bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost-Utility Analysis of Primary Prophylaxis Versus Secondary Prophylaxis With Granulocyte Colony-Stimulating Factor in Elderly Patients With Diffuse Aggressive Lymphoma Receiving Curative-Intent Chemotherapy
Authors: Chan Kelvin K.W. , Siu Eric , Krahn Murray D. , Imrie Kevin , Alibhai Shabbir M.H. 
Published: March 2012

PurposeThe 2006 American Society of Clinical Oncology (ASCO) guideline recommended primary prophylaxis (PP) with granulocyte colony-stimulating factor (G-CSF) instead of secondary prophylaxis (SP) for elderly patients with diffuse aggressive lymphoma receiving chemotherapy. We examined the cost-effectiveness of PP when compared with SP.MethodsWe conducted a cost-utility analysis to compare PP to SP for diffuse aggressive lymphoma. We used a Markov model with an eight-cycle chemotherapy time horizon with a government-payer perspective and Ontario health, economic, and cost data. Data for efficacies of G-CSF, probabilities, and utilities were obtained from published literature. Probabilistic sensitivity analysis (PSA) was conducted.ResultsThe incremental cost-effectiveness ratio of PP to SP was $700,500 per quality-adjusted life-year (QALY). One-way sensitivity analyses (willingness-to-pay threshold = $100,000/QALY) showed that if PP were to be cost-effective, the cost of hospitalization for febrile neutropenia (FN) had to be more than $31,138 (2.5 × > base case), the cost of G-CSF per cycle less than $960 (base case = $1,960), the risk of first-cycle FN more than 47% (base case = 24%), or the relative risk reduction of FN with G-CSF more than 91% (base case = 41%). Our result was robust to all variables. PSA revealed a 10% probability of PP being cost-effective over SP at a willingness-to-pay threshold of $100,000/QALY.ConclusionPP is not cost-effective when compared with SP in this population. PP becomes attractive only if the cost of hospitalization for FN is significantly higher or the cost of G-CSF is significantly lower.
Prospective Study of 2-[18F]Fluorodeoxyglucose Positron Emission Tomography in the Assessment of Regional Nodal Spread of Disease in Patients With Breast Cancer: An Ontario Clinical Oncology Group Study
Authors: Pritchard Kathleen I. , Julian Jim A. , Holloway Claire M.B. , McCready David , Gulenchyn Karen Yvonne , George Ralph , Hodgson Nicole , Lovrics Peter , Perera Francisco , Elavathil Leela , O'Malley Frances P. , Down Nancy , Bodurtha Audley , Shelley Wendy , Levine Mark N. 
Published: March 2012

Purpose 2-[18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) is potentially useful in assessing lymph nodes and detecting distant metastases in women with primary breast cancer. Patients and Methods Women diagnosed with operable breast cancer within 3 months underwent FDG-PET at one of five Ontario study centers followed by axillary lymph node assessment (ALNA) consisting of sentinel lymph node biopsy (SLNB) alone if sentinel lymph nodes (SLNs) were negative, SLNB with axillary lymph node dissection (ALND) if SLNB or PET was positive, or ALND alone if SLNs were not identified. Results Between January 2005 and March 2007, 325 analyzable women entered this study. Sentinel nodes were found for 312 (96%) of 325 women and were positive for tumor in 90 (29%) of 312. ALND was positive in seven additional women. Using ALNA as the gold standard, sensitivity for PET was 23.7% (95% CI, 15.9% to 33.6%), specificity was 99.6% (95% CI, 97.2% to 99.9%), positive predictive value was 95.8% (95% CI, 76.9% to 99.8%), negative predictive value was 75.4% (95% CI, 70.1% to 80.1%), and prevalence was 29.8% (95% CI, 25.0% to 35.2%). Using logistic regression, tumor size was predictive for prevalence of tumor in the axilla and for PET sensitivity. PET scan was suspicious for distant metastases in 13 patients; three (0.9%) were confirmed as metastatic disease and 10 (3.0%) were false positive. Conclusion FDG-PET is not sufficiently sensitive to detect positive axillary lymph nodes, nor is it sufficiently specific to appropriately identify distant metastases. However, the very high positive predictive value (96%) suggests that PET when positive is indicative of disease in axillary nodes, which may influence surgical care.
Assessing the Impact of a Cooperative Group Trial on Breast Cancer Care in the Medicare Population
Authors: Soulos Pamela R. , Yu James B. , Roberts Kenneth B. , Raldow Ann C. , Herrin Jeph , Long Jessica B. , Gross Cary P. 
Published: March 2012

