bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Facilitated Survey Instrument Captures Significantly More Anesthesia Events Than Does Traditional Voluntary Event Reporting
Authors: Oken Andrew , Rasmussen Mark D. , Slagle Jason M. , Jain Sonia , Kuykendall Tod , Ordonez Nelda , Weinger Matthew B. 
Published: March 2009

Background
This study sought to evaluate the effectiveness of an active survey method for detecting anesthesia nonroutine events (NREs). An NRE is any aspect of clinical care perceived by clinicians or observers as a deviation from optimal care based on the context of the clinical situation.

Methods
A Comprehensive Open-ended Nonroutine Event Survey (CONES) was developed to elicit NREs. CONES, which consisted of multiple brief open-ended questions, was administered to anesthesia providers in the postanesthesia care unit. CONES data were compared with those from the same hospital's anesthesia quality assurance (QA) process, which relied on self-reporting of predefined adverse events.

Results
CONES interviews were conducted after 183 cases of varying patient, anesthesia, and surgical complexity. Fifty-five cases had at least one NRE (30.4% incidence). During the same 30-month period, the QA process captured 159 cases with 96.8% containing at least one NRE among the 8,303 anesthetic procedures conducted (1.9% overall incidence). The CONES data were more representative of the overall surgical population. There were significant differences in NRE incidence (P < 0.001), patient impact (74.5% vs. 96.2%; P < 0.001), and injury (23.6% vs. 60.3%) between CONES and QA data. Outcomes were more severe in the QA group (P < 0.001). Extrapolation of the CONES data suggested a significantly higher overall incidence of anesthesia-related patient injury (7.7% vs. only 1.0% with the QA method).

Conclusions
An active surveillance tool using the NRE construct identified a large number of clinical cases with potential patient safety concerns. This approach may be a useful complement to more traditional QA methods of self-reporting.
Comparison of Catheter-related Infection and Tip Colonization between Internal Jugular and Subclavian Central Venous Catheters in Surgical Neonates
Authors: Breschan Christian , Platzer Manuela , Jost Robert , Schaumberger Florian , Stettner Haro , Likar Rudolf 
Published: March 2009

Background
The primary aim of this study was to compare catheter-associated infections and tip contaminations between percutaneously placed central venous catheters in the internal jugular and subclavian veins in surgical neonates undergoing major noncardiac surgery.

Methods
The prospectively computerized protocols of 295 procedures were analyzed retrospectively.

Results
One hundred twenty-nine internal jugular venous (group I) and 107 subclavian venous catheters (group S) were included. The median postconceptual age was 37 weeks in group I and 38 in group S. The weight ranged from 580 g to 4.5 kg in group I and from 820 g to 4.5 kg in group S at the time of insertion. Significantly more catheter-associated infections were observed in group I (15.5 vs. 4.7%; chi-square analysis: P < 0.01). The internal jugular venous catheters were also associated with a significantly increased probability of an earlier onset of a catheter-associated infection compared with the subclavian venous catheters (log rank test: P < 0.01; Cox model: P < 0.01). This probability was only slightly increased by a lower weight (Cox model: P = 0.075), and it was not increased by a lower age (Cox model: P = 0.93). Significantly more catheter tips were contaminated by pathogens in group I (55.8 vs. 33.6%; chi-square analysis: P < 0.01).

Conclusion
The internal jugular venous catheters were associated with a higher infection rate as well as earlier onset of catheter-associated infection compared with the subclavian venous catheters.
Isoflurane Preconditioning Improves Long-term Neurologic Outcome after Hypoxic–Ischemic Brain Injury in Neonatal Rats
Authors: Zhao Ping , Peng Longyun , Li Liaoliao , Xu Xuebing , Zuo Zhiyi 
Published: March 2009

Background
Preconditioning the brain with relatively safe drugs seems to be a viable option to reduce ischemic brain injury. The authors and others have shown that the volatile anesthetic isoflurane can precondition the brain against ischemia. Here, the authors determine whether isoflurane preconditioning improves long-term neurologic outcome after brain ischemia.

