bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intraoperative Positioning of the Hindfoot With the Hindfoot Alignment Guide
Authors: Frigg Arno , Jud Lukas , Valderrabano Victor 
Published: September 2013

Background: In a previous study, intraoperative positioning of the hindfoot by visual means resulted in the wrong varus/valgus position by 8 degrees and a relatively large standard deviation of 8 degrees. Thus, new intraoperative means are needed to improve the precision of hindfoot surgery. We therefore sought a hindfoot alignment guide that would be as simple as the alignment guides used in total knee arthroplasty. Methods: A novel hindfoot alignment guide (HA guide) has been developed that projects the mechanical axis from the tibia down to the heel. The HA guide enables the positioning of the hindfoot in the desired varus/valgus position and in plantigrade position in the lateral plane. The HA guide was used intraoperatively from May through November 2011 in 11 complex patients with simultaneous correction of the supramalleolar, tibiotalar, and inframalleolar alignment. Pre- and postoperative Saltzman views were taken and the position was measured. Results: The HA guide significantly improved the intraoperative positioning compared with visual means: The accuracy with the HA guide was 4.5 ± 5.1 degrees (mean ± standard deviation) and without the HA guide 9.4 ± 5.5 degrees ( P < .05). In 7 of 11 patients, the preoperative plan was changed because of the HA guide (2 avoided osteotomies, 5 additional osteotomies). Conclusions: The HA guide helped to position the hindfoot intraoperatively with greater precision than visual means. The HA guide was especially useful for multilevel corrections in which the need for and the amount of a simultaneous osteotomy had to be evaluated intraoperatively. Level of Evidence: Level IV, case series.
The enactment of knowledge translation: a study of the Collaborations for Leadership in Applied Health Research and Care initiative within the English National Health Service
Authors: D’Andreta Daniela , Scarbrough Harry , Evans Sarah 
Published: September 2013

Objectives We contribute to existing knowledge translation (KT) literature by developing the notion of ‘enactment’ and illustrate this through an interpretative, comparative case-study analysis of three Collaborations for Leadership in Applied Health Research and Care (CLAHRC) initiatives. We argue for a focus on the way in which the CLAHRC model has been ‘enacted’ as central to the different KT challenges and capabilities encountered. Methods A comparative, mixed method study created a typology of enactments (Classical, Home-grown and Imported) using qualitative analysis and social network analysis. Results We identify systematic differences in the enactment of the CLAHRC model. The sources of these different enactments are subsequently related to variation in formative interpretations and leadership styles, the implementation of different governance structures, and the relative epistemic differences between the professional groups involved. Conclusions Enactment concerns the creative agency of individuals and groups in constituting a particular context for their work through their local interpretation of a particular KT model. Our theory of enactment goes beyond highlighting variation between CLAHRCs, to explore the mechanisms that influence the way a particular model is interpreted and acted upon. We thus encourage less focus on conceptual models and more on the formative role played by leaders of KT initiatives.
Cardiac Risk Assessment, Morbidity Prediction, and Outcome in the Vascular Intensive Care Unit
Authors: Dover Mary , Tawfick Wael , Hynes Niamh , Sultan Sherif 
Published: September 2013

