bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pharmakokinetik und Dosierung von Fluconazol bei kontinuierlichen Hämofiltrations‐ (CAVH, CVVH) und Hämodialyseverfahren (CAVHD, CVVHD)
Authors: Pittrow L. , Penk A. 
Published: April 2009

Zusammenfassung. Kontiniuerliche Hämofiltrations‐(CAVH, CVVH) und Hämodialyse‐verfahren (CAVHD, CVVHD) werden zunehmend bei Patienten mit akutem Nierenversagen (ARF) eingesetzt. Zwischen den einzelnen Verfahren bestehen deutliche Unterschiede hinsichtlich der Elimination von Fluconazol aus dem Plasma*. Diese ist bei CVVHD, abhängig von der Dialysat‐ und Ultrafiltratflußrate, im Gegensatz zur CVVH und der intermittierenden Hämodialyse am stärksten ausgeprägt, wobei die Fluconazol‐Clearance bei CVVHD 2 L/h sogar über derjenigen von Gesunden liegen kann. Um unter kontinuierlichen Verfahren therapeutische Fluconazol‐Plasmaspiegei zu erreichen, sollte initial die gleiche Anfangsdosis wie bei nierengesunden Patienten appliziert werden, gefolgt von der auf die Hälfte reduzierten Erhaltungsdosis, wie sie für Patienten mit einer eingeschränkten Kreatinin‐Clearance von bis zu 11 ml/min vorgesehen ist. Aufgrund theoretischer Überlegungen wird diese halbe Erhaltungsdosis je nach gewähltem Verfahren mit einem Faktor multipliziert, der das Ausmaß der extrakorporalen Elimination der verabreichten Wirkstoffmenge berücksichtigt (CAVH, CVVH: x2,2 bei einer Ultrafiltratflußrate von 0,5 L/h; CAVHD, CVVHD: x3,8 bei einer kombinierten Dialysat‐/Ultrafiltratflußrate von 1,5 L/h). Um subtherapeutische Plasmaspiegel bei vitalen Indikationen zu*** vermeiden, empfiehlt sich ‐ auch im Hinblick auf die geringe Anzahl einschlägiger Untersuchungen mit relativ niedrigen Dosierungen bis zu 200 mg/die ‐ die Messung der Plasma(tal)spiegel von Fluconazol.Summary. Continuous haemofiltration (CAVH, CVVH) and haemodialysis (CAVHD, CVVHD) are increasingly used in patients with acute renal failure (ARF). The elimination rates of fluconazole vary considerably among the different procedures*. In CVVHD, the elimination rate is, depending on the combined dialysate/ultrafiltrate flow rate, the most marked compared to CVVH and intermittent dialysis with a fluconazole clearance exceeding the values of healthy persons in CVVHD 2 L/h. To achieve therapeutic plasma levels during continuous renal replacement therapy, the same loading dose as in patients without renal failure should be applied, followed by the adjusted maintenance dose for anuric patients multiplied by a factor taking the extracorporeal elimination of the absorbed dose into account (CAVH, CVVH: x2.2, ultrafiltrate flow 0.5 L/h; CAVHD, CVVH: x3.8, combined dialysate / ultrafiltrate flow 1.5 L/h). Despite the broad therapeutic margin of fluconazole, drug monitoring is recommended with respect to the very limited number of in‐***
Subungual and periungual congenital blue naevus
Authors: Gershtenson Platina Coy , Krunic Aleksandar , Chen Helen , Konanahalli Madhuri , Worobec Sophie 
Published: April 2009

ABSTRACTSubungual pigmented lesions should raise concern about malignant melanoma. Blue naevus of the nail apparatus is a rare entity, with only ten cases described in the literature. We report a 21‐year‐old Hispanic woman with a slowly enlarging 1.7 × 2.3‐cm subungual and periungual pigmented plaque present since birth on her right second toe. Initial biopsy was consistent with a blue naevus of the cellular type and, given the recent clinical change and periungual extension, complete excision was recommended. The entire nail unit was resected down to periosteum with prior avulsion of the nail plate. Reconstruction was performed with a full‐thickness skin graft. Follow up at 1 year revealed well‐healed graft and donor sites with complete return of function. We present a case of a congenital subungual and periungual blue naevus of the cellular type and review the literature on this rare presentation of a congenital blue naevus.
Electronic e‐isotretinoin prescription chart: Improving physicians' adherence to isotretinoin prescription guidelines
Authors: Tang Mark BY , Tan Eugene ST , Tian Elizabeth AL , Loo SC , Chua SH 
Published: April 2009

