bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediction of fluid responsiveness using respiratory variations in left ventricular stroke area by transoesophageal echocardiographic automated border detection in mechanically ventilated patients
Authors: Cannesson Maxime , Slieker Juliette , Desebbe Olivier , Farhat Fadi , Bastien Olivier , Lehot Jean-Jacques 
Published: December 2006

Abstract
Background
Left ventricular stroke area by transoesophageal echocardiographic automated border detection has been shown to be strongly correlated to left ventricular stroke volume. Respiratory variations in left ventricular stroke volume or its surrogates are good predictors of fluid responsiveness in mechanically ventilated patients. We hypothesised that respiratory variations in left ventricular stroke area (ΔSA) can predict fluid responsiveness.

Methods
Eighteen mechanically ventilated patients undergoing coronary artery bypass grafting were studied immediately after induction of anaesthesia. Stroke area was measured on a beat-to-beat basis using transoesophageal echocardiographic automated border detection. Haemodynamic and echocardiographic data were measured at baseline and after volume expansion induced by a passive leg raising manoeuvre. Responders to passive leg raising manoeuvre were defined as patients presenting a more than 15% increase in cardiac output.

Results
Cardiac output increased significantly in response to volume expansion induced by passive leg raising (from 2.16 ± 0.79 litres per minute to 2.78 ± 1.08 litres per minute; p < 0.01). ΔSA decreased significantly in response to volume expansion (from 17% ± 7% to 8% ± 6%; p < 0.01). ΔSA was higher in responders than in non-responders (20% ± 5% versus 10% ± 5%; p < 0.01). A cutoff ΔSA value of 16% allowed fluid responsiveness prediction with a sensitivity of 92% and a specificity of 83%. ΔSA at baseline was related to the percentage increase in cardiac output in response to volume expansion (r = 0.53, p < 0.01).

Conclusion
ΔSA by transoesophageal echocardiographic automated border detection is sensitive to changes in preload, can predict fluid responsiveness, and can quantify the effects of volume expansion on cardiac output. It has potential clinical applications.
Dissection of a metastatic gene expression signature into distinct components
Authors: Roepman Paul , de Koning Erica , van Leenen Dik , de Weger Roel A , Kummer J Alain , Slootweg Piet J , Holstege Frank CP 
Published: December 2006

Abstract
Background
Metastasis, the process whereby cancer cells spread, is in part caused by an incompletely understood interplay between cancer cells and the surrounding stroma. Gene expression studies typically analyze samples containing tumor cells and stroma. Samples with less than 50% tumor cells are generally excluded, thereby reducing the number of patients that can benefit from clinically relevant signatures.

Results
For a head-neck squamous cell carcinoma (HNSCC) primary tumor expression signature that predicts the presence of lymph node metastasis, we first show that reduced proportions of tumor cells results in decreased predictive accuracy. To determine the influence of stroma on the predictive signature and to investigate the interaction between tumor cells and the surrounding microenvironment, we used laser capture microdissection to divide the metastatic signature into six distinct components based on tumor versus stroma expression and on association with the metastatic phenotype. A strikingly skewed distribution of metastasis associated genes is revealed.

Conclusion
Dissection of predictive signatures into different components has implications for design of expression signatures and for our understanding of the metastatic process. Compared to primary tumors that have not formed metastases, primary HNSCC tumors that have metastasized are characterized by predominant down-regulation of tumor cell specific genes and exclusive up-regulation of stromal cell specific genes. The skewed distribution agrees with poor signature performance on samples that contain less than 50% tumor cells. Methods for reducing tumor composition bias that lead to greater predictive accuracy and an increase in the types of samples that can be included are presented.
Anthracyclines, Mitoxantrone, Radiotherapy, and Granulocyte Colony-Stimulating Factor: Risk Factors for Leukemia and Myelodysplastic Syndrome After Breast Cancer
Authors: Le Deley Marie-Cécile , Suzan Florence , Cutuli Bruno , Delaloge Suzette , Shamsaldin Akthar , Linassier Claude , Clisant Stéphanie , de Vathaire Florent , Fenaux Pierre , Hill Catherine 
Published: December 2006

