bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical utility of routine MPL exon 10 analysis in the diagnosis of essential thrombocythaemia and primary myelofibrosis
Authors: Boyd Elaine M. , Bench Anthony J. , Goday‐Fernández Andrea , Anand Shubha , Vaghela Krishna J. , Beer Phillip , Scott Mike A. , Bareford David , Green Anthony R. , Huntly Brian , Erber Wendy N. 
Published: February 2010

SummaryApproximately 50% of essential thrombocythaemia and primary myelo‐fibrosis patients do not have a JAK2 V617F mutation. Up to 5% of these are reported to have a MPL exon 10 mutation but testing for MPL is not routine as there are multiple mutation types. The ability to routinely assess both JAK2 and MPL mutations would be beneficial in the differential diagnosis of unexplained thrombocytosis or myelofibrosis. We developed and applied a high resolution melt (HRM) assay, capable of detecting all known MPL mutations in a single analysis, for the detection of MPL exon 10 mutations. We assessed 175 ET and PMF patients, including 67 that were JAK2 V617F‐negative by real time polymerase chain reaction (PCR). Overall, 19/175 (11%) patients had a MPL exon 10 mutation, of whom 16 were JAK2 V617F‐negative (16/67; 24%). MPL mutation types were W515L (11), W515K (4), W515R (2) and W515A (1). One patient had both W515L and S505N MPL mutations and these were present in the same haemopoietic colonies. Real time PCR for JAK2 V617F analysis and HRM for MPL exon 10 status identified one or more clonal marker in 71% of patients. This combined genetic approach increases the sensitivity of meeting the World Health Organization diagnostic criteria for these myeloproliferative neoplasms.
The management of pregnancy in paroxysmal nocturnal haemoglobinuria on long term eculizumab
Authors: Kelly Richard , Arnold Louise , Richards Stephen , Hill Anita , Bomken Charlotte , Hanley John , Loughney Andrew , Beauchamp Jon , Khursigara Gus , Rother Russell P. , Chalmers Elizabeth , Fyfe Andrew , Fitzsimons Edward , Nakamura Ryotaro , Gaya Anna , Risitano Antonio M. , Schubert Jörg , Norfolk Derek , Simpson Nigel , Hillmen Peter 
Published: February 2010

SummaryIn Paroxysmal nocturnal haemoglobinuria (PNH), pregnancy is associated with increased maternal and foetal complications to such an extent that the condition has been considered relatively contra‐indicated in PNH. Eculizumab has revolutionized the treatment of PNH. We evaluate its use in pregnancy to date. We report on seven patients exposed to eculizumab at different stages of pregnancy including the first two patients to receive the drug from conception to delivery. There was no evidence of complement blockade from cord blood samples taken at delivery. Eculizumab appears safe to use in this setting and is likely to prevent many of the complications usually observed.
The role of haematopoietic growth factors granulocyte colony‐stimulating factor and granulocyte‐macrophage colony‐stimulating factor in the management of drug‐induced agranulocytosis
Authors: Andrès Emmanuel , Maloisel Frédéric , Zimmer Jacques 
Published: February 2010

SummaryDrug‐induced agranulocytosis (neutrophil count <0·5 × 109/l) is a rare haematological complication with an incidence of no more than 10 cases per million inhabitants per year in Europe. Over the past few years there has been a steady decline in mortality rate, (currently at <5%), which can be partly explained by earlier recognition and the improved clinical management of associated intercurrent infections that may lead to severe sepsis if left untreated. The true impact of the use of haematopoietic growth factors, such as granulocyte colony‐stimulating factor (G‐CSF) and granulocyte‐macrophage colony‐stimulating factor (GM‐CSF), on the decreased mortality rate remains unknown. Yet, most studies show that these molecules, especially G‐CSF, reduce the duration of agranulocytosis, antibiotic course and length of hospital stay. Their use is particularly recommended in patients with poor prognostic factors, such as a neutrophil count <0·1 × 109/l, age over 65 years, severe infection or multiple co‐morbidities. In all cases, the drug responsible for causing the agranulocytosis must be discontinued and remain permanently contraindicated. The appropriate Medicines Regulatory Agency must also be notified of the adverse event.
Influence of dietary vitamin K intake on subtherapeutic oral anticoagulant therapy
Authors: Rombouts Eva K. , Rosendaal Frits R. , Van Der Meer Felix J. M. 
Published: February 2010

