bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reporting clinical trial information: colorectal cancer trials at Sydney Cancer Centre
Authors: Chua W. , Horvath L. , Beale P. , Clarke S. J. 
Published: February 2011

AbstractBackground:  Clinical trial units are integral to the functioning of a medical oncology department with patient access to clinical trials an important component in patient care. There has been a paucity of potential key performance indicators in medical oncology and clinical trial information may be utilised for this purpose. The aim of this study was to record retrospectively and collate prospectively collected information regarding basic demographics, response rate, progression and survival plus grade 3 or 4 toxicity in patients enrolled in clinical trials for metastatic colorectal cancer at the Sydney Cancer Centre between 1999 and 2007.Methods:  Baseline patient demographics, clinical response, progression dates, grade 3 or 4 toxicities plus treatment‐related fatalities were collected from individual clinical trials. Outcome measures were clinical response, progression‐free survival and overall survival.Results:  There was a total of 14 trials undertaken during the defined period for patients with metastatic colorectal cancer. There was available information for 243 patient trials with sufficient information regarding response rates, toxicity, progression and survival. Tumour response rates ranged from 27% to 66% for first line chemotherapy trials and 0% to 20% for non‐first line chemotherapy trials. The overall progression‐free survival was 6.4 months and overall survival 14.0 months for all trials. There was one treatment‐related fatality on clinical trial during this period.Conclusions:  Results of our clinical database have been used here to illustrate the concept and value of reporting clinical trial information in medical oncology. Public reporting of such information may allow for comparisons between units and for quality improvement.
Smoking cessation post‐discharge following nicotine replacement therapy use during an inpatient admission
Authors: Williams J. H. , Jones T. E. 
Published: February 2011

AbstractBackground: Cigarette smoking remains a health issue despite declining prevalence in Australia. The burden of tobacco‐related morbidity affects hospitals, particularly those in lower socioeconomic areas where prevalence is highest.Aim: We have shown that nicotine replacement therapy (NRT) use during hospitalization increases motivation to quit post‐discharge. We postulated that subjects using the nicotine patch post‐discharge, in comparison to the inhaler, would have higher rates of abstinence at 12 months after discharge. The aim was to compare the efficacy of the nicotine patch or inhaler formulation for cessation post‐discharge, following use during admission.Methods: Post‐discharge, subjects chose their preferred formulation (patch or inhaler) based on their experience with NRT during admission. Tailored, medium‐intensity support was provided with subsidized NRT during outpatient visits. Subjects were followed for 12 months. Exhaled breath CO confirmed non‐smoking.Results: Of 123 subjects enrolled, 37 elected to use the inhaler, 50 the patch and 36 no NRT. At 12 months continuous abstinence rates were 38%, 38% and 25% respectively.Discussion: This study built upon the ‘teachable moment’ provided by hospitalization and the inpatient use of NRT, encouraging cessation post‐discharge. Both NRT formulations provided similar 12 month cessation rates, and were superior to those achieved by subjects electing not to use NRT. Although the patch was the most popular formulation, the inhaler provided an equally efficacious alternative which addressed other facets of cigarette addiction. Subjects electing not to use NRT were less successful.Continuous abstinence rates were equivalent to community‐based studies using NRT. We recommend a similar programme to other hospitals.
Myelodysplasia in the Wellington region 2002–2007: disease incidence and treatment patterns
Authors: Irwin J. , D'Souza A. , Johnson L. , Carter J. 
Published: February 2011

AbstractAims:  To obtain accurate incidence data for myelodysplasia in the Wellington Region of New Zealand (NZ), to analyse the treatment these patients received and to review their outcome.Methods:  Patients diagnosed with myelodysplasia between 1 January 2002 and 1 September 2007 were identified. Their bone marrow biopsy, clinical record, cytogenetic analysis and transfusion record were analyzed.Results:  Seventy myelodysplastic patients were identified yielding an incidence of 2.75 per 100 000 per year. Median survival was 23 months, and transformation to acute leukaemia occurred in five patients (7.1%). Three patients (4.3%) received an allogeneic bone marrow transplant, and five patients (7.1%) received disease modifying treatment. Fifty‐six of 70 patients (80%) received a blood transfusion, a mean of 32.9 red blood cell (RBC) units were transfused to each transfusion recipient during the study period of 68 months. One of 70 patients developed a clinical syndrome of iron overload.Conclusion:  The incidence of myelodysplasia in Wellington, NZ is similar to incidence figures from previously published studies. The treatment these patients received was predominantly supportive through RBC transfusion. Effective iron chelation therapy measures were not used although there appeared to be a low incidence of clinical iron overload in the study population. The data in this study will be available for comparison with future studies to assess trends in incidence, treatment and outcome in myelodysplastic patients in NZ.
Socioeconomic deprivation, readmissions, mortality and acute exacerbations of bronchiectasis
Authors: Roberts M. E. , Lowndes L. , Milne D. G. , Wong C. A. 
Published: February 2011

