertebrobasilar ischemic stroke, focussing on the differences and possible advantages of the “monorail” technique in comparison with the “over-the-wire” technique. In both patients, the clinical picture was characterized by progressive brainstem symptoms followed by acute loss of consciousness related to an atherothrombotic occlusion and subocclusion of the dominant intracranial vertebral artery, respectively. In one patient, superselective thrombolytic therapy and balloon angioplasty resulted in a dissection flap at the vertebrobasilar junction. The latter was treated by successful deployment of a coronary stent. In the other patient, the subocclusive lesion was directly treated by angioplasty and stenting without thrombolytic therapy. The clinical outcome was poor for one patient (“locked in” syndrome) while the other had a complete clinical recovery. In acute atherothrombotic vertebrobasilar stroke transluminal cerebral angioplasty and stenting may be successfully performed allowing vessel recanalization.
The So-Called Anterior Meningeal Artery: An Anatomic Study for Treatment Modalities
Authors: Shimizu S. , Garcia A.S. , Tanriover N. , Fujii K. 
Published: January 2017

The so called anterior meningeal artery (AMA) is a branch of the vertebral artery (VA), which had been interpreted as a supplying vessel of the dura in the foramen magnum and upper cervical level. In this study, we examined the anatomy of this artery and relationships to its surrounding structures for treatment modalities. With the aid of magnification, five adult cadaveric head and neck complex and five cervical spines were examined after perfusion of the vessels with colored silicone. The AMA arose from the VA between the C2 and C3 level, and passed medially through the intrervertebral foramen anterior to the dural sheath of the third cervical nerve root. It ran upwards dorsal to the deep layer of the posterior longitudinal ligament (PLL) with anterior internal vertebral venous plexus. Rostrally, it formed an arcade above the apex of the odontoid process with its contralateral mate. The AMA gave off several tiny branches to the deep layer of the PLL, ligaments and soft tissues above the apex of the odontoid process, and vertebral bodies of the axis. At the level of the foramen magnum, it ended in several small twigs to the dura. Anastomoses between the AMA system and adjacent vessels were observed. One was directed through the hypoglossal canal to the ascending pharyngeal artery and the other was with the V3 segment of the VA. The origin and course of the two AMA, and anastomoses were symmetric. Although the AMA feeds the ventral dura of the foramen magnum, the perfusion area is larger than its name suggests, including the bony and ligamentous structures in the craniovertebral junction. Anatomical knowledge of the AMA, including its anastomoses and layer relationships to the surrounding structures, may help to perform treatment modalities in this region rationally.
Can Periprocedural Hypotension in Carotid Artery Stenting Be Predicted?
Authors: Tsurumi A. , Miyachi S. , Hososhima O. , Izumi T. , Ohshima T. , Matsubara N. , Kinkori T. , Naito T. , Wakabayashi T. 
Published: January 2017

Periprocedural hypotension, which frequently occurs during carotid artery stenting (CAS), is an important risk factor for complications such as stroke or death after CAS. To determine if a scoring model can be established to predict periprocedural hypotension (systolic blood pressure < or = 90 mm Hg) and prolonged periprocedural hypotension (requiring vasopressor for > 3 hours) in CAS, we conducted a prospective cohort study of patients undergoing interventional treatment of cervical carotid artery stenosis in an urban tertiary referral hospital from April 2006 to April 2007. Forty-eight stenotic lesions in 45 consecutive patients treated with CAS were included in the study. Multivariate analysis showed three independent risk factors of periprocedural hypotension; “fibrous plaque on Virtual Histology” (P = 0.029), “stenotic lesion involving both the common carotid artery and internal carotid artery on angiogram” (P = 0.004), and “patients without history of diabetes mellitus” (P = 0.020). Further, “distance between carotid bifurcation and point of minimum lumen size < or = 10 mm on angiogram” (P = 0.003) was an independent risk factor of prolonged periprocedural hypotension. Carotid morphologic autonomic pathologic score (carotid MAPS), determined by adding one point for each of those risk factors (total 0 to 4), had good discrimination for both periprocedural hypotension (area under receiver operating characteristic curve: ROC AUC = 0.876; SE 0.053) and prolonged periprocedural hypotension (ROC AUC = 0.811; SE 0.066). Carotid MAPS is useful for predicting periprocedural hypotension and prolonged periprocedural hypotension during CAS.
Endovascular Treatment for Very Small Supraclinoid Aneurysms with Stent-Assisted Coiling
Authors: Fang C. , Li M-H. , Zhang P-L , Wang W. , Tan H-Q. , Xu H-W. , Zhou B. 
Published: January 2017

The endovascular treatment of very small aneurysms (lesions less than 3 mm in maximum diameter) with wide necks remains a challenge for saccular embolization. We retrospectively analyzed our data using Neuroform stent-assist-ed coiling for very small supraclinoid aneurysms with wide neck to evaluate the feasibility and efficacy of endovascular treatment of these lesions. We conducted a review of our experience and results of endovascular treatments in six patients with seven very small aneurysms. All aneurysms were located at the side wall of the supraclinoid segment of the ICA. They were ruptured in two patients and unruptured in four. The technique of stent-assisted coiling was used in all cases with coiling before stenting and additional coils after deployment of the stent in the same session. All patients were successfully embolized with stent-assisted coiling. The coils were introduced into the lumen for subtotal occlusion in five aneurysms and for partial occlusion in two. During one to two years follow-up angiography, all aneurysms were completely occluded and no recurrence occurred. No complications were observed. Endovascular stent-assisted coil embolization of supraclinoid very small aneurysms with wide necks is effective and feasible. Subtotal aneurysm occlusion might progress to total occlusion.
Vertebral Dissecting Aneurysm Treated with Wingspan Stent Deployment and Detachable Coils
Authors: Lv M. , Lv X. , Li Y. , Yang X. , Wu Z. 
Published: January 2017

We describe the first documented endovascular treatment of vertebral dissecting aneurysm using a Wingspan stent and detachable coils. A 54-year-old man presented with a nonruptured vertebral dissecting aneurysm. Because of the dissecting nature of the vertebral aneurysms, a 3×15-mm Wingspan stent was placed in the left vertebral artery. One month later, several detachable coils were introduced into the aneurysm. Six-month follow-up angiogram confirmed the obliteration. Vertebral dissecting aneurysm can be treated with Wingspan stent placement and detachable coils.