bluuebunny/crossref_metadata_2025_split huggingface dataset:
Re‐prescribing of causative drugs in persons discharged after serious drug‐induced upper gastrointestinal bleeding
Authors: Dall M. , dePont Christensen R. , Schaffalitzky de Muckadell O. B. , Lassen A. T. , Hallas J. 
Published: February 2012

SummaryBackgroundSeveral drug classes are known to be associated with serious upper gastrointestinal bleeding (UGIB), among others NSAID, low‐dose acetylsalicylic acid (ASA), vitamin K antagonists (VKA), clopidogrel and selective serotonin reuptake inhibitors (SSRIs). There are few data on how and to what extent these drugs are reintroduced in patients who have been discharged after a bleeding episode related to any of them.AimTo assess if physicians re‐prescribed potential causative drugs after an episode of UGIB and to explore whether drugs with antihaemostatic action (DAHA) are re‐prescribed without a gastro‐protective agent.MethodsBy use of the Kaplan–Meyer method, we estimated the time from UGIB to re‐prescribing for 3652 cases who were all admitted to hospital with a diagnosis of serious upper gastrointestinal bleeding from 1995 to 2006. Data on drug exposure were retrieved from a Danish prescription database, a recent study on drug‐related UGIB, and The National Board of Health in Denmark.ResultsOne‐year rates of re‐prescribing after UGIB were; 82%, 25%, 43%, 68%, 55%, 71% for SSRIs, NSAID, low‐dose ASA, VKA, clopidogrel and dipyridamol, respectively. However, re‐prescribing rates without proton pump inhibitors (PPIs) were markedly lower 25%, 3%, 5%, 1%, 17% and 6%, respectively. Non‐users of DAHA had a prevalence of PPI use of about 30% a few months after an UGIB.ConclusionsDrugs with antihaemostatic action are re‐prescribed to a large extent after an episode of upper gastrointestinal bleeding, but usually covered by PPIs. This use of PPI is specific for users of drugs with antihaemostatic action.
Are there new threshold and goals in the treatment of arterial hypertension?
Authors: Segura Julian , Ruilope Luis M. 
Published: February 2012

Eur J Clin Invest 2012AbstractBackground  About half of the global burden of cardiovascular disease has been attributed to high blood pressure (BP). Worldwide, 7·6 million premature deaths (about 13·5% of the global total), 54% of strokes, and 47% of cases of ischemic heart disease were caused by high BP in 2001.Methods and results  All guidelines agree that pharmacological treatment of patients with hypertension should be initiated as soon as BP rises >140/90 mmHg. Available data support the reduction of BP to values to <140/90 mmHg, but do not favor a reduction to <130/80 mmHg in patients with diabetes or a history of cardiovascular disease because of the absence of evidence obtained in prospective studies.Conclusions  This review updates the controversies and challenges involved in the treatment of patients with established arterial hypertension, such as the progression of high‐normal BP to overt hypertension, the choice of appropriate threshold and goal BP levels, the adequate number of drugs to be used since the early stages of hypertension, and which type of combination therapy offers most advantages to the patient.
Clinical simulation fidelity and nurses’ identification of critical event risk: a signal detection analysis
Authors: Thompson Carl , Yang Huiqin , Crouch Simon 
Published: February 2012

thompson c., yang h. & crouch s. (2012) Clinical simulation fidelity and nurses’ identification of critical event risk: a signal detection analysis.Journal of Advanced Nursing68(11), 2477–2485.AbstractAims. This article is a report of a study exploring the effect of increasing fidelity on nurses’ risk detection in clinical simulation and the effect of clinical experience on nurses’ risk detection ability.Background. Clinical environments can be recreated successfully using simulation. However, how judgement changes as simulation fidelity increases is unknown. Knowledge of the effects of increased fidelity on judgement may help in the design of educational interventions seeking to improve clinical judgement in nurses.Design. Quasi experimental signal detection study.Method. During 2008–2009, using a quasi experimental signal detection design, 63 nursing students and 34 experienced nurses were presented with 25 paper and 25 human simulator ‘cases’ based on real patient records from a single UK National Health Service hospital. Nurses judged whether a simulated case was ‘at risk’ or ‘not at risk’ of a critical event. Clinical judgement performance was measured using standard signal detection measures.Findings. Judgement performance, as measured by hit rates and signal detection ability were significantly lower in higher fidelity clinical simulations. False alarm rates and bias (β) did not differ according to the fidelity of simulation. Clinical experience did not predict the ability to detect risk.Conclusion. As fidelity of simulation increased, both novice and experienced nurses’ were less likely to be able to separate important clinical risk from clinical noise in a simulated clinical environment.
Outcome and complications of endoscopic ultrasound guided pancreatic pseudocyst drainage using combined endoprosthesis and naso‐cystic drain
Authors: Puri Rajesh , Mishra Smruti R , Thandassery Ragesh Babu , Sud Randhir , Eloubeidi Mohamad A 
Published: February 2012