AbstractBackground:  Bronchiectasis is known to cause significant morbidity in children in New Zealand. Little is known of the disease in adults.Aim:  Our objective was to characterise a cohort of adults who presented to hospital with acute exacerbations of the disease.Methods:  We retrospectively collected information on all exacerbations treated as inpatients from a single hospital in South Auckland, New Zealand during 2002.Results:  We collected information on 307 exacerbations in 152 patients. Twenty‐seven per cent were of Maaori ethnic origin, and 44% Pacific. Seventy per cent lived in areas categorised as the 20% most deprived in New Zealand. Comorbid conditions were present in 80% of patients – most commonly chronic obstructive pulmonary disease, asthma, diabetes and cardiac disease. Seventy (46%) patients had at least one readmission and 32 patients (21%) died within 12 months of admission to hospital. Greater deprivation was associated with increased mortality at 12 months after admission after adjusting for other factors (OR 11, 95% CI 2.0–61, P= 0.006). In the subgroup who underwent high‐resolution computed tomographic scanning (93), increasing severity of bronchiectasis (modified Bhalla score) was associated with readmission within 12 months (P= 0.004), but not mortality (P= 0.419).Conclusions:  We have shown that exacerbations of bronchiectasis in South Auckland are more common in patients who are predominantly of Maaori or Pacific descent and are socioeconomically deprived. Admission to hospital for an exacerbation is associated with high readmission and mortality rates.
Diagnostic utility of endobronchial ultrasound‐guided transbronchial needle aspiration compared with transbronchial and endobronchial biopsy for suspected sarcoidosis
Authors: Plit M. , Pearson R. , Havryk A. , Da Costa J. , Chang C. , Glanville A. R. 
Published: February 2011

AbstractBackground:  Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) is an accurate and minimally invasive technique that has been shown to have excellent diagnostic yield in the investigation of mediastinal and hilar lymphadenopathy. There is, however, little evidence comparing this procedure to the traditional diagnostic approach of transbronchial lung (TBLB) and endobronchial (EB) biopsies combined with characteristic clinical and radiological features in sarcoidosis.Aim:  To compare the diagnostic yield of EBUS‐TBNA, TBLB and EB in patients with suspected sarcoidosis.Methods:  Data from 40 consecutive patients with suspected sarcoidosis who underwent combined EBUS‐TBNA with TBLB and EB biopsies were recorded.Results:  A total of 37 patients was confirmed as sarcoidosis, and three had other diagnoses. There was no difference in diagnostic accuracy rates between EBUS‐TBNA and TBLB for all stages of sarcoidosis (84% vs 78%, P= 0.77). Combined EBUS‐TBNA and TBLB procedures yielded a diagnostic accuracy of 100%. There was a highly significant difference in diagnostic accuracy between EBUS‐TBNA and EB in stage I (80% vs 27%) (P < 0.01) and stage II disease (86% vs 27%) (P < 0.01). Similarly, a highly significant difference in diagnostic accuracy was seen between TBLB and EB (P < 0.01). No adverse events occurred.Conclusion:  Endobronchial ultrasound‐guided transbronchial needle aspiration alone has a high diagnostic yield with a very low complication rate for patients with suspected sarcoidosis.
Prevalence and determinants of QT interval prolongation in medical inpatients
Authors: Pasquier M. , Pantet O. , Hugli O. , Pruvot E. , Buclin T. , Waeber G. , Aujesky D. 
Published: February 2011

