bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of a Pharmacist‐Managed Hypertension Program on Health System Costs: An Evaluation of the Study of Cardiovascular Risk Intervention by Pharmacists—Hypertension (SCRIP‐HTN)
Authors: Houle Sherilyn K. D. , Chuck Anderson W. , McAlister Finlay A. , Tsuyuki Ross T. 
Published: September 2012

Study ObjectiveTo quantify the potential cost savings of a community pharmacy–based hypertension management program based on the results of the Study of Cardiovascular Risk Intervention by Pharmacists—Hypertension (SCRIP‐HTN) study in terms of avoided cardiovascular events—myocardial infarction, stroke, and heart failure hospitalization, and to compare these cost savings with the cost of the pharmacist intervention program.DesignAn economic model was developed to estimate the potential cost avoidance in direct health care resources from reduced cardiovascular events over a 1‐year period.Measurements and Main ResultsThe SCRIP‐HTN study found that patients with diabetes mellitus and hypertension who were receiving the pharmacist intervention had a greater mean reduction in systolic blood pressure of 5.6 mm Hg than patients receiving usual care. For our model, published meta‐analysis data were used to compute cardiovascular event absolute risk reductions associated with a 5.6‐mm Hg reduction in systolic blood pressure over 6 months. Costs/event were obtained from administrative data, and probabilistic sensitivity analyses were performed to assess the robustness of the results. Two program scenarios were evaluated—one with monthly follow‐up for a total of 1 year with sustained blood pressure reduction, and the other in which pharmacist care ended after the 6‐month program but the effects on systolic blood pressure diminished over time. The cost saving results from the economic model were then compared with the costs of the program. Annual estimated cost savings (in 2011 Canadian dollars) from avoided cardiovascular events were $265/patient (95% confidence interval [CI] $63–467) if the program lasted 1 year or $221/patient (95%CI $72–371) if pharmacist care ceased after 6 months with an assumed loss of effect afterward. Estimated pharmacist costs were $90/patient for 6 months or $150/patient for 1 year, suggesting that pharmacist‐managed programs are cost saving, with the annual net total cost savings/patient estimated to be $131 for a program lasting 6 months or $115 for a program lasting 1 year.ConclusionOur model found that community pharmacist interventions capable of reducing systolic blood pressure by 5.6 mm Hg within 6 months are cost saving and result in improved patient outcomes. Wider adoption of pharmacist‐managed hypertension care for patients with diabetes and hypertension is encouraged.
Impact of Various Body Weights and Serum Creatinine Concentrations on the Bias and Accuracy of the Cockcroft‐Gault Equation
Authors: Winter Mary A. , Guhr Kelly N. , Berg Gina M. 
Published: September 2012

Study ObjectiveTo evaluate the impact of various body weights and serum creatinine (Scr) concentrations on the bias and accuracy of the Cockcroft‐Gault creatinine clearance (C‐G Clcr) equation compared with measured 24‐hour Clcr.DesignRetrospective analysis.SettingTertiary care hospital.PatientsA total of 3678 patients with stable renal function and who underwent a 24‐hour urine collection between July 1, 1996, and June 30, 2010.Measurements and Main ResultsFor each patient, C‐G Clcr was calculated and compared with a measured 24‐hour Clcr. Body weight adjustments to the calculation were performed based on the following weight classifications: underweight, normal weight, overweight, obese, and morbidly obese. In addition, C‐G Clcr was calculated by using rounded Scr values based on two Scr thresholds—0.8 mg/dl and 1 mg/dl—for patients with measured Scr values below those thresholds. Those patients were then evaluated after stratification into two age groups: all ages and a subgroup of patients aged 65 years or older. The Scr‐rounded C‐G Clcr values were compared with the C‐G Clcr values using actual Scr values. Mean differences were calculated, and accuracy was evaluated. Use of actual body weight in the calculations for underweight patients resulted in an unbiased Clcr of −0.22 ml/minute (p=0.898). Use of ideal body weight in the calculations of patients of normal weight returned an unbiased Clcr of −1.3 ml/minute (p=0.544). An unbiased C‐G Clcr could not be calculated for other weight categories. In those patients, adjusted body weight using a factor of 0.4 (ABW0.4) was the least biased and most accurate. In patients aged 65 years or older with an Scr less than 0.8 mg/dl and less than 1 mg/dl, actual Scr was unbiased (−3 ml/min [p=1] and −9 ml/min [p=0.279], respectively) and more accurate than rounded Scr. In patients of all ages with an Scr less than 0.8 mg/dl and less than 1 mg/dl, actual Scr proved less biased (−4.5 ml/min [p=0.038] and −5.5 ml/min [p<0.001], respectively) and more accurate than rounded Scr.ConclusionAn unbiased C‐G Clcr can be calculated using actual body weight in underweight patients and ideal body weight in patients of normal weight. Using ABW0.4 for overweight, obese, and morbidly obese patients appears to be the least biased and most accurate method for calculating their C‐G Clcr. Rounding Scr in patients with low Scr did not improve accuracy or bias of the Clcr calculations.
Cellular senescence occurring in the rabbit medial collateral ligament during healing
Authors: Hsu Wei‐Hsiu , Peng Kuo‐Ti , Lai Li‐Ju , Hung Chien‐Hui , Chang Pey‐Jium 
Published: September 2012

