bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improved Risk Adjustment in Public Reporting: Coronary Artery Bypass Graft Surgical Site Infections
Authors: Berríos-Torres Sandra I. , Mu Yi , Edwards Jonathan R. , Horan Teresa C. , Fridkin Scott K. 
Published: April 2012

Objective.The objective was to develop a new National Healthcare Safety Network (NHSN) risk model for sternal, deep incisional, and organ/space (complex) surgical site infections (SSIs) following coronary artery bypass graft (CABG) procedures, detected on admission and readmission, consistent with public reporting requirements.Patients and Setting.A total of 133,503 CABG procedures with 4,008 associated complex SSIs reported by 293 NHSN hospitals in the United States.Methods.CABG procedures performed from January 1, 2006, through December 31, 2008, were analyzed. Potential SSI risk factors were identified by univariate analysis. Multivariate analysis with forward stepwise logistic regression modeling was used to develop the new model. The c-index was used to compare the predictive power of the new and NHSN risk index models.Results.Multivariate analysis independent risk factors included ASA score, procedure duration, female gender, age, and medical school affiliation. The new risk model has significantly improved predictive performance over the NHSN risk index (c-index, 0.62 and 0.56, respectively).Conclusions.Traditionally, the NHSN surveillance system has used a risk index to provide procedure-specific risk-stratified SSI rates to hospitals. A new CABG sternal, complex SSI risk model developed by multivariate analysis has improved predictive performance over the traditional NHSN risk index and is being considered for endorsement as a measure for public reporting.
Cost-Effectiveness Analysis of Active Surveillance Screening for Methicillin-ResistantStaphylococcus aureusin an Academic Hospital Setting
Authors: Kang JaHyun , Mandsager Paul , Biddle Andrea K. , Weber David J. 
Published: April 2012

Objective.To evaluate the cost-effectiveness of 3 alternative active screening strategies for methicillin-resistantStaphylococcus aureus(MRSA): universal surveillance screening for all hospital admissions, targeted surveillance screening for intensive care unit admissions, and no surveillance screening.Design.Cost-effectiveness analysis using decision modeling.Methods.Cost-effectiveness was evaluated from the perspective of an 800-bed academic hospital with 40,000 annual admissions over the time horizon of a hospitalization. All input probabilities, costs, and outcome data were obtained through a comprehensive literature review. Effectiveness outcome was MRSA healthcare-associated infections (HAIs). One-way and probabilistic sensitivity analyses were conducted.Results.In the base case, targeted surveillance screening was a dominant strategy (ie, was associated with lower costs and resulted in better outcomes) for preventing MRSA HAL Universal surveillance screening was associated with an incremental cost-effectiveness ratio of $14,955 per MRSA HAL In one-way sensitivity analysis, targeted surveillance screening was a dominant strategy across most parameter ranges. Probabilistic sensitivity analysis also demonstrated that targeted surveillance screening was the most cost-effective strategy when willingness to pay to prevent a case of MRSA HAI was less than $71,300.Conclusion.Targeted active surveillance screening for MRSA is the most cost-effective screening strategy in an academic hospital setting. Additional studies that are based on actual hospital data are needed to validate this model. However, the model supports current recommendations to use active surveillance to detect MRSA.
Comparison of the Microbiological Efficacy of Hydrogen Peroxide Vapor and Ultraviolet Light Processes for Room Decontamination
Authors: Havill Nancy L. , Moore Brent A. , Boyce John M. 
Published: April 2012

