bluuebunny/crossref_metadata_2025_split huggingface dataset:
Audit of the care of the dying in a network of hospitals and institutions in Queensland
Authors: Hardy J. R. , Haberecht J. , Maresco‐Pennisi D. , Yates P. 
Published: May 2007

AbstractBackground: Most Australians die in institutions and there is evidence to suggest that the care of these patients is not always optimal. Care pathways for the dying have been designed to transfer benchmarked hospice care to other settings (e.g. acute hospitals and residential age‐care facilities) by defining goals of best care, providing guidelines to provide that care and documenting outcome.Method: A retrospective audit was undertaken across a network of health‐care institutions in Queensland. The 18 goals considered essential for the care of the dying within the Liverpool Care Pathway were taken as a benchmark. Documentation of achievement of each of these goals was sought.Results: The notes of 160 patients who had died in eight institutions (four hospitals, three hospices, one nursing home) were reviewed. Several areas for improvement were identified, particularly in those goals relating to communication, resuscitation orders and care after death. Few units documented the provision of written information to families. Most patients were prescribed medications in anticipation of pain and agitation but less were prescribed drugs for other common symptoms in the dying. Most of the goals were achieved in a higher percentage of cases in hospice units. Marked differences in practice were noted between different institutions.Conclusion: The audit identified several aspects in the care of the terminally ill that could be improved. End‐stage pathways may provide a model for improving the care of patients dying in hospitals and institutions in Australia.
Severe intimal hyperplasia with ischaemic colitis in two patients with hepatitis C
Authors: Randall K. L. , Yong J. , Steele R. H. , Spicer S. T. , Howlin K. J. , Quin J. 
Published: May 2007

AbstractMany extrahepatic manifestations of hepatitis C have been described, including renal disease and vasculitis. We describe the novel finding of intimal hyperplasia associated with severe ischaemic events in two patients with hepatitis C. The combination of genotype 1a hepatitis C virus, rapidly progressive mesangiocapillary glomerulonephritis and intimal hyperplasia with ischaemic sequelae, may represent a new syndrome.
Good outcome in HIV‐infected refugees after resettlement in New Zealand: population study
Authors: Nisbet S. M. , Reeve A. M. , Ellis‐Pegler R. B. , Woodhouse A. F. , Ingram R. J. , Roberts S. A. , McAllister S. M. , Thomas M. G. 
Published: May 2007

AbstractBackground: The aims of this study were to determine the clinical characteristics on arrival and the subsequent clinical outcome of HIV‐infected UN quota refugees who settled in New Zealand during the last 11 years and to estimate their rate of HIV transmission.Methods: A population study was conducted. Data were provided by the Mangere Refugee Resettlement Centre, the infectious disease physicians caring for the subjects, the New Zealand AIDS Epidemiology Group and laboratories carrying out HIV viral load assays.Results: One hundred of 7732 (1.3%) UN quota refugees were HIV positive; mean age 30 years, 56% were men, median initial CD4 count was 320 (range 20–1358). HIV infection was most commonly acquired by heterosexual intercourse (74%). The median follow up was 5.0 years (range 1 month to 9.7 years). Five died and 15 subjects had 16 AIDS‐defining illnesses, most commonly tuberculosis (n = 10). Sixty subjects commenced highly active antiretroviral therapy of whom 36/59 (61%) had an undetectable HIV viral load after 1 year of treatment. None of the six children born to HIV‐infected women in New Zealand were infected. There were two known cases of horizontal transmission of HIV infection.Conclusion: Although HIV‐infected quota refugees often have to overcome severe social, cultural and financial handicaps, their clinical outcome is generally very good, with response rates to highly active antiretroviral therapy that are similar to other patient groups. Furthermore, they have not been a significant source of transmission of HIV infection after resettlement in New Zealand.
How intravenous immunoglobulin is used in clinical practice: audits of two Sydney teaching hospitals
Authors: Lin M. W. , Kirkpatrick P. E. , Riminton D. S. 
Published: May 2007