ABSTRACTOral isotretinoin is a highly effective treatment for refractory nodulocystic acne. However, it can be associated with serious adverse effects such as teratogenicity and hepatitis. Inadequate cumulative dosing may also result in reduced therapeutic efficacy and higher disease relapse. A preliminary audit had previously revealed a poor and inconsistent adherence to local isotretinoin prescribing guidelines by physicians. To achieve greater than 90% adherence to isotretinoin guidelines for all acne patients prescribed systemic isotretinoin at the National Skin Centre, Singapore, key areas and the reasons for non‐adherence were identified. A specifically designed ‘one‐stop’ electronic isotretinoin chart was launched within the electronic medical records (EMR) system to address important safety areas; namely, informed patient consent, pregnancy testing, baseline laboratory tests, and automatic calculation of cumulative and target doses of isotretinoin. Physician adherence to prescribing guidelines improved from a baseline of 50–60% to greater than 90% (range 95–100%) for 30 consecutive months post intervention. The e‐isotretinoin chart has resulted in significant improvement in physicians' adherence to isotretinoin prescription guidelines and highlights the utility of EMR technology in influencing safe prescribing behaviour among doctors.
Vulval fixed drug eruption due to paracetamol
Authors: Drummond Catherine , Fischer Gayle 
Published: April 2009

ABSTRACTParacetamol is a readily available non‐prescription analgesic. Fixed drug eruption (FDE) is a well‐reported side effect of paracetamol, usually the classic, pigmenting type. In women, it may present as a chronic, erosive vulvitis. We describe a case of FDE due to paracetamol presenting as a chronic erosive vulvitis in an older woman taking multiple medications. Diagnosis was delayed because paracetamol is available without prescription, taken intermittently and may be omitted from the clinical history. Cessation of paracetamol led to prompt resolution of symptoms. Consideration should be given to paracetamol as a cause of FDE presenting as a chronic erosive vulvitis.
Allergic contact dermatitis from exposure to Grevillea robusta in New Zealand
Authors: Derraik José GB , Rademaker Marius 
Published: April 2009

ABSTRACTThere are a number of reports in the literature of allergic contact dermatitis as a result of exposure to the sawdust and plant parts of Grevillea robusta. While this tree is prevalent in New Zealand, there seems to have been no previous published accounts of contact dermatitis, although anecdotal evidence indicates that such cases may be common. Two brief case reports are provided regarding severe phytodermatitis to G. robusta among professional arborists in New Zealand. As with other common plants capable of inducing allergic contact dermatitis, greater awareness among arborists, orchardists, forestry workers, gardeners, and health professionals will likely result in a reduction of cases.
Increased liver stiffness measurement by transient elastography in severe acute exacerbation of chronic hepatitis B
Authors: Wong Grace L‐H , Wong Vincent W‐S , Choi Paul C‐L , Chan Anthony W‐H , Chim Angel M‐L , Yiu Karen K‐L , Chan Francis K‐L , Sung Joseph J‐Y , Chan Henry L‐Y 
Published: April 2009