Objective.To compare the microbiological efficacy of hydrogen peroxide vapor (HPV) and ultraviolet radiation (UVC) for room decontamination.Design.Prospective observational study.Setting.500-bed teaching hospital.Methods.HPV and UVC processes were performed in 15 patient rooms. Five high-touch sites were sampled before and after the processes and aerobic colony counts (ACCs) were determined. Carrier disks with ~106Clostridium difficile (CD) spores and biological indicators (BIs) with 104 and 106Geobacillus stearothermophilus spores were placed in 5 sites before decontamination. After decontamination, CD log reductions were determined and BIs were recorded as growth or no growth.Results.93% of ACC samples that had growth before HPV did not have growth after HPV, whereas 52% of sites that had growth before UVC did not have growth after UVC (P < .0001). The mean CD log reduction was >6 for HPV and ~2 for UVC. After HPV 100% of the 104 BIs did not grow, and 22% did not grow after UVC, with a range of 7%–53% for the 5 sites. For the 106 BIs, 99% did not grow after HPV and 0% did not grow after UVC. Sites out of direct line of sight were significantly more likely to show growth after UVC than after HPV. Mean cycle time was 153 (range, 140–177) min for HPV and 73 (range, 39–100) min for UVC (P < .0001).Conclusion.Both HPV and UVC reduce bacterial contamination, including spores, in patient rooms, but HPV is significantly more effective. UVC is significantly less effective for sites that are out of direct line of sight.
Making Gerontocracy Work: Population Aging and the Generosity of Public Long‐term Care
Authors: Ellegård Lina Maria 
Published: April 2012

AbstractThis paper examines how the aging population affects the generosity of public long‐term care (LTC) in Sweden. Theoretically, aging has a direct effect on LTC policy because the elderly become a more important voter group. However, concerns for other citizens may dampen the political importance of the elderly. Fixed effects regressions on municipality‐level panel data for 1999‐2007 suggest that LTC generosity slightly decreases in response to an aging population. In particular, a smaller share of the elderly become entitled to LTC.
Pleomorphic lobular carcinoma: a distinctive clinical and molecular breast cancer type
Authors: Monhollen Laketa , Morrison Carl , Ademuyiwa Foluso O , Chandrasekhar Rameela , Khoury Thaer 
Published: April 2012

Monhollen L, Morrison C, Ademuyiwa F O, Chandrasekhar R, Khoury T  (2012) Histopathology 61, 365–377Pleomorphic lobular carcinoma: a distinctive clinical and molecular breast cancer typeAims:  Pleomorphic lobular carcinoma (PLC) is an aggressive variant of invasive lobular carcinoma. The aim of this study was to redefine PLC in terms of molecular classification.Methods and results:  Cases of PLC were selected between 1995 and 2010. Key clinicopathological features were recorded for most of the patients. A panel of immunohistochemical stains including E‐cadherin, oestrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), cytokeratin (CK)5/6, CK14, CK17, anti‐cytokeratin (CAM) 5.2, CD117, vimentin, epidermal growth factor receptor (EGFR), p53 and gross cystic disease fluid protein‐15 (GCDFP‐15) were performed. HER2 test by fluorescence in‐situ hybridization (FISH) was also performed. The log‐rank test was used for statistical analyses. Forty cases fulfilled the criteria for PLC (26 with available tissue). The median age was 61 years and median tumour size was 2.0 cm. There were five of 38 (13.2%) triple‐negative cases. The basal type was seen in one of 25 cases (4%), which had a triple‐negative phenotype. HER2 was amplified in 14 of 38 cases (35%). Older patients and negative hormonal receptor status correlated significantly with worse clinical outcome (P < 0.03). The 5‐year recurrence‐free and overall survival was 54.9% and 76.2%, respectively.Conclusions:  Pleomorphic lobular carcinoma is a distinctive breast cancer subtype. It has hybrid clinicopathological characteristics of ductal and lobular carcinoma.
The relevance of the epidemiology of human sex ratios at birth to some medical problems
Authors: James William H. 
Published: April 2012