AbstractBackground and Aim:  Endoscopic ultrasound guided pancreatic pseudocyst drainage (EUS‐PPD) is increasingly being used for management of pancreatic pseudocysts. We evaluated the outcome and complications of EUS‐PPD with modified combined technique by inserting both endoprosthesis and naso‐cystic drain.Methods:  Forty patients referred between August 2007 and January 2010 for EUS‐PPD were prospectively studied. EUS‐PPD was attempted for symptomatic pancreatic pseudocysts which were; (i) resistant to conservative treatment, (ii) in contact with the gastric or duodenal wall on EUS and (iii) having no bulge seen on endoscopy. Controlled radial expansion wire guided balloon dilation of the puncture tract was performed followed by insertion of a 10 French double pigtail stent and 7‐Fr naso‐biliary drain. The early and late outcome and complications of EUS‐PPD were analyzed.Results:  Thirty‐two patients had non‐infected and eight had infected pseudocysts. EUS‐PPD was technically successful in all. Pseudocysts resolved completely in 39 patients, while one with infected pseudocyst underwent surgical resection for bleeding in the cyst. Naso‐cystic drain was removed in 39 patients after median duration of 13 days. Thereafter, the double pigtail stent was removed in all cases after median duration of 10 weeks. Pseudocyst recurred in one patient requiring a second session of EUS‐PPD. All 32 patients without cystic infection were successfully treated by EUS‐PPD. Seven out of eight patients (87%) with cystic infection were successfully treated by EUS‐PPD.Conclusion:  Endoscopic ultrasound guided pancreatic pseudocyst drainage with modified combined technique is safe and is associated with high success rate.
Enhanced recovery after laparoscopic colorectal resection with primary anastomosis: accelerated discharge is safe and does not give rise to increased readmission rates
Authors: Gash K. J. , Greenslade G. L. , Dixon A. R. 
Published: February 2012

AbstractAims  Enhanced recovery programmes after colorectal surgery are promoted to minimize complications and expedite recovery, thus reducing length of hospital stay where appropriate and improving the overall standard of patient care. There are few published trials of enhanced recovery programmes in the context of laparoscopic colorectal surgery.Methods  Data were prospectively collected on all laparoscopic colorectal resections carried out in our institution from May 2004 to November 2009. An informal move to 48‐h discharge was introduced in May 2004 and the official enhanced recovery programme was launched in November 2008. We identified all patients with a primary anastomosis discharged within 3 days of surgery. Early outcomes – leaks, complications, readmission rates and returns to theatre – were analysed.Results  In all, 606 resections were performed in this period. Median length of stay was 4 (0–52) days. Of these patients, 279 (46%) met the criteria of accelerated discharge by day 3: 2 (0.7%) were discharged on the day of surgery, 70 (25.1%) within 24 h, 116 (41.6%) within 48 h and 91 (32.6%) by 72 h. Age was not a significant factor in determining length of stay. Patients undergoing right hemicolectomy were more likely to be discharged by 24 h than those with left‐sided anastomoses, and patients having total mesorectal excision resections were more likely to stay 3 days. The readmission rate was 4%, regardless of day of discharge.Conclusion  Accelerated discharge is feasible and safe. High readmission rates reported in enhanced recovery programmes after open colorectal surgery have not occurred in our laparoscopic experience.
The use of triclosan eluting stents effectively reduces ureteral stent symptoms: a prospective randomized trial
Authors: Mendez‐Probst Carlos E. , Goneau Lee W. , MacDonald Kyle W. , Nott Linda , Seney Shannon , Elwood Chelsea N. , Lange Dirk , Chew Ben H. , Denstedt John D. , Cadieux Peter A. 
Published: February 2012