AbstractBackground:  QT interval prolongation carries an increased risk of torsade de pointes and death.Aim:  We sought to determine the prevalence of QT prolongation in medical inpatients and to identify determinants of this condition.Methods:  We enrolled consecutive patients who were admitted to the internal medicine ward and who had an electrocardiogram performed within 24 h of admission. We collected information on baseline patient characteristics and the use of QT‐prolonging drugs. Two blinded readers manually measured the QT intervals. QT intervals were corrected for heart rate using the traditional Bazett formula and the linear regression‐based Framingham formula. We used logistic regression to identify patient characteristics and drugs that were independently associated with QTc prolongation.Results:  Of 537 inpatients, 22.3% had a prolonged QTc based on the Bazett formula. The adjusted odds for QTc prolongation based on the Bazett correction were significantly higher in patients who had liver disease (OR 2.9, 95% CI: 1.5–5.6), hypokalaemia (OR 3.3, 95% CI: 1.9–5.6) and who were taking ≥1 QT‐prolonging drug at admission (OR 1.7, 95% CI: 1.1–2.6). Overall, 50.8% of patients with QTc prolongation received additional QT‐prolonging drugs during hospitalisation.Conclusions:  The prevalence of QTc prolongation was high among medical inpatients but depended on the method used to correct for heart rate. The use of QT‐prolonging drugs, hypokalaemia and liver disease increased the risk of QTc prolongation. Many patients with QTc prolongation received additional QT‐prolonging drugs during hospitalisation, further increasing the risk of torsade de pointes and death.
An audit of laryngoscopes and application of a new ISO standard
Authors: Baker Paul A. , McQuoid Shane , Thompson John M.D. , Jacobs Robert J. 
Published: February 2011

SummaryObjective:  The International Organization for Standardization (ISO) recently published an International Standard (ISO 7376:2009) which specifies illuminance levels and tests for illumination from hook‐on type laryngoscopes used for intubation. A clinical study examining luminance for laryngoscopy found that 100 cd·m−2 was the minimum level acceptable for laryngoscopy. The purpose of this study was to measure the quality of light from laryngoscopes available for use by anesthetists in an anesthetic department and compare them to the ISO illuminance standard and published minimum acceptable luminance limits.Methods:  A measuring device was constructed to support each laryngoscope in a standardized manner. For 190 reusable laryngoscopes, illuminance was measured with a lux meter at the base of this device. Eighteen clinically available laryngoscopes were then examined in detail, as a snapshot study, with multiple light recordings according to the ISO Standard. We also measured the luminance provided by each laryngoscope.Results:  Only two of the 18 laryngoscopes met the minimum illuminance level of 500 lux after 10 min. Nine laryngoscopes provided a luminance <100 cd·m−2, which is the reported minimum required luminance for laryngoscopy. None of the 18 laryngoscopes tested complied with the ISO standard for laryngoscope light distribution.Conclusions:  Laryngoscope light should be regularly audited. Results from these audits can be used to retire or repair substandard laryngoscopes to maintain acceptable standards of laryngoscope light. Audit results produce tangible evidence that is useful when applying for capital expenditure. Light measurements are not easy to make. There needs to be a convenient device to reliably measure laryngoscope illumination.
Anesthesia can be safely provided for children in a high‐field intraoperative magnetic resonance imaging environment
Authors: Cox Robin G. , Levy Ron , Hamilton Mark G. , Ewen Alastair , Farran Peter , Neil Stuart G. 
Published: February 2011

SummaryObjectives:  To describe the challenges associated with providing safe anesthesia and perioperative care for children in a remote intraoperative magnetic resonance (iMR) operating room (OR) and to identify perioperative anesthesia outcomes, including adverse events related to the iMR environment.Background:  Increasingly, children undergo neurosurgical procedures in a high‐field iMR OR. We describe a 10‐year experience of providing anesthesia for children in this environment with a mobile 1.5‐Tesla magnet.Methods:  A 10‐year retrospective analysis was conducted of children who underwent neurosurgical procedures in a high‐field mobile iMR OR. Primary outcomes related to perioperative adverse events and recovery profiles. Results were expressed as mean ± sd or median (range), as appropriate.Results:  One hundred and five procedures were performed on 98 children, aged 4 months–18 years, weighing 6–112 kg. The commonest two diagnostic categories were tumor (n = 52) and seizures (n = 27). Median anesthetic time was 439 (185–710) mins. There were no significant adverse events related to the iMR environment. The mean postanesthetic care unit admission temperature was 37 ± 0.9°C and the mean modified Aldrete Score at 30 mins was 7.2 ± 0.9. Two patients experienced seizures in the immediate postoperative period, readily controlled with propofol. There was one breach of MR safety protocol, and no adverse events related to patient transport.Conclusions:  Anesthesia and perioperative care of children in an iMR setting were associated with a very low incidence of complications, despite the duration of the procedures involved. Such success depends upon a cohesive team‐based approach.
Effect of caudal block on sevoflurane requirement for lower limb surgery in children with cerebral palsy
Authors: Kim Soo Hwan , Chun Duk‐Hee , Chang Chul Ho , Kim Tae Wan , Kim Young Mi , Shin Yang‐Sik 
Published: February 2011