SummaryJames WH. The relevance of the epidemiology of human sex ratios at birth to some medical problems. Paediatric and Perinatal Epidemiology 2012; 26: 181–189.The human sex ratio (proportion male at birth) shows considerable variation which is central to reproductive epidemiology. For example, it has reportedly shown significant secular trends and wartime variation, and it has shown replicated variation with parental exposure to several deleterious chemicals. However, scientific progress in identifying the causes of these forms of variation has been very slow and, as described here, this has elicited some scepticism. Benefits may be expected from identifying these causes. Two (non‐competing) hypotheses have emerged, the first relating to the hormonal regulation of sex ratio at conception, and the second to the sex‐selective effects of stressors during pregnancy. It is shown here that if the first of these hypotheses was substantially correct, it would illuminate a number of scientific and medical problems, for example, the causes of autism and of selected sex‐related congenital malformations and obstetric pathologies.
The outcome of critical illness in decompensated alcoholic liver cirrhosis
Authors: KAVLI M. , STRØM T. , CARLSSON M. , DAHLER‐ERIKSEN B. , TOFT P. 
Published: April 2012

BackgroundThe mortality of patients suffering from acute decompensated liver disease treated in the intensive care unit (ICU) varies between 50% and 100%. Previously published data suggest that liver‐specific score systems are less accurate compared with the ICU‐specific scoring systems acute physiology and chronic health evaluation II (APACHE II) and simplified organ failure assessment (SOFA) in predicting outcome. We hypothesized that in a Scandinavian cohort of ICU patients, APACHE II, SOFA, and simplified acute physiology score (SAPS II) were superior to predict outcome compared with the Child–Pugh score.MethodsA single‐centre retrospective cohort analysis was conducted in a university‐affiliated ICU. Eighty‐seven adult patients with decompensated liver alcoholic cirrhosis were admitted from January 2007 to January 2010.ResultsThe patients were severely ill with median scores: SAPS II 60, SOFA (day 1) 11, APACHE II 31, and Child–Pugh 12. Receiver operating characteristic curves area under curve was 0.79 for APACHE II, 0.83 for SAPS II, and 0.79 for SOFA (day1) compared with 0.59 for Child–Pugh. In patients only in need of mechanical ventilation, the 90‐day mortality was 76%. If respiratory failure was further complicated by shock treated with vasopressor agents, the 90‐day mortality increased to 89%. Ninety‐day mortality for patients in need of mechanical ventilation, vasoactive medication, and renal replacement therapy because of acute kidney injury was 93%.ConclusionAPACHE II, SAPS II, and SOFA were better at predicting mortality than the Child–Pugh score. With three or more organ failures, the ICU mortality was > 90%. APACHE II > 30, SAPS II > 60, and SOFA at day 1 > 12 were all associated with a mortality of > 90%. Referral criteria of patients suffering from decompensated alcoholic liver disease should be revised.
Micafungin in haematology
Authors: Gamaletsou Maria N. , Sipsas Nikolaos V. , Kontoyiannis Dimitrios P. 
Published: April 2012

SummaryInvasive fungal infections have emerged as a major cause of increased morbidity and mortality among severely immunosuppressed patients with haematological malignancy. Micafungin, a new member of the echinocandin class, is a valuable addition to the antifungal armamentarium of the 21st century as it is active against Candida species, Aspergillus species, and other unusual mycoses that frequently affect these high risk patients. Available data on the safety and efficacy of micafungin as prophylaxis, preemptive/empirical treatment, or treatment of documented invasive fungal infection in patients with haematological malignancies are summarized in this review.
Azole‐resistant Candida spp. – emerging pathogens?
Authors: Tobudic Selma , Kratzer Christina , Presterl Elisabeth 
Published: April 2012

SummaryInvasive fungal infections cause significant morbidity and mortality in immunocompromised patients. Azoles, and fluconazole in particular, are very active against Candida albicans, and are used widely because of their good tolerability. However, the increasing use of azole antifungals for the treatment of mucosal and systemic Candida infections has resulted in the selection and/or emergence of resistant Candida strains. The main mechanisms of azole resistance among Candida species are the development of bypass pathways, alterations in the ERG 11 gene encoding the azole target enzyme, and the up‐regulation of genes encoding efflux pumps. A better understanding of the mechanisms and clinical impact of antifungal resistance is essential to prompt and efficient treatment of patients with invasive mycoses and to improve the outcome of such infections.
Candida biofilms associated with CVC and medical devices
Authors: Chandra Jyotsna , Mukherjee Pranab K. , Ghannoum Mahmoud A. 
Published: April 2012

