bluuebunny/crossref_metadata_2025_split huggingface dataset:
Out-of-Hospital ICU Transfers to an Oncological Referral Center
Authors: Gutierrez Cristina , Cárdenas Yenny R. , Bratcher Kristie , Melancon Judd , Myers Jason , Campbell Jeannee Y. , Feng Lei , Price Kristen J. , Nates Joseph L. 
Published: January 2017

Objective: To determine resource utilization and outcomes of out-of-hospital transfer patients admitted to the intensive care unit (ICU) of a cancer referral center. Design: Single-center cohort. Setting: A tertiary oncological center. Patients: Patients older than 18 years transferred to our ICU from an outside hospital between January 2013 and December 2015. Measurements and Main Results: A total of 2127 (90.3%) were emergency department (ED) ICU admissions and 228 (9.7%) out-of-hospital transfers. The ICU length of stay (LOS) was longer in the out-of-hospital transfers when compared to all other ED ICU admissions ( P = .001); however, ICU and hospital mortality were similar between both groups. The majority of patients were transferred for a higher level of care (77.2%); there was no difference in the amount of interventions performed, ICU LOS, and ICU mortality between nonhigher level-of-care and higher level-of-care patients. Factors associated with an ICU LOS ≥10days were a higher Sequential Organ Failure Assessment (SOFA) score, weekend admissions, presence of shock, need for mechanical ventilation, and acute kidney injury on admission or during ICU stay ( P < .008). The ICU mortality of transferred patients was 17.5% and associated risk factors were older age, higher SOFA score on admission, use of mechanical ventilation and vasopressors during ICU stay, and renal failure on admission ( P < .0001). Data related to the transfer such as LOS at the outside facility, time of transfer, delay in transfer, and longer distance traveled were not associated with increased LOS or mortality in our study. Conclusion: Organ failure severity on admission, and not transfer-related factors, continues to be the best predictor of outcomes of critically ill patients with cancer when transferred from other facilities to the ICU. Our data suggest that transferring critically ill patients with cancer to a specialized center does not lead to worse outcomes or increased resource utilization when compared to patients admitted from the ED.
Impact of an Antipsychotic Discontinuation Bundle During Transitions of Care in Critically Ill Patients
Authors: D’Angelo Ryan G. , Rincavage Molly , Tata Asha L. , Millstein Leah S. , Gulati Mangla S. , Flurie Rachel W. , Gonzales Jeffrey P. 
Published: January 2017

Introduction: Delirium affects a large proportion of patients admitted to the intensive care unit (ICU) and is associated with increased morbidity and mortality. Antipsychotics have become frequently used agents for the treatment of delirium; however, they are often continued at transitions of care. This has potential negative short- and long-term health consequences that are preventable. We investigated the antipsychotic tapering bundle’s impact on the rate of antipsychotic continuation at transitions from the medical intensive care unit (MICU). Methods: This was a preretrospective and postretrospective chart review that included adult patients in the MICU initiated on antipsychotic therapy for ICU delirium. A bundled multidisciplinary education program and antipsychotic discontinuation algorithm were implemented in the MICU to provide recommendations for safe and effective use of antipsychotics for ICU delirium and minimize continuation of therapy at transitions of care. Rates of antipsychotic continuation at transition from the MICU were compared between the preintervention and postintervention groups with the χ2 test. Results: A total of 140 patients in the prebundle group and 141 patients in the postbundle group were enrolled. Overall, baseline characteristics were similar. After implementation of the discontinuation bundle, antipsychotic continuation at MICU discharge decreased (27.9% in the prebundle group vs 17.7% in the postbundle group; P < .05). In the multivariate analysis, patients were less likely to be continued on antipsychotic therapy at MICU discharge after implementation of the bundle (odds ratio [OR]: 0.47; 95% confidence interval [CI]: 0.26-0.86). There were also lower rates of overall antipsychotic continuation at hospital discharge (OR: 0.4; 95% CI: 0.18-0.89). Conclusion: This is the first study to demonstrate a reduction in antipsychotic continuation at transition from the MICU after implementation of an antipsychotic discontinuation bundle in ICU patients. We believe this bundle allows for safer transitions of care from the MICU and decreases unnecessary antipsychotic therapy.
External Validation of Two Classification and Regression Tree Models to Predict the Outcome of Inpatient Cardiopulmonary Resuscitation
Authors: Guilbault Ryan W. R. , Ohlsson Marcus Andreas , Afonso Anna M. , Ebell Mark H. 
Published: January 2017