Methods
Six-day-old rats were exposed to 1.5% isoflurane for 30 min at 24 h before the brain hypoxia-ischemia that was induced by left common carotid arterial ligation and then exposure to 8% oxygen for 2 h. The neuropathology, motor coordination, and learning and memory functions were assayed 1 month after the brain ischemia. Western analysis was performed to quantify the expression of the heat shock protein 70, Bcl-2, and survivin 24 h after isoflurane exposure.

Results
The mortality was 45% after brain hypoxia-ischemia. Isoflurane preconditioning did not affect this mortality. However, isoflurane preconditioning attenuated ischemia-induced loss of neurons and brain tissues, such as cerebral cortex and hippocampus in the survivors. Isoflurane also improved the motor coordination of rats at 1 month after ischemia. The learning and memory functions as measured by performance of Y-maze and social recognition tasks in the survivors were not affected by the brain hypoxia-ischemia or isoflurane preconditioning. The expression of Bcl-2, a well-known antiapoptotic protein, in the hippocampus is increased after isoflurane exposure. This increase was reduced by the inhibitors of inducible nitric oxide synthase. Inducible nitric oxide synthase inhibition also abolished isoflurane preconditioning-induced neuroprotection.

Conclusions
Isoflurane preconditioning improved the long-term neurologic outcome after brain ischemia. Inducible nitric oxide synthase may be involved in this neuroprotection.
Sevoflurane Directly Excites Locus Coeruleus Neurons of Rats
Authors: Yasui Yutaka , Masaki Eiji , Kato Fusao 
Published: March 2009

Background
Sevoflurane, an anesthetic showing high incidence of emergence agitation in human patients, especially in children, increases noradrenaline release in the preoptic area in the rat brain. The clinically observed frequency of emergence agitation with sevoflurane is significantly reduced by drugs activating alpha2 adrenoceptors. The locus coeruleus (LC) is a source nucleus of widely spreading noradrenergic projections in the central nervous system and is also known as one of the principal targets of some alpha2-adrenoceptor agonists, such as dexmedetomidine. The authors analyzed the effects of sevoflurane and other anesthetics on the membrane current of the LC neurons to study the mechanism of the paradoxical "excitatory" effects of the anesthetics.

Methods
Effects of volatile and nonvolatile anesthetics on the membrane potential and currents of LC neurons in pontine slices of the rat were evaluated. Action potential-dependent transmission was suppressed with tetrodotoxin.

Results
Sevoflurane at 5% (measured concentration in the recording chamber, 0.5 mm) induced an early-phase inward current in most of LC neurons in a robust manner, which significantly increased the firing frequency in the absence of tetrodotoxin under current clamp recording. Preadministration of dexmedetomidine (1-3 nm) occluded this increase in firing frequency with sevoflurane. This inward current was inhibited by a gap junction inhibitor carbenoxolone and was not observed with nonvolatile general anesthetics and in non-LC neurons examined.

Conclusions
The excitatory current activated by sevoflurane in LC neurons, likely to be mediated by gap junction-related mechanisms, might be one of the potential cellular mechanisms underlying paradoxical excitatory effect of sevoflurane.
Neurokinin-1 Receptor Antagonists Inhibit the Recruitment of Opioid-containing Leukocytes and Impair Peripheral Antinociception
Authors: Rittner Heike L. , Lux Christian , Labuz Dominika , Mousa Shaaban A. , Schäfer Michael , Stein Christoph , Brack Alexander 
Published: March 2009

Background
Neurokinins (e.g., substance P) contribute to pain transmission in the central nervous system, peripheral neurogenic inflammation, and leukocyte recruitment in inflammation. Leukocyte recruitment involves (1) up-regulation of adhesion molecule expression through neurokinin-1 (NK1) receptors on endothelial cells, (2) augmented chemokine production, or (3) chemotaxis through NK1 receptors on leukocytes. In inflammation, leukocytes can trigger endogenous antinociception through release of opioid peptides and activation of opioid receptors on peripheral sensory neurons. The authors hypothesized that NK1 receptor antagonists impair recruitment of opioid-containing leukocytes and stress-induced antinociception.