SummaryIt is unclear what advice should be given to patients using vitamin K antagonists with respect to dietary vitamin K intake. We performed a nested case–control study in patients attending a Dutch anticoagulation clinic, to determine the association between vitamin K intake and subtherapeutic International Normalized Ratio (INR) values and the interaction between usual and recent vitamin K intake. Compared to patients with a normal usual vitamin K intake, those with a high vitamin K intake had a decreased risk of a subtherapeutic INR [Hazard Ratio (HR) 0·80, 95% confidence interval (CI): 0·56–1·16] and patients with a low vitamin K intake an increased risk (HR 1·33, 95% CI: 0·79–2·25). In patients with a low usual vitamin K intake, recent vitamin K intake was twice as high in cases as in controls (164 vs. 85 μg/d). Such a difference was not observed in patients with a normal or high usual vitamin K intake. Our results suggest that a high vitamin K intake reduces the risk of a low INR by lessening the influence of incidental consumption of vitamin K rich food on the INR. These findings support the recommendation for patients on vitamin K antagonists to eat a sufficient amount of vitamin‐K containing foods.
Behaviour of male and female parasitoids in the field: influence of patch size, host density, and habitat complexity
Authors: MARTIJN BEZEMER T. , HARVEY JEFFREY A. , KAMP ANDRÉ F. D. , WAGENAAR ROEL , GOLS RIETA , KOSTENKO OLGA , FORTUNA TAIADJANA , ENGELKES TIM , VET LOUISE E. M. , VAN DER PUTTEN WIM H. , SOLER ROXINA 
Published: February 2010

1. Two field experiments were carried out to examine the role of patch size, host density, and complexity of the surrounding habitat, on the foraging behaviour of the parasitoid wasp Cotesia glomerata in the field.2. First, released parasitoids were recaptured on patches of one or four Brassica nigra plants, each containing 10 hosts that were placed in a mown grassland area. Recaptures of females were higher than males, and males and females aggregated at patches with four plants.3. In experiment 2, plants containing 0, 5 or 10 hosts were placed in unmown grassland plots that differed in plant species composition, on bare soil, and on mown grassland. Very low numbers of parasitoids were recaptured in the vegetated plots, while high numbers of parasitoids were recaptured on plants placed on bare soil or in mown grassland. Recaptures were higher on plants on bare soil than on mown grassland, and highest on plants containing 10 hosts. The host density effect was significantly more apparent in mown grassland than on bare soil.4. Cotesia glomerata responds in an aggregative way to host density in the field. However, host location success is determined mostly by habitat characteristics, and stronger host or host‐plant cues are required when habitat complexity increases.
Using discrete choice experiment to elicit doctors' preferences for the report card design of diabetes care in Taiwan – a pilot study
Authors: Chen Tsung‐Tai , Chung Kuo‐Piao , Huang Heng‐Chiang , Man Lao‐Nga , Lai Mei‐Shu 
Published: February 2010

AbstractObjectives  Little is known about doctors' preferences regarding public report card design. Taiwan just announced the first diabetes report card on April 2008. The aim of this study was to investigate the Diabetes Mellitus (DM) providers' preferences towards four report card attributes: update frequency, risk adjustment, content information and display format.Methods  A discrete choice questionnaire was mailed to hospital and primary care doctors in the northern part of Taiwan, with 221 study targets. The response rate was 29%.Results  Using random effect logistic regression, doctors' preference attribute rankings were risk adjustment for patients (44.7%), content information (25.2%), display format (18.3%) and update frequency (11.8%). One‐year update frequency, risk adjustment, detailed scores of technical quality and interpersonal quality and bar chart display were the most important items noted in our survey.Conclusions  This is the first study to investigate provider's preferences for a diabetes report card. It enables the policy maker to clearly see the implication of trade‐offs between different choices when designing a report card that doctors will like. Our findings suggest that doctors do not favour the ‘less is more’ principle, or the higher frequency of updates that patients may prefer. Rather, our findings suggest that risk adjustment and more information content are the most important factors for doctors. Future studies should use discrete choice experiment on different aspects of report card design, such as vulnerable patients or health care administrations.
Impact of prevention structures and processes on pressure ulcer prevalence in nursing homes and acute‐care hospitals
Authors: Lahmann Nils A. , Halfens Ruud J. G. , Dassen Theo 
Published: February 2010