Objective: To prospectively validate a previously developed classification and regression tree (CART) model that predicts the likelihood of a good outcome among patients undergoing inpatient cardiopulmonary resuscitation. Design: Prospective validation of a clinical decision rule. Setting: Skåne University Hospital in Malmo, Sweden. Patients: All adult patients (N = 287) experiencing in-hospital cardiopulmonary arrest and undergoing cardiopulmonary resuscitation between 2007 and 2010. Interventions: Patients from Skåne University Hospital who underwent CPR (N = 287) were classified using the CART models to predict their likelihood of survival neurologically intact or with minimal deficits, based on a cerebral performance category score of 1. Discrimination and classification accuracy of the score in the Swedish population was compared to that in the original (derivation and internal validation) populations. Measurements and Main Results: For model 1, the area under the receiver–operating characteristic curve (AUROCC) was 0.77, compared with 0.76 and 0.73 in the original derivation and validation populations, respectively. Model 1 classified 71 (2.8%) of 287 patients as being at a very low risk of a good neurologic outcome compared with 157 (26.1%) of 287 patients predicted to be at an above average risk of a good neurologic outcome. Model 2 had a similar AUROCC as the original validation population of 0.71 but lower than the original derivation population. Model 2 performed similarly to Model 1 with regards to its ability to correctly classify patients as very low or higher than average likelihood of a good neurologic outcome. Conclusion: Two CART models validated well in a different population, displaying similar discrimination and classification accuracy compared to the original population. Although additional validation in larger populations is desirable before widespread adoption, these results are very encouraging.
Biodegradable Polyurethanes: Biodegradable Low Adherence Films for the Prevention of Adhesions after Surgery
Authors: Rehman Ihtesham Ur 
Published: January 2017

Adhesions commonly occur after internal disease or surgery. The natural healing response leads to the formation of vascular and avascular adhesions after inflammatory diseases and surgical interventions. A barrier film could be incorporated during surgery between layers of tissues that must not adhere to one another. The film would be biodegradable so that it disappears over a period of time, and would ideally be two sided, allowing relative movement at that interface, while being firmly anchored on the opposite side to prevent displacement. Polyesterurethane-polydimethylsiloxane graft polymers are synthesised. Chemical characterization of the polymer is performed by using Fourier Transform Infrared Spectroscopy and Gel Permeation Chromatography. In vitro hydrolytic degradation is carried out in which films are immersed at 37°C in alkaline solution. Degradation is assessed by tensile testing as a function of time to determine the degradation of mechanical strength, infrared spectroscopy, and mass loss. A titration method is also used to determine quantitatively the hydrolytic degradation. In order to study the adhesions of films, an in-vitro model based on a gelatine test, which is simple and rapid, is described. Suitable candidate films investigated from the in-vitro work are subjected to in vivo tests for both biodegradation and their ability to prevent adhesion.
Clinical Audit: Integrating the Management of Quality
Authors: Packwood T. 
Published: January 2017

The recent implementation of clinical audit by the Department of Health seeks to both integrate existing professional audit activities, and to integrate the resulting multi-professional audit more closely with other quality-assurance activities developed by corporate management and purchasers. This paper, which is based on studies of medical and clinical audit undertaken over the past 3 years, examines the potential for integration in the light of, first, the history and characteristics of the different forms of quality assurance initiative and, second, a comparison of their different properties. In many ways clinical audit appears to stand between domination by both professional and managerial influences, which may enhance its potential for integrating different approaches. If, however, clinical audit is to succeed it is suggested that it requires a strong managerial infrastructure; with clearly delineated responsibilities related to the different modes of quality assurance.
A Review and Update on Adult Syphilis, with Particular Reference to its Treatment
Authors: Goldmeier D , Hay P 
Published: January 2017