Purpose To determine the risk factors for acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) after breast cancer. Patients and Methods We conducted a case-control study among women treated for breast cancer between 1985 and 2001 in French general hospitals, cancer centers, or clinics. We included 182 AML and MDS patients and 534 matched controls. Breast cancer characteristics, type of treatment, and family history of cancer were compared in both groups. Results The risk of AML/MDS was increased after topoisomerase-II inhibitor–based chemotherapy (P < 10−16) and was higher for mitoxantrone-based chemotherapy than for anthracycline-based chemotherapy (relative risk [RR] = 15.6; 95% CI, 7.1 to 34.2; and RR = 2.7; 95% CI, 1.7 to 4.5, respectively). After adjustment for other treatment components, the risk of AML/MDS in patients who received radiotherapy was multiplied by 3.9 (95% CI, 1.4 to 10.8) but was not increased by alkylating agents. Patients receiving granulocyte colony-stimulating factor (G-CSF) support had an increased risk of AML/MDS (RR = 6.3; 95% CI, 1.9 to 21), even when controlling for chemotherapy doses. Similar results were obtained when AML and MDS were considered separately. Conclusion This large case-control study demonstrates that the risk of AML/MDS is much higher with mitoxantrone-based chemotherapy than with anthracyclines-based chemotherapy in a population of women recently treated for breast cancer. The risk of AML/MDS associated with mitoxantrone must be kept in mind when using this drug to treat diseases other than breast cancer (eg, prostate cancer or multiple sclerosis). In addition, our study suggests the need to monitor the long-term effects of G-CSF therapy.
Effect of Patient Socioeconomic Status and Body Mass Index on the Quality of Breast Cancer Adjuvant Chemotherapy
Authors: Griggs Jennifer J. , Culakova Eva , Sorbero Melony E.S. , van Ryn Michelle , Poniewierski Marek S. , Wolff Debra A. , Crawford Jeffrey , Dale David C. , Lyman Gary H. 
Published: December 2006

Purpose The purpose of this study was to investigate the relationship between socioeconomic status (SES) and the use of intentionally reduced doses of chemotherapy in the adjuvant treatment of breast cancer. Patients and Methods Patients with breast cancer treated with a standard chemotherapy regimen (n = 764) were enrolled in a prospective registry after signing informed consent. Detailed information was collected on patient, disease, and treatment, including chemotherapy doses. Zip code level data on median household income, proportion of people living below the poverty level, and educational attainment were obtained from the US Census. Doses for the first cycle of chemotherapy lower than 85% of standard were considered to be reduced. Univariate analyses and multivariate logistic regression were performed to identify factors associated with the use of reduced first cycle doses. Results In univariate analysis, individual education attainment, zip code SES measures, body mass index, and geographic region were all significantly associated with receipt of intentionally reduced doses of chemotherapy. In multivariate analysis, controlling for geography, factors independently associated with reduced doses were obesity (odds ratio [OR], 2.47; 95% CI, 1.36 to 4.51), severe obesity (OR, 4.04; 95% CI, 1.46 to 11.19), and education less than high school (OR, 3.07; 95% CI, 1.57 to 5.99). Conclusion Social disparities in breast cancer outcomes may be in part the result of lower quality chemotherapy doses in the adjuvant treatment of breast cancer. Efforts to address such prescribing patterns may help reduce SES disparities in breast cancer survival.
American Society of Clinical Oncology/College of American Pathologists Guideline Recommendations for Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer
Authors: Wolff Antonio C. , Hammond M. Elizabeth H. , Schwartz Jared N. , Hagerty Karen L. , Allred D. Craig , Cote Richard J. , Dowsett Mitchell , Fitzgibbons Patrick L. , Hanna Wedad M. , Langer Amy , McShane Lisa M. , Paik Soonmyung , Pegram Mark D. , Perez Edith A. , Press Michael F. , Rhodes Anthony , Sturgeon Catharine , Taube Sheila E. , Tubbs Raymond , Vance Gail H. , van de Vijver Marc , Wheeler Thomas M. , Hayes Daniel F. 
Published: December 2006