Study Type – Therapy (RCT)Level of Evidence 1bWhat's known on the subject? and What does the study add?Infection, encrustation and ureteral‐stent‐related symptoms (USRS) including pain, urgency and frequency are all major problems associated with stent use. No current ureteral stent or exogenously applied therapy adequately deals with these problems and antibiotic use is ineffective once a bacterial biofilm forms on the device. Triclosan is a broad spectrum antibacterial agent widely used in numerous healthcare products and has been previously shown to reduce inflammation on the skin and in the oral cavity. This study tested a triclosan‐impregnated ureteral stent for its ability to reduce infection, encrustation and USRS.This study shows that while a triclosan‐impregnated ureteral stent cannot reduce infection rates alone compared with antibiotic use, the stent can reduce several USRS including pain during indwelling. This study suggests that the triclosan eluting stent may have a role in treating patients, perhaps in combination with standard antibiotic therapy.OBJECTIVE
To evaluate the capacity of triclosan‐loaded ureteral stents to reduce stent‐associated bacterial attachment, biofilm formation and encrustation, thereby potentially reducing infection development and other device‐related sequelae.
PATIENTS AND METHODS
Twenty subjects requiring short‐term stenting (7–15 days) were randomized to receive either a Percuflex Plus® non‐eluting stent (control) or a Triumph® triclosan eluting stent.
Control‐stented subjects received 3 days of levofloxacin prophylaxis (500 mg once daily) while Triumph®‐stented subjects did not.
All subjects were assessed for positive urine and stent cultures, stent biofilm development and encrustation.
Following device removal, each subject completed an analogue‐scale symptom assessment questionnaire.
RESULTS
Ureteral stenting was performed after nine ureteroscopic and one extracorporeal shock wave lithotripsy procedure in the control group and eight ureteroscopic and two shock wave lithotripsy procedures in the triclosan group.
No significant differences were observed for culture, biofilm and encrustation between the two groups.
Subjects in the triclosan group reported significant reductions in lower flank pain scores during activity (58.1% reduction, P= 0.017) and urination (42.6%, P= 0.041), abdominal pain during activity (42.1%, P= 0.042) and urethral pain during urination (31.7%, P= 0.049).
CONCLUSIONS
In this study, the use of the Triumph® triclosan eluting stent had no marked impact on biofilm formation, encrustation or infection development in short‐term stented patients.
The Triumph® device led to significant reductions in several common ureteral‐stent‐related symptoms, supporting its use in this patient population.
An examination of the dynamic changes in prostate‐specific antigen occurring in a population‐based cohort of men over time
Authors: Inman Brant A. , Zhang Jingyu , Shah Nilay D. , Denton Brian T. 
Published: February 2012

