bluuebunny/crossref_metadata_2025_split huggingface dataset:
Completing an Advance Directive in the Primary Care Setting: What Do We Need for Success?
Authors: Ramsaroop Sharda D. , Reid M. C. , Adelman Ronald D. 
Published: January 2007

OBJECTIVES: To systematically review studies designed to increase advance directive completion in the primary care setting and employ meta‐analytic techniques to quantify their effects.DESIGN: Extensive bibliographic searches of English‐language literature published from January 1991 through July 2005 were conducted. Investigators abstracted prespecified information (e.g., design, study duration, types of interventions employed) and advance directive completion rates for intervention and control arms in each investigation and calculated absolute rate differences (i.e., difference in completion rates between the two groups) for each study. Individual study and pooled‐effect sizes were also calculated, along with 95% confidence intervals (CIs).SETTING: Literature review.RESULTS: Eighteen studies were retained in the final sample. Most studies employed multimodal interventions. The most common approach consisted of educational materials directed at patients (through mailing or at visit) coupled with a patient–healthcare provider interaction in a group or individual setting (n=7). Absolute differences in completion rates varied from a high of 44% (favors intervention) to a low of –2% (favors control). Effect sizes could be calculated for 15 of the 18 studies. The pooled effect size was 0.50 (95% CI=0.17–0.83), indicating a moderate overall effect in favor of the intervention.CONCLUSION: The majority of studies demonstrated statistically significant effects associated with the advance directive intervention. The most successful interventions incorporated direct patient–healthcare professional interactions over multiple visits. Passive education of patients using written materials (without direct counseling) was a relatively ineffective method for increasing advance directive completion rates in the primary care setting.
Stroke‐Independent Association Between Metabolic Syndrome and Functional Dependence, Depression, and Low Quality of Life in Elderly Community‐Dwelling Brazilian People
Authors: Roriz‐Cruz Matheus , Rosset Idiane , Wada Taizo , Sakagami Teiji , Ishine Masayuki , Roriz‐Filho Jarbas S. , Cruz Thadeu R. S. , Rodrigues Rosalina P. , Resmini Isvania , Sudoh Shinji , Wakatsuki Yoshio , Nakagawa Masanori , Souza Antonio C. , Kita Toru , Matsubayashi Kozo 
Published: January 2007

OBJECTIVES: Metabolic syndrome (Met.S) is a risk factor for stroke, dementia, and ischemic heart disease (IHD). It is unclear whether Met.S is an independent risk factor for functional dependence, depression, cognitive impairment, and low health‐related quality of life (HRQoL) in a population free of clinical stroke.DESIGN: Cross‐sectional.SETTING: Two communities in southern Brazil.PARTICIPANTS: Four hundred twenty people aged 60 and older.MEASUREMENTS: An adapted (body mass index ≥30 kg/m2 and blood pressure ≥140/90) Adult Treatment Panel III definition was used in diagnosing Met.S. Depression (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised) and Mini‐Mental State Examination were evaluated along with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). HRQoL was measured using a visual analogue scale (0–10). All values were adjusted for age, sex, and presence of IHD.RESULTS: Forty (9.5%) subjects had a stroke and were excluded from the final analysis. Met.S was present in 37.4% of the stroke‐free population. Met.S was significantly and independently associated with 2.24 times as much ADL dependence, 2.39 times as much IADL dependence, a 2.12 times higher risk of depression, a 2.27 times higher likelihood of cognitive impairment, and a 1.62 times higher chance of low self‐perceived HRQoL (all P<0.05). Adjustment for its own components reduced the strength of the above associations but did not eliminate their statistical significance. If Met.S were removed from this population, dependence, depression, cognitive impairment, and low QoL would be reduced 15.0% to 21.4%.CONCLUSION: Met.S was significantly associated with functional dependence, depression, cognitive impairment, and low HRQoL, and its effects were independent of clinical stroke, IHD, and its own individual components.
Pneumonia and Lower Respiratory Infections in Nursing Home Residents: Predictors of Hospitalization and Mortality
Authors: Chan Carusone Soo B. , Walter Stephen D. , Brazil Kevin , Loeb Mark B. 
Published: January 2007