Purpose To develop a guideline to improve the accuracy of human epidermal growth factor receptor 2 (HER2) testing in invasive breast cancer and its utility as a predictive marker. Methods The American Society of Clinical Oncology and the College of American Pathologists convened an expert panel, which conducted a systematic review of the literature and developed recommendations for optimal HER2 testing performance. The guideline was reviewed by selected experts and approved by the board of directors for both organizations. Results Approximately 20% of current HER2 testing may be inaccurate. When carefully validated testing is performed, available data do not clearly demonstrate the superiority of either immunohistochemistry (IHC) or in situ hybridization (ISH) as a predictor of benefit from anti-HER2 therapy. Recommendations The panel recommends that HER2 status should be determined for all invasive breast cancer. A testing algorithm that relies on accurate, reproducible assay performance, including newly available types of brightfield ISH, is proposed. Elements to reliably reduce assay variation (for example, specimen handling, assay exclusion, and reporting criteria) are specified. An algorithm defining positive, equivocal, and negative values for both HER2 protein expression and gene amplification is recommended: a positive HER2 result is IHC staining of 3+ (uniform, intense membrane staining of > 30% of invasive tumor cells), a fluorescent in situ hybridization (FISH) result of more than six HER2 gene copies per nucleus or a FISH ratio (HER2 gene signals to chromosome 17 signals) of more than 2.2; a negative result is an IHC staining of 0 or 1+, a FISH result of less than 4.0 HER2 gene copies per nucleus, or FISH ratio of less than 1.8. Equivocal results require additional action for final determination. It is recommended that to perform HER2 testing, laboratories show 95% concordance with another validated test for positive and negative assay values. The panel strongly recommends validation of laboratory assay or modifications, use of standardized operating procedures, and compliance with new testing criteria to be monitored with the use of stringent laboratory accreditation standards, proficiency testing, and competency assessment. The panel recommends that HER2 testing be done in a CAP-accredited laboratory or in a laboratory that meets the accreditation and proficiency testing requirements set out by this document.
Pilot randomised controlled trial of community pharmacy administration of buprenorphine versus methadone
Authors: Cameron Isobel M , Matheson Catriona I , Bond Christine M , Lawrie Thane , McNamee Paul , Robinson Andrew , Robertson George , Eagles Lucy E 
Published: December 2006

Abstract

Objectives
The established regime for opiate substitute prescribing for drug misusers is daily methadone administered under supervision in community pharmacies. Buprenorphine has recently been introduced as an alternative. However there is a lack of evidence of the effectiveness of buprenorphine maintenance therapy (BMT) in the UK treatment setting. This study aimed to assess methods for a randomised controlled trial (RCT) and the feasibility of pharmacy-based supervised self-administration (SSA) of buprenorphine compared to methadone.

Setting
Specialist substance misuse service, general practices and community pharmacies in Aberdeen, Scotland.

Method
The design was a pilot RCT. Opiate-dependent drug misusers, newly referred for maintenance treatment were randomised to receive BMT or methadone maintenance therapy (MMT). Clients and pharmacists were interviewed at baseline and at the end of a 12-week intervention period. Clients completed the quality of life measure EQ-5D. Pharmacy activities were timed.

Key findings
Twenty-one opiate-dependent clients were recruited (BMT = 11, MMT = 10). Recruitment levels improved as the trial progressed. Clients' treatment preferences were evident. Withdrawals occurred early with BMT. Clients found SSA of buprenorphine acceptable, but found daily administration more manageable than three times weekly. Pharmacists found the dispensing of buprenorphine to be an acceptable role, but felt less certain of ensuring against diversion with buprenorphine than they were with methadone. Pharmacy activities associated with buprenorphine took longer than those associated with methadone (mean = 7 min 25 s versus mean = 3 min 27 s, respectively).