Study Type – Diagnosis (exploratory cohort)Level of Evidence 2bWhat's known on the subject? and What does the study add?A single serum PSA measurement is commonly used as a screening test to identify men with prostate cancer. A rise in PSA over time may identify men at increased risk of prostate cancer. Dynamic measures of PSA change (ex: PSA velocity, PSA doubling time) are frequently used to justify prostate biopsy in men.We demonstrate that the current serum PSA is the best predictor of future prostate cancer risk among commonly available clinical variables. We show that dynamic measures of PSA change do not improve upon PSA's ability to predict future prostate cancer. Our study suggests that dynamic measures of PSA change may not be useful in screening for prostate cancer.OBJECTIVE
To determine whether prostate‐specific antigen velocity (PSA‐V), PSA doubling time (PSA‐DT), or PSA percentage change (PSA‐PC) add incremental information to PSA alone for community‐based men undergoing prostate cancer (PCa) screening.
PARTICIPANTS AND METHODS
A population‐based cohort of 11 872 men from Olmsted County, MN undergoing PSA screening for PCa from 1993 to 2005 was analysed for PSA, PSA‐DT, PSA‐PC and PSA‐V and subsequent PCa.
Receiver‐operating characteristics curves and logistic regression were used to calculate the area under the curve (AUC) and Aikaike's information criterion.
Reclassification analysis was performed and the net reclassification improvement and integrated discrimination improvement were measured.
The method of Begg and Greenes was used to adjust for verification bias.
RESULTS
The single best predictor of future PCa was PSA (AUC = 0.773) with PSA‐V (AUC = 0.729) and PSA‐DT/PSA‐PC (AUC = 0.689) performing worse.
After age adjustment, combining PSA with PSA‐V (AUC = 0.773) or PSA‐DT/PSA‐PC (AUC = 0.773) resulted in no better predictions than PSA alone.
Reclassification analysis showed that adding PSA‐V or PSA‐DT/PSA‐PC to PSA did not result in a meaningful amount of reclassification.
CONCLUSIONS
PSA is a better predictor of future PCa than PSA‐V, PSA‐DT, or PSA‐PC.
Adding PSA‐V, PSA‐DT, or PSA‐PC to PSA does not result in clinically relevant improvements in the ability to predict future PCa.
Patients aged more than 70 had higher risk of locally advanced prostate cancers and biochemical recurrence in Korea
Authors: Kim Jung Kwon , Cho Sung Yong , Jeong Chang Wook , Lee Seung Bae , Ku Ja Hyeon , Hong Sung Kyu , Byun Seok‐Soo , Kwak Cheol , Him Hyeon Hoe , Lee Sang Eun , Jeong Hyeon 
Published: February 2012

Study Type – Prognosis (cohort series)Level of Evidence 2bWhat's known on the subject? and What does the study add?This study reports that patients aged 70 years or older have a higher possibility of locally advanced cancer than younger patients. Instead of conservative management, radical eradication of clinically localized prostate cancer should be actively considered in well‐selected healthy patients older than 70 years.OBJECTIVE
To analyse the differences in the clinicopathological results between two groups of Korean patients aged younger or older than 70 years with clinically localized prostate cancer.
METHODS
A cohort of consecutive male patients who underwent radical prostatectomy was retrospectively analysed. In total, 995 patients (74.6%) were younger than 70 years, and 338 patients (25.4%) were 70 years or older.
Biochemical recurrence (BCR) ‐free survival was evaluated in the patients, who were followed up for more than 24 months.
The Kaplan–Meier method was used to calculate survival estimates for BCR‐free survival. Multivariate Cox proportional hazard regression analysis was performed to predict non‐organ‐confined status and BCR.
RESULTS
Mean preoperative prostate‐specific antigen (PSA) levels and biopsy or pathological Gleason scores showed no differences between the two age groups.
Older patients, aged more than 70 years, displayed significantly higher risk of locally advanced prostate cancer and BCR than younger patients.
Subgroup analysis showed that the risk of the presence of locally advanced disease was significantly increased in patients of 70 years or older when we compared the proportion of locally advanced disease only in patients with PSA <4 ng/mL.
Multivariate analysis showed that old age, high PSA and high Gleason score were significantly associated with non‐organ confined status and BCR.
CONCLUSIONS
Patients aged 70 years or older had a higher possibility of locally advanced cancer than younger patients.
Radical eradication of clinically localized prostate cancer should be actively considered in well‐selected healthy patients older than 70 years.
Debulking surgery in the setting of very high‐risk prostate cancer scenarios
Authors: Oderda Marco , Joniau Steven , Spahn Martin , Gontero Paolo 
Published: February 2012