Methods
Rats were treated intraperitoneally and intrathecally with peripherally restricted (SR140333) or blood-brain barrier-penetrating (L-733,060) NK1 receptor antagonists and were evaluated for paw pressure thresholds, numbers of infiltrating opioid-containing leukocytes and leukocyte subpopulations, expression of adhesion molecules, NK1 receptors, and chemokines 24-48 h after complete Freund adjuvant-induced hind paw inflammation.

Results
Systemic and peripherally selective, but not intrathecal, NK1 receptor blockade reduced stress-induced antinociception (control: 177 +/- 9 g, L-733,060: 117 +/- 8 g, and control: 166 +/- 30 g, SR140333: 89 +/- 3 g; both P < 0.05, t test) without affecting baseline hyperalgesia. In parallel, local recruitment of opioid-containing leukocytes was decreased (L-733,060 and SR140333: 56.0 +/- 4.3 and 59.1 +/- 7.9% of control; both P < 0.05, t test). NK1 receptors were expressed on peripheral neurons, infiltrating leukocytes and endothelial cells. Peripheral NK1 receptor blockade did not alter endothelial expression of intercellular adhesion molecule-1 or local chemokine and cytokine production, but decreased polymorphonuclear cell and macrophage recruitment.

Conclusions
Endogenous inhibition of inflammatory pain is dependent on NK1 receptor-mediated recruitment of opioid-containing leukocytes.
Craniocervical Motion during Direct Laryngoscopy and Orotracheal Intubation with the Macintosh and Miller Blades
Authors: LeGrand Scott A. , Hindman Bradley J. , Dexter Franklin , Weeks Julie B. , Todd Michael M. 
Published: March 2009

Background
Previous studies have characterized segmental craniocervical motion that occurs during direct laryngoscopy and intubation with a Macintosh laryngoscope blade. Comparable studies with the Miller blade have not been performed. The aim of this study was to compare maximal segmental craniocervical motion occurring during direct laryngoscopy and orotracheal intubation with Macintosh and Miller blades.

Methods
Eleven anesthetized and pharmacologically paralyzed patients underwent two sequential orotracheal intubations, one with a Macintosh blade and another with a Miller in random order. During each intubation, segmental craniocervical motion from the occiput to the fifth cervical vertebra (C5) was recorded using continuous lateral cinefluoroscopy. Single-frame images corresponding to the point of maximal cervical motion for both blade types were compared with a preintubation image. Using image analysis software, angular change in the sagittal plane at each of five intervertebral segments was compared between the Macintosh and Miller blades.

Results
Extension at occiput-C1 was greater with the Macintosh blade compared with the Miller (12.1 degrees +/- 4.9 degrees vs. 9.5 degrees +/- 3.8 degrees, respectively; mean difference = 2.7 degrees +/- 3.0 degrees; P = 0.012). Total craniocervical extension (occiput-C5) was also greater with the Macintosh blade compared with the Miller (28.1 degrees +/- 9.5 degrees vs. 23.2 degrees +/- 8.4 degrees, respectively; mean difference = 4.8 degrees +/- 4.4 degrees; P = 0.008).

Conclusions
Compared with the Macintosh, the Miller blade was associated with a statistically significant, but quantitatively small, decrease in cervical extension. This difference is likely too small to be important in routine practice.
Extensive and Partial Protein Hydrolysate Preterm Formulas
Authors: Szajewska Hania 
Published: March 2009

ABSTRACTProtein hydrolysate formulas for preterm infants recently have been developed. However, the indications for the use of such formulas are unclear. The aim of this article is to systematically evaluate the effect of protein hydrolysate formulas in the feeding of preterm infants through searching the MEDLINE (1966–August 2006) and Cochrane Library (Issue 4, 2006) databases. There is little evidence to support the use of extensive and partial protein hydrolysate formulas for preterm infants. High quality, long‐term trials are required before these formulas should be offered routinely in preference to other types of formula for preterm infants.
Evaluation and Management of Persistent Problems After Surgery for Hirschsprung Disease in a Child
Authors: Dasgupta Roshni , Langer Jacob C 
Published: March 2009