Conclusion
Recruitment to a trial comparing MMT to BMT for opiate-dependent clients within a UK treatment setting is feasible. Clients and pharmacists found buprenorphine acceptable.
Why educational interventions are not always effective: a theory-based process evaluation of a randomised controlled trial to improve non-prescription medicine supply from community pharmacies†
Authors: Watson Margaret C , Bond Christine M , Walker Anne , Grimshaw Jeremy 
Published: December 2006

Abstract

Objective
The Theory of Planned Behaviour (TPB) has been used to explore health professionals' intentions to behave in a particular way. This study measured community pharmacists' behavioural intention and actual behaviour as part of an evaluation of a randomised controlled trial (RCT) of two educational interventions to promote the appropriate treatment of vaginal candidiasis in community pharmacies. This study aimed to explore reasons for the success or failure of educational interventions by conducting a theory-based process evaluation alongside the RCT.

Method
The RCT was conducted in 60 community pharmacies in Grampian, Scotland, and compared educational outreach visits and continuing education workshops. A postal questionnaire was conducted, comprising five measures derived from TPB: behaviour; behavioural intention, attitudes, subjective norms, and perceived behavioural control; together with a measure of clinical knowledge of candidiasis and its treatment; and a measure of guideline compliance. Guideline compliance was assessed using four scenarios. Simulated patient visits were made to participating pharmacies to derive objective measures of actual behaviour.

Results
Completed questionnaires were returned from 50 pharmacists (response rate: 83%). Forty (80%) respondents were fully guideline compliant (correct response with all four scenarios). Pharmacists' knowledge was high and they had positive attitudes towards the supply of antifungals, as well as strong intentions to sell them appropriately. No statistically significant differences were shown in questionnaire responses or actual behaviour across the four trial groups.

Conclusion
This evaluation demonstrates that the interventions may have failed because of psychological ceiling effects, i.e. existing attitudes and intentions were already strong. Further studies are needed to identify factors that prevent strong intentions from being put into practice, in order to develop effective interventions.
Perspectives on the role of the community pharmacist in the provision of healthcare to people with intellectual disabilities: exploration of the barriers and solutions
Authors: Di Blasi Amanda , Kendall Sharon , Spark M Joy 
Published: December 2006

AbstractObjectiveThe objective of this study was twofold: to gain an understanding of the perceptions of individual pharmacists in relation to their role in the provision of healthcare for people with intellectual disabilities, and to identify barriers impacting on successful implementation of this role; secondly to explore strategies and solutions for improving pharmacists' involvement in the delivery of healthcare to this group.SettingA purposeful sample of 10 community pharmacists, located in the Loddon Mallee Region, north central rural Victoria, Australia.MethodA descriptive qualitative design was adopted in this study. Data collection was via face-to-face, one-to-one, semi-structured interviews. The data were analysed thematically via a three-stage coding process: open, axial and selective coding.Key findingsThe study highlighted factors such as time resources; education, training, and experience in the field of intellectual disabilities; inadequate interprofessional communication; and the client's communication abilities and capacity to understand to be the most significant barriers to the provision of healthcare to people with intellectual disabilities, for this sample of community pharmacists. Suggested solutions to these barriers included emphasising the need for education and training, and increased staff recruitment. Community pharmacists emphasised the need for adequate collaboration with other health professionals, and the importance of communication with people with intellectual disabilities and their carers.ConclusionThe research study highlighted a significant number of barriers perceived by the sample of community pharmacists, and proposed solutions to overcome these barriers in order to better assist community pharmacists in providing healthcare to people with intellectual disabilities.
The use of consultation skills assessment tools in pharmacist-patient consultations
Authors: Greenwood Katherine , Howe Amanda , Holland Richard 
Published: December 2006

Abstract

Objective
The consultations assessed in this study occurred as part of a larger randomised controlled trial (the HeartMed trial) which was evaluating the impact of home visits by pharmacists to patients with heart failure. Pharmacists are increasingly being expected to take on roles involving extended interviews with patients, but while the doctor-patient consultation has been well researched, such analysis has rarely been undertaken in pharmacy practice. The aim of this study was to analyse the consultation skills used by pharmacists using two validated consultation skills assessment tools (the Henbest and Stewart rating scale and the SEGUE score), and to assess the applicability of these tools to the pharmacist-patient consultation.