OBJECTIVES: To compare predictors of hospitalization and death in nursing home residents with pneumonia and other lower respiratory infections (LRIs).DESIGN: A nested cohort study.SETTING: Nine nursing homes in southern Ontario.PARTICIPANTS: Three hundred fifty‐three nursing home residents with LRIs (enrolled in the control arm of a clinical trial).MEASUREMENTS: Comorbidities, vaccination status, age, health‐related quality of life, functional status, and vital statistics were evaluated as potential predictors of hospitalization and mortality at 30 days.RESULTS: Moderate to high disease severity score on a practical severity scale was a strong independent predictor of hospitalization (odds ratio (OR)=7.12, P<.001) and mortality (OR=5.04, P=.003). Diagnosis of pneumonia, established using chest radiograph, was also associated with hospitalization (OR=2.43, P=.008) and mortality (OR=2.35, P=.02). Oxygen saturation (<90%) was a strong independent predictor of hospitalization (OR=3.02, P=.004) but was not a significant predictor of mortality in multivariable analyses. Diagnosis of congestive heart failure (OR=2.26, P=.02) was an independent predictor of hospitalization, whereas receipt of pneumococcal vaccine (OR=0.36, P=.01) and greater functional independence (OR=0.92, P=.02) were negatively associated with hospitalization.CONCLUSION: In nursing home residents with LRI, severity of illness and radiographically confirmed pneumonia are predictive of death and hospitalization.
Canadian experience with detection of bacterial contamination in apheresis platelets
Authors: Ramírez‐Arcos Sandra , Jenkins Craig , Dion Jocelyne , Bernier France , Delage Gilles , Goldman Mindy 
Published: January 2007

BACKGROUND: In Canada, both blood suppliers, Héma‐Québec (HQ) and Canadian Blood Services (CBS), implemented bacterial testing in apheresis platelets (PLTs) with an automated microbial detection system (BacT/ALERT, bioMérieux).STUDY DESIGN AND METHODS: Validation of the BacT/ALERT Classic and 3D systems involved apheresis PLT spiking with different bacteria at concentrations of 10 and 102 colony‐forming units per mL. As of February 2006, more than 95 percent of apheresis PLTs were screened for bacterial contamination at HQ and CBS. Between 3.5 and 10 mL of PLTs is inoculated into BacT/ALERT aerobic culture bottles followed by incubation for a maximum of 7 days.RESULTS: During the validation studies, all bacteria were detected at all concentrations and volumes tested. Upon implementation of bacterial screening, the percentage of initial positive samples at CBS and HQ was 0.09 and 0.07 percent, respectively. The rate of indeterminate cultures was significantly higher at CBS than at HQ, whereas the rates for true‐positive, false‐positive, and false‐negative results did not differ significantly. Six confirmed‐positive cultures, including three coagulase‐negative staphylococci and three Enterobacteriaceae species, were detected and PLT units contaminated with these bacteria were not transfused. The rate of true‐positive cultures was significantly lower than that reported by other blood operators. Unfortunately, failed detection of two contaminated units resulted in septic transfusion reactions.CONCLUSION: Bacterial screening of apheresis PLTs in Canada was successfully implemented, and transfusion of contaminated units was prevented. Rapid bacterial detection systems that could be used before transfusion, however, may further reduce the risk of transfusion reactions.
The efficacy of photochemical treatment with amotosalen HCl and ultraviolet A (INTERCEPT) for inactivation ofTrypanosoma cruziin pooled buffy‐coat platelets
Authors: Castro Emma , Gironés Nuria , Bueno José Luis , Carrión Javier , Lin Lily , Fresno Manuel 
Published: January 2007

BACKGROUND:This study evaluated the efficacy of photochemical treatment (PCT) with amotosalen and ultraviolet A (UVA) light to inactivateTrypanosoma cruziin contaminated platelet (PLT) components.STUDY DESIGN AND METHODS:Fifteen pools of buffy‐coat PLTs (BC‐PLTs) were inoculated with approximately 5 × 103to 5 × 105per mL of viableT. cruziof the G, Tulahuen (T), or Y strains. Samples from BC‐PLTs were assayed for infectivity before and after PCT with 150 µmol per L amotosalen and 3 J per cm2UVA light. Infectivity was determined with three different methods: 1) in vitro culture to detect viable epimastigotes, 2) [3H]thymidine incorporation in culture, and 3) in vivo inoculation into interferon‐γ receptor (IFN‐γR)‐deficient mice.RESULTS:The in vitro assay yielded viable parasite titers of 3.9 × 105, 2.8 × 104, and 5.6 × 103per mL (corresponding to 5.6, 4.4, and 3.8 logs/mL) for the Y, T, and G strains, respectively. PCT was able to inactivate all three strains ofT. cruzito below the limit of detection (10 parasites/mL) in the sensitive in vivo assay. Because 10‐mL samples, each concentrated into a 1‐mL sample for inoculation, were tested in the in vivo assay, log reductions achieved were greater than 5.6, greater than 4.4, and greater than 3.8 for the Y, T, and G strains ofT. cruzi, respectively.CONCLUSIONS:The pathogen reduction system with amotosalen HCl and UVA demonstrated robust efficacy for inactivation of high doses of three different strains ofT. cruziand offers the potential to make the PLT supply safer.
H5N1 influenza virus and the safety of plasma products
Authors: Kreil T.R. , Unger U. , Orth S.M. , Petutschnig G. , Kistner O. , Poelsler G. , Berting A. 
Published: January 2007