SummaryIntravascular device‐related infections are often associated with biofilms (microbial communities encased within polysaccharide‐rich extracellular matrix) formed by pathogens on surfaces of these devices. Candida species are the most common fungi isolated from catheter, denture and voice prosthesis‐associated infections, and also are commonly isolated from contact lens‐related infections (e.g. fungal keratitis). These biofilms exhibit decreased susceptibility to most antimicrobial agents, which contributes to the persistence of infection. Drug resistance in fungal biofilms is multifactorial and phase‐dependent, e.g. efflux pumps mediate resistance in biofilms during early phase whereas altered membrane sterol composition contributes to resistance in mature phase. Both substrate type and surface coatings play an important role in the pathogenesis of device‐related fungal biofilms. Microarray and proteomic analyses have identified the differentially expressed genes and proteins in Candida biofilms, and recent studies demonstrate that microbial biofilms interact with host immune cells. In this review, we will summarise recent advances in research on fungal biofilms and their relevance to device‐associated infections.
Clinical feature of asymptomatic reflux esophagitis in patients who underwent upper gastrointestinal endoscopy
Authors: Nagahara Akihito , Hojo Mariko , Asaoka Daisuke , Sasaki Hitoshi , Oguro Masako , Mori Hiroki , Matsumoto Kenshi , Osada Taro , Yoshizawa Takashi , Watanabe Sumio 
Published: April 2012

AbstractBackground and Aim:  Prevalence of gastroesophageal reflux disease (GERD) varies in regions, but few reports on clinical features and quality of life (QOL) of asymptomatic GERD exist in Japan.Methods:  Endoscopy was performed in our department between April 2008 and September 2010. Among 6409 cases answering Frequency of Scale for the Symptoms of GERD (FSSG) and SF8 QOL (PCS: physical component summary; MCS: mental component summary), proton pump inhibitor or histamine 2 receptor antagonist users were excluded, and 388 cases diagnosed as reflux esophagitis (RE) (Los Angeles Classification grade A, B, C, D) were analyzed. Asymptomatic cases with FSSG total score = 0 were defined as asymptomatic RE (AsymRE) and FSSG total score ≥ 1 as symptomatic RE (SymRE). Each clinical feature was analyzed.Results:  The frequency of AsymRE was 11.6% of RE (AsymRE, n = 45; SymRE, n = 343). Patient characteristics in AsymRE, SymRE were male/female = 35/10; 239/104 (not significant), mean age (year) = 63.5 ± 14.3; 58.3 ± 12.7 (P < 0.01), body mass index = 23.9 ± 4.3; 23.5 ± 3.7 (ns), respectively. Regarding the grade of RE, grade A 80.0%, B 17.8%, C 2.2% and D 0% in AsymRE, and grade A 72.6%, B 24.8%, C 2.0% and D 0.6% in SymRE (ns). PCS in SF8 was AsymRE; SymRE = 51.8 ± 9.8; 49.0 ± 7.7 (P < 0.01) and MCS in SF8 was AsymRE; SymRE = 51.4 ± 9.4; 48.2 ± 7.6 (P < 0.01), respectively.Conclusion:  The prevalence of asymptomatic RE was high, particularly in elderly subjects. Unlike symptomatic RE, QOL was not impaired at all with asymptomatic RE. No differences were seen between groups in clinical features such as endoscopic severity of RE, indicating that asymptomatic RE is a condition that should not be overlooked clinically.
Utility and problems of endoscopic submucosal dissection for early gastric cancer in elderly patients
Authors: Tokioka Satoshi , Umegaki Eiji , Murano Mitsuyuki , Takeuchi Nozomi , Takeuchi Toshihisa , Kawakami Ken , Yoda Yukiko , Kojima Yuichi , Higuchi Kazuhide 
Published: April 2012