Syphilis has become less common in Europe in the last decade, but has once again become a major problem in the USA, and remains so in many developing countries. Several treponemal genes have now been cloned and expressed in Escherichia coli, allowing study of treponemal proteins. The importance of cell mediated immunity in syphilis has been demonstrated in animal models. A diagnosis of syphilis is usually confirmed by dark-field microscopy or serological tests. Seroconversion may be delayed in HIV infected individuals. A positive reaginic test in cerebrospinal fluid (CSF) has a high specificity but low sensitivity in the diagnosis of neurosyphilis. Indeed, virulent treponemes can be identified in CSF samples which have negative reaginic tests, normal cell counts and protein levels. In the CSF, the FTA-Abs test has a high sensitivity but low specificity for neurosyphilis. Penicillin remains the treatment of choice for all stages of syphilis, although it penetrates the blood brain barrier poorly. Treatment with intramuscular benzathine penicillin 2.4 million units stat, or 600,000 units procaine penicillin daily does not produce treponemicidal levels within the CSF. However, the incidence of neurosyphilis is low in immunocompetent patients treated with such regimens during early syphilis. Acceptable alternatives in penicillin-allergic patients include ceftriaxone and doxycycline. Erythromycin is not recommended as it has produced unacceptably high rates of treatment failure. Recently, a strain of macrolide-resistant Treponema pallidum was isolated from a patient with secondary syphilis. For the treatment of neurosyphilis, treponemicidal levels of penicillin can be achieved in the CSF using 2.4 million units procaine penicillin daily with concurrent probenecid 500 mg 4 times a day, or an intravenous infusion of benzyl penicillin 12–24 million units daily. Early syphilis can be treated adequately over 10 days, but 21 to 28 days is appropriate for late syphilis. In HIV-infected patients syphilis may present atypically with initially negative serological tests. Treatment of early syphilis in HIV-positive patients has been associated with the early development of neurosyphilis. It is advisable to treat all patients co-infected with HIV with an antibiotic regimen that achieves adequate levels within the CSF.
Knowledge of HIV Transmission and Risk Behaviour in Kenyan Health Care Workers
Authors: Rogstad Karen E , Tesfaledet G , Abdullah Mohammed S , Ahmed-Jushuf Imtyaz H 
Published: January 2017

In order to determine knowledge of HIV transmission, sexual risk behaviour and perception of risk in African health care workers, 200 employees at the Aga Khan Hospital, Nairobi, Kenya, were asked to complete an anonymous self-administered questionnaire. There was a 75% response rate. Twenty-five per cent believed that condoms were not protective against HIV transmission. Eighty-nine per cent believed oral sex to be a risk factor, as did 70% for kissing, 41% for masturbation of a partner and 43% for nursing an AIDS patient. Younger people were more likely to think condoms were ineffective ( P = 0.007) and that insect bites were a significant risk factor ( P = 0.004). Twenty-seven per cent had changed their sexual behaviour as a result of the AIDS epidemic, but 48% did not use condoms with non-regular partners. Four had current or previous homosexual relationships. Seventy per cent believed they were at risk of being HIV positive but only 12% had been tested. We have shown that even in the educated group, misconceptions regarding HIV transmission were high and many continue to be at risk for their sexual behaviour. In addition, in-service training regarding HIV transmission should be considered for health care workers in Africa.
HIV Testing and Prevalence in Pregnancy in Edinburgh
Authors: Johnstone F D , Brettle R P , Burns S M , Peutherer J , Mok J Y Q , Robertson J R , Hamilton B , Tappin D M 
Published: January 2017