AbstractAim  The study aimed to give a description analysis of pressure ulcer‐related structures, processes and outcomes in nursing homes and acute‐care hospitals that participated once, twice and thrice in prevalence surveys.Design  Repeated nationwide, multicentre, cross sectional surveys have been conducted.Methods  A total of 7377 residents in 60 nursing homes and 28,102 patients in 82 acute‐care hospitals in Germany participated in annual point prevalence surveys. Because of their strong differences in sampling and in order to be able to display the differences occurring during the repeated (first, second and third) participation of the institutions, they were arranged according to their frequency and order of participation. The percentage of used guidelines and risk assessment scales (structures), prevention devices and measures (processes), and prevalence and nosocomial prevalence (outcomes) among all persons at risk was calculated.Results  The samples within the arranged groups showed no clinically relevant demographical differences. Nosocomial prevalence rates in hospitals dropped from 26.3% in the first year to 11.3% in the last year (nursing homes from 13.7% to 6.4%). The use of pressure ulcer‐related structures remarkably increased during each repetition to more than 90%. Regarding the use of preventive measures and devices as an indicator for pressure ulcer‐related processes results were more incoherent.Conclusion  Repeated participation in pressure ulcer surveys led to a decrease in outcomes (lower pressure ulcer prevalence rates), to high opposite effects regarding pressure ulcer‐related structures (increased use of all guidelines/risk assessment scales) and to moderate adverse effects regarding pressure ulcer‐related processes (increased use of most preventive measures and devices).
Training inpatient mental health staff how to enhance patient engagement with medications: Medication Alliance training and dissemination outcomes in a large US mental health hospital
Authors: Byrne Mitchell K. , Willis Aimee , Deane Frank P. , Hawkins Barbara , Quinn Rebecca 
Published: February 2010

AbstractRationale, aims and objectives  The Medication Alliance training programme has previously been shown to be effective in enhancing clinician knowledge, attitudes and skills in regard to non‐adherent individuals in a community‐based psychiatric setting. The current study attempts to replicate these findings in an inpatient setting and assess the feasibility of dissemination using a train‐the‐trainer model.Method  One hundred and thirteen staff from four wards at an inpatient psychiatric facility attended Medication Alliance training workshops over 3 days. Two wards comprised an expert trained group (n = 67); and the remaining two wards made up a novice trained group (n = 46). The novice trained group attended training 6 months after the expert group, and were trained by selected trainees from the expert group. Participants completed a package of questionnaires both before and after their training to determine if Medication Alliance resulted in any changes in knowledge, attitudes and skills.Results  Paired t‐tests showed significant improvements across both groups for knowledge, attitudes and one skill domain following training in Medication Alliance. There were no differences at baseline between groups and analysis of post‐test scores yielded no significant difference between the groups in terms of training effect for knowledge, attitudes or skills.Conclusions  Medication Alliance can be successfully implemented in an inpatient setting, enhancing knowledge, attitudes and at least some skill domains of staff in dealing with non‐adherent patients. The equivalence of results between the expert and novice trained training groups suggests that Medication Alliance may be more broadly disseminated using a cost‐effective train‐the‐trainer model.
Does the organization of care processes affect outcomes in patients undergoing total joint replacement?
Authors: Vanhaecht Kris , Bellemans Johan , De Witte Karel , Diya Luwis , Lesaffre Emmanuel , Sermeus Walter 
Published: February 2010

