bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using the clinical challenges encountered by junior residents to inform curriculum for paediatric pre‐intern students
Authors: Lester‐Smith David , Campbell Dianne E , Elliott Elizabeth J 
Published: March 2010

Aim:  To develop and evaluate a novel skills‐based education programme for medical students completing a paediatric pre‐internship (PrInt) at the Children's Hospital at Westmead (CHW), Sydney which incorporated a mini‐clinical evaluation exercise style formative assessment component and was based upon a local needs assessment of junior staff.Methods:  We designed a teaching programme which included four interactive tutorials and formative assessment tasks using observed clinical exercises (OCE). The final programme was informed by a local need‐based assessment of out‐of‐hours junior doctors' tasks. Students rated their level of confidence prior to and after the tutorial and following the OCE. Students provided structured and free text feedback on the programme.Results:  Of 29 PrInt students (2007–2008), with collectively 85 tutorial attendances, 84% rated the programme excellent (39%) or very good (45%). For each topic students' confidence increased after the tutorial and again after the OCE (P < 0.001). Improvement was most marked for skills for which students rated themselves pre‐teaching as having poor confidence (pain management and calculation of rehydration fluids). Overall, the proportion with ‘high’ confidence increased from 8.2% pre‐tutorial to 38.8% post‐tutorial and 72.9% post‐OCE (P < 0.001). Competence in skills was assessed by OCE and all students achieved scores of >90%. Diaries from junior doctors during 20 shifts at the CHW recorded 398 out‐of‐hours activities, the most common of which are ordering intravenous fluids (19.6%), reviewing asthmatics (16.6%) and recharting medications (16.3%).Conclusion:  PrInt students value structured teaching incorporating OCE, which allows assessment of clinical skills and direct formative feedback and promotes gains in confidence, knowledge and skills. Addition of OCE to the teaching programme significantly increased the confidence of PrInt students in performing specific tasks compared with an educational session alone. Local needs assessment of junior doctors by out‐of‐hours survey both confirmed selection of appropriate topics (pain, fluids) and informed additional topics (asthma management and bronchodilator weaning regime) for future PrInt student programmes.
Anti‐angiogenesis drugs in lung cancer
Authors: LEE Siow Ming , BAAS Paul , WAKELEE Heather 
Published: March 2010

ABSTRACTIn the last years much attention has been given to the implementation of the so‐called targeted drugs. One of the targets of tumours is the vasculature and this has led to the development of anti‐angiogenic drugs. In lung cancer the use of these drugs has resulted in both positive and negative studies. In this paper the pros and cons are presented. We hope that this information will help the physician in making a proper treatment choice.
ENDOSCOPIC DIAGNOSIS OF INTRADUCTAL PAPILLARY‐MUCINOUS NEOPLASM OF THE PANCREAS BY MEANS OF PERORAL PANCREATOSCOPY USING A SMALL‐DIAMETER VIDEOSCOPE AND NARROW‐BAND IMAGING
Authors: Miura Tomihiro , Igarashi Yoshinori , Okano Naoki , Miki Kazumasa , Okubo Yoichiro 
Published: March 2010

Background:  Intraductal papillary‐mucinous neoplasm (IPMN) is an intraductal tumor in which the mucin‐producing epithelium shows proliferated papillary and a wide variety of pathological changes ranging from hyperplasia to adenocarcinoma. Therefore, it is important to determine whether an IPMN is benign or malignant. In the present study of patients with IPMN, the protrusion was observed by a peroral pancreatoscopy (PPS) using a small‐diameter videoscope and narrow‐band imaging (NBI). We carried out the differential diagnosis of benign lesion to malignant lesion.Methods:  Between April 2003 and May 2009, PPS using a small‐diameter videoscope by means of NBI was carried out on 21 hospitalized patients with IPMN (10 cases of adenocarcinoma, 11 cases of adenoma or hyperplasia; 14 males and seven females, with a mean age of 69.4 years).Results:  Fifteen focal lesions of the 16 cases in the head of the pancreas (93.7%) and four focal lesions of the five cases in the pancreatic body (80%) were observable, whereas two lesions (adenocarcinoma in the pancreatic body, and adenoma in the uncus of pancreas) were not observable. Endoscopically, seven cases were classified as villous type and two cases as vegetative type, and nine cases were diagnosed as adenocarcinoma. Ten cases with sessile type or semipedunculated type were diagnosed as adenoma or hyperplasia. Vascular patterns and protrusions were detected more clearly in the NBI images than under white light observation.Conclusions:  When combined with a videoscope and NBI, pancreatoscopy provided a clear image and was useful for evaluating whether the IPMN was benign or malignant.
MAGNIFYING ENDOSCOPIC OBSERVATION WITH NARROW BAND IMAGING FOR SPECIALIZED INTESTINAL METAPLASIA IN BARRETT'S ESOPHAGUS WITH SPECIAL REFERENCE TO LIGHT BLUE CRESTS
Authors: Norimura Daisuke , Isomoto Hajime , Nakayama Toshiyuki , Hayashi Tomayoshi , Suematsu Takashi , Nakashima Yujiro , Inoue Naoki , Matsushima Kayoko , Yamaguchi Naoyuki , Ohnita Ken , Mizuta Yohei , Inoue Kenichiro , Shikuwa Saburo , Nakao Kazuhiko , Kohno Shigeru 
Published: March 2010