AbstractMedial collateral ligament (MCL) healing proceeds in a temporally ordered fashion after injury. Despite the critical roles of fibroblasts during ligament repair, the phenotypic features of these healing fibroblasts have not been well characterized. Here, we show that healing MCL fibroblasts obtained from rabbits at 3‐week postinjury exhibited higher rates of senescent phenotypes and produced higher levels of TGF‐β1, collagens, α‐SMA, and matrix metalloproteinases (MMPs), than the corresponding fibroblasts from sham‐operated MCLs. Mechanical stretch further enhanced the cellular senescence and the expression of TGF‐β1, collagens, α‐SMA, and MMPs in both sham and healing MCL fibroblasts. In addition to MCL fibroblasts at 3‐week postinjury, the increased cellular senescence was also detected in healing MCL fibroblasts obtained at 4‐ and 6‐week postinjury. Most importantly, the association between the cellular senescence and ligament healing was confirmed in tissue sections by the senescence‐associated β‐galactosidase (SA‐β‐gal) staining. Using a recombinant TGF‐β1 and a neutralizing antibody, we found that those phenotypic changes, such as cellular senescence and the expression of collagens and MMPs, in MCL fibroblasts under mechanical loading conditions were regulated through TGF‐β1. Taken together, our results propose that cellular senescence and turnover of extracellular matrixes regulated by TGF‐β1 in MCL fibroblasts are critical for ligament healing. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:81–90, 2012
Influence of age on postural compensation after unilateral deafferentation due to vestibular schwannoma surgery
Authors: Gauchard Gérome C. , Lion Alexis , Perrin Philippe P. , Parietti‐Winkler Cécile 
Published: September 2012

AbstractObjectives/Hypothesis:To evaluate the age‐related effects of vestibular schwannoma (VS) on postural control and whether the postoperative postural strategies differ according to age.Study Design:Longitudinal, transversal study.Methods:Forty‐seven VS patients were split into three groups according to age (group I, 14 patients aged from 30 to 44 years; group II, 21 patients aged from 45 to 59 years; and group III, 12 patients aged from 60 to 75 years). All patients underwent vestibular and posturographic testing shortly before as well as 8 days and 3 months after surgical tumor removal.Results:Vestibular and postural performance followed a classical time course with degradation just after surgery and recovery 3 months after surgery, whatever the age group. However, in the elderly the improvement of postural performances compared to preoperatively was more important, especially in conflicting situations.Conclusions:Despite of age‐related decline in postural control and cognitive processes, neuroplasticity allowed not only a recovery but even an improvement of balance after surgical VS removal in the elderly. This study highlights the interest of VS surgery even at a more advanced age. Laryngoscope, 2012
Changing microbiology of pediatric neck abscesses in iowa 2000–2010
Authors: Walker Paul C. , Karnell Lucy Hynds , Ziebold Christine , Kacmarynski Deborah S.F. 
Published: September 2012