AbstractBackground  Surgeons realize that safe and efficient care processes for total joint replacement requires more than just well‐performed operations. Orthopaedic teams are reorganizing care process to improve efficacy and shorten length of stay. Little is known on the impact of organizational changes on patient outcome. This paper studies the relation between the organization of care processes and patient outcomes in hip and knee. Clinical pathways are used as one of the methods to structure the care process. Although evidence is available on the effect of pathways in total joint replacement, their impact with the organization of the care process has not been studied previously.Methods  A cross‐sectional multicentre study was performed on 39 care processes and 737 consecutive patients. Regression models were used to analyse the relation between the organization of the care process and risk‐adjusted patient outcomes. The use of pathways and the organization of the care process, measured by the Care Process Self Evaluation Tool (CPSET), were measured at organizational level. Length of stay, pain, mobility and elapsed time to discharge were measured at patient level.Results  The use of pathways had a positive effect on four out of five subscales and the overall CPSET score. Using pathways decreased length of stay (P = 0.014), pain (P = 0.052) and elapsed time to discharge (P = 0.003). The CPSET subscale communication was related with three risk adjusted outcomes. Multivariate analysis demonstrated a significant effect by three different variables on the length of stay; (1) use of pathways; (2) coordination of care processes; and (3) communication with patients and family. Both the use of pathways and coordination of the care process were determinants for the elapsed time to discharge. A significant interaction effect was found between use of pathways and coordination of the care process.Conclusion  This large multicentre study revealed the relation between the use of pathways, organization of the care process and patient outcomes. This information is important for both clinicians and managers to understand and further improve the organization of orthopaedic care.Level of evidence  Level I prognostic study.
Knowledge and attitudes about oral cancer among dentists in Spain
Authors: López‐Jornet Pia , Camacho‐Alonso Fabio , Molina‐Miñano Francisco 
Published: February 2010

AbstractObjectives  Detecting oral cancer (OC) at an early stage is the most effective means of improving survival and reducing morbility from disease. The objective was to study the knowledge, opinions and attitudes held by general dentists in Spain regarding aspects of OC in general clinic practice.Methods  A 44‐item questionnaire relating to OC was randomly distributed by email to 1000 dentists in the different autonomous communities in Spain.Results  The response rate was 42.7%. Only 49.7% of the dentists who replied considered themselves to have up‐to‐date knowledge on OC. A total of 94.7% of those interviewed hold the opinion that it is the dentists who are qualified to carry out the oral examination. In addition, 41.8% felt that family doctors and 13.8% that dental hygienists were also capable of making this examination. We should highlight that dentists who rated their undergraduate OC training favourably were more likely to agree that their OC knowledge was current than those who rated their undergraduate training unfavourably [odds ratio (OR) = 4.1, 95% confidence interval (CI) = 1.1–4.2, P = 0.019). Respondents who performed oral cancer examinations on all patients 40 years of age or older were 1.8 times more likely to agree that their OC knowledge was current; however, the differences were not significant (OR = 1.3, 95% CI = 0.6–2.7, P = 0.392).Conclusions  Gaps in knowledge exist, strongly suggesting the need for continued courses of education detection and prevention of OC.
The evidence base for the evaluation and management of dizziness
Authors: Kerber Kevin A. , Fendrick A. Mark 
Published: February 2010

AbstractObjectives  Dizziness presentations pose many clinical challenges. The objective of this study is to broadly summarize the evidence base that supports clinical decisions in dizziness presentations.Methods  MEDLINE (1966 to September 2007), Web of Science and The Cochrane Library were searched for articles with clinical relevance on topics concerning dizziness. Additional sources were also searched for clinical practice guidelines. The following information was abstracted from each article: year of publication, journal type, type of article and the topics of the article.Results  Of nearly 3000 articles identified, 1244 articles met the inclusion criteria. The most common article type was a case report or case series, followed by expert opinion or review articles, studies of medical tests and clinical trials. Meta‐analyses and systematic reviews were found on benign paroxysmal positional vertigo and Meniere's disease, but only a few other topics. No clinical practice guidelines were found that focus specifically on dizziness.Conclusions  The evidence base for the evaluation and management of dizziness seems to be weak. Future work to establish or summarize evidence in clinically meaningful ways could contribute to efforts to optimize patient care and health care utilization for one of the most common presenting symptoms.
Carbon‐constrained health care enterprise
Authors: Gell Michael 
Published: February 2010