AbstractBackground and Aim:  Endoscopic submucosal dissection (ESD) is reported to be a safe and reliable procedure for the elderly, but these reports could have already had a bias at the time ESD was performed. However, the reports have not clearly stated the criteria of indications. In the present study, we retrospectively elucidated the usefulness and problems of ESD for early gastric cancer in elderly patients (≥ 65 years) in comparison with non‐elderly patients.Methods:  The subjects were selected from 412 consecutive patients with early gastric cancer (515 lesions) for which ESD was performed between June 2002 and February 2010. The following were used for analysis between groups: pre‐ and postoperative performance status (PS) of subjects, prevalence rates of pre‐existing comorbidities, characteristics of lesions, treatment outcomes, durations of hospitalization, operating times, incidence rates of complications and durations of hospitalization, and postoperative hemorrhage rates, and duration of hospitalization in patients with anticoagulant therapy.Results:  Of the lesions in the elderly, four patients (1.0%) were elderly with a PS of 3. The PS increased to six patients (1.6%) after the procedure. None of the non‐elderly had a PS of 3 before or after the procedure. The ratio of patients with a pre‐existing comorbidity was higher in the elderly than in the non‐elderly. There were no differences between the two groups in the characteristics of the lesions, their duration of hospitalization, their operating times, or the incidence rates of complications. However, the elderly with perforations had a significantly longer hospitalization than the comparable non‐elderly. The percentage of the patients taking anticoagulant drugs was significantly higher among the elderly. Of the patients on anticoagulant therapy, the duration of hospitalization tended to be longer in the elderly but no significant difference was found. None of the non‐elderly with postoperative hemorrhage had received anticoagulant therapy. In the elderly with postoperative hemorrhage, 15.8% of the lesions were in those who had received anticoagulant therapy, indicating a significantly higher percentage of such lesions in the elderly group.Conclusion:  We conclude that ESD is useful in elderly patients because there is a similar risk as for the non‐elderly if the approach is individualized, and the following are taken into consideration when making the final decision of performing ESD in an elderly patient: patients should have a PS of 0, 1, or 2; determine whether or not anticoagulant therapy can be discontinued and whether or not treatment can be performed reliably without complications.
Effect of ecabet sodium treatment on urea breath test and stool antigen tests in volunteers with Helicobacter pylori infection
Authors: Okuda Masumi , Yamamoto Noriyasu , Fukuda Nobuhisa , Maekawa Kohei , Kusaka Takeshi , Hashimoto Manabu , Kotake Junichiro , Koizuka Hiromasa , Fukuda Yoshihiro 
Published: April 2012

AbstractBackground and Aim:  Ecabet sodium is reported to have a bactericidal effect on Helicobacter pylori and inhibit urease activity in vitro.Methods:  Seven male volunteers (mean age, 51.3 years; range, 45–55 years) with H. pylori infection were medicated with 1 g ecabet sodium t.i.d. for 4 weeks. The urea breath test (UBT) was performed 10 times per person: before medication, seven times in 2 weeks, and once in the third and fourth weeks. Stool antigen tests (HpSA PLUS and Testmate pylori antigen) were performed five times per person: before medication and weekly during medication.Results:  The premedication UBT value ranged from 4.9‰ to 77.4‰ and from 2.9‰ to 44‰ at the end of the treatment period. Not one of the subjects had a negative UBT result during medication. The optical densities of the HpSA and Testmate pylori antigen tests ranged from 0.4 to > 3.0 premedication and from 0.0 to > 3.0 at the end of treatment. HpSA and Testmate pylori antigen were negative in two cases.Conclusions:  In this study, ecabet sodium did not effect the results of UBT in volunteers with H. pylori infection. Ecabet sodium may influence stool antigens because in two of seven cases the H. pylori stool antigen tests returned negative results.
Effect of gastric acid suppression with pantoprazole on the efficacy of calcium carbonate as a phosphate binder in haemodialysis patients
Authors: CERVELLI MATTHEW J , SHAMAN AHMED , MEADE ANTHONY , CARROLL ROBERT , MCDONALD STEPHEN P 
Published: April 2012