The objective was to study the changes in pregnancy HIV prevalence with time. Data were collected from multiple sources to provide a comprehensive record of all HIV seropositive pregnant women identified in the Edinburgh area (Scotland) until December 1992. There were 177 pregnancies in 108 HIV seropositive identified women. Risk factors were injection drug use (79% of pregnancies) and a known HIV seropositive injection drug-using partner (16%). Prevalence has decreased for Edinburgh City women from 0.5% of all pregnancies in 1986 to 0.1% in 1992; It was higher for induced abortion (0.6%) than for delivery (0.2%). HIV testing in pregnancy has declined. Comparison with unlinked anonymized testing showed that in 1990–1991, 20/22 seropositive women were known. In 1992, only 3 of 10 seropositive pregnancies were identified. The cohort initially infected by exposure to a ‘drug related’ risk factor between 1983 and 1985 may have increasingly finished childbearing, deliberately decided against pregnancy because of HIV status, and declined because of death, illness and emigration from the area, There may not have been major early tertiary heterosexual spread; however, data from 1992 suggest that this could now be impacting on pregnancy prevalence. Local testing policies have not adapted to this possible change.
The Association of Human Papillomavirus Infection with Balanoposthitis: A Description of Five Cases with Proposals for Treatment
Authors: Birley H D L , Luzzi G A , Walker M M , Ryait B , Taylor-Robinson D , Renton A M 
Published: January 2017

The features and clinical course of chronic balanitis in 5 patients are presented. In each case, histological examination of a cutaneous biopsy sample showed pronounced features of human papillomavirus (HPV) infection. In addition, HPV DNA was demonstrated in each biopsy specimen by a polymerase chain reaction and was found to be type 6 by Southern blot hybridization in 4 of the cases. Although the association of histological features of HPV infection with balanitis does not prove that HPV is causal, the failure to find other causes, the prolonged and distressing symptoms, and the ineffectiveness of topical steroids in improving symptoms, all suggest the importance of HPV infection. While effective treatment needs to be sought and developed, the response of one patient to oral isotretinoin suggests that this agent may be appropriate for a larger trial.
A prospective study of acute poisonings in Finnish hospital patients
Authors: Lapatto-Reiniluoto Outi , Kivistö Kari T , Pohjola-Sintonen Sinikka , Luomanmäki Kimmo , Neuvonen Pertti J 
Published: January 2017

1 We have carried out a prospective study of all adult patients presenting with acute poisoning during one month to the Helsinki University Central Hospital (Meilahti Hospital). 2 Two hundred and twenty-six cases of acute poisoning (113 males and 113 females) presented to the emergency department. Most cases in both men (66%) and women (67%) involved alcohol. As to drugs, psychotropic agents predominated in both men and women. The frequency of patient presentation peaked between 7 p.m. and 9 p.m. and was lowest between 8 a.m. and 10 a.m. In most cases, the delay from ingestion of the poison to presentation was longer than 4h. 3 The clinical status of the patients on arrival was generally good; more than half (55%) of them were fully awake. Serious symptoms (e.g. unconsciousness, insufficient respiration necessitating intubation, aspiration, convulsions or hypotension) occurred in 15% of the presentations. There were no fatalities. 4 One hundred and thirty-five patients (60%) received at least one 50-g dose of activated charcoal. However, charcoal was given in 86% of the cases of drug poisoning. Gastric lavage was performed in 112 cases (50%), and 106 cases (47%) involved both gastric lavage and administration of charcoal. Twenty-one patients received antidotes (flumazenil, calcium gluconate or naloxone) and three patients were hemodialysed. 5 Of the 226 cases, 142 (63%) were managed solely in the emergency department. Of the 84 cases admitted to the hospital, eight had to be managed in the intensive care unit. Almost all patients (94%) were discharged within 24 h. 6 In this survey on 226 consecutive cases of acute poisoning, about two-thirds of the cases involved alcohol, while the most common drugs taken were psychotropic agents. The poisoning was mild in the great majority of the cases. Activated charcoal was generally administered in all but trivial cases of drug poisoning.
Oncogenicity studies of piperonyl butoxide in rats and mice
Authors: Butler W H , Gabriel K L , Osimitz T G , Preiss F J 
Published: January 2017

