bluuebunny/crossref_metadata_2025_split huggingface dataset:
Financial Aspects of Renal Replacement Therapy in Acute Kidney Injury
Authors: James Matthew T. , Tonelli Marcello ,   for the Alberta Kidney Disease Network
Published: April 2011

AbstractAcute kidney injury (AKI) is associated with high morbidity and mortality and consumes substantial health‐care resources, particularly when renal replacement therapy is required. Randomized controlled trials (RCTs) have not identified the optimal mode of renal replacement for AKI in terms of clinically relevant endpoints such as patient survival or recovery of renal function. As for other complex health interventions, the costs and consequences of AKI treatment are relevant to health‐care providers and decision makers aiming to maximize health outcomes despite fixed health resources. Studies from several different centers suggest that continuous renal replacement therapy (CRRT) is more costly than intermittent hemodialysis and less economically attractive than even intensive intermittent dialysis. On the other hand, while the incremental costs of providing CRRT are significant, they remain relatively small compared with the projected costs of providing chronic dialysis to survivors who do not recover renal function. Even small differences in the risk of chronic dialysis in survivors are likely to determine the economic attractiveness of the different types of renal replacement therapies. To clarify the true incremental cost‐effectiveness of these therapies, future RCTs should collect data on long‐term survival, the need for chronic dialysis, and detailed information on costs.
Microbial Control in Renal Support for Acute Kidney Injury
Authors: Luo Yang , Kanagasundaram Nigel S. 
Published: April 2011

AbstractRenal support offers a lifeline for our patients with acute kidney injury but the decision to start it requires a careful evaluation of both its benefits and its risks. Among the latter must be included the threat from microorganisms. The hazards associated with vascular access are real, accepted but also reducible. We discuss the nature of the problem and measures that might reduce the risk. We also discuss a different potential hazard—that of bacterial contamination of the fluids used in our renal therapies. Although a well‐established fact of chronic hemodialysis practice, its scale and relevance in acute renal support has only just started to be defined.
Defining a Significant Stenosis in an Autologous Radio‐Cephalic Arteriovenous Fistula for Hemodialysis
Authors: Fahrtash Farzan , Kairaitis Lukas , Gruenewald Simon , Spicer Tim , Sidrak Hannah , Fletcher John , Allen Richard , Swinnen Jan 
Published: April 2011

AbstractThe current definition of a significant stenosis in an autologous arteriovenous fistula (aAVF), the percentage narrowing compared with the adjacent “normal” vessel, is inaccurate. We believe a significant stenosis in the aAVF is an absolute minimal luminal diameter determined by the requirements of the hemodialysis pump. To determine what absolute diameter constitutes a hemodynamically significant stenosis in a radio‐cephalic autologous arteriovenous fistula (RC aAVF), the minimal luminal diameter of dysfunctional RC aAVF was compared to that of functional RC aAVF using grayscale and color ultrasound. There were 93 fistulas in study group and 77 in control group. The mean minimum luminal diameter in study group was significantly lower than in control group (2.19 vs. 4.71 mm, p 0.001). With a cutoff value of 2.7 mm, there was 90% sensitivity and 80% specificity in distinguishing functional fistula from dysfunctional fistula. The area under the receiver–operator curve was 90% (CI 84–94%), indicating that a 2.7 mm diameter is accurate in discriminating functional from dysfunctional fistulas. An absolute minimal luminal diameter of 2.7 mm, as determined with grayscale and color ultrasound, is a useful cutoff for defining significant stenosis in a RC aAVF.
Peritoneal Dialysis in Acute Kidney Injury: Lessons Learned and Applied
Authors: Burdmann Emmanuel A. , Chakravarthi Rajasekara 
Published: April 2011