Objectives: The aim of this study is to examine the predictive value of the Lee revised cardiac risk index (RCRI) for a standard vascular intensive care unit (ICU) population as well as assessing the utility of transthoracic echocardiography and the impact of prior coronary artery disease (CAD) and coronary revascularization on patient outcome. Design: This is a retrospective review of prospectively maintained Vascubase and prospectively collected ICU data. Materials and Methods: Data from 363 consecutive vascular ICU admissions were collected. Findings were used to calculate the RCRI, which was then correlated with patient outcomes. All patients were on optimal medical therapy (OMT) in the form of cardioselective β-blocker, aspirin, statin, and folic acid. Results: There was no relationship found between a reduced ejection fraction and patient outcome. Mortality was significantly increased for patients with left ventricular hypertrophy (LVH) as identified on echo (14.9% vs 6.5%, P = .028). The overall complication rates were significantly elevated for patients with valvular dysfunction. Discrimination for the RCRI on receiver–operating characteristic analysis was poor, with an area under the receiver–operating characteristic curve of .621. Model calibration was reasonable with an Hosmer-Lemeshow Ĉ statistic of 2.726 ( P = .256). Of those with known CAD, 41.22% of the patients receiving best medical treatment developed acute myocardial infarction (AMI) compared to 35.3% of those who previously underwent percutaneous cardiac intervention and 23.5% of those who had undergone coronary artery bypass grafting. There was 3-fold increase in major adverse clinical events in patients with troponin rise and LVH. Conclusions: The RCRI’s discriminatory capacity is low, and this raises difficulties in assessing cardiac risk in patients undergoing vascular intervention. The AMI is highest in the OMT group without prior cardiac intervention, which mandates protocols to identify patients requiring cardiac intervention prior to vascular procedures.
Computational Fluid Dynamics Investigation of Chronic Aortic Dissection Hemodynamics Versus Normal Aorta
Authors: Karmonik Christof , Müller-Eschner Matthias , Partovi Sasan , Geisbüsch Philipp , Ganten Maria-Katharina , Bismuth Jean , Davies Mark G. , Böckler Dittmar , Loebe Matthias , Lumsden Alan B. , Tengg-Kobligk Hendrik von 
Published: September 2013

Objectives: To evaluate hemodynamic changes during aneurysmal dilatation in chronic type B aortic dissections compared to hemodynamic parameters in the healthy aorta with the use of computational fluid dynamics (CFD). Methods: True lumen (TL)/false lumen (FL) dimensional changes, changes in total pressure (TP), and wall shear stress (WSS) were evaluated at follow-up (FU) compared to initial examination (IE) with transient CFD simulation with geometries derived from clinical image data and inflow boundary conditions from magnetic resonance images. The TL/FL pressure gradient between ascending and descending aorta (DAo) and maximum WSS at the site of largest dilatation was compared to values for the healthy aorta. Results: Hemodynamic changes at site of largest FL dilatation included 77% WSS reduction and 69% TP reduction. Compared to the healthy aorta, pressure gradient between ascending and DAo was a factor of 1.4 higher in the TL and a factor of 1.5 in the FL and increased at FU (1.6 and 1.7, respectively). Maximum WSS at the site of largest dilatation was a factor of 3 lower than that for the healthy aorta at IE and decreased by more than a factor of 2 at FU. Conclusions: The FL dilatation at FU favorably reduced TP. In contrast, unfavorable increase in pressure gradient between ascending and DAo was observed with higher values than in the healthy aorta. Maximum WSS was reduced at the site of largest dilation compared to healthy aorta.
Diffuse large B-cell lymphoma in adults aged 75 years and older: a single institution analysis of cause-specific survival and prognostic factors
Authors: Smith Stephen D. , Chen Andy , Spurgeon Stephen , Okada Craig , Fan Guang , Dunlap Jennifer , Braziel Rita , Maziarz Richard 
Published: September 2013

Background: Very elderly patients (75 years and older) with diffuse large B-cell lymphoma (DLBCL) will be increasingly considered for cancer treatment as the population ages, but are underrepresented in clinical trials. Here we report outcomes of very elderly DLBCL patients treated in the modern era at the Oregon Health and Science University (OHSU). Methods: We queried the OHSU Tumor Registry for DLBCL cases treated since 2002. A total of 73 patients aged 75 years or older were analyzed under Institutional Review Board approval. Results: With a median follow up of 31 months, cause-specific survival was 58% and overall survival 51% at 3 years. Incorporation of an anthracycline did not influence outcomes. More than one extranodal site or poor-risk disease by Revised International Prognostic Index score were adversely prognostic, but pathologic features studied were not. Conclusions: Very elderly patients with DLBCL require prospective studies, which employ novel risk stratification and therapeutic approaches.
Cigarette smoking is a modifiable risk factor for Barrett's oesophagus
Authors: Balasubramanian Gokulakrishnan , Gupta Neil , Giacchino Maria , Singh Mandeep , Kanakadandi Vijay , Gaddam Srinivas , Wani Sachin B , Higbee April D , Rastogi Amit , Bansal Ajay , Sharma Prateek 
Published: September 2013