Purpose The Cancer and Leukemia Group B (CALGB) C9343 trial found that adjuvant radiation therapy (RT) provided minimal benefits for older women with breast cancer. Although treatment guidelines were changed to indicate that some women could forego RT, the impact of the C9343 results on clinical practice is unclear. Patients and Methods We used the Surveillance, Epidemiology, and End Results (SEER) –Medicare data set to assess the use of adjuvant RT in a sample of women ≥ 70 years old diagnosed with stage I breast cancer from 2001 to 2007 who fulfilled the C9343 inclusion criteria. We used log-binomial regression to estimate the relation between publication of C9343 and use of RT in the full sample and across strata of patient and health system characteristics. Results Of the 12,925 Medicare beneficiaries in our sample (mean age, 77.7 years), 76.5% received RT. Approximately 79% of women received RT before study publication compared with 75% after (adjusted relative risk of receiving RT postpublication v prepublication: 0.97; 95% CI, 0.95 to 0.98). Although use of RT was lower after the trial within all strata of age and life expectancy, the magnitude of this decrease did not differ significantly by strata. For instance, among patients with life expectancy less than 5 years, RT use decreased by 3.7%, from 44.4% prepublication to 40.7% postpublication. Among patients with life expectancy ≥ 10 years, RT use decreased by 3.0%, from 92.0% to 89.0%. Conclusion The C9343 trial had minimal impact on the use of RT among older women in the Medicare population, even among the oldest women and those with shorter life expectancies.
Sequential combination treatment (arterial embolization and percutaneous radiofrequency ablation) of inoperable renal cell carcinoma: single-center pilot study
Authors: Nakasone Yutaka , Kawanaka Koichi , Ikeda Osamu , Tamura Yoshitaka , Yamashita Yasuyuki 
Published: March 2012

Background Potential drawbacks of percutaneous radiofrequency ablation (RFA) for renal cell carcinoma (RCC) include local recurrence after RFA due to a limited ablation area, massive hemorrhage induced by kidney puncture, and difficulty in visualizing the tumor at CT-guided puncture. Purpose To evaluate retrospectively the technical success, effectiveness, and complications elicited in patients with unresectable RCC following single-session sequential combination treatment consisting of renal arterial embolization followed by RFA. Material and Methods Ten patients (12 RCCs) who were not candidates for surgery were included in this pilot study. All tumors ranged from 18–66 mm in size (mean 31 ± 3.9 mm), and were percutaneously ablated several hours after embolization of the tumor vessels with iodized oil and gelatin sponges. We evaluated the technical success, effectiveness, effect on renal function, and complications of this treatment. Effectiveness was judged on CT and/or MR images obtained every three months after RFA. The effect on renal function was assessed based on the creatinine level and glomerular filtration rate (GFR) before, one week, and three months after the procedure. Results Renal arterial embolization followed by percutaneous RFA was technically successful in all patients. On contrast CT and/or MR images obtained one week and three months after RFA we observed necrosis in the embolized segment of all RCCs. There were no major complications during and after the procedure. All patients reported tolerable pain and a burning sensation during RFA. After the procedure, five patients (50%) experienced back pain, one each manifested fluid collection, subcapsular hematomas, hematuria, or nausea. There were no instances of recurrence during a mean follow-up period of 47 ± 3.8 months. We noted no significant difference in serum creatinine and GFR before and after treatment. Conclusion Our pilot study suggests that sequential combination treatment by renal arterial embolization followed by percutaneous RFA is feasible in patients with inoperable RCC. The treatment complications were acceptable and excellent effects were obtained.
Evaluation of middle cerebral artery stents using multidetector row CT angiography in vivo study: comparison of the three different kernels
Authors: Jang Jin Hee , Lim Yeon Soo , Lee Youn Joo , Yoo Won Jong , Sung Mi Sook , Kim Bum Soo 
Published: March 2012