AbstractPeritoneal dialysis (PD) is a simple, safe, gentle, and efficient renal replacement therapy (RRT) method. It is able to correct acute kidney injury (AKI)‐induced metabolic, electrolytic, and acid–base disorders and volume overload both in and out the intensive care unit setting. Some PD modalities, such as high‐volume PD and continuous flow PD, can provide RRT doses and efficiency comparable to extracorporeal blood purification methods. PD is particularly suitable for children, patients with refractory heart failure or hemodynamically instable, conditions where systemic anticoagulation should be avoided, patients with difficulty for vascular access and hypo‐ and hyperthermia conditions. In the following manuscript, PD technical aspects and the possible advantages and limitations of this RRT method will be discussed, and the more recent literature on clinical experience with PD for treatment of AKI will be reviewed.
Renal Replacement Therapy in Special Situations: Heart Failure and Neurological Injury
Authors: Mathew Roy O. , Cerdá Jorge 
Published: April 2011

AbstractThe cardiorenal syndrome is a complicated and increasingly prevalent entity requiring a multidisciplinary approach. Renal replacement therapy (RRT) in the form of slow ultrafiltration (UF) demonstrates promise for the treatment of acutely decompensated heart failure. Despite the lack of evidence for decreased mortality, there is considerable short‐term benefit in decreased rehospitalizations and a restoration of diuretic responsiveness. Given the potential for improvement in quality of life and cost if hospitalizations are minimized, slow UF should be considered in patients with repeated hospitalization for decompensated heart failure. Acute neurologic injury is a highly unstable state requiring strict adherence to evidence‐based guidelines to achieve the best possible functional outcomes. With improved short‐term survival, a greater burden of non‐neurologic injury may hinder long‐term functional recovery. Acute kidney injury is among such important considerations that can lead to worsened neurological injury. Careful application of continuous modalities of therapy, probably early in the course of illness to avoid intradialytic osmolar shifts and provide hemodynamic stability, will allow for unimpeded neurologic recovery. Newer evidence on dose and RRT modality on patients with acute and chronic brain injury will certainly add important knowledge to this field.
The Influence of Hemodialysis Membrane Permeability on Serum Paraoxonase‐1 Activity and Oxidative Status Parameters
Authors: Horoz Mehmet , Kiykim Ahmet A. , Cimen Burak , Erdem Abdullah 
Published: April 2011

AbstractWe aimed to measure oxidative stress parameters and paraoxonase‐1 (PON‐1) enzyme activities in chronic hemodialysis (HD) patients and to investigate whether HD membrane permeability has any influence on those measures. Forty‐seven HD patients and 24 controls were enrolled. At the first step of the study, all HD patients had undergone HD treatment via “low‐flux” membranes for 4 weeks. At the second step of the study, the membranes were switched to “high‐flux” membranes and HD treatments were also performed via “high‐flux” membranes for 4 weeks. Blood samples were withdrawn after completion of 4 weeks treatment for each membrane. Total oxidant status (TOS), total antioxidant status (TAS), and paraoxonase and arylesterase activities were measured in blood samples of the patients and the controls. TOS and oxidative stress index (OSI) of both membranes were higher than controls (all, P < 0.05), while TAS and paraoxonase and arylesterase activities were lower (all P < 0.05). Paraoxonase (P < 0.05, r = −0.437 and P < 0.05, r = −0.453, respectively) and arylesterase (P < 0.05, r = −0.333 and P < 0.05, r = −0.371, respectively) activities of “low‐flux” and “high‐flux” membranes were inversely correlated with OSI. There were no significant differences between “low‐flux” and “high‐flux” membranes in regard to oxidative stress parameters or PON‐1 enzyme activities (all, P > 0.05). HD patients have increased oxidative stress and decreased serum PON‐1 activities inversely correlated with oxidative stress. Membrane permeability seems to have no influence on oxidative stress parameters and PON‐1 enzyme activities.
Impaired Glutamatergic Neurotransmission in Migraine With Aura? Evidence by an Input–Output Curves Transcranial Magnetic Stimulation Study
Authors: Cosentino Giuseppe , Fierro Brigida , Vigneri Simone , Talamanca Simona , Palermo Antonio , Puma Angela , Brighina Filippo 
Published: April 2011