1 The oncogenicity of Piperonyl butoxide (PBO) has been studied in the mouse and rat. CD-1 mice were administered PBO in the diet at target doses of 0, 30, 100 and 300 mg/kg/day for 79 weeks and Sprague - Dawley rats 0, 30, 100 and 500 mg/kg/day for 104/105 weeks. 2 At termination of the study in the mouse there was evidence of increased liver weights and an increased incidence of eosinophilic adenomas at 100 and 300 mg/kg/day in males and 300 mg/kg/day in females. 3 In rats there was increased liver weights at 100 and 500 mg/kg/day associated with hepatocyte hypertrophy in both male and female rats. There was no increased incidence of neoplasia at any site. Hyper-trophy and hyperplasia of thyroid follicles was observed at 500 mg/kg/day in both sexes. 4 The observations reflect the expected changes related to the induction of the mixed function oxygenase group of enzymes. In the mouse the increased incidence of eosinophilic adenomas is not considered relevant for human risk evaluation.
A comparison of the efficacy of new asymmetric bispyridinium oxime BI-6 with other oximes (obidoxime, HI-6) against soman in rats
Authors: Kassa J 
Published: January 2017

1 The influence of three oximes (obidoxime, HI-6 and the new asymmetric bispyridinium oxime BI-6) in combination with atropine on soman-induced cholinergic and stressogenic effects in rats was studied. 2 The oxime BI-6 produced significantly higher reactivation of soman-inhibited blood and diaphragm cholinesterases than obidoxime. On the other hand, its reactivating effect was not so high as the effect of the oxime HI-6. 3 There were not significant differences in the reactivation of soman-inhibited brain acetycholinesterase among all three oximes tested. 4 The influence of the oxime BI-6 on soman-induced stressogenic effects was greater than the antistressogenic effects of HI-6 or obidoxime at 1 h or 3 h following soman poisoning. 5 These findings confirm that the oxime BI-6 has no definite advantages over HI-6 in the antidotal treatment of soman poisoning but BI-6 is significantly more effective in rats than obidoxime, one of the oximes presently in use.
Influence of ranitidine on the morphine-3- glucuronide to morphine-6-glucuronide ratio after oral administration of morphine in humans
Authors: Aasmundstad Tor A , Størset Per 
Published: January 2017

1 In humans morphine is metabolised to morphine-3- glucuronide (M3G) which possess no opioid activity, and morphine-6-glucuronide (M6G) which is a potent opioid receptor agonist that probably contribute to the desired as well as toxic effects of morphine. 2 In order to investigate the possible effect of ranitidine on morphine glucuronidation indicated by clinical studies and later confirmed in vitro, a double blind cross-over study on eight human volunteers administered oral morphine plus ranitidine or placebo was conducted. 3 Urine was collected in fractions for 24 h. Serum and urine samples were prepared by solid phase extraction andmorphine, M3G and M6G were quantified by HPLC. 4 Ranitidine significantly reduced the individual serum M3G/M6G ratio, and tended to increase the serum AUC(0 - 90) of morphine. In contrast, ranitidine had no significant effect on the urinary M3G/M6G ratio. The urinary recovery of morphine or morphine glucuronides was unaffected by ranitidine. 5 Possible explanations to the apparent incongruity between the serum and urine data are discussed.
Multilevel models for censored and latent responses
Authors: Rabe-Hesketh Sophia , Yang Shuying , Pickles Andrew 
Published: January 2017

Multilevel models were originally developed to allow linear regression or ANOVA models to be applied to observations that are not mutually independent. This lack of independence commonly arises due to clustering of the units of observations into ‘higher level units’ such as patients in hospitals. In linear mixed models, the within-cluster correlations are modelled by including random effects in a linear model. In this paper, we discuss generalizations of linear mixed models suitable for responses subject to systematic and random measurement error and interval censoring. The first example uses data from two cross-sectional surveys of schoolchildren to investigate risk factors for early first experimentation with cigarettes. Here the recalled times of the children’s first cigarette are likely to be subject to both systematic and random measurement errors as well as being interval censored. We describe multilevel models for interval censored survival times as special cases of generalized linear mixed models and discuss methods of estimating systematic recall bias. The second example is a longitudinal study of mental health problems of patients nested in clinics. Here the outcome is measured by multiple questionnaires allowing the measurement errors to be modelled within a linear latent growth curve model. The resulting model is a multilevel structural equation model. We briefly discuss such models both as extensions of linear mixed models and as extensions of structural equation models. Several different model structures are examined. An important goal of the paper is to place a number of methods that readers may have considered as being distinct within a single overall modelling framework.