Setting
The study involved pharmacist consultations with patients who were aged over 18 years, living in independent accommodation and were prescribed two or more medicines taken on at least a daily basis. These patients were recruited to the HeartMed trial during an acute admission to hospital with heart failure, and were visited by a pharmacist during the first six weeks following hospital discharge.

Method
The pharmacist-patient consultations were tape-recorded, transcribed and evaluated using two different consultation skills tools — the Henbest and Stewart rating scale which assesses ‘patient centredness’ and the SEGUE score which assesses the content of the consultation.

Key findings
Both consultation skills tools were easily applied to the pharmacist-patient consultations. The pharmacists scored well on both the tools despite relatively little formal training.

Conclusions
Existing consultation skills tools can be used to assess pharmacist-patient consultations.
Professional development of pharmaceutical care in type 2 diabetes mellitus: a multidisciplinary conceptual model
Authors: Power Ailsa , Douglas Elizabeth , McGregor Anna Marie , Hudson Steve 
Published: December 2006

Abstract

Objective
To generate a validated model of care providing a framework for continued professional development of the community pharmacist for patients with type 2 diabetes mellitus.

Setting
A purposive sample of medical, nursing and community pharmacist interviewees in 10 health boards in Scotland.

Method
Investigation, using a semi-structured questionnaire approach, of the views held by 19 healthcare practitioners.

Key findings
A model of multidisciplinary diabetes care was generated to aid definition of pharmaceutical care provision. Processes emphasised in the model were: compliance monitoring, agreed multidisciplinary protocols and the continuity of patient education. Potential areas for community pharmacist contributions included the running of diabetes clinics, provision of patient education, near-patient testing, repeat dispensing and identification of clinic defaulters.

Conclusions
Development of the community pharmacists' role for patients with type 2 diabetes mellitus requires extensions to current independently delivered patient-centred services through working in partnership with other professionals. Methods of improved communication and attention to methods of referral, where appropriate, are important focal points. The targeting of this care and the care model that is best suited to particular settings will be subject to local variation. The generation of a diabetes care model offers pharmacists a means of matching learning opportunities to their needs. It is also a step towards the development of appropriate continued professional development tools and systems to equip community pharmacists for the future.
A pharmacovigilance study for monitoring adverse drug reactions with antihypertensive agents at a South Delhi hospital
Authors: Aqil Mohammed , Imam Faisal , Hussain Arshad , Alam M S , Kapur Prem , Pillai K K 
Published: December 2006

Abstract

Objective
The aim of the present study was to conduct a pharmacovigilance study to monitor adverse drug reactions (ADRs) associated with antihypertensive drugs.

Setting
The study was conducted in the medicine outpatient department of the 150-bedded Majeedia Hospital in South Delhi.

Method
The study was conducted by a registered pharmacist by way of one-to-one patient interview by the pharmacist based on a questionnaire (ADR monitoring form) drafted according to World Health Organization (WHO) ADR monitoring guidelines.

Key findings
A total of 22 ADRs were observed in 205 patients (95 males and 110 females) of mean age 49.6 ± 12 years and mean body mass index 25.7 ± 14.9 kg/m2. Out of 22 ADRs, 13 (59.1%) were mild, 8 (36.4%) were moderate and only 1 (4.5%) was classified as severe. Amlodipine was the drug associated with maximum ADRs (36.4%), followed by atenolol (13.6%), metoprolol and nevibilol (4.5% each).

Conclusion
The above pharmacovigilance study presents the ADR profile of antihypertensive medicines prescribed in our university teaching hospital. Calcium channel blockers was the prescribed drug category associated with maximum ADRs, followed by beta-blockers, angiotensin-converting enzyme inhibitors and diuretics.