AbstractBackground and Aims:  The proposed cut‐off values for the degree of fibrosis as assessed by liver stiffness measurement (LSM) might not be applicable in severe acute exacerbation of chronic hepatitis B (CHB). We aimed to assess the effect of necroinflammatory activity on LSM in this condition.Methods:  We prospectively recruited consecutive patients with severe acute exacerbation of CHB (alanine aminotransferase or ALT > 10× upper limit of normal). The relationship of ALT levels and LSM were serially assessed and liver biopsy was carried out after ALT normalization.Results:  Eleven patients (10 male, median age 43 years) were followed up for 25 weeks; nine patients received antiviral therapy. Overall, LSM was positively correlated with ALT levels (r = 0.67, P < 0.001). At initial presentation, the median serum ALT and LSM was 1136 (581–2210) IU/L and 26.3 (11.1–33.3) kPa. A progressive reduction in LSM was observed during subsequent visits in parallel with the reduction of ALT levels. At the last visit, the median ALT was 27 (11–52) IU/L and LSM was 7.7 (4.7–10.8) kPa. Among the five patients who had liver biopsy carried out at week 25, four patients had F2 fibrosis (LSM 5.7–8.1 kPa) and one patient had F3 fibrosis (LSM 8.6 kPa).Conclusions:  LSM using transient elastography with the current proposed cut‐off values might misdiagnose liver cirrhosis in patients suffering from severe acute exacerbation of CHB. LSM should be assessed after normalization of ALT levels in order to accurately assess the degree of fibrosis.
The effect of postoperative fasting on vomiting in children and their assessment of pain
Authors: RADKE OLIVER C. , BIEDLER ANDREAS , KOLODZIE K. , CAKMAKKAYA OZLEM S. , SILOMON MALTE , APFEL CHRISTIAN C. 
Published: April 2009

SummaryBackground:  Mandatory postoperative food intake has been shown to increase nausea and vomiting, and so postoperative fasting has become common practice even if patients request food or drink.Objective:  We sought to investigate whether postoperative fasting reduces the incidence of postoperative vomiting in children when compared with a liberal regimen in which they are allowed to eat and drink upon request.Methods:  One hundred forty‐seven children scheduled for outpatient surgery were randomized to one of two groups. After anesthesia, patients in the ‘fasting’ group were expected to fast for 6 h. The children in the ‘liberal’ group were allowed to eat and drink according to their own needs. The incidence of vomiting and the children’s well‐being were recorded at several time points over a 24‐hour period. Parents were also asked to rate, on a scale of 0–6, how much their children were bothered by fasting, pain, and nausea/vomiting.Results:  Age (4.8 ± 2.6 years), weight (20 ± 9 kg) and gender (73% boys) were comparable between the groups. The incidence of vomiting was 15% in the liberal and 22% in the fasting group (P = 0.39) and, between 1 and 12 h after extubation, children in the liberal group were significantly happier (P < 0.001). Children in the liberal group were significantly less bothered by their pain than those in the fasting group (P < 0.001).Conclusion:  Postoperative fasting did not reduce the incidence of vomiting after general anesthesia in children when compared with a liberal regimen. Furthermore, the ability to eat and drink at will decrease the bothersome aspects of pain and lead to happier patients.
Intraoperative opioid dosing in children with and without cerebral palsy
Authors: LONG LAWRENCE S. , VED SUDHA , KOH JEFFREY L. 
Published: April 2009

SummaryObjective: To describe the differences in intraoperative opioid dosing and associated outcomes in children with and without cerebral palsy (CP).Background: Previous work on children with cognitive impairment has suggested that they receive less intraoperative opioid than children without cognitive impairment. This finding may be due to a common concern that impaired children are hypersensitive to the adverse effects of opioids. Patterns in intraoperative opioid dosing have yet to be studied in children with motor impairment (e.g. CP).Methods: We examined the medical records of pediatric patients with CP who underwent orthopedic surgery over the last decade at our institution, as well as the records of a randomly selected group of pediatric orthopedic patients without CP (non‐CP). Outcome variables were intraoperative opioid dosing, postoperative intensive care unit (ICU) admission, and postoperative oxygen desaturation. We collected demographic, surgical, and medical data for covariate analysis. A stepwise multivariate regression was used for each outcome.Results: Seventy‐one (71) CP and 77 non‐CP charts were included in the study. CP children received significantly less intraoperative opioid (3.26 ± 3.01 μg·kg−1fentanyl dose equivalents) than non‐CP children (4.58 ± 3.79 μg·kg−1) (P = 0.02), and this difference was corroborated by the regression analysis, which significantly associated CP with decreased opioid dosing (P < 0.001). In addition, intraoperative opioid dosing, but not CP, predicted ICU admission (odds ratio: 1.463, 95% CI: 1.042–2.054,P = 0.03) and postoperative oxygen desaturation (odds ratio: 1.174, 95% CI: 1.031–1.338,P = 0.02).Conclusions: Similar to prior research on children with cognitive impairment, a reduction in intraoperative opioid dosing was found in children with CP. Given the discrepant doses of intraoperative opioid between groups, it is unclear whether children with CP are at any greater risk for untoward opioid‐related events.
Influence of anesthetic management on quality of magnetoencephalography scan data in pediatric patients: a case series
Authors: KÖNIG MATTHIAS W. , MAHMOUD MOHAMED A. , FUJIWARA HISAKO , HEMASILPIN NAT , LEE KI H. , ROSE DOUGLAS F. 
Published: April 2009