(Headache 2011;51:726‐733)Objective.— An imbalance between activity of inhibitory and facilitatory intracortical circuits could play a central role in migraine etiology. We used input–output curves to achieve further information about intracortical excitability of motor cortex in migraine with aura.Methods.— Input–output curves were measured in the right abductor pollicis brevis muscle at rest in 12 patients suffering from migraine with aura and 8 healthy subjects. Stimuli were delivered at intensity ranging from 100% to 160% of resting motor threshold with 10‐second inter‐stimulus intervals. Seven patients were studied before and during treatment with levetiracetam.Results.— Results showed a greater motor‐evoked potential amplitude in response to increasing intensity of stimuli in patients compared to controls (P < .02). This increased facilitatory effect was abolished by levetiracetam (P < .005).Conclusions.— Our findings support the hypothesis of an interictal cortical hyper‐responsivity in migraine patients that appears to be normalized by levetiracetam. This effect could support the potential therapeutic role of levetiracetam in migraine with aura prevention.
Sumatriptan–Naproxen Sodium for Menstrual Migraine and Dysmenorrhea: Satisfaction, Productivity, and Functional Disability Outcomes
Authors: Cady Roger K. , Diamond Merle L. , Diamond Michael P. , Ballard Jeanne E. , Lener Michelle E. , Dorner Deborah P. , Derosier Frederick J. , McDonald Susan A. , White Jonathan , Runken M. Chris 
Published: April 2011

(Headache 2011;51:664‐673)Objective.— To evaluate the impact of a sumatriptan/naproxen sodium combination tablet on patient satisfaction, productivity, and functional disability in menstrual migraine treated during the mild pain phase of a single menstrual migraine attack associated with dysmenorrhea.Background.— Menstrual migraineurs with dysmenorrhea represent a unique patient population not previously studied. When health outcomes end points are analyzed alongside traditional efficacy end points in migraine studies, a more comprehensive and robust understanding of the many factors that may influence patients' choice of and adherence to pharmacological treatments for migraine is observed.Methods.— In 2 replicate, multicenter, randomized, double‐blind, placebo‐controlled trials, participants with menstrual migraine and dysmenorrhea treated a single menstrual migraine attack with a single fixed‐dose tablet of sumatriptan 85 mg formulated with RT Technology™ and naproxen sodium 500 mg (sumatriptan–naproxen sodium) or placebo.Results.— Participants randomized to sumatriptan–naproxen sodium were significantly more satisfied than those randomized to placebo at 24 hours post dose, as demonstrated by higher satisfaction subscale scores for efficacy (P < .001 for both studies), functionality (P = .003 for study 1; P < .001 for study 2), and ease of use (P = .027 for study 1; P = .011 for study 2). There was little bothersomeness of side effects associated with either treatment. Use of sumatriptan–naproxen sodium was also associated with lower reported “lost‐time equivalents” in work and leisure time (pooled analysis, P = .003) and lower rates of functional disability (P = .05, study 1; P < .001, study 2) compared with placebo.Conclusion.— A fixed‐dose combination tablet containing sumatriptan and naproxen sodium significantly improved patient satisfaction, productivity, and restoration of normal functioning in menstrual migraineurs with dysmenorrhea.
Hybrid Cemented/Cementless Total Hip Replacement in Dogs: Seventy‐Eight Consecutive Joint Replacements
Authors: Gemmill Toby J. , Pink Jonathan , Renwick Alasdair , Oxley Bill , Downes Ciara , Roch Simon , McKee W. Malcolm 
Published: April 2011

Objective:To evaluate the use of hybrid total hip replacement (THR), using a cementless acetabular component and a cemented femoral component.Study Design:Prospective case series.Sample Population:Client‐owned dogs (n=71).Materials and Methods:Consecutive clinical cases that had hybrid THR were studied. Radiographic features, pain scores, and lameness scores were recorded pre‐ and postoperatively. Longer term outcome was assessed by owner questionnaire.Results:Hybrid THRs (n=78) were performed in 71 dogs. Four cases (5%) had major postoperative complications; 3 were resolved after revision surgery, and 1 owner requested an explantation. No other major complications were identified on follow‐up radiographs (67 THR) at 12 weeks. On clinical follow up (77 THR) at 4 weeks, lameness had improved in 68, was unchanged in 8, and was worse in 1. Pain had decreased in 72, was unchanged in 4, and was worse in 1. At 12 weeks (69 THR) compared with preoperative status, lameness had improved in 67 and was unchanged in 2. Pain had improved in 68 and was unchanged in 1. Longer term follow‐up (mean, 16 months) was available for all hips. No further complications were reported. Owner satisfaction was good for 76 THRs and reasonable for 2.Conclusions:Hybrid THR can be performed successfully with a low complication rate and represents an alternative to either entirely cemented or cementless implantation.
Evaluation of Four Techniques for Injecting the Trochanteric Bursa of Horses
Authors: Tóth Ferenc , Schumacher Jim , Schramme Michael , Hecht Silke 
Published: April 2011