BACKGROUND: The ever‐increasing number of human H5N1 influenza virus infections may enable these viruses to acquire the ability to spread effectively among humans and potentially to cause a pandemic. Recently, more systemic virus dissemination was reported during H5N1 virus infection of humans, resulting in significant virus concentrations also in the blood. The observation has raised concerns about the safety of labile blood products for transfusion and consequentially also for plasma derivatives. To confirm the safety margins of plasma products, dedicated virus inactivation processes used during their production were investigated for their effectiveness in inactivating this virus of recent concern.STUDY DESIGN AND METHODS: Virus inactivation by steps commonly used during the manufacture of plasma derivatives, such as pasteurization for human albumin, solvent/detergent treatment for intravenous immunoglobulin (IVIG), vapor heating for factor VIII inhibitor bypassing activity, and incubation at low pH for IVIG, were investigated with a reassortant strain of H5N1 influenza virus.RESULTS: The results show that H5N1 influenza behaves as expected for lipid‐enveloped viruses; that is, the virus is effectively inactivated by all the commonly used virus inactivation procedures tested.CONCLUSION: The safety margins of plasma derivatives against the theoretical transmission of H5N1 influenza virus are very substantial.
Coagulation parameters in apheresis and leukodepleted whole‐blood plasma during storage
Authors: Boström F. , Sjödahl M. , Wehlin L. , Egberg N. , Lundahl J. 
Published: January 2007

BACKGROUND: Thawing fresh‐frozen plasma (FFP) may cause delay in delivery, and one approach to circumvent this is to store plasma at +4°C. Thawed plasma is commonly discarded after a few days of storage, owing to the assumption that coagulation factor activity decreases to clinically unacceptable levels.STUDY DESIGN AND METHODS: Eighteen apheresis plasma (AP) units were collected from blood donors. The collected plasma was divided into two equal parts: one part frozen at −74°C as FFP and one part stored at +4°C as fresh liquid plasma (FLP). Thirty‐nine units of whole blood (WB) were collected from blood donors and leukodepleted by inline filtration, followed by plasma separation. Twenty plasma units were frozen at −74°C as FFP and 19 plasma units were stored at +4°C as FLP for 28 days. Plasma aliquots were collected before freezing and immediately after thawing FFP and before and during storage of FLP at Days 14 and 28. Factor (F)V, FVIII, D‐dimers, and C1‐esterase inhibitor levels were assessed.RESULTS: No significant differences in coagulation factor levels were assessed between FLP prepared from AP and FLP prepared from WB. FV and FVIII levels decreased on average 25 and 50 percent, respectively, at Day 14 of storage. C1‐esterase inhibitor and D‐dimers levels were not affected.CONCLUSION: Leukodepleted apheresis and WB plasma stored for 14 days retain sufficient levels of FV and FVIII activity for maintenance of normal hemostasis and could therefore be considered useful in selected clinical situations.
Influence of Reciprocating Tachycardia on the Development of Atrial Fibrillation in Patients with Preexcitation Syndrome
Authors: KALARUS ZBIGNIEW , LENARCZYK RADOSŁAW , KOWALSKI OSKAR , PRUSZKOWSKA‐SKRZEP PATRYCJA , KRUPA HUBERT , ŚREDNIAWA BEATA , SOKAL ADAM , ZIELIŃSKA TERESA 
Published: January 2007