Aim:  Barrett's esophagus (BE) with specialized intestinal metaplasia (SIM) is at high risk of esophageal adenocarcinoma. Magnified endoscopy with narrow band imaging (ME‐NBI) can be useful for detecting this condition. In addition to pit patterns, light blue crests (LBC), blue‐whitish patchy areas on the metaplastic epithelia of the stomach, can predict SIM in BE under ME‐NBI observation.Methods:  A total of 54 patients with BE underwent ME‐NBI to identify IM pits (tubular and villous pits) and LBC. Biopsy samples were taken for histological evaluation of IM, immunohistochemical staining for CD10, MUC2 and MUC5AC antigen, transmission electron microscopy and real‐time polymerase chain reaction (RT‐PCR) analysis of CD10 mRNA expression.Results:  IM pit pattern with ME‐NBI for the diagnosis of IM yielded acceptable sensitivity, specificity and accuracy at 92%, 77% and 83%, respectively. However, the sensitivity, specificity and accuracy of LBC with ME‐NBI for IM were comparably high at 79%, 97% and 89%, respectively. Upon immunohistochemistry, all 19 metaplastic epithelia of LBC‐positive BE showed immunoreactivity against anti‐MUC2 antibody, whereas CD10 antigen was identified in 11 of the 19 LBC‐positive BE. Brush borders were seen on IM epithelia using electron microscopy. On real‐time PCR analysis, CD10 mRNA levels in the LBC‐positive BE were higher compared to those in the LBC‐negative BE.Conclusion:  The appearance of LBC can be an accurate sign to predict SIM in BE and may be associated with high CD10 expression, possibly along with brush borders.
HEALING OF SOLITARY RECTAL ULCERS WITH MULTIPLE SESSIONS OF ARGON PLASMA COAGULATION
Authors: Somani Sanjay Kumar , Ghosh Arindam , Avasthi Gurcharan , Goyal Richa , Gupta Puneet 
Published: March 2010

Background:  Solitary rectal ulcer syndrome (SRUS) is an uncommon disorder of evacuation. Management of bleeding ulcers is usually unsatisfactory with conventional treatment. Argon plasma coagulation (APC) has been reported to control bleeding; however, it has not been shown to result in ulcer healing. The aim of the present study was to: (i) to investigate the efficacy and safety of APC in controlling bleeding from SRUS; and (ii) to study its efficacy in the healing of ulcer/s.Methods:  Twenty‐four patients with bleeding SRUS diagnosed on clinical, colonoscopic, and histological findings were randomized to receive either standard care alone (12 patients) or to undergo multiple sessions of APC in addition (12 patients). All patients were followed up to determine ulcer healing.Results:  Twenty‐four patients with a mean duration of symptoms of 12.6 ± 4.8 months were included. Bleeding was controlled with one (n = 5) or two sessions (n = 7) of APC. Reduction in size and depth of ulcer was noted. Eight out of 12 patients who received APC had complete healing of ulcers after four to eight sessions, carried out 2–4 weeks apart. The remaining four patients had a reduction in size and depth of ulcers compared to their pretreatment appearance. All patients were advised to have a high intake of fluids, fiber and laxatives, and to undergo biofeedback and behavior modification therapy in addition to the treatment.Conclusions:  APC controls bleeding in patients with SRUS and it also improves the healing of these ulcers.
COMPARISON OF ULTRAFLEX AND NITI‐S STENTS FOR PALLIATION OF UNRESECTABLE MALIGNANT GASTRODUODENAL OBSTRUCTION
Authors: Maetani Iruru , Ukita Takeo , Nambu Tomoko , Shigoka Hiroaki , Omuta Shigefumi , Endo Takuro , Takahashi Kei 
Published: March 2010