Background There are very few reports assessing middle cerebral artery (MCA) stents using multidetector computed tomography (MDCT). Purpose To assess MCA stents using multidetector CT angiography (CTA) in vivo evaluation: the differences in the CTA results according to the three different kernels. Material and Methods We retrospectively evaluated 27 MCA stents from 26 patients who underwent CTA with 16- and 64-slice MDCT after percutaneous transluminal angioplasty and stenting (PTAS). By CTA, using medium-smooth kernel (B30), medium-sharp kernel (B50), and sharp kernel (B60), the lumen diameter, artificial luminal narrowing (ALN), and subjective visibility score of the stented vessels were evaluated. The subjective visibility score ranged from 1 (poor quality) to 5 (excellent) using a five-point scale. Results There were excellent inter-observer agreements for the lumen diameter measurements ( P < 0.001). The mean diameter of the stented vessels was 2.10 ± 0.31 mm on digital subtraction angiography (DSA), 0.93 ± 0.20 mm on CTA using B30, 1.18 ± 0.27 mm on CTA using B50, and 1.29 ± 0.29 mm on CTA using B60. The mean ALN was 55.7 ± 6.0% on CTA using B30, 43.8 ±7.5% on CTA using B50, and 38.7 ± 8.3% on CTA using B60. CTA with higher kernels had a smaller ALN than images with smaller kernels. The median subjective visibility score on the CTA using B50 was 3, which was higher than for the other kernels. The differences in the lumen diameter, ALN, and the subjective visibility score of the stented vessels on CTA using the three different kernels was statistically significant ( P < 0.001). Conclusion The sharp kernel was better to assess the lumen diameter and ALN, but was inferior to the medium-sharp kernel for in-stent evaluation due to high image-to-noise. CTA with medium-sharp kernel showed good lumen visibility and acceptable ALN for MCA stents. This could therefore be a non-invasive, readily applicable clinical method for assessing MCA stent patency after stent placement.
Lesions of uncertain malignant potential (B3) on core biopsy in the NHS Breast Screening Programme: is the screening round relevant?
Authors: Hunt RJ , Steel JR , Porter GJR , Holgate CS , Watkins RM 
Published: March 2012

INTRODUCTION Most women who have screening mammography and undergo subsequent open biopsy following an indeterminate core biopsy result are eventually found to have benign disease. However, a significant number have malignant disease and the rate of malignancy in such cases may be influenced by various factors. This study examined the effect of the type of screening round (prevalent or incident) on the likelihood of breast cancer being present. METHODS A total of 199 women who had NHS breast screening mammograms and subsequent indeterminate (B3) core biopsy results followed by excision biopsy over an 11-year period in a single breast screening unit were reviewed. RESULTS The rate of malignancy following excision of a lesion graded as B3 on core biopsy was 21% for women in the prevalent screening round compared to 33% in subsequent rounds (Fisher's exact test, p=0.038). CONCLUSIONS The incidence of malignancy associated with a B3 core biopsy result appears to be related to the screening round in which the lesion is detected, being approximately 50% higher in the subsequent incident rounds compared to the initial prevalent round. This finding may be useful in formulating management plans for women who have an indeterminate biopsy result.
A quick and effective method of limb preparation with health, safety and efficiency benefits
Authors: Naderi N , Maw K , Thomas M , Boyce DE , Shokrollahi K 
Published: March 2012

INTRODUCTION Pre-operative limb preparation (PLP) usually involves lifting the limb and holding it in a fixed ‘static’ posture for several minutes. This is hazardous to theatre staff. Furthermore, ‘painting’ the limb can be time consuming and difficult areas such as between toes and fingers may remain unsterile. We demonstrate the time efficiency and asepsis achieved using the ‘sterile bag’ preparation technique. An additional advantage is the ability to prepare and anaesthetise a limb prior to theatre, increasing efficiency substantially for units with a large throughput of cases, such as day-case hand surgery lists. METHODS We monitored the duration of PLP in 20 patients using the ‘sterile bag’ technique compared to 20 patients using a conventional ‘painting’ method. Additionally, microbiology samples acquired from prepared upper limbs of 27 sequential patients operated on by a single surgeon over a two-month period were sent for culture immediately prior to commencement of surgery. RESULTS The mean duration of the ‘sterile bag’ PLP was significantly lower than that of the conventional method (24 seconds vs 85 seconds, p=0.045). The technique can take as little as ten seconds (n=1). Final microbiology reports showed no growth for any of the 27 patients from whom a culture sample was taken. CONCLUSIONS The sterile bag technique is effective in achieving asepsis, has the potential to increase theatre efficiency and reduces manual handling hazards compared to the conventional method. It is now taught to all theatre staff in our hospital during manual handling training. It can be undertaken in approximately ten seconds with practice for the upper limb.
Alcohol skin preparation causes surgical fires
Authors: Rocos B , Donaldson LJ 
Published: March 2012