Objective: To describe the anatomic features of the equine trochanteric bursa and to evaluate 4 techniques for bursa centesis.Study Design: Prospective, randomized design.Animals: Equine cadavers (n=2) and 20 live horses.Methods: The trochanteric bursae of 2 equine cadavers were injected with latex to identify the boundaries of the bursae. Four techniques for centesis of the trochanteric bursa were evaluated by attempting to inject dye into both trochanteric bursae of 20 live horses. Techniques included injection of the bursa with the limb‐bearing weight and injection with the limb nonweight bearing and supported on a block, with or without ultrasonographic guidance of the needle. Ultrasonographic guidance of the needle was performed with or without the use of a guide channel attached to the ultrasound probe. Each of the 4 techniques was used to inject 10 bursae. The region of the bursa was dissected after horses were euthanatized to determine the location of the dye.Results: The trochanteric bursa was most successfully injected with the limb positioned caudally with the foot on a block, even though topographic landmarks for centesis were more difficult to identify when the limb was in this position. The highest incidence of success was achieved when the needle was inserted using ultrasonographic guidance with the foot in a Hickman block.Conclusion: Positioning the limb caudally with the foot nonweight bearing and on a block facilitated centesis of the trochanteric bursa.
Smoking Cessation and Chronic Pain: Patient and Pain Medicine Physician Attitudes
Authors: Hooten W. Michael , Vickers Kristin S. , Shi Yu , Ebnet Kaye L. , Townsend Cynthia O. , Patten Christi A. , Warner David O. 
Published: April 2011

Abstract:Although previous studies suggest that the clinical setting of an interdisciplinary pain treatment program may provide an optimal environment to promote smoking cessation, currently available smoking cessation interventions may be less effective for adults with chronic pain due, in part, to unrecognized clinical factors related to chronic pain. The specific aim of this qualitative study was to solicit information from adult smokers with chronic pain participating in an interdisciplinary pain treatment program regarding their perceptions of how smoking affects pain symptoms, and how these beliefs, cognitions, and emotions may either impede or facilitate smoking cessation. Similar information was solicited from a group of pain specialty physicians. The study involved 18 smokers with chronic pain, and seven physicians. Patients reported that smoking was an important coping strategy for pain and distress, primarily by offering an opportunity for distraction and avoidance, respectively. The majority of patients using opioids reported that opioid consumption stimulated smoking. Important barriers were identified toward making a quit attempt during pain treatment including quitting smoking while making changes in opioid use, and perceived difficulty managing multiple treatment‐related stressors. Several pain‐related benefits of smoking cessation were identified by physicians, but important barriers to providing smoking cessation services were recognized including lack of time and knowledge about how to help patients quit smoking. The findings of this study identified several novel and important clinical factors that should be incorporated into a targeted smoking cessation intervention for adults with chronic pain.
Expectations of an Emergency Medicine Clerkship Director
Authors: Rogers Robert L. , Wald David A. , Lin Michelle , Zun Leslie S. , Christopher Theodore , Manthey David E. 
Published: April 2011