Background: We sought to evaluate the influence of atrio‐ventricular reentrant tachycardia (AVRT) on atrial pressures during tachycardia and the presence of atrial fibrillation (AF) in patients with preexcitation syndrome.
Methods: The study population consisted of 88 patients (37 females, mean age 37.3 years) with left‐sided accessory pathway and AVRT induced during electrophysiologic study. The AF‐inducible group consisted of 32 patients with sustained episodes of AF provoked during electrophysiologic study, whereas the noninducible group comprised 56 patients without AF.
Results: We found significantly higher values of maximal and mean left (LAP) and right (RAP) atrial pressures in the AF group compared with noninducible group: LAP max 32.0 versus 20.8, LAP mean 21.6 versus 13.2, RAP max 15.2 versus 11.5, RAP mean 8.2 versus 6.2 respectively (P < 0.001). When analyzing the effect of AVRT on atrial pressures, we found a significant (P < 0.001) negative correlation between anterograde conduction times during tachycardia and LAP max and LAP mean in the whole population, but a significant positive correlation between retrograde conduction time and left atrial pressures. Similar effects of AVRT on the right atrial pressures were found.
Conclusions: Atrial pressures during AVRT, which depend on the electrophysiological features of tachycardia, play an important role in the genesis of atrial fibrillation in patients with preexcitation syndrome.
The Effects of Pulmonary Vein Isolation on the Morphology of P Waves: The Contribution of Pulmonary Vein Muscle Excitation to the Formation of P Waves
Authors: DATE TARO , YAMANE TEIICHI , INADA KEIICHI , MATSUO SEIICHIRO , KANZAKI YASUKO , MIYANAGA SATORU , SHIBAYAMA KENRI , MIYAZAKI HIDEKAZU , SUGIMOTO KEN‐ICHI , TANIGUCHI IKUO , MOCHIZUKI SEIBU 
Published: January 2007

Background: Although the pulmonary veins have been demonstrated to play an important role in initiating and perpetuating atrial fibrillation, the role that cardiac muscle tissue in the pulmonary veins plays regarding the formation of P wave remains to be elucidated. We sought to clarify the contribution of pulmonary vein cardiac muscles to the formation of P waves by analyzing the P loops/waves in patients with atrial fibrillation.
Methods: The subjects in this study consisted of 21 patients (mean age, 57 ± 10 years) with drug‐refractory, paroxysmal atrial fibrillation who had undergone a segmental ostial isolation of all four pulmonary veins from the left atrium. Vectorcardiograms, intracardiac electrograms, and electrocardiograms (ECGs) were recorded before and after pulmonary vein isolation.
Results: The morphology of P waves changed after pulmonary vein isolation procedures with a significant increase in the maximal amplitude of both the leftward force in lead x and the anterior force in lead z (P < 0.05). The middle part (second one of three parts) of P loop on the horizontal plane shifted anteriorly and leftward after pulmonary vein isolation. Intracardiac electrograms in the pulmonary veins demonstrated the averaged activation times of all four pulmonary veins to range from 40% to 84% of the P duration.
Conclusions: The excitation of cardiac muscle tissue, which has migrated to the pulmonary veins, was thus found to play an important role in the formation of the middle part of the P wave/loop.
Dual‐Site Right Atrial Pacing Increases Left Atrial Appendage Flow in Patients with Sick Sinus Syndrome and Paroxysmal Atrial Fibrillation
Authors: STOCKBURGER MARTIN , BARTELS RALF , GERHARDT LARS , BUTTER CHRISTIAN 
Published: January 2007

Background: Dual‐site right atrial pacing has been proposed as a promising concept for prevention of paroxysmal atrial fibrillation (PAF). Effects of this pacing configuration on left atrial appendage (LAA) flow and transmitral flow may be of prognostic and hemodynamic relevance. This study aims to characterize acute changes in left atrial flow depending on dual‐site right atrial pacing.
Methods: In 12 patients (66 ± 8.8 years, 4 women) with PAF and sinus bradycardia a pacemaker with a right atrial dual‐site lead configuration (right atrial lateral and coronary sinus ostium) was implanted. Flow velocities in the left pulmonary vein (LPV), LAA, and across the mitral valve were assessed by transesophageal echocardiography and compared during sinus rhythm (SR) and dual‐site (DS) pacing.
Results: Dual‐site pacing resulted in higher maximum (SR: 0.57 m/s; pacing: 0.77 m/s; P < 0.02) and mean (SR: 0.33 m/s; DS: 0.47 m/s; P < 0.01) LAA emptying flow when compared with SR. The passive transmitral flow component (maximum E‐wave velocity) was lower during dual‐site pacing (SR: 0.53 m/s vs DS: 0.44 m/s, P < 0.02). The E/A ratio tended to be lower during dual‐site pacing (SR: 1.21 vs DS: 1.01, P = 0,10). LPV flow velocities during SR and DS pacing did not differ.
Conclusion: DS right atrial stimulation in patients with PAF increases the LAA emptying flow velocity and shifts the transmitral flow pattern towards a lower passive component when compared with sinus rhythm. The change in LAA flow may contribute to a lower incidence of thromboembolism and merits further investigation.
The Salty Dog: Serum Sodium and Potassium Effects on Modern Pacing Electrodes
Authors: McVENES, B.A. RICK , HANSEN NANCY , LAHTINEN STUART P. , STOKES KEN 
Published: January 2007