ABSTRACTHirschsprung disease occurs approximately once in every 5000 live‐born infants. It is characterized by the absence of ganglion cells in the myenteric and submucosal plexuses of the intestine. Once the diagnosis of Hirschprung disease has been made, most patients are now treated with a transanal approach to resection. We review the early and late postoperative complications. Late complications include persistent mechanical obstruction, recurrent or acquired aganglionosis, disordered motility in the proximal colon or small bowel, internal sphincter achalasia, or functional megacolon caused by stool‐holding behavior. These children require complex interdisciplinary care to ensure an adequate quality of life.
Intestinal Permeability and Effects of Lactobacillus rhamnosus Therapy in Children With Short Bowel Syndrome
Authors: Sentongo Timothy A , Cohran Valeria , Korff Simona , Sullivan Chris , Iyer Kishore , Zheng Xiaotian 
Published: March 2009

ABSTRACTBackground:The present study was conducted to investigate the effects of Lactobacillus rhamnosus (also known as LGG) on intestinal permeability (IP) in children with short bowel syndrome (SBS).Patients and Methods:In a double‐blind, placebo‐controlled crossover clinical trial, baseline IP (ie, lactulose‐to‐mannitol ratio) was measured in subjects with SBS and healthy control subjects. Subjects with SBS received LGG or placebo for 4 weeks, followed by a 3‐week washout before therapy was crossed over for another 4 weeks. IP, quantitative fecal cultures for Lactobacillus species (in colony‐forming units [cfu] per gram of stool) and hydrogen breath test (HBT) were performed during LGG and placebo phases of therapy.Results:Twenty‐one children (SBS, n = 9; control, n = 12) with a median age of 4.5 years (range 1.6–16.4 years) enrolled. Baseline IP measurements were similar in patients with SBS and control subjects: 0.08 ± 0.06 (mean ± SD) versus 0.07 ± 0.05 (P = 1.0). IP was correlated with age in control subjects (r = −0.83, P = 0.001) but not among patients with SBS (r = −0.55, P = 0.16). Fecal colonization with Lactobacillus species did not differ during LGG versus placebo therapy (median 1.4 × 109 cfu/g [range 4.0 × 105 to 4.0 × 109 cfu/g] vs 6.0 × 109 cfu/g [1.0 × 103 to 1.0 × 1010 cfu/g], respectively; P = 0.83). LGG therapy had no consistent effects on IP (P = 0.58) or its relationship with age (r = −0.40, P = 0.29), and was associated with conversion to positive HBT results in 1 subject.Conclusions:In this sample of children with SBS, the IP was within normal limits but did not correlate with age. LGG therapy had no consistent effects on IP. These findings do not support empiric LGG therapy to enhance IP in children with SBS.
Family Medicine Education in Brazil: Challenges, Opportunities, and Innovations
Authors: Blasco Pablo González , Levites Marcelo Rozenfeld , Janaudis Marco Aurélio , Moreto Graziela , Roncoletta Adriana Fernanda Tamassia , de Benedetto Maria Auxiliadora Craice , Pinheiro Thais Raquel 
Published: March 2009

Abstract

Since 1988, Brazil’s public health system has tried to build a national health system that responds to the needs and expectations of Brazil’s population. In 1994, the government created the Family Health Program to help carry out that goal. However, the dearth of family physicians in Brazil—the central figures in that program—limits the program’s effectiveness. The lack of family physicians can be traced primarily to the medical schools, which at that time were not training such physicians. This, in turn, can be traced to a number of conditions in Brazil (e.g., the bias toward specialization in both medical education and care) that favor specialists and discourage generalists.
In 1992, a group of physicians founded an academic society in São Paulo to promote the humanistic dimensions of doctoring and “establish the proper basis and scientific methodology for family medicine.” The society’s board eventually began teaching humanistic medicine to medical students, who became interested in family medicine. The board realized that its mission should expand to find ways to introduce and integrate family medicine into the medical schools of Brazil, to establish family medicine’s academic credentials, help attract students to family medicine as a career, and secure family medicine’s credibility in the marketplace. Since that time, the society has developed a variety of initiatives involving students, faculty, and medical schools to pursue these goals. The authors describe these initiatives, the progress made, and the challenges ahead.
Perspective: Medical Students’ Perceptions of the Poor: What Impact Can Medical Education Have?
Authors: Wear Delese , Kuczewski Mark G. 
Published: March 2009