SummaryBackground:  Caudal block is a widely used technique for providing perioperative pain management in children. In this randomized double‐blinded study, we evaluated the effects of preoperative caudal block on sevoflurane requirements in children with cerebral palsy (CP) undergoing lower limb surgery while bispectral index (BIS) values were maintained between 45 and 55.Methods:  52 children undergoing Achilles‐tendon lengthening were randomized to receive combined general–caudal anesthesia (caudal group, n = 27) or general anesthesia alone (control group, n = 25). Caudal block was performed with a single dose of 0.7 ml·kg−1 of 1.0% lidocaine containing epinephrine at 5 μg·ml−1. The control group received no preoperative caudal block. The endtidal sevoflurane concentrations (ETsev) were adjusted every minute to maintain the BIS values between 45 and 55.Results:  The ETsev required to maintain the BIS values were not significantly different between the control and caudal groups after induction of anesthesia [2.1 (0.2) vs 2.2 (0.4); P = 0.773]. However, significantly higher ETsev was observed in the control group before surgical incision [2.0 (0.2) vs 1.8 (0.3); P = 0.013] and during the first 20 min after surgical incision [2.2 (0.3) vs 1.4 (0.3); P < 0.001]. There was no significant difference in BIS values between the control and caudal groups throughout the study period (P > 0.05). In the caudal group, the caudal block was successful in 25 of 27 (92.6%) patients.Conclusions:  Caudal block effectively reduced sevoflurane requirements by 36% compared to general anesthesia alone in children with CP undergoing lower limb surgery while BIS values were maintained between 45 and 55.
A survey of blood transfusion practice in French‐speaking pediatric anesthesiologists
Authors: Jouffroy Romain , Baugnon Thomas , Carli Pierre , Orliaguet Gilles 
Published: February 2011

SummaryBackground:  There are so far no existing consensus guidelines regarding red blood cell transfusion during pediatric surgery, and there is a little information regarding red blood cell transfusion policy among pediatric anesthesiologists.Objectives:  To determine the transfusion threshold and the volumes of packed red blood cell (PRBC) transfusion among French‐speaking pediatric anesthesiologists.Materials and methods:  A questionnaire of case scenarios was sent to active members of the French Language Society of Pediatrics Anesthesiologists (ADARPEF).Results:  Of the 324 active members of the ADARPEF, 175 (54%) completed the questionnaire. The threshold for blood transfusion varied from 6 to 12 g·dl−1 depending on the scenario. The hemoglobin threshold for blood transfusion and the volume of blood transfused vary among ADARPEF physicians, for the same class of patients. The median [95% CI] hemoglobin threshold for starting blood transfusion was 7.9 [6.9–8.9], 7.3 [6.4–8.2], and 8.1 [7.0–9.2] g·dl−1 in the pre‐, intra‐, and postoperative phase, respectively. The median [95% CI] PRBC volume transfused was 11.7 [6.6–16.8] ml·kg−1, and the median hemoglobin target was 11.3 [9.8–12.8] g·dl−1. Physicians ranked age (79%), clinical tolerance of anemia (99%), underlying medical conditions (95%), hemodynamic instability (89%), hemostasis disorder (86%), and sepsis (79%) as the most significant factors affecting their transfusion decisions. Most pediatric anesthesiologists (89%) measure the hemoglobin level before PRBC transfusion.Conclusions:  This survey identifies significant differences in transfusion practice patterns among pediatric anesthesiologists with a median transfusion threshold of 7.6 [6.6–8.6] g·dl−1 and a median PRBC volume transfusion of 11.7 [16.8–6.6] ml·kg−1.
The impact of total quality management adoption on small and medium enterprises’ financial performance
Authors: Kober Ralph , Subraamanniam Thanesvary , Watson John 
Published: February 2011