Aim:  Self‐expandable metallic stents are widely used for palliation of malignant gastric outlet obstruction (GOO), but clinical outcomes of different stents have not been compared. Here, we compared outcomes in patients with a GOO receiving either an Ultraflex (UF) or a Niti‐S (NS) stent.Methods:  Prospective outcomes in 53 patients receiving palliative placement of an NS stent for symptomatic GOO over a 3‐year period were compared with those obtained retrospectively in 31 patients receiving a UF stent in a previous 5‐year period. Main outcome measurement was between‐group comparison of clinical outcome, complications, and reintervention.Results:  Baseline characteristics between the groups were comparable. No difference in technical or clinical success rate was observed. Median procedure time for NS placement was shorter than for UF (15 vs 40 min; P < 0.0001). Complications were more frequent with NS than with UF placement, albeit without statistical significance (16% vs 25%). Although two severe complications occurred in each group, neither was stent related in the NS group. Reintervention was more frequent in the NS group (3% vs 21%; P = 0.0485). Median survival time was 53 versus 88 days for UF versus NS stents, respectively.Conclusion:  Although no significant difference was seen with regard to feasibility, reintervention was less frequent with UF stents than with NS stents. However, UF stents require much more procedure time, and a complicated and difficult placement procedure. These observations suggest that although NS stents placed using a through‐the‐scope technique may be more patient friendly than UF stents, further optimization of through‐the‐scope stents is still required. Further prospective comparison of NS and UF stents in GOO treatment is warranted.
Centralization and the relationship between volume and outcome in knee arthroplasty procedures
Authors: Marlow Nicholas E. , Barraclough Bruce , Collier Neil A. , Dickinson Ian C. , Fawcett Jonathon , Graham John C. , Maddern Guy J. 
Published: March 2010

AbstractBackground:  Centralization aims to reduce adverse patient outcomes by concentrating complex surgical procedures in specified hospitals.Objectives:  This review assessed the efficacy of centralization for knee arthroplasty by examining the relationship between hospital and surgeon volume and patient outcomes.Data Sources and Review Methods:  The systematic review identified studies using multiple databases, including Medline and Embase. Two independent researchers ensured studies met the inclusion criteria. Morbidity, mortality, length of stay, financial outcomes and statistical rigour were examined. Correlations between volume and outcome were reported.Results:  Twelve primary knee arthroplasty studies examined hospital volume, which was significantly associated with decreased morbidity (five of seven studies), mortality (two of five studies) and length of stay (two of three studies). Three primary knee arthroplasty studies examined surgeon volume, which was significantly associated with decreased morbidity (two of three studies), mortality (zero of two studies) and length of stay (one of one study). Two revision knee arthroplasty studies examined hospital volume. One study examined but did not test for significance between hospital volume and patient morbidity; both studies examined volume and patient mortality reporting inconclusive results; and one study reported no significant association between volume and length of stay. None of the revision knee arthroplasty studies examined surgeon volume.Conclusions:  Significant associations between increased hospital and surgeon volume and improved patient outcomes were reported. However, when these results were separated by arthroplasty type, the association appeared tenuous. Judgements regarding centralization of knee arthroplasty should be made with caution until further evidence is published.
ORIGINAL ARTICLE: Severe hyponatraemia in elderly hospitalized patients: prevalence, aetiology and outcome
Authors: Shapiro D. S. , Sonnenblick M. , Galperin I. , Melkonyan L. , Munter G. 
Published: March 2010