Academic Emergency Medicine 2011; 18:513–518 © 2011 by the Society for Academic Emergency MedicineAbstractThe clerkship director (CD) serves as a faculty leader within a school of medicine and plays a vital role in the hierarchy of undergraduate medical education. Collectively, CDs across specialties serve a multitude of roles and are responsible for clerkship administration, curricular development, teaching, mentoring, and advising students. The emergency medicine (EM) CD has a vitally important role to play in the future development of medical students. EM CDs should be valued and supported, because they often represent our specialty within the medical school and play a vital role in training the physicians of tomorrow. Opportunities and resources must be made available to CDs to run and maintain a successful EM clerkship, while also balancing their clinical duties and academic endeavors. In addition, EM CDs need support from their respective medical schools and departments to run highly successful medical student rotations.This article was prepared with the objective of establishing the importance of the EM CD, defining the job description of the CD, explaining the importance of adequate release time to perform the role of the CD, and describing the necessary resources and support for the position. With EM becoming an increasingly popular and integral rotation for medical students, it is likely that additional emphasis will be placed on the role of the EM CD. This reference document serves as a template for the job description and expectations of an EM CD.
Using Second Life Virtual Simulation Environment for Mock Oral Emergency Medicine Examination
Authors: Schwaab Jillian , Kman Nicholas , Nagel Rollin , Bahner David , Martin Daniel R. , Khandelwal Sorabh , Vozenilek John , Danforth Douglas R. , Nelson Richard 
Published: April 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:559–562 © 2011 by the Society for Academic Emergency MedicineAbstractObjectives:  Oral examination is a method used to evaluate emergency medicine (EM) residents and is a requirement for board certification of emergency physicians. Second Life (SL) is a virtual three‐dimensional (3‐D) immersive learning environment that has been used for medical education. In this study we explore the use of SL virtual simulation technology to administer mock oral examinations to EM residents.Methods:  This was a prospective observational study of EM residents who had previously completed mock oral examinations, participating in a similar mock oral examination case scenario conducted via SL. EM residents in this training program completed mock oral examinations in a traditional format, conducted face to face with a faculty examiner. All current residents were invited to participate in a similar case scenario conducted via SL for this study. The examinee managed the case while acting as the physician avatar and communicated via headset and microphone from a remote computer with a faculty examiner who acted as the patient avatar. Participants were surveyed regarding their experience with the traditional and virtual formats using a Likert scale.Results:  Twenty‐seven EM residents participated in the virtual oral examination. None of the examinees had used SL previously. SL proved easy for examinees to log into (92.6%) and navigate (96.3%). All felt comfortable communicating with the examiner via remote computer. Most examinees thought the SL encounter was realistic (92.6%), and many found it more realistic than the traditional format (70.3%). All examinees felt that the virtual examination was fair, objective, and conducted efficiently. A majority preferred to take oral examinations via SL over the traditional format and expressed interest in using SL for other educational experiences (66.6 and 92.6%, respectively).Conclusions:  Application of SL virtual simulation technology is a potential alternative to traditional mock oral examinations for EM residents.
Coast Guard Reliability‐Centered Maintenance
Authors: LINTON ERIC M. 
Published: April 2011

AbstractSince 2001, the Coast Guard's surface fleet has had a condition‐based maintenance (CBM) policy. The reliability‐centered maintenance (RCM) process is used to implement the policy by identifying minimum system maintenance requirements. The Coast Guard's RCM program provides the standards and capabilities needed to develop preventive maintenance systems that satisfy operational requirements. RCM requirements are based on the industry standard SAE JA‐1011, which provides evaluation criteria for RCM processes. Department of Defense (DoD) data‐deliverable specifications, training programs, continuous improvement functions, information system requirements, and condition assessment programs complete the Coast Guard's RCM program. This paper discusses the genesis of the Coast Guard surface fleet's RCM program, how it is managed, and the benefits that it provides.
Automated Noise Measurement System for Radar and EW Transmitter Components
Authors: HOOVER LOWELL , CRESPO WILLIAM , MITSDARFFER BRYAN 
Published: April 2011

AbstractThe development of a 2–18 GHz instrument for radar and electronic warfare (EW) transmitter test and measurement is reported. The transmitter component analyzer was developed by NSWC Crane to measure critical performance parameters of the AN/SPY‐1 radar's components. Typical measurements include clutter attenuation, clutter improvement factor, intrapulse noise, moving target indicator residues, random pulse jitter, systematic pulse jitter, phase noise, and amplitude noise.