AbstractThis paper examines whether the management accounting practice of total quality management (TQM) positively impacts on the financial performance of small and medium enterprises (SMEs). While research has investigated the impact of TQM on larger firms, to date, there has been no comprehensive analysis of the impact of TQM on SMEs’ financial performance. Our analysis of Australian Bureau of Statistics financial data for 3776 SMEs found no evidence that TQM improved financial performance after controlling for size and risk. Our results contribute to literature by highlighting that management accounting practices developed for larger companies may not necessarily be transposable to SMEs.
Regulatory mechanisms underlying C4 photosynthesis
Authors: Wang Lin , Peterson Richard B. , Brutnell Thomas P. 
Published: February 2011

SummaryC4 photosynthesis is an adaptation that evolved to alleviate the detrimental effects of photorespiration as a result of the gradual decline in atmospheric carbon dioxide levels. In most C4 plants, two cell types, bundle sheath and mesophyll, cooperate in carbon fixation, and, in so doing, are able to alleviate photorespiratory losses. Although much of the biochemistry is well characterized, little is known about the genetic mechanisms underlying the cell‐type specificity driving C4. However, several studies have shown that regulation acts at multiple levels, including transcriptional, post‐transcriptional, post‐translational and epigenetic. One example of such a regulatory mechanism is the cell‐specific accumulation of major photorespiratory transcripts/proteins in bundle sheath cells, where ribulose‐1,5‐bisphosphate carboxylase/oxygenase is localized. Although many of the genes are expressed in the bundle sheath, some are expressed in both cell types, implicating post‐transcriptional control mechanisms. Recently, ultra‐high‐throughput sequencing techniques and sophisticated mass spectrometry instrumentation have provided new opportunities to further our understanding of C4 regulation. Computational pipelines are being developed to accommodate the mass of data associated with these techniques. Finally, we discuss a readily transformable C4 grass –Setaria viridis– that has great potential to serve as a model for the genetic dissection of C4 photosynthesis in the grasses.

Contents

Summary
9

I.
Introduction
10

II.
Regulation of C4 differentiation
11

III.
The photorespiratory pathway: a case study for transcriptional and post‐transcriptional controls
14

IV.
Future perspectives of C4 research – an introduction to a C4 model
16

Acknowledgements
17

References
17
High‐Flux Dialyzers, Backfiltration, and Dialysis Fluid Quality
Authors: Schiffl Helmut 
Published: February 2011

AbstractCurrently, high‐flux hemodialysis is the most common mode of dialysis therapy worldwide. Its steadily increasing use is largely based on the desire to reduce the excessively high morbidity and mortality of end‐stage renal disease patients maintained on conventional dialysis (low‐flux, mostly cellulosic membranes) by offering better biocompatibility and enhanced removal of uremic toxins. Two large randomized trials suggest a survival benefit for selected subgroups of high‐flux dialysis patients such as diabetics, patients with hypoalbuminemia, or patients who have been on dialysis for a long period (> 3.7 years).The major disadvantage of high‐flux hemodialysis relates to the use of dialysis fluid, which is commonly not pure and may endanger patients treated with high‐flux hemodialysis. Endotoxin fragments and other bacterial substances derived from bacteriologically contaminated dialysis fluid may, even at bacterial counts or endotoxin concentrations within the limits of accepted standards of dialysis fluid purity, enter from the dialysate into the patient′s blood either by convective transfer (backfiltration) or by movement down the concentration gradient (backdiffusion). Repeated exposure of high‐flux hemodialysis patients to backtransport of dialysate contaminants aggravates the uremia‐associated inflammatory response syndrome and contributes to long‐term morbidity. At present, the only solution to circumvent the risks of backtransport is the use of dry powder cartridges for bicarbonate concentrate and the use of bacteria‐ and endotoxin‐retentive filters for the online production of ultrapure dialysis fluid. Use of ultrapure dialysis fluid (bacteria <0.1 CFU/ml and endotoxin <0.03 IU/ml) has been found to reduce inflammation and comorbidities in clinical investigations compared to commercial dialysis fluid.The European Renal Association and a number of national societies in Europe or in Japan strongly recommend the use of ultrapure dialysis for high‐flux hemodialysis.