AbstractBackground: Hyponatraemia is the commonest electrolyte disorder in the elderly. Data on severe hyponatraemia and the prevalence of cerebral salt wasting syndrome (CSWS) in elderly hospitalized patients are lacking. We studied the incidence, frequency of various aetiologies, outcome and the possible role of CSWS in severe hyponatraemia in elderly medical patients.Methods: A prospective, observational, non‐interventional study conducted over a 5‐month period in medical wards. Eighty‐six patients aged over 65 years with serum sodium levels ≤125 mEq/L were included. All patients were examined by one of the authors, who also evaluated potential contributing factors. Demographic, clinical and outcome data were extracted from the medical records.Results: The mean age of the patients was 82.1 + 8.7 years. The prevalence of hyponatraemia was 6.2% (8.1% women and 4.0% men (P < 0.001)). There was no increase in incidence of hyponatraemia with age. The leading cause of hyponatraemia was the syndrome of inappropriate antidiuretic hormone secretion (SIADH), whose aetiology could be determined in only 46% of cases. Aetiology was multifactorial in 51% of patients (1.7 aetiological factors per patient). All patients with thiazide‐induced hyponatraemia had other contributing factors. Hyperglycaemia and hypoalbuminaemia were predictors of neurological manifestations of hyponatraemia. Overall in‐hospital mortality was 19%. Only hypoalbuminaemia was found as an independent risk factor for death. In none of the patients was the hyponatraemia due to CSWS.Conclusion: Severe hyponatraemia in elderly hospitalized medical patients is more frequent in women and of multifactorial aetiology in 50% of cases. It is most commonly caused by SIADH; CSWS is an unlikely cause.
Malignant mesothelioma
Authors: Kao S. C.‐H. , Reid G. , Lee K. , Vardy J. , Clarke S. , Van Zandwijk N. 
Published: March 2010

AbstractMalignant mesothelioma (MM) is an aggressive tumour that commonly affects the mesothelial surfaces of the pleural and peritoneal cavities, and occasionally, the tunica vaginalis and the pericardium. Formerly a rare tumour, MM is increasing in incidence in Australia due to the heavy nationwide use of asbestos from 1940 until the 1980s. The incidence is expected to peak in Australia in the next decade, mirroring the long latency period between asbestos exposure and development of MM. Diagnosis of MM can be difficult. Definitive pathological diagnosis is required and it often requires an experienced pathologist to differentiate MM from other benign or malignant processes. Treatment of MM requires a multidisciplinary approach, regardless of palliative or curative intent. Treatment options, such as surgery, chemotherapy, radiotherapy and active symptom control or a combination of these, may be used. Further research is needed to advance the therapeutic options for MM, and strategies to realize personalisation of therapy through discovery of predictive markers. In the Australian society where asbestos contamination of the built environment is very high, education and stringent public health measures are required to prevent a second wave of increased MM incidence.
Transfer from residential aged care to emergency departments: an analysis of patient outcomes
Authors: Arendts G. , Dickson C. , Howard K. , Quine S. 
Published: March 2010

AbstractBackground: In order to design optimal systems to meet the acute healthcare needs of the frail elderly living in residential care, good clinical information is essential. The aims of this study were to analyse the casemix and outcomes of patients transferred from residential aged care facilities to public hospital emergency departments in New South Wales.Methods: Individual patient data from six hospital emergency departments and inpatient wards were obtained from merged databases and analysed using descriptive and comparative statistics.Results: Outcomes in 4680 patient transfers over a 12‐month period in 2006–2007 were analysed. Transfers occur mostly in high‐acuity patients, with approximately three of every four transfers admitted; one in every 12 dying; and admitted patients undergoing an average of 2.4 interventions or procedures during each hospital stay. Several variables are associated with prolonged length of emergency department stay including triage urgency, type of hospital and transfers occurring in winter or out of hours.Conclusions: Patients transferred from aged care facilities to emergency departments are predominantly high‐acuity patients with a substantial likelihood of hospitalisation, intervention and death. Nevertheless, scope exists for some episodes of acute care, in both discharged and admitted patients, to be provided outside a hospital setting.
Assessing individual clinical performance: a primer for physicians
Authors: Scott I. A. , Phelps G. , Brand C. 
Published: March 2010

AbstractThe assessment of individual physician performance has attracted interest from several quarters, including statutory licensing agencies and credentialing bodies of healthcare institutions. Performance measures and assessment methods have been developed, although their validity, reliability and feasibility in regards to physician specialty practice are open to challenge. Despite this, professional colleges and societies will be increasingly obliged to ensure their members are demonstrating high‐quality performance on the basis of assessment methods viewed as being transparent, impartial and reproducible. This article provides an overview of the current state of the art which hopefully will serve to inform future debate both within and outside professional circles.
Cytochrome P450 2D6 enzyme neuroprotects against 1‐methyl‐4‐phenylpyridinium toxicity in SH‐SY5Y neuronal cells
Authors: Mann Amandeep , Tyndale Rachel F. 
Published: March 2010