AbstractObjectives/Hypothesis:To examine the changing microbiology of pediatric neck abscesses over a 10‐year period with particular interest in methicillin‐resistant Staphylococcus aureus (MRSA) infections and their associated antibacterial‐resistance patterns, including resistance to clindamycin, a frequently used antibiotic for Staphylococcus aureus.Study Design:Retrospective chart review at a tertiary academic medical center.Methods:One hundred and twenty‐two consecutive pediatric patients managed between January 2000 and June 2010 with incision and drainage of a proven neck abscess.Results:Seventy‐four patients with 76 abscesses were identified. A microorganism was found in 65 (85%) of the 76 abscesses. Forty‐three percent grew Staphylococcus aureus (SA), 12% were methicillin‐resistant Staphylococcus Aureus (MRSA), and 31% were methicillin‐susceptible Staphylococcus aureus (MSSA). There was a significant increase in the incidence of MRSA infections during the study period, with only one case of MRSA diagnosed in the first half of the study (from 2000–2004) compared with seven in the second half (from 2005–2010) (P = 0.023). The second most common bacterial etiology or isolate was Streptococcus pyogenes in 27%, while the remaining 30% grew mixed oral flora and other microorganisms.Conclusions:These findings demonstrate a statistically significant rise in the proportion of MRSA neck infections in pediatric patients in Iowa. Resistance to clindamycin was highest among MSSA isolates. Clindamycin‐resistant S. aureus and Streptococcus pyogenes are established pathogens in neck infections. In communities with similar microbiology patterns, empiric treatment with combination therapy of a beta lactam and vancomycin or trimethoprim/sulfamethoxazole should be initiated until culture results are available. Laryngoscope, 2013
Incidence and implication of vocal fold paresis following neonatal cardiac surgery
Authors: Dewan Karuna , Cephus Constance , Owczarzak Vicki , Ocampo Elena 
Published: September 2012

AbstractObjectives/Hypothesis:To study the incidence and implications of vocal fold paresis (VFP) following congenital neonatal cardiac surgery.Study Design:Retrospective chart review.Methods:All neonates who underwent median sternotomy for cardiac surgery from May 2007 to May 2008 were evaluated. Flexible laryngoscopy was performed to evaluate vocal fold function after extubation. Swallow evaluation and a modified barium swallow study were performed prior to initiating oral feeding if the initial screening was abnormal.Results:A total of 101 neonates underwent cardiac surgery during the study period. Ninety‐four patients underwent a median sternotomy, and 76 of these were included in the study. Fifteen (19.7%) had vocal fold paresis (VFP) postoperatively. Almost 27% of the patients with aortic arch surgery had VFP while only 4.1% of the patients with nonaortic arch surgery developed VFP (P=0.02) Those patients who underwent aortic arch surgery weighed significantly less (P<0.01). All the patients with VFP had significant morbidity related to swallowing and nutrition (P=0.01) and required longer postsurgical hospitalization (P=0.02).Conclusions:The reported incidence of VFP following cardiac surgery via median sternotomy ranges between 1.7% and 67% depending on the type of surgery and the weight of the infant at the time of surgery. In our cohort, 19.7% had VFP. Surgery requiring aortic arch manipulation had a higher incidence of complications and required longer hospitalizations. These results may be used to improve informed consent and to manage postoperative expectations by identifying patients who are at higher risk for complications.
Evaluating cost and reliability integrated performance of stochastic logistics systems
Authors: Jane Chin‐Chia , Laih Yih‐Wenn 
Published: September 2012

AbstractThe significance of integrating reliability into logistics performance has been established [The Logistics Performance Index and Its Indicators, World Bank International Trade and Transport Departments, (2010)]. Hence, as a response to the work by the World Bank, the present article aims to evaluate the performance indexRb,dof logistics systems as the probability that a specified demanddcan be distributed successfully through multistate arc capacities from the source to the destination under the constraint that the total distribution cost should not exceed the cost limitationb. This article provides a pioneering approach for a straightforward computation of the performance indexRb,d. The proposed algorithm is a hybrid between the polynomial time capacity‐scaling algorithm, which was presented by Edmonds and Karp [JACM 19 (1972)], and the decomposition algorithm, which was presented by Jane and Laih [IEEE (2008)]. Currently, the proposed approach is the only algorithm that can directly computeRb,d. An illustration of the proposed algorithm is presented. The results of the computational experiments indicate that the presented algorithm outperforms existing algorithms. © 2012 Wiley Periodicals, Inc. Naval Research Logistics, 2012
Nonlinear manifold learning for meshfree finite deformation thin‐shell analysis
Authors: Millán Daniel , Rosolen Adrian , Arroyo Marino 
Published: September 2012