Study Type – Therapy (case series)Level of Evidence 4What's known on the subject? and What does the study add?Nowadays radical prostatectomy (RP) is considered an effective treatment in high‐risk prostate cancer (PCa) and the indications for a surgical approach are expanding, even in cases of very high PSA or node‐positive disease. We explored the outcomes of debulking surgery in the setting of these very high‐risk PCa patients, in order to assess its feasibility.This review confirms the important role achieved by surgery in the complex setting of patients with very high‐risk PCA. Excellent survival rates have been reported, even when PSA exceeds 100 ng/mL. The completion of RP with lymphadenectomy might give a survival benefit in patients who were found intraoperatively to be node‐positive. Furthermore, salvage RP confirmed to be the most effective treatment option after RT failure. On the contrary, up‐to‐date surgery of isolated nodal recurrences has shown only little benefit. Finally, there is no evidence supporting the efficacy of debulking surgery in metastatic or in hormone‐refractory tumours. An accurate selection of the patient is essential.OBJECTIVE
To conduct a critical analysis of the available literature on the feasibility of debulking surgery in the setting of very high‐risk prostate cancer (PCa) scenarios.
PATIENTS AND METHODS
We performed a systematic literature search of PubMed and Embase using combinations of the following keywords: radical prostatectomy, surgery, high‐risk, high PSA (prostate‐specific antigen), radiorecurrent, hormone‐refractory, metastatic prostate cancer, salvage.
With the term ‘very high‐risk PCa’ we indicated a clinical disease beyond the common definition of high‐risk PCa, i.e. any clinical stage > T3, N0 or N+, any PSA level > 50 ng/mL and any recurrent disease after primary treatment.
RESULTS
Radical prostatectomy (RP) achieved excellent survival rates in high‐risk PCa, even in patients with very high PSA level. The completion of RP with lymphadenectomy might give a survival benefit in patients who were found intraoperatively to be node‐positive.
Salvage RP was confirmed to be the most effective treatment option after radiotherapy failure, with increased functional outcomes and decreased side‐effects in the most recent series.
Surgery of isolated nodal recurrences after previous radical therapy has shown little benefit according to the few available series.
There is no evidence supporting the efficacy of debulking surgery in metastatic or hormone‐refractory PCa.
CONCLUSION
Debulking surgery achieved an important role in several aggressive PCa scenarios. An accurate selection of the patient is essential.
Validation of a novel robotic‐assisted partial nephrectomy surgical training model
Authors: Hung Andrew J. , Ng Casey K. , Patil Mukul B. , Zehnder Pascal , Huang Eric , Aron Monish , Gill Inderbir S. , Desai Mihir M. 
Published: February 2012

Study Type – Therapy (case series)Level of Evidence 4What's known on the subject? and What does the study add?One area of particular growth for robotic surgery has been partial nephrectomy. Despite a perceived notion that robotic‐assisted partial nephrectomy is more easily adaptable compared to laparoscopic partial nephrectomy, there is nonetheless an associated learning curve.Validated training models with a corresponding assessment method for robotic‐assisted partial nephrectomy were previously unavailable. We have designed and validated a RAPN surgical model appropriate for resident and fellow training.OBJECTIVE
To evaluate the face, content and construct validities of a novel ex vivo surgical training model for robotic‐assisted partial nephrectomy (RAPN).
METHODS
We prospectively identified participants as novice (not completed any robotic console cases), intermediate (at least one robotic console case but <100 cases), and expert (≥100 robotic console cases). Each participant performed a partial nephrectomy using the da Vinci Si Surgical System on an ex vivo porcine kidney with an embedded Styrofoam ball that mimics a renal tumour. Subjects completed a post‐study questionnaire assessing training model realism and utility. Participants were anonymously judged by three expert reviewers using a validated laparoscopic assessment tool. Performance between groups was compared using the tukey–kramer test.
RESULTS
The 46 participants recruited for this study included 24 novices, nine intermediates, and 13 experts. Overall, expert surgeons rated the training model as ‘very realistic’ (median visual analogue score 7/10) (face validity). Experts also rated the model as an ‘extremely useful’ training tool for residents (median 9/10) and fellows (9/10) (content validity), although less so for experienced robotic surgeons (5/10). Experts outscored novices on overall performance (P= 0.0002) as well as individual metrics, including ‘depth perception,’‘bimanual dexterity,’‘efficiency,’‘tissue handling,’‘autonomy,’‘precision,’ and ‘instrument and camera awareness’ (P < 0.05) (construct validity). Experts similarly outperformed intermediates in most metrics (P < 0.05).
CONCLUSION
Our novel ex vivo RAPN surgical model has demonstrated face, content and construct validity. Future development of this model should include simulation of haemostasis management and renal reconstruction.