Abstract

There is currently little knowledge or understanding of medical students’ knowledge and attitudes toward the poor. Teaching hospitals bring students face-to-face with poor and uninsured patients on a regular basis. However, an overview of the research available suggests that this contact does not result in students’ greater understanding and empathy for the plight of the poor and may, in fact, lead to an erosion of positive attitudes toward the poor. A basic understanding of justice suggests that as the poor are disproportionately the subjects of medical training, this population should enjoy a proportionate benefit for this service. Furthermore, medicine’s social contract with the public is often thought to include an ideal of service to the underserved and a duty to help educate the general public regarding the health needs of our nation.
In their discussion, the authors situate medical students’ attitudes toward the poor within larger cultural perspectives, including attitudes toward the poor and attributions for poverty. They provide three suggestions for improving trainees’ knowledge of and attitudes toward the poor—namely, increasing the socioeconomic diversity of students, promoting empathy through curricular efforts, and focusing more directly on role modeling. The authors argue that service learning, especially efforts that include gaining detailed knowledge of a particular person or persons, coupled with critical reflection, presents a very promising direction toward achieving these goals. Finally, they posit an agenda for future educational research that might contribute to the increased efficacy of medical education in this important formative domain.
On Outcomes and Humility
Authors: Wear Delese 
Published: March 2009

Abstract

The competency movement in medical education asserts itself in every corner of students’ experiences from matriculation through residency. Such a focus on making sure trainees achieve desired levels of skills, knowledge, and technique is highly desired by the patients they will be servicing, but educators’ need to turn nearly every dimension of medical education into a competency is an ill-advised leap that transforms a complex educational mission into a bottom-line venture. This commentary provides a critical examination of the wholesale use of competency measures in academic medicine, using the concurrent articles by Murray-García and García about multiculturalism and by Kumagai about narrative medicine as thoughtful examples of educational efforts that turn away from this narrow orientation, focusing instead on the ongoing reflective processes and humility that mark the lifelong development of skilled, empathic physicianhood.
Airway Changes during Labor and Delivery
Authors: Kodali Bhavani-Shankar , Chandrasekhar Sobhana , Bulich Linda N. , Topulos George P. , Datta Sanjay 
Published: March 2009

Background
There are no prospective studies that evaluated airway changes during labor. The purpose of this study was to evaluate airway changes in women undergoing labor and delivery.

Methods
Two studies were undertaken to evaluate airway changes during labor. The first study used the conventional Samsoon modification of the Mallampati airway class. The airway was photographed at the onset and the end of labor. Women with class 4 airways were excluded from initial participation. In the second study, upper airway volumes were measured using acoustic reflectometry at the onset and the conclusion of labor. Acoustic reflectometry software computed the values for the components of upper airway, oral volume, and pharyngeal volume.

Results
In study 1 (n = 61), there was a significant increase in airway class from prelabor to postlabor (P < 0.001). The airway increased one grade higher in 20 (33%) and two grades higher in 3 (5%) after labor. At the end of labor, there were 8 parturients with airway class 4 (P < 0.01) and 30 parturients with airway class 3 or class 4 (P < 0.001). In study 2 (n = 21), there were significant decreases in oral volume (n = 21; P < 0.05), and pharyngeal area (P < 0.05) and volume (P < 0.001) after labor and delivery. No correlation was observed between airway changes during labor and duration of labor, or fluids administered during labor in either study.

Conclusion
Airways can change during labor. Therefore, a careful airway evaluation is essential just before administering anesthesia during labor rather than obtaining this information from prelabor data.