Background: This study was conducted to characterize the behavior of chronic modern endocardial electrodes with capacitively coupled constant voltage pulse generators in canines.
Methods: Five animals were studied with chronic paired unipolar microporous platinum, and porous steroid‐eluting electrodes in the ventricle. Screw‐in and passive fixation electrodes were also implanted in the atrium. IV infusions of 500–800 mL of 50 meq KCl in 500 mL Ringer's solution, and 3% NaCl were given over periods of 120 and 80 minutes, respectively, during separate anesthetized monitors.
Results: Mean maximum Na+ and K+ achieved was 158 and 8.3 meq/L, respectively. During KCl infusion, ventricular threshold, current, and energy decreased. In the atrium, half the leads went to exit block at ∼7.0 meq/L K+. Others continued to perform acceptably. The atrial electrogram decreased 70% with no change in the ventricular signal. No change in impedance occurred. During NaCl infusion, no changes in atrial or ventricular threshold occurred while current increased 21%–32%. This resulted in a 40%–55% increase in energy due to a 20% decrease in impedance. The atrial electrogram decreased 32%–36% while the ventricular amplitude decreased 25%. Slew rate decreased 19%–27%. Control studies for effects of heart rate, fluid volume, and anesthesia duration did not cause any changes.
Conclusion: These data support the conclusion that threshold is a voltage mediated response. Thus, voltage thresholds, not energy, current or pulse duration is the most relevant parameter for safety margin determination. Atrial parameters should be followed during electrolyte imbalances. Correlation in humans is needed.
Pacemaker Endocarditis: Clinical Features and Management of 60 Consecutive Cases
Authors: MASSOURE PIERRE‐LAURENT , REUTER SYLVAIN , LAFITTE STEPHANE , LABORDERIE JULIEN , BORDACHARD PIERRE , CLEMENTY JACQUES , ROUDAUT RAYMOND 
Published: January 2007

Background: The incidence of endocarditis related to pacemakers is increasing, while the diagnosis and management remain difficult. The objective of this study was to evaluate the clinical features and management of endocarditis after implantation of pacemakers (PM) or cardioverter defibrillators (ICD).
Methods: We analyzed the hospital course of 60 consecutive patients (48 men, mean age 68 ± 12 years) admitted to our center for PM (n = 59) or ICD (n = 1) endocarditis between 1998 and 2004.
Results: Fever (78%), asthenia (65%), and local symptoms (35%) were common. Positive cultures were obtained in 53 cases (Staphylococcus 89%). Sixteen patients (27%) had pulmonary embolism. Vegetations (mean size 15.2 ± 8 mm, range 5 to 35 mm) were found in 54 cases (90%), with transthoracic echocardiography in 26 cases (43%), and transesophageal echocardiography (TEE) in 50 cases (89% of the 56 patients who had TEE). Devices were removed surgically (n = 20) or percutaneously (n = 37). In the surgical group, vegetations were larger (17.9 ± 7 mm vs 13.2 ± 7 mm, P = 0.01). After removal, 42 patients (70%) had a new PM. Mortality factors (6 deaths – follow up 3.4 ± 2 years) were the number of vegetations and absence of extraction of the device (P < 0.02). Clinical features and management of the 37 patients with early onset endocarditis (within 1 year after implantation) did not differ from those with late onset.
Conclusions: PM endocarditis was essentially staphylococcal. TEE was required for the diagnosis of vegetations. Complete removal of the device is required and associated with a favorable outcome.