SummaryBackground:  Magnetoencephalography (MEG) is increasingly used in the presurgical evaluation of pediatric seizure patients. Many pediatric patients require sedation or anesthesia to tolerate these exams. However, the available literature on anesthetic management in this population is very limited.Methods:  We retrospectively reviewed the records of all patients who underwent MEG scanning at our institution with regard to the interaction of anesthetic management and quality of scan data.Results:  High‐dose propofol infusions (≥200 μg·kg−1·min−1) were associated with high frequency artifacts that interfered with the identification of epileptiform discharges. Lower‐dose propofol infusions (≤100 μg·kg−1·min−1) did not produce artifacts but required co‐administration of fentanyl to prevent patient motion. Dexmedetomidine infusions were not associated with signal artifacts and prevented patient motion very well in our initial patients and became our standard technique.Conclusion:  In our experience, dexmedetomidine infusions are preferable to propofol‐based techniques for pediatric MEG scans due to the absence of adverse effect on interictal activity.
New soft clinical indicators of neonatal illness severity (Accepted as a poster)
Authors: Johnson C. , Escaped M. , Hagan R. , von Ungern‐Sternberg B.S. 
Published: April 2009

Background:  The Pediatric Risk of Mortality (PRISM) Score serves as a standard for assessing neonatal illness severity. Clinicians also use the Clinical Risk Index for Babies (CRIB) score, American Society of Anesthesiology (ASA) patient classification system, and Patient‐to‐Chart‐Weight Ratio (PCWR).Aims:  This study aimed to determine whether parental behaviour itself accurately reflects illness severity.Method:  Following Ethics Committee approval, neonates admitted to our Neonatal Intensive Care Unit (NICU) underwent a 12‐week assessment. Investigators determined weekly PRISM and CRIB scores, ASA classifications, and patient and case note weights. Additionally, investigators catalogued possessions in, around, and adhering to patients’ cribs, placing each into ‘soft toys’, ‘spiritual amulets’ or ‘other items’ categories.Results:  Investigators followed 102 neonates, collecting 249 observations. PRISM scores correlated best with the ‘spiritual amulets’ category (R2 = 0.82). TOI (Token and Ornament Index), calculated by combining all possessions in the ‘soft toys’, ‘spiritual amulets’, and ‘other items’ categories, correlated nearly so (R2 = 0.71). CRIB Score (R2 = 0.63), ASA classification (R2 = 0.61), and ‘soft toys’ category (R2 = 0.39) all correlated to lesser degrees. Birth and current weight, post conceptual age, NICU days, and PCWR each demonstrated insignificant correlations, the latter even when adjusted for age, NICU days, birth or current weight.Conclusion:  Through gift giving, parents reliably reflect PRISM scores and, by extension, neonatal illness severity. Specifically, number of spiritual amulets alone and TOI correlate well and may therefore serve as independent indicators of clinical status and, potentially, anaesthetic risk. Despite widespread application of PCWR, this study found no support for its validity.Keywords:  neonatal intensive care; illness severity; PRISM score; parental behaviour.
Drainage Network Modelling for Water‐Sensitive Urban Design
Authors: Kunapo Joshphar , Chandra Shobhit , Peterson Jim 
Published: April 2009