INTRODUCTION Surgical fires are a rare but serious preventable safety risk in modern hospitals. Data from the US show that up to 650 surgical fires occur each year, with up to 5% causing death or serious harm. This study used the National Reporting and Learning Service (NRLS) database at the National Patient Safety Agency to explore whether spirit-based surgical skin preparation fluid contributes to the cause of surgical fires. METHODS The NRLS database was interrogated for all incidents of surgical fires reported between 1 March 2004 and 1 March 2011. Each report was scrutinised manually to discover the cause of the fire. RESULTS Thirteen surgical fires were reported during the study period. Of these, 11 were found to be directly related to spirit-based surgical skin preparation or preparation soaked swabs and drapes. CONCLUSIONS Despite manufacturer's instructions and warnings, surgical fires continue to occur. Guidance published in the UK and US states that spirit-based skin preparation solutions should continue to be used but sets out some precautions. It may be that fire risk should be included in pre-surgical World Health Organization checklists or in the surgical training curriculum. Surgical staff should be aware of the risk that spirit-based skin preparation fluids pose and should take action to minimise the chance of fire occurring.
The power of words: sources of anxiety in patients undergoing local anaesthetic plastic surgery
Authors: Caddick J , Jawad S , Southern S , Majumder S 
Published: March 2012

INTRODUCTION With local or regional anaesthesia being employed for more as well as more complex surgical procedures, an increasing number of patients remain fully conscious during their operation. This is generally perceived as being advantageous to the patient as less time is spent in hospital and the side effects of general anaesthesia are avoided. However, there is no direct measure of the patient experience during ‘awake surgery’, in particular of which aspects of the process may be distressing. METHODS Seventy patients undergoing day case plastic surgery under local anaesthesia were asked to complete a short questionnaire immediately following their operation. This was designed to identify specific factors likely to either increase or reduce anxiety during surgery. The questionnaire was initially validated on a pilot group of ten patients. RESULTS Unsurprisingly, painful stimuli such as injections were identified as potential stressors. More interestingly, the data highlighted that some commonly used surgical terms such as ‘knife’ and ‘scalpel’ provoke considerable anxiety in the conscious patient. This varied according to age and sex with younger and female patients being most vulnerable. Other events identified as potential stressors, such as casual conversations and movements among theatre staff, were actually shown to be non-stressful and, in some cases, stress relieving. CONCLUSIONS Technical jargon used by surgical staff can elevate anxiety levels among patients who are awake for their operation. Careful consideration of the words we use may reduce this, particularly in female patients.
The use of pre-operative computed tomography in the assessment of the acute abdomen
Authors: Weir-McCall J , Shaw A , Arya A , Knight A , Howlett DC 
Published: March 2012

INTRODUCTION While there are a lot of data on the accuracy of computed tomography (CT) in diagnosing specific causes of an acute abdomen, there is very little information on the accuracy of CT in the acute general surgical admissions workload. We look at the diagnostic accuracy of CT in patients presenting with an acute abdomen who ultimately required a laparotomy. METHODS Patients who underwent an emergency laparotomy between 2008 and 2010 at Eastbourne District General Hospital with pre-operative CT on the same admission were included in the study. The CT report was compared with the laparotomy and histology findings and, where a discrepancy existed, the original imaging was reviewed by a senior consultant blinded to the original report and laparotomy findings. RESULTS A total of 196 emergency laparotomies were performed over the 2–year period, with 112 patients undergoing pre-operative CT. Fifteen patients were excluded from the study due to missing notes. In the remaining 97 patients, 80 CT reports correlated with the final operative diagnosis, giving a diagnostic accuracy of 82%. Of these, the on-call registrar was the initial reporter in 37 scans, with a diagnostic accuracy of 78%. On review of the CT by a second consultant, this increased to 90 correlations, yielding an accuracy of 93%. Delay between CT and the operation did not significantly alter diagnostic accuracy, nor was there any statistically significant reduction in accuracy in reports issued by on-call registrars. CONCLUSIONS On first reporting, CT misses 18% of diagnoses that ultimately require operative intervention. Reducing the threshold for obtaining a second consultant radiologist review significantly improves the diagnostic accuracy to 93%.
CONFERENCE PRECIS
Authors: Christensen Peter , Rajagopalan Mrinalini , Arcak Sinem , O'Meara Simon 
Published: March 2012