SUMMARYCalculations on general point‐set surfaces are attractive because of their flexibility and simplicity in the preprocessing but present important challenges. The absence of a mesh makes it nontrivial to decide if two neighboring points in the three‐dimensional embedding are nearby or rather far apart on the manifold. Furthermore, the topology of surfaces is generally not that of an open two‐dimensional set, ruling out global parametrizations. We propose a general and simple numerical method analogous to the mathematical theory of manifolds, in which the point‐set surface is described by a set of overlapping charts forming a complete atlas. We proceed in four steps: (1) partitioning of the node set into subregions of trivial topology; (2) automatic detection of the geometric structure of the surface patches by nonlinear dimensionality reduction methods; (3) parametrization of the surface using smooth meshfree (here maximum‐entropy) approximants; and (4) gluing together the patch representations by means of a partition of unity. Each patch may be viewed as a meshfree macro‐element. We exemplify the generality, flexibility, and accuracy of the proposed approach by numerically approximating the geometrically nonlinear Kirchhoff–Love theory of thin‐shells. We analyze standard benchmark tests as well as point‐set surfaces of complex geometry and topology. Copyright © 2012 John Wiley & Sons, Ltd.
Phase II study of pre‐irradiation chemotherapy for childhood intracranial ependymoma. Children's Cancer Group protocol 9942: A report from the Children's Oncology Group
Authors: Garvin James H. , Selch Michael T. , Holmes Emi , Berger Mitchell S. , Finlay Jonathan L. , Flannery Ann , Goldwein Joel W. , Packer Roger J. , Rorke‐Adams Lucy B. , Shiminski‐Maher Tania , Sposto Richard , Stanley Philip , Tannous Raymond , Pollack Ian F. ,   for the Children's Oncology Group
Published: September 2012

AbstractPurposeStandard therapy for childhood intracranial ependymoma is maximal tumor resection followed by involved‐field irradiation. Although not used routinely, chemotherapy has produced objective responses in ependymoma, both at recurrence and in infants. Because the presence of residual tumor following surgery is consistently associated with inferior outcome, the potential impact of pre‐irradiation chemotherapy was investigated.MethodsBetween 1995 and 1999, the Children's Cancer Group undertook a Phase II trial of pre‐irradiation chemotherapy in children 3–21 years of age with intracranial ependymoma and radiological evidence of post‐operative residual tumor.ResultsOf 84 patients, 41 had residual tumor, and were given four cycles of cisplatin‐based chemotherapy prior to irradiation. Of 35 patients fully evaluable for response to chemotherapy, 14 (40%) demonstrated complete response, 6 (17%) partial response, 10 (29%) minor response or stable disease, and 5 (14%) demonstrated progressive tumor growth. For the entire group, 5‐year overall survival (OS) and event‐free survival (EFS) was 71 ± 6%, and 57 ± 6%, respectively. The pre‐irradiation chemotherapy group demonstrated EFS comparable to that of patients with no residual tumor who received irradiation alone (55 ± 8% vs. 58 ± 9%, P = 0.45). Any benefit of chemotherapy was restricted to patients with greater than 90% tumor resection.ConclusionsChildren with near total resection of ependymoma may benefit from pre‐irradiation chemotherapy. Patients with subtotal resection have inferior outcome despite responses to chemotherapy, and should be considered for second‐look surgery prior to irradiation. Pediatr Blood Cancer 2012; 59: 1183–1189. © 2012 Wiley Periodicals, Inc.
Angiotensin‐converting enzyme inhibitor use and pneumonia risk in community‐dwelling older adults: results from a population‐based case–control study
Authors: Dublin Sascha , Walker Rod L. , Jackson Michael L. , Nelson Jennifer C. , Weiss Noel S. , Jackson Lisa A. 
Published: September 2012