AbstractCytochrome P450 (CYP) 2D6 is an enzyme that is expressed in liver and brain. It can inactivate neurotoxins such as 1‐methyl‐4‐phenyl‐1,2,3,6‐tetrahydropyridine, 1,2,3,4‐tetrahydroisoquinoline and β‐carbolines. Genetically slowCYP2D6metabolizers are at higher risk for developing Parkinson’s disease, a risk that increases with exposure to pesticides. The goal of this study was to investigate the neuroprotective role of CYP2D6 in anin‐vitroneurotoxicity model. SH‐SY5Y human neuroblastoma cells express CYP2D6 as determined by western blotting, immunocytochemistry and enzymatic activity. CYP2D6 metabolized 3‐[2‐(N,N‐diethyl‐N‐methylammonium)ethyl]‐7‐methoxy‐4‐methylcoumarin and the CYP2D6‐specific inhibitor quinidine (1 μm) blocked 96 ± 1% of this metabolism, indicating that CYP2D6 is functional in this cell line. Treatment of cells with CYP2D6 inhibitors (quinidine, propanolol, metoprolol or timolol) at varying concentrations significantly increased the neurotoxicity caused by 1‐methyl‐4‐phenylpyridinium (MPP+) at 10 and 25 μmby between 9 ± 1 and 22 ± 5% (P < 0.01). We found that CYP3A is also expressed in SH‐SY5Y cells and inhibiting CYP3A with ketoconazole significantly increased the cell death caused by 10 and 25 μmof MPP+by between 8 ± 1 and 30 ± 3% (P < 0.001). Inhibiting both CYP2D6 and CYP3A showed an additive effect on MPP+neurotoxicity. These data further support a possible role for CYP2D6 in neuroprotection from Parkinson’s disease‐causing neurotoxins, especially in the human brain where expression of CYP2D6 is high in some regions (e.g. substantia nigra).
Semaphorin 3A‐Neuropilin‐1 signaling regulates peripheral axon fasciculation and pathfinding but not developmental cell death patterns
Authors: Haupt Corinna , Kloos Karina , Faus‐Kessler Theresa , Huber Andrea B. 
Published: March 2010

AbstractIn early development, an excess of neurons is generated, of which later about half will be lost by cell death due to a limited supply of trophic support by their respective target areas. However, some of the neurons die when their axons have not yet reached their target, thus suggesting that additional causes of developmental cell death exist. Semaphorin 3A (Sema3A), in addition to its function as a guidance cue and mediator of timing and fasciculation of motor and sensory axon outgrowth, can also induce death of sensory neurons in vitro. However, it is unknown whether Neuropilin‐1 (Npn‐1), its binding receptor in axon guidance, also mediates the death‐inducing activity. We show here that abolished Sema3A‐Npn‐1 signaling does not influence the cell death patterns of motor or sensory neurons in mouse during the developmental wave of programmed cell death. The number of motor and sensory neurons was unchanged at embryonic day 15.5 when this wave is concluded. Interestingly, the defasciculation of early motor and sensory projections that is observed in the absence of Sema3A or Npn‐1 persists to postnatal stages. Thus, Sema3A‐Npn‐1 signaling plays an important role in the guidance and fasciculation of motor and sensory axons but does not contribute to the developmental elimination of these neurons.
Fundamentals of neuronal apoptosis relevant to pediatric anesthesia
Authors: BLAYLOCK MORGAN , ENGELHARDT THOMAS , BISSONNETTE BRUNO 
Published: March 2010

SummaryThe programmed cell death or apoptosis is a complex biochemical process that has risen to prominence in pediatric anesthesia. Preclinical studies report a dose‐dependant neuronal apoptosis during synaptogenesis following exposure to intravenous and volatile anesthetic agents. Although emerging clinical data do not universally indicate an increased neurodegenerative risk of general anesthesia in early human life, a great deal of uncertainty was created within the pediatric anesthesia community. This was at least partially caused by the demand of understanding of basic science concepts and knowledge of apoptosis frequently out of reach to the clinician. It is, however, important for the pediatric anesthesiologist to be familiar with the basic science concepts of neuronal apoptosis to be able to critically evaluate current and future preclinical data in this area and future clinical studies. This current review describes the extrinsic and intrinsic pathways involved in the cell death process and discusses techniques commonly employed to determine apoptosis. In addition, potential mechanisms of anesthesia‐induced neuronal apoptosis are illustrated in this review.