'"MIDDLE EASTERN" ARCHITECTURE IN CONTEXT', PANEL CONVENED AT THE SOCIETY OF ARCHITECTURAL HISTORIANS (SAH) 64TH ANNUAL MEETING, NEW ORLEANS, APRIL 14, 2011
'UNWRAPPING GIFTS OF THE SULTAN', LOS ANGELES COUNTY MUSEUM OF ART (LACMA), JUNE 10–12, 2011 A symposium in
conjunction with the exhibition 'Gifts of the Sultan: the Arts of Giving at the Islamic Courts' at LACMA from June 5 to September 5, 2011; at the Museum of Fine Arts in Houston from October 23, 2011 to January 15, 2012; and at the Museum of Islamic Art in Doha, Qatar in Spring 2012
'"GOD
IS BEAUTIFUL, HE LOVES BEAUTY": THE OBJECT IN ISLAMIC ART AND CULTURE', FOURTH BIENNIAL HAMAD BIN KHALIFA SYMPOSIUM ON ISLAMIC ART, MUSEUM OF ISLAMIC ART, DOHA, QATAR, OCTOBER 29–31, 2011
Sleep-Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years
Authors: Bonuck Karen , Freeman Katherine , Chervin Ronald D. , Xu Linzhi 
Published: March 2012

OBJECTIVES:
Examine statistical effects of sleep-disordered breathing (SDB) symptom trajectories from 6 months to 7 years on subsequent behavior.

METHODS:
Parents in the Avon Longitudinal Study of Parents and Children reported on children’s snoring, mouth breathing, and witnessed apnea at ≥2 surveys at 6, 18, 30, 42, 57, and 69 months, and completed the Strengths and Difficulties Questionnaire at 4 (n = 9140) and 7 (n = 8098) years. Cluster analysis produced 5 “Early” (6–42 months) and “Later” (6–69 months) symptom trajectories (“clusters”). Adverse behavioral outcomes were defined by top 10th percentiles on Strengths and Difficulties Questionnaire total and subscales, at 4 and 7 years, in multivariable logistic regression models.

RESULTS:
The SDB clusters predicted ≈20% to 100% increased odds of problematic behavior, controlling for 15 potential confounders. Early trajectories predicted problematic behavior at 7 years equally well as at 4 years. In Later trajectories, the “Worst Case” cluster, with peak symptoms at 30 months that abated thereafter, nonetheless at 7 years predicted hyperactivity (1.85 [1.30–2.63]), and conduct (1.60 [1.18–2.16]) and peer difficulties (1.37 [1.04–1.80]), whereas a “Later Symptom” cluster predicted emotional difficulties (1.65 [1.21–2.07]) and hyperactivity (1.88 [1.42–2.49]) . The 2 clusters with peak symptoms before 18 months that resolve thereafter still predicted 40% to 50% increased odds of behavior problems at 7 years.

CONCLUSIONS:
In this large, population-based, longitudinal study, early-life SDB symptoms had strong, persistent statistical effects on subsequent behavior in childhood. Findings suggest that SDB symptoms may require attention as early as the first year of life.
Utilizing Improvement Science Methods to Improve Physician Compliance With Proper Hand Hygiene
Authors: White Christine M. , Statile Angela M. , Conway Patrick H. , Schoettker Pamela J. , Solan Lauren G. , Unaka Ndidi I. , Vidwan Navjyot , Warrick Stephen D. , Yau Connie , Connelly Beverly L. 
Published: March 2012

OBJECTIVE:
In 2009, The Joint Commission challenged hospitals to reduce the risk of health care–associated infections through hand hygiene compliance. At our hospital, physicians had lower compliance rates than other health care workers, just 68% on general pediatric units. We used improvement methods and reliability science to increase compliance with proper hand hygiene to &gt;95% by inpatient general pediatric teams.

METHODS:
Strategies to improve hand hygiene were tested through multiple plan-do-study-act cycles, first by 1 general inpatient medical team and then spread to 4 additional teams. At the start of each rotation, residents completed an educational module and posttest about proper hand hygiene. Team compliance data were displayed daily in the resident conference room. Real-time identification and mitigation of failures by a hand-washing champion encouraged shared accountability. Organizational support ensured access to adequate hand hygiene supplies. The main outcome measure was percent compliance with acceptable hand hygiene, defined as use of an alcohol-based product or hand-washing with soap and turning off the faucet without using fingers or palm. Compliance was defined as acceptable hand hygiene before and after contact with the patient or care environment. Covert bedside observers recorded at least 8 observations of physicians’ compliance per day.

RESULTS:
Physician compliance with proper hand hygiene improved to &gt;95% within 6 months and was sustained for 11 months.

CONCLUSIONS:
Instituting a hand-washing champion for immediate identification and mitigation of failures was key in sustaining results. Improving physician compliance with proper hand hygiene is achievable and a first step in decreasing health care–associated infections.