BackgroundCigarette smoking has been associated with an increased risk of oesophageal adenocarcinoma (OAC). However, the impact of smoking and more importantly smoking cessation on Barrett’s oesophagus (BO) is unclear.ObjectiveThe aim of the study is to evaluate the association between cigarette smoking and presence of BO in a large prospective cohort of patients with gastro‐oesophageal reflux disease (GORD).MethodsPatients presenting to the endoscopy unit for upper endoscopy completed a validated GORD questionnaire and information on demographics (age, gender, and ethnicity), cigarette smoking [status (current/past), amount (pack years) and duration of smoking cessation], clinical data [medication history, body mass index (BMI), and family history] and endoscopic findings [BO and hiatal hernia] were recorded. Cigarette smokers (current and past) and nonsmokers were compared using Fisher’s Exact test for categorical variables and Mann–Whitney test for continuous variables. Effects of cigarette smoking and smoking cessation on BO risk was assessed by stepwise logistic regression analysis.ResultsA total of 1056 patients were included in the analysis [mean age: 57.2 ± 12.7years, Caucasian 880 (83.3%), male 985 (93.3%), and mean BMI 29.6 (SD: ± 5.6)]. 827 (78.3%) were smokers and 229 (21.6%) were nonsmokers. 474 subjects (44.9%) had a previous history of smoking. Anytime smokers were more likely to have BO (adjusted OR: 3.3; 95 CI: 1.7–6.3; p  < 0.01). Higher smoking burden (pack years) was associated with higher risk of BO in this GORD cohort (p for trend < 0.01). Duration of smoking cessation was inversely associated with risk of BO (p for trend: 0.01).ConclusionThis study shows that smokers with reflux symptoms have about threefold higher risk of BO compared with nonsmokers, whereas discontinuing smoking is associated with a significant reduced risk. Smoking cessation appears to be a viable option to reduce BO risk in patients with reflux disease.
Prescription Assistance for Older Adults with Limited Incomes: Client and Program Characteristics
Authors: Upchurch Gina A , Menon Manoj P , Levin Kimberly S , Catellier Diane J , Conlisk Elizabeth A 
Published: September 2013

Objective: To describe the sociodemographic, medication-related, health services utilization and health characteristics of the community-dwelling senior citizens (≥65 y) with limited incomes who enrolled in Senior PHARM Assist, a community-based prescription assistance program. Patients: Senior citizens (n = 387) enrolled in the program between June 1994 and May 1996. All eligible participants were 65 years of age or older, had incomes below 140% of the federal poverty level, but were not enrolled in Medicaid. All the patients were living in Durham County and were taking prescription medications. Measurements: Self- or caregiver-reported. In addition to demographic characteristics, polypharmacy (taking ≥5 prescription medications in the last month), medication adherence (adherence to directions on the medication container), medication knowledge (client or caregiver stated appropriate purpose for taking the medication), adverse effects from medications, and activities of daily living and instrumental activities of daily living limitations were measured. Results: Eighty percent of the senior citizens lived below the federal poverty level, 82% were women, 53% were African-American, 53% lived alone, and the mean monthly income for a single person was $595 and for a couple was $939. They were taking, on average, 8.9 medications, were adherent with 71% of their medications, knew the purpose of 69% of their medications, and reported adverse effects from 10% of their prescription medications. Conclusions: This population of community-dwelling seniors takes, on average, a higher number of prescription medications than previously reported, posing a higher risk for the hazards associated with polypharmacy and uncoordinated prescribing, such as nonadherence, drug interactions, and adverse effects. There may be a greater need for future intervention programs to include a comprehensive educational component, such as a coordinated medication review, in addition to financial assistance.
Clinical Application and Evaluation of Vancomycin Dosing in Adults
Authors: Rushing Todd A , Ambrose Peter J 
Published: September 2013