AbstractBackground: The clinical demand for i.v. immunoglobulin (IVIg) continues to increase in Australia for reasons that are not clear. IVIg is distributed for approved indications according to Australian Health Ministers’ Advisory Council 2000 guidelines that are currently under review. IVIg may also be purchased by hospitals for uses not covered by these indications on an individual patient use basis. These audits were developed to examine current hospital practice in IVIg use.Methods: Six‐month prospective audits of all IVIg use were conducted at two teaching hospitals in Sydney (Concord and Royal Prince Alfred Hospitals). Medical files and dispensing records were examined and compared with current guidelines.Results: One hundred and sixty‐five recipients received 24 251 g of IVIg (mean total use 147 g/patient) for 36 distinct diagnoses, with 5.5% mortality. Drug committees supplied 1580 g of IVIg (6.5% of total product issued) to 12 recipients (7.3% of total recipients). The clinical specialties of immunology, haematology and neurology accounted for 92.9% of IVIg use, with 51.8% of overall use for replacement indications. Forty‐two patients (25.5%) received IVIg for non‐category 1 indications (4718 g, 19.5% of total product). Patients receiving IVIg for category 1 disorders had a 94.4% compliance with the guideline prerequisites where data were sufficient for assessment.Discussion: Our findings show a greater than expected proportion of non‐category 1 IVIg use and substantial contributions from drug committees. Careful case selection within category 1 indications is evident in the high level of compliance with qualifying criteria. Current distribution procedures do not enable capture of outcome data to inform guideline revisions.Conclusion: These audits emphasize the requirement for updated National Clinical Practice Guidelines, improved approval procedures, consensus statements in the specialties of immunology, haematology and neurology and clarification of the role of drug committees.
Road not taken: lessons to be learned from Queen v. Gillett
Authors: Beran R. G. , Devereux J. A. 
Published: May 2007

AbstractFollowing the decision in the Gillet Case it may no longer be safe to rely on the Austroads guidelines when considering fitness to drive. This paper examines the case and its implications. Although the Guidelines claimed ‘… the identification and application of world best‐practice…’, they were disregarded by the court in Gillet. Both expert witnesses testified that on disclosure of epilepsy the accused would have been endorsed as fit for a licence application to the Roads & Traffic Authority, on the basis of 10 years of only nocturnal seizures, in accordance with the guidelines. The Court rejected this evidence and interpreted failure to disclose epilepsy as recognition of perceived risk and the previously undiagnosed sleep apnoea as the basis for that risk, despite being diagnosed after the accident. There needs to be greater certainty in the application of the guidelines, with legislative intervention and licenses should display a bold statement advising drivers of their responsibility to notify authorities of illnesses that could potentially affect driving.
The in‐plane and out‐of‐plane stress constraint factors and K‐T‐Tz description of stress fields near the border of a quarter‐elliptical corner crack
Authors: ZHAO J. , GUO W. , SHE C. 
Published: May 2007

ABSTRACTThe elastic T‐stress and stress intensity factor K for quarter‐elliptical corner cracks have been investigated in elastic plates by detailed three‐dimensional finite‐element calculations. The distributions of normalized K and T‐stress have been obtained along the crack front with aspect ratios (a/c) of 0.2, 0.3, 0.4, 0.5, 0.6, 0.8 and 1.0, and far‐field tension and the effect of Poisson's ratio have also been considered. The normalized K increases and the normalized T‐stress decreases with the increase of Poisson's ratio v. For v= 0.3, the normalized K gradually increases in the range of crack‐face angle φ≥ 22.5° and decreases in the range of φ≤ 22.5° with the increase of a/c. The normalized T‐stress increases in the beginning and then decreases with increasing φ except for a/c= 0.2 and a/c= 0.3. By fitting the numerical results with the least squares method, empirical formulae have been given for the convenience of engineering applications. Combining with the corresponding out‐of‐plane constraint factor Tz, the three‐parameter K‐T‐Tz approach has been provided, which can accurately describe the stress field around the crack front.
Characterization of black band disease in Red Sea stony corals
Authors: Barneah Orit , Ben‐Dov Eitan , Kramarsky‐Winter Esti , Kushmaro Ariel 
Published: May 2007

SummaryMicrobial communities associated with black band disease (BBD) in massive stony corals from the Northern Red Sea (Eilat) were examined for the first time using molecular tools and microscopy. A high microbial diversity was revealed in the affected tissue in comparison with the healthy area of the same colony. Microscopy revealed the penetration of cyanobacteria into the coral mesoglea and adjacent tissues. Cyanobacterial sequences from Red Sea BBD‐affected corals formed a cluster with sequences previously identified from black band and red band diseased corals from the Indo‐Pacific and Caribbean. In addition, 11 sequences belonging to the genus Vibrio were retrieved. This group was previously documented as pathogenic to corals. Sulfate‐reducing bacteria, a group known to be associated with BBD and produce toxic sulfide, were studied using specific primers for the amplification of the dissimilatory sulfite reductase gene (dsrA). This technique facilitated and improved the resolution of the study of diversity of this group. All the sequences obtained were closely related to sequences of the genus Desulfovibrio and 46% showed high homology to Desulfovibrio desulfuricans. The complex nature of BBD and the lack of success in isolating a single causative agent suggest that BBD may be considered a polymicrobial disease.
The role of primary tumour resection in patients with stage IV colorectal cancer
Authors: Konyalian V. R. , Rosing D. K. , Haukoos J. S. , Dixon M. R. , Sinow R. , Bhaheetharan S. , Stamos M. J. , Kumar R. R. 
Published: May 2007