AbstractRationale  The health economy is a significant part of a national economy accounting typically for about 8% of GDP spent. As national economies respond to the dual challenges of severe economic turbulence on the global scale and climate change mitigation, the health economy is coming under increasing pressure to respond. Indications for sharp reductions in budgets and reductions in greenhouse gas emissions, such as carbon dioxide, are widespread.Aims  In this paper an analysis is undertaken of the diverse forces acting on a typical health care enterprise. The forces, both economic and carbon related, are investigated in terms of their effects through the enterprise and across its boundaries on the supply, demand and waste sides. The overall aim is to show how the enterprise and whole supply chains may flip synchronously into a low‐carbon evolutionary pathway.Objectives  By illustrating how different elements of the health care enterprise may respond to these developments, diverse opportunities for cost reduction, carbon reduction and product (goods and services) development are identified. These opportunities involve a variety of waste reduction and energy and materials conservation measures as well as new ways of collaborating with other enterprises going through similar transformations. The overall objective is to show that the carbon‐constrained health care enterprise and the low‐carbon health economy in which it sits may broaden its role in the coming decades to include a degree of responsibility for the health of the environment. This broader role is likely to supplement and entangle with the traditional role of the health economy, currently focused narrowly on human health, and lead to extensive organisational transformation, and infrastructure and product developments.
Implications of complex adaptive systems theory for interpreting research about health care organizations
Authors: Jordon Michelle , Lanham Holly Jordan , Anderson Ruth A. , McDaniel Jr Reuben R. 
Published: February 2010

AbstractRationale  Data about health care organizations (HCOs) are not useful until they are interpreted. Such interpretations are influenced by the theoretical lenses used by the researcher.Objective  Our purpose was to suggest the usefulness of theories of complex adaptive systems (CASs) in guiding research interpretation. Specifically, we addressed two questions: (1) What are the implications for interpreting research observations in HCOs of the fact that we are observing relationships among diverse agents? (2) What are the implications for interpreting research observations in HCOs of the fact that we are observing relationships among agents that learn?Methods  We defined diversity and learning and the implications of the non‐linear relationships among agents from a CAS perspective. We then identified some common analytical practices that were problematic and may lead to conceptual and methodological errors. Then we described strategies for interpreting the results of research observations.Conclusions  We suggest that the task of interpreting research observations of HCOs could be improved if researchers take into account that the systems they study are CASs with non‐linear relationships among diverse, learning agents. Our analysis points out how interpretation of research results might be shaped by the fact that HCOs are CASs. We described how learning is, in fact, the result of interactions among diverse agents and that learning can, by itself, reduce or increase agent diversity. We encouraged researchers to be persistent in their attempts to reason about complex systems and learn to attend not only to structures, but also to processes and functions of complex systems.
Evaluating health management programmes over time: application of propensity score‐based weighting to longitudinal data
Authors: Linden Ariel , Adams John L. 
Published: February 2010

AbstractHealth management programmes are generally evaluated as point treatment studies in which only a baseline and outcome measurement are used in the analysis, even when multiple observations for each individual are available. By summarizing observations into two distinct measurements the evaluator loses any ability to discern patterns of change in the outcome variable over time in relation to the intervention. There are several statistical models available to evaluate longitudinal data that are typically regression‐like in form and designed to adjust for clustering at the individual level. Most evaluators of longitudinal studies tend to adjust for the effect of time‐dependent confounding by including these covariates as independent variables in the model. However, this standard adjustment approach is likely to provide biased estimates. In this paper we describe the application of the propensity score‐based weighting technique to longitudinal data to estimate the effect of treatment on an outcome. This method reweights each treatment pattern to represent the entire population at each time point and provides an unbiased treatment effect. We illustrate the technique using data from a disease management programme and demonstrate its superiority over standard analytical adjustments in correcting for time‐dependent confounding for each time period under study.