Objective: To evaluate the accuracy of a vancomycin dosing method (study method) in estimating volume of distribution (Vd) and clearance of vancomycin (Clvanco) and the frequency with which it would provide serum vancomycin concentrations (SVCs) within a specified range compared with other published methods. Methods: One hundred and seven patients with 108 pairs of SVCs were used to calculate patient-specific Vd and Clvanco. Based on these patient-specific Vd and Clvanco values, the predictive ability of the estimated parameters from the study dosing method (Vd [L] = 0.17 [age] + 0.22 [actual body weight] + 15; Clvanco = creatinine clearance) was evaluated against three previously published pharmacokinetic dosing methods, using predictive performance analysis (precision and bias). Furthermore, the patient-specific pharmacokinetic parameters were used to simulate steady-state peak and trough SVCs, using first-order pharmacokinetic equations from doses derived from the study method, the three different pharmacokinetic methods, and two other published dosing schemes. The frequency with which each method would have achieved target peak and trough SVCs was determined. Results: The study method was found to be more precise and less biased (p < 0.05) than comparative methods in predicting vancomycin Vd and Clvanco. The study method also resulted in a higher frequency of steady-state peak and trough SVCs within the target range specified. Conclusions: The study method presented here provided a reliable estimation of vancomycin pharmacokinetic parameters that was easily applied to various patient populations to individualize vancomycin dosing, and frequently yielded SVCs within a predictable and desired range.
Zaleplon for Insomnia
Authors: Maidment Ian D 
Published: September 2013

Objective: To assess the effectiveness data of zaleplon. Data Sources: Primary and review articles were identified by MEDLINE (1985 to August 2000) and via secondary sources. Study Selection and Data Extraction: All of the articles identified from the data sources were evaluated, and all information deemed relevant was included in this review. Data Synthesis: Eight studies were identified. Two trials in a nonelderly population investigated the effectiveness of zaleplon and the incidence of withdrawal symptoms. Zaleplon's only significant effect on insomnia was to reduce sleep latency by six to 16 minutes. The tools used in the trials showed that stopping zaleplon after 14–28 days of therapy did not cause significant rebound events. Two recent studies that investigated the use of zaleplon in the elderly produced similar results, although one study showed that stopping zaleplon causes significant rebound events. Three studies determined whether zaleplon caused any hangover effects and concluded that there is a low potential for these effects in a nonelderly population. In healthy nonelderly volunteers, standard doses of zaleplon had no residual effects when taken as little as two hours before the subjects arose. One small-scale study indicated that the abuse potential of zaleplon is similar to that of benzodiazepines. Conclusions: Although zaleplon significantly reduces sleep latency, the effect does not appear to be highly clinically significant. Zaleplon's short half-life does appear to reduce the risk of hangover effects. Until further data become available, zaleplon should be considered to have the same abuse potential as benzodiazepines.
Once-Weekly Intravenous Administration of Recombinant Human Erythropoietin for Anemia following Hematopoietic Stem Cell Transplantation
Authors: Bilgrami Syed FA , Naqvi Bilal H , Fox Judee M , Furlong Fiona M , Clive Jonathan M 
Published: September 2013

Objective: To determine the response to once-weekly intravenous administration of recombinant human erythropoietin (rHuEPO) in individuals who develop severe anemia following hematopoietic stem cell transplantation (HSCT). Design: A serum erythropoietin (EPO) concentration was obtained by chemiluminescence immunoassay in recipients of allogeneic or autologous stem cell transplantation who had developed severe anemia (hemoglobin <8.5 g/dL). If the erythropoietin concentration was not as high as predicted for the degree of anemia, rHuEPO was initiated at a dosage of 40,000 units intravenously once weekly. The medication was administered through a permanent indwelling central venous catheter on an outpatient basis. Hemoglobin concentration was measured at least weekly for up to 12 weeks prior to the administration of rHuEPO, and for an equivalent period following the initiation of therapy. Packed red blood cells were transfused for a hemoglobin concentration <8.5 g/dL. The mean weekly transfusion requirements prior to and following the initiation of rHuEPO were compared. Results: Ten consecutive patients who developed severe anemia after allogeneic (n = 8) or autologous (n = 2) HSCT for a variety of hematologic malignancies were eligible for the study. The median age was 43.5 years, and the male to female ratio was 3:7. There was no evidence of renal failure, iron or vitamin deficiency, hemoglobinopathy, or active blood loss. The median EPO concentration was 102 mU/mL. rHuEPO was begun at a median of 41 days following stem cell infusion. Patients received a median dose of 580 units/kg/wk. Two patients developed severe intestinal hemorrhage as a result of acute graft-versus-host disease. The remaining eight individuals received their last transfusion of packed red blood cells a median of 27 days after the initiation of rHuEPO therapy. The mean weekly transfusion requirement prior to and following the commencement of rHuEPO therapy was 0.93 and 0.40, respectively. This difference was statistically significant (p = 0.024). Conclusions: rHuEPO 40,000 units intravenously once weekly may reduce packed red blood cell transfusion requirements in some patients who develop severe anemia after HSCT. However, its use should be limited to individuals who are either intolerant of, or unwilling to use, the subcutaneous route of administration.
Angiotensin-Converting Enzyme Inhibitors in Congestive Heart Failure: Practice versus Guidelines
Authors: Thilly Nathalie , Briançon Serge , Juilliere Yves , Dufay Edith , Zannad Faiez 
Published: September 2013