AbstractWhile drainage network models may be relatively easy to assemble as a prerequisite to site selection for infrastructure supporting suburbanisation with Water‐Sensitive Urban Design (WSUD), this is unlikely to be the case if the terrain is very subdued. Both ab initio and retro‐fit WSUD implementation for such terrain refers, in the first instance, to a drainage network model that includes information on the scope for optimising residential space while conforming to: (1) statutory planning rules about the provision of public open space; and (2) WSUD drainage network design such that runoff waters are retained long enough to allow at least temporary storage. It is shown in this research that a technique applied to condition a LiDAR DEM can accurately model the drainage network of a basin at the land‐parcel scale. The drainage network for ab initio WSUD is best defined using multi‐flow modelling, with the relative significance of stream segments indicated by their stream order derived using the Strahler method. In contrast, when applying the retro‐fit WSUD, the relative significance of segments given by the Shreve stream order method was found to be more useful. The approaches described in this article are designed to support the initial site planning stage and avoid the need for immediate and expensive detailed field survey. At the same time they can be deployed to show how much scope there is for WSUD retro‐fit in established housing areas up‐stream of an infill development area. Thus, basin‐wide appraisal is facilitated and the need for earthmoving is minimised.
A Chain‐Code‐Based Map Matching Algorithm for Wheelchair Navigation
Authors: Ren Ming , Karimi Hassan A 
Published: April 2009

AbstractAccurate vehicle tracking is essential for navigation systems to function correctly. Unfortunately, GPS data is still plagued with errors that frequently produce inaccurate trajectories. Research in map matching algorithms focuses on how to efficiently match GPS tracking data to the underlying road network. This article presents an innovative map matching algorithm that considers the trajectory of the data rather than merely the current position as in the typical map matching case. Instead of computing the precise angle which is traditionally used, a discrete eight‐direction chain code, to represent a trend of movement, is used. Coupled with distance information, map matching decisions are made by comparing the differences between trajectories representing the road segments and GPS tracking data chain‐codes. Moreover, to contrast the performance of the chain‐code algorithm, two evaluation strategies, linear and non‐linear, are analyzed. The presented chain‐code map matching algorithm was evaluated for wheelchair navigation using university campus sidewalk data. The evaluation results indicate that the algorithm is efficient in terms of accuracy and computational time.
The Effects of Quality Control on Decreasing Error Propagation in the LandScan USA Population Distribution Model: A Case Study of Philadelphia County
Authors: Patterson Lauren , Urban Marie , Myers Aaron , Bhaduri Budhendra , Bright Eddie , Coleman Phillip 
Published: April 2009

AbstractLandScan USA is a 90 m population distribution model that is used for a variety of applications, including emergency management. Models should have a measure of accuracy; however, the accuracy of population distribution models is difficult to determine due to the inclusion of multiple input datasets and the lack of quantifiable, observable (validated) data to confirm model output. Validated data enables quantification of: (1) overall model accuracy and (2) changes in model output at different levels of quality control. This article examines the effect of quality control for two national school datasets incorporated as input in LandScan USA for Philadelphia County, Pennsylvania; which had a local, validated school dataset available. The effect of each stage of quality control efforts utilized throughout the LandScan USA process were assessed to determine what level of quality control was required to have a statistically significant change of the model's population distribution. The typical level of quality control for LandScan USA resulted in 36% of schools being moved to the correct location and 20% of missing student enrollments were found, compared to 87% and 98% respectively for the validated dataset. The costs of increasing quality control resulted in a six‐fold increase in labor time; however, the additional quality control did not produce statistically significant improvements in the LandScan USA model. Thus, typical quality control efforts for schools in LandScan USA produced a population distribution similar to the validated level of quality control, and can be applied with confidence for policy, planning, and emergency situations.
A Least‐Cost Approach to Personal Exposure Reduction
Authors: Davies Gemma , Whyatt Duncan 
Published: April 2009

AbstractConcerns over the potential negative health effects from exposure to air pollution have led to interest in assessing personal exposure and finding ways to reduce it. As journey‐time exposure accounts for a disproportionately high amount of an individual's total exposure, this article assesses the potential to apply least‐cost techniques within a GIS in order to identify paths of lower journey‐time exposure. The methodology adopted uses pollution surfaces for PM10 and CO generated by the dispersion model ADMS, with an analysis mask derived from OS MasterMap to create a least‐cost surface. Actual routes taken by a cohort of 11–13 year old children on their journeys to school are used to compare observed journey time exposure with the exposure along alternative routes generated using the least‐cost path function. While the least‐cost approach proved to be successful in defining low exposure routes the ability to scale up this approach is constrained by the amount of editing required to successfully create an analysis mask from OS MasterMap data. Such alternative routes have the potential to assist in promoting safer environmental choices, however, their likelihood of adoption is dependant on a number of social and environmental influences which affect an individual's route choice.