AbstractObjective  The management of stage IV colorectal cancer is controversial. Resection of the primary tumour to prevent obstruction, bleeding or perforation is the traditional approach, although survival benefit is undetermined. Management consisting of diverting ostomy, enteric bypass, laser recanalization or endoscopic stenting is an alternative to radical resection. The purpose of this study was to determine the role of resection of the primary tumour in patients with stage IV colorectal cancer, with specific attention paid to survival benefit and safety.Method  This was a retrospective review of all stage IV colon and rectal cancer patients in our tumour registry between 1991 and 2002. Data collected included patient demographics, presenting symptoms, detail from the hospital course including diagnostic data and operative management, complications and survival time (days). Survival analysis was performed to assess the effect of primary tumour resection on long‐term survival.Results  109 patients were studied. Sixty‐two (57%) patients (group I) underwent resection of the primary tumour, whereas 47 (43%) patients (group II) were managed without resection. Median survival times for groups I and II were 375 (IQR: 179–759) and 138 (IQR: 35–262) days respectively (P < 0.0001). After controlling for age, sex, tumour location and level of liver involvement as well as liver function, patients who underwent resection still survived longer (HR = 0.34, 95% CI: 0.21–0.55).Conclusion  Palliative resection of the primary tumour plays an essential role in the management of stage IV colorectal cancer. Resection can offer increased survival and is indicated in certain patients with incurable disease. Limited metastatic tumour burden of the liver was associated with better survival in such patients.
Laparoscopic ventral rectopexy, posterior colporrhaphy and vaginal sacrocolpopexy for the treatment of recto‐genital prolapse and mechanical outlet obstruction
Authors: Slawik S. , Soulsby R. , Carter H. , Payne H. , Dixon A. R. 
Published: May 2007

AbstractObjective  Whilst trans‐abdominal fixation +/− resection offers better functional results and lower recurrence than perineal procedures, mesh rectopexy is complicated by constipation. Laparoscopic autonomic nerve‐sparing, ventral rectopexy allows correction of the underlying abnormalities of the rectum, vagina, bladder and pelvic floor.Method  A prospective database was used to audit our 7‐year experience of this technique. The recto‐vaginal septum was mobilized anteriorly to the pelvic floor avoiding nerve damage. A prolene mesh was sutured to the ventral rectum, posterior vagina and vaginal fornix and secured to the sacral promontory. Patients were assessed with questionnaires and Cleveland Clinic scores.Results  Eighty patients, six males, median age 59 years (range 31–90) underwent laparoscopic prolapse surgery between Jan 1997 and Dec 2005; 55% had full thickness prolapse and 46% rectal anal intussusception. Five had a solitary rectal ulcer. A total of 58% had undergone previous surgery; hysterectomy 33%, posterior colporrhaphy 15%, posterior rectopexy 6%, Delorme's rectal mucosectomy 5% and Birch colposuspension 3%. Half (54%) were incontinent (mean Wexner score 11, range 2–17) and 31% reported symptoms of obstructed defecation; seven had slow transit constipation and underwent resection.The median operative time was 125 min (range 50–210) with one conversion. Median time to diet was 12 h and median length of stay 3 days (1–12). No patient has developed recurrent full thickness prolapse at a median follow‐up of 54 months (30–96). Incontinence improved in 39 of 43 patients (91%); median post‐operative Wexner score 1 (0–9). Obstructed defecation resolved in 20 of 25 patients (80%). Pelvic pain resolved in all but one. Complications occurred in 21%; faecal impaction 4%, wound infection 2%, bleeding 2%, leak 1%, chest infection 1%, retention 1%. Three developed minor evacuatory difficulties and two, urinary stress incontinence.Conclusion  Laparoscopic ventral rectopexy is safe with relatively low morbidity. In the medium‐term, it provides good results for prolapse and associated symptoms of incontinence and obstructed defecation.
Faecal incontinence in male patients
Authors: Kim T. , Chae G. , Chung S. S. , Sands D. R. , Speranza J. R. , Weiss E. G. , Nogueras J. J. , Wexner S. D. 
Published: May 2007