ABSTRACTAim:  Metallic phosphate binders require acidity to dissociate to the free metallic ion and bind phosphorus. Altered gastric acidity may, therefore, influence phosphate‐binding efficacy. We evaluated the clinical effect of pantoprazole on the efficacy of calcium carbonate phosphate binders in haemodialysis patients.Methods:  The study had two parts: a cross‐sectional study (n = 67), and an interventional, crossover, double‐blind, randomized, placebo‐controlled trial in 26 patients given pantoprazole 40 mg daily or placebo for two consecutive 6‐week periods.Results:  The cross‐sectional study showed no difference between those on and off acid suppressants in phosphate (1.43 ± 0.45 vs 1.46 ± 0.31 mmol/L, P = 0.782) or other parameters except age (72.2 ± 9.8 vs 63.8 ± 14.8 years, P = 0.01). In the interventional study, phosphate was higher during pantoprazole than placebo (1.59 ± 0.3 vs 1.42 ± 0.3 mmol/L, P = 0.005). Serum calcium (2.37 ± 0.2 vs 2.46 ± 0.2 mmol/L, P = 0.012) and ionized calcium (1.17 ± 0.1 vs 1.22 ± 0.1 mmol/L, P = 0.013) were lower during pantoprazole treatment. CaxPO4 (3.76 ± 0.7 vs 3.48 ± 0.7 mmol2/L2, P = 0.032) and intact parathyroid hormone (31.9 ± 21.4 vs 23.6 ± 17.7 pmol/L, P = 0.004) were higher on pantoprazole.Conclusion:  These results demonstrate clinical evidence for an adverse effect of gastric acid suppression on the effectiveness of calcium carbonate phosphate binders. Given their frequent co‐prescription, this interaction may be a minor but common reason why some patients fail to control hyperphosphataemia. Clinicians should regularly assess the need for acid suppressants. Further studies are needed to investigate interactions with other phosphate binders.
Relationship between serum levels of tumour necrosis factor‐related apoptosis‐inducing ligand and the survival of Chinese peritoneal dialysis patients
Authors: POON PETER YAM‐KAU , SZETO CHEUK‐CHUN , KWAN BONNIE CHING‐HA , CHOW KAI‐MING , LEUNG CHI‐BON , LI PHILIP KAM‐TAO 
Published: April 2012

ABSTRACTAim:  Tumour necrosis factor‐related apoptosis‐inducing ligand (TRAIL) can counteract inflammation and atherosclerosis, both common causes of morbidity in peritoneal dialysis (PD) patients. We examined the relation between serum soluble TRAIL (sTRAIL) levels and the outcome of Chinese PD patients.Methods:  We studied 116 new PD patients (67 males, age 56.7 ± 13.4 years). Baseline serum sTRAIL level was determined and grouped to tertiles 1 (lowest) to 3 (highest). All patients were followed for 20.9 ± 7.0 months.Results:  Patient survival was 83.4%, 74.2% and 100% for tertiles 1 to 3, respectively, at 24 months (P = 0.021). Multivariate Cox regression analysis showed that serum sTRAIL level was an independent predictor of patient survival after adjusting for confounding factors (adjusted hazard ratio 0.962, 95% confidence interval [CI] 0.935–0.991, P = 0.010).Conclusion:  A higher baseline serum sTRAIL level was associated with a better survival of PD patients. The detailed mechanism deserves further investigation.