Background: Angiotensin-converting enzyme (ACE) inhibitors decrease morbidity and mortality in patients with systolic heart failure. In the practice of cardiology, ACE inhibitors are insufficiently prescribed by cardiologists. Objective: To measure the deviation between observed practice and clinical practice guidelines (CPGs), and to identify factors contributing to the deviation. Methods: CPGs have been developed from available international guidelines via a procedure involving a consensus group. A practice survey was conducted on 208 patients less than 75 years old hospitalized in public hospital cardiology units. Factors associated with nonadherence to CPGs were identified among characteristics of patients, practitioners, and cardiology units in logistic regression models. Results: In patients for whom the prescription of ACE inhibitors was not contraindicated, ACE inhibitor therapy was not initiated in 14%, and the CPR dosages were not attained in 51.2% of the cases. Factors associated with treatment not being initiated were age over 60 years (p = 0.001), increased ejection fraction (p = 0.005), and treatment with diuretics (p = 0.001) and digitalis glycosides (p = 0.008) at hospital admission. Factors associated with prescription of subtarget doses were age over 60 years (p = 0.024), low serum potassium concentration (p = 0.014), and absence of digitalis glycoside treatment (p = 0.039) at the start of ACE inhibitor administration. Conclusions: Our work has shown that cardiologists tend to adapt their prescription of ACE inhibitors to clinical situations that are not considered relevant in international guidelines. The implementation of CPGs in cardiology units should target adequate information about these situations.
Nesiritide for Acute Decompensated Heart Failure
Authors: Barclay Teresa S , Kim Joanne J , Lee Audrey J 
Published: September 2013

Objective: To evaluate nesiritide for the treatment of acute decompensated heart failure (HF) with respect to its pharmacology, pharmacokinetics, clinical efficacy, adverse effect profile, and outcomes. Data Source: Primary and review articles were identified by MEDLINE search (1966–March 2001). Data from the PRECEDENT trial and additional dosing/administration and safety information were obtained from Scios, Inc. Study Selection: All of the articles identified from the data sources were evaluated and all information deemed relevant was included in this review. Data Synthesis: Research into the cardiac natriuretic peptides has revealed that brain natriuretic peptide (BNP) is elevated in patients with HF and may counterregulate the pathophysiologic mechanisms involved in progression of the disease. Nesiritide (Natrecor), recombinant human BNP, is the first natriuretic peptide to be approved by the FDA for treatment of acute decompensated HF. Nesiritide is a potent venous and arterial vasodilator that reduces pulmonary capillary wedge pressure and systemic vascular resistance in a dose-dependent manner with minimal effect on heart rate. It improves signs and symptoms of HF; however, its effect on patient outcomes is unclear because of limited data. The most commonly reported adverse effects in clinical trials were dose-related hypotension and nausea. Conclusions: Nesiritide is an intravenous arterial and venous vasodilator that may be particularly useful in patients who may not tolerate the arrhythmogenic effects of dobutamine and milrinone or who cannot tolerate nitroglycerin and nitroprusside. Further well-designed comparative studies are needed to define nesiritide's place in management of acute decompensated HF.