AbstractObjective  Data concerning faecal incontinence (FI) in men are lacking. The aim of this study was to evaluate the historical aetiology and contrast aetiologies in younger and older men suffering from FI.Method  After institutional review board approval, a retrospective chart review was undertaken of all patients with FI seen between 1999 and 2005. The data of male patients was further analysed to assess the impact of age and historical aetiology on FI.Results  A total of 404 males were included, 203 patients were <70 years of age (group A) and 201 patients were ≥70 years of age (group B). The most common prior diagnosis in group A was perianal sepsis in 23 (11.3%) patients and symptomatic haemorrhoids in 20 (9.9%) patients; in group B it was prostate cancer in 57 (28.4%) patients, symptomatic haemorrhoids in 31 (15.4%) patients and neurological diseases in 18 (9%) patients. The most common prior procedure in group A was restorative proctectomy/proctocolectomy in 32 (15.8%) patients, fistulotomy or haemorrhoidectomy in 21 (10.3%) and 19 (9.4%) patients respectively. In group B, radiation therapy for prostate cancer was utilized in 48 (23.9%) patients and haemorrhoidectomy in 29 (14.4%) patients. Comparing group A and group B relative to diagnosis – perianal sepsis, perineal trauma, congenital disorders, HIV infection and anal cancer were more common in group A, whereas prostate cancer, neurological diseases and colon cancer were significantly more common in group B.Conclusion  Prostate cancer, symptomatic haemorrhoids, perianal sepsis, rectal cancer and a history of restorative rectal resection were common associations with FI in men. The aetiologies for FI in men vary with age.
Eplerenone improves prognosis in postmyocardial infarction diabetic patients with heart failure: results from EPHESUS
Authors: O’Keefe J. H. , Abuissa H. , Pitt B. 
Published: May 2007

Background:  The Epleronone Post‐Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) trial demonstrated that selective aldosterone blockade with eplerenone significantly reduced total mortality by 15%, combined cardiovascular (CV) mortality/CV hospitalization by 13%, CV mortality by 17% and sudden cardiac death by 21%, vs. placebo when added to standard care in patients with left ventricular systolic dysfunction (LVSD) and signs of congestive heart failure (CHF) following acute myocardial infarction (AMI). We retrospectively evaluated the effect of eplerenone vs. placebo in a subset of 1483 diabetic patients with LVSD and signs of CHF following AMI.Methods:  Diabetic status was determined from medical histories at screening. Analyses were based on time to first occurrence of an event. Results were based on a Cox’s proportional hazards regression model stratified by region with treatment, subgroup and treatment‐by‐subgroup interaction as factors. The 95% confidence intervals for the risk ratios were based on the Wald’s test.Results:  Treatment with eplerenone in diabetic patients with CHF following AMI reduced the risk of the primary endpoint, a composite of CV mortality or CV hospitalization, by 17% (p = 0.031). The absolute risk reduction of the primary endpoint was greater in the diabetic cohort (5.1%) than in the non‐diabetic cohort (3%). Hyperkalaemia occurred more often with eplerenone than with placebo (5.6 vs. 3%, p = 0.015). Among the diabetic cohorts, the prespecified endpoint of ‘any CV disorder’ occurred in 28% of the eplerenone group and 35% of the placebo group (p = 0.007).Conclusion:  Eplerenone treatment may reduce adverse CV events in diabetic patients with LVSD and signs of CHF following AMI.
The majority of cases of neonatal diabetes in Spain can be explained by known genetic abnormalities
Authors: Rica I. , Luzuriaga C. , Pérez de Nanclares G. , Estalella I. , Aragonés A. , Barrio R. , Bilbao J. R. , Carlés C. , Fernández C. , Fernández J. M. , Fernández‐Rebollo E. , Gastaldo E. , Giralt P , Gomez Vida J. M. , Gutiérrez A. , López Siguero J. P. , Martínez‐Aedo M. J. , Muñoz M. , Prieto J. , Rodrigo J. , Vargas F. , Castano L. 
Published: May 2007