ABSTRACTPurposeTo test whether angiotensin‐converting enzyme (ACE) inhibitor use is associated with decreased risk of community‐acquired pneumonia in older adults.MethodsWe analyzed data from a nested case–control study of community‐dwelling, immunocompetent adults aged 65–94 within an integrated healthcare delivery system. Cases of ambulatory and hospitalized pneumonia from 2000 to 2003 were identified from International Classification of Disease, version 9, codes and validated using medical record review. Controls were matched to cases by age, sex, and calendar year. Using health plan pharmacy data, we defined current use as filling ≥2 prescriptions during the 180 days prior to the case's diagnosis date. We calculated standardized doses per day using World Health Organization defined daily doses. Multivariable conditional logistic regression estimated adjusted odds ratios (ORs) for pneumonia in relation to ACE inhibitor use, adjusting for comorbidity, functional and cognitive status, and other covariates from medical record review and pharmacy data.ResultsCurrent use of ACE inhibitors was seen in 23% (242/1039) of cases and 21% (433/2022) of controls. Lisinopril accounted for 95% of prescriptions. The OR for pneumonia comparing current use to no current use was 0.99 (95% confidence interval [CI] 0.83–1.19). The OR for use of more than two standardized daily doses per day was 1.39 (95% CI 0.93–2.06) compared to no current use.ConclusionsACE inhibitor use is not associated with reduced pneumonia risk in community‐dwelling older adults. Copyright © 2012 John Wiley & Sons, Ltd.
Impaired Maraviroc and Raltegravir Clearance in a Human Immunodeficiency Virus–Infected Patient with End‐Stage Liver Disease and Renal Impairment: A Management Dilemma
Authors: Pau Alice K. , Penzak Scott R. , Boyd Sarita D. , McLaughlin Mary , Morse Caryn G. 
Published: September 2012

Current product labels for maraviroc and raltegravir provide no dosing guidance for patients with end‐stage liver disease and worsening renal function. We describe a 41‐year‐old man with human immunodeficiency virus (HIV) infection and rapidly progressive liver failure and vanishing bile duct syndrome at presentation. Despite discontinuation of all potential offending drugs, the patient's liver function continued to deteriorate. To achieve and maintain HIV suppression while awaiting liver transplantation, a regimen consisting of maraviroc, raltegravir, and enfuvirtide was started. These agents were chosen because the patient was not exposed to them before the onset of liver failure. While receiving product label–recommended twice‐daily dosing of these drugs, he achieved and maintained HIV suppression. During a complicated and prolonged hospitalization, the patient also developed renal dysfunction. As hepatic metabolism is the primary route of clearance of maraviroc and raltegravir, we predicted that using approved doses of these drugs could result in significant drug accumulation. Since the safety profiles of supratherapeutic concentrations of these agents are not well defined, we chose to use therapeutic drug monitoring to guide further dosing. The reported concentrations showed severely impaired metabolic clearance of both drugs, with markedly prolonged elimination half‐lives of 189 hours for maraviroc and 61 hours for raltegravir. Previously reported half‐lives for maraviroc and raltegravir in HIV‐infected patients with normal hepatic and renal function are 14–18 hours and 9–12 hours, respectively. Based on these results, the dosing intervals were extended from twice/day to twice/week for maraviroc and every 48 hours for raltegravir. Unfortunately, the patient's clinical condition continued to deteriorate, and he eventually died of complications related to end‐stage liver disease. This case illustrates the difficulties in managing antiretroviral therapy in an HIV‐infected patient with combined severe liver and renal failure. Prolonged excessively high exposure to maraviroc and raltegravir is likely to result in some level of concentration‐dependent toxicity. Until more data are available, therapeutic drug monitoring remains the only evidence‐based approach to optimize dosage selection of these drugs in this patient population.
Fracture Risk and Bone Mineral Density Reduction Associated with Proton Pump Inhibitors
Authors: Lau Yuen Ting , Ahmed Nasiya N. 
Published: September 2012

Many patients receive prolonged proton pump inhibitor (PPI) therapy for upper gastrointestinal disorders, but the long‐term safety of PPIs, particularly increased risk of hip and nonhip fractures, has been questioned. To summarize the current literature on the risk of bone mineral density (BMD) reduction and fracture associated with PPI therapy, we conducted a literature search to identify all pertinent studies from 1980–February 2011. A total of 14 observational studies were included in this review. Most studies evaluated the risk of fracture associated with prolonged PPI exposure. Eight studies found an increased fracture risk at the hip, and five studies found an increased fracture risk at the spine associated with PPIs. Three studies showed reduction in fracture risk associated with PPIs after discontinuation for 1 month–1 year. Three studies evaluated the risk of BMD reduction associated with PPIs but did not find consistent changes in baseline or subsequent BMD. The current data suggest a modest increase in the risk of hip fracture and vertebral fracture associated with PPIs, although some studies showed conflicting results. Further studies will be needed to determine whether the increased risk of fracture is due to PPI exposure or residual confounding.