AbstractBackground  Neonatal diabetes is a rare disease characterized by hyperglycaemia within the first 3 months of life and requiring insulin treatment; it can either be transient (TNDM) or permanent (PNDM). Alterations at band 6q24 and heterozygous activating mutations in KCNJ11, the gene encoding the pore‐forming subunit of the KATP channel, can cause neonatal diabetes.Aims  We screened the 6q24 region, KCNJ11, GCK, FOXP3 and IPF1 genes for mutations in families with PNDM or TNDM to establish a phenotype–genotype correlation.Methods  Twenty‐two patients with neonatal diabetes were recruited. Inclusion criteria were insulin‐treated diabetes diagnosed within the first 3 months and insulin treatment for at least 15 days. Clinical data were recorded in a questionnaire.Results  We identified 17 genetic alterations in our patients: six alterations at the 6q24 band associated with TNDM and nine mutations in KCNJ11, five of which were novel. The analysis for a phenotype–genotype correlation showed that patients with 6q24 alterations had a lower birth weight and were diagnosed earlier than patients with KCNJ11 mutations. At follow‐up of the TNDM patients with genetic alterations, 43% developed diabetes or impaired glucose tolerance in later life (one with 6q24 duplication and two with N48D and E227K mutations at KCNJ11 gene). Furthermore, half the first‐degree relatives who carried a genetic alteration but who had not suffered from neonatal diabetes were diagnosed with diabetes or impaired glucose tolerance before the age of 30 years.Conclusions  KCNJ11 mutations are common in both TNDM and PNDM and are associated with a higher birth weight compared with patients with 6q24 abnormalities. Patients with TNDM should be screened for abnormalities in glucose metabolism in adult life.
Genetic variation within the APPL locus is not associated with metabolic or inflammatory traits in a healthy White population
Authors: Staiger H. , Machicao F. , Machann J. , Schick F. , Kuulasmaa T. , Laakso M. , Fritsche A. , Stefan N. , Häring H‐U. 
Published: May 2007

AbstractAims  APPL1 (adaptor protein containing PH domain, PTB domain and leucine zipper motif 1) is the first identified cytosolic protein that directly binds to adiponectin receptors and mediates cellular responses to adiponectin. We set out to determine whether genetic variation within the APPL locus (encoding APPL1) contributes to insulin resistance, changes in lipid metabolism or inflammatory parameters in a healthy White population.Methods  We genotyped 640 healthy subjects with and without a family history of diabetes for the four single nucleotide polymorphisms (SNPs) rs6774584, rs3087684, rs17791685 and rs528035 and performed correlational analyses with metabolic and inflammatory traits.Results  SNPs rs6774584, rs3087684, rs17791685 and rs528035 are representative of the four blocks of high linkage disequilibrium covering a 78‐kb genomic locus that harbours the APPL gene. None of these SNPs correlated with anthropometric data (gender, age, body mass index, body fat, waist–hip ratio) or with family history of diabetes. Furthermore, no correlations were found with parameters of insulin sensitivity or insulin secretion. None of the SNPs was correlated with ectopic lipid content or with plasma lipids (non‐esterified fatty acids, glycerol, triglycerides, total cholesterol, high‐density lipoprotein‐, low‐density lipoprotein‐cholesterol). Moreover, no correlations were detected with leucocyte measures or plasma concentrations of C‐reactive protein, monocyte chemoattractant protein 1, interleukin 6 or tumour necrosis factor‐alpha. Finally, diplotypes derived from these SNPs did not reveal correlations with insulin sensitivity, insulin secretion, lipid measures or inflammatory parameters either.Conclusions  We conclude that genetic variation within the APPL locus may not play a major role in the development of prediabetes phenotypes.
The effect of α‐lipoic acid on symptoms and skin blood flow in diabetic neuropathy
Authors: Jin H. Y. , Joung S. J. , Park J. H. , Baek H. S. , Park T. S. 
Published: May 2007

AbstractAims  Multiple pathogenic pathways are involved in diabetic neuropathy and diverse treatments have been tried without success. The aim of this study was to assess the effect of α‐lipoic acid on skin blood flow in patients with diabetic neuropathy.Methods  We measured skin blood flow in 13 control subjects and 19 patients with diabetic neuropathy using the laser Doppler blood flow technique. Skin blood flow and the extent of skin blood flow changes were compared before and after diabetic patients received 600 mg/day α‐lipoic acid intravenously for 14 days.Results  Although no significant differences in absolute values of skin blood flow or in the extent of changes were noted, symptoms were reduced after α‐lipoic acid treatment.Conclusions  This study suggests that α‐lipoic acid, a potent antioxidant, improves symptoms of diabetic neuropathy. Larger studies are needed to determine whether improvements in skin blood flow also occur in patients with diabetic neuropathy.