bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementing the severe sepsis care bundles outside the ICU by outreach
Authors: Carter Chris 
Published: September 2007

AbstractSepsis is not a new challenge facing the health care team, it remains a complex disease, which is difficult to identify and treat. Mortality from sepsis remains high and continues to be a common cause of death among critically ill patients, despite advances in critical care. Sepsis accounts for an estimated 27% of all intensive care admissions in England, Wales and Northern Ireland, and accounted for 46% of all intensive care bed days. Recent research studies and the surviving sepsis campaign have shown that identifying and providing key interventions to patients with severe sepsis and septic shock prior to their admission to the intensive care unit significantly improve outcomes. The aim of this paper was to identify how the Critical Care Outreach Team at one local hospital implemented the severe sepsis resuscitation care bundle for patients in the emergency department (ED) and on the general wards. It will include a presentation on the various ways the team raised the profile of severe sepsis and the care bundle at hospital and at national level. It also includes audit data that have been collected. The results showed that if the resuscitation care bundle was implemented within the first 24 h of hospital admission, mortality was 29%, whereas if the care bundle was instigated after this time mortality was more than at 49%. Audit data showed that the commonest sign of severe sepsis seen in patients in the ED and on wards was tachypnoea. This article discusses the successful implementation of the severe sepsis resuscitation care bundle and the positive impact an Outreach team can have in changing practice in the way patients are managed with severe sepsis. The audit data support the need for regular physiological observations and the use of a Patient At Risk Trigger scoring tool to identify patients at risk of deterioration. This allows referral to the Outreach team, who assess the patient and if appropriate initiate the care bundle.
Epileptic Automatisms in the Criminal Courts: 13 Cases Tried in England and Wales between 1975 and 2001
Authors: Reuber Markus , Mackay Ronnie D. 
Published: September 2007

SummaryObjectives:To explore the relationship of epilepsy and criminal behavior.Methods:Case series based on all criminal cases found “not guilty by reason of insanity” (NGRI) because of epilepsy in England and Wales between 1975 and 2001. Data were extracted from medico‐legal reports held by the Mental Health Unit at the Home Office and the Department for Constitutional Affairs in London, UK.Results:Thirteen cases were identified, accounting for 7.3% of all verdicts of NGRI. Charges included murder (1), attempted murder (1) assault (7), arson (2), abduction/kidnapping (3), and burglary (1). Of the defendants, 92.3% were male, 76.9% had neuropsychological impairments, 84.6%% had psychiatric comorbidity, 92.3% were unemployed at the time of the offence, and 69.2% had been convicted of criminal offences previously. Eight of 10 defendants treated with antiepileptic drugs were complying poorly with medication. A total of 61.5% offenses were committed in a state of alcohol intoxication. Psychotic symptoms may have been present when the offense was committed in 52.8% of cases. Over two‐thirds of offenses probably occurred during the postictal period.Conclusions:This case series suggests that it is exceptional for epileptic seizures to cause criminal acts or omissions. The relatively low standard of proof required means that some of cases found NGRI on account of epilepsy were not actually related to seizures. There were no definite examples of ictal criminal behavior. Most offenses related to seizures are likely to have occurred in the postictal phase.
Mechanisms of Epileptogenesis in Tuberous Sclerosis Complex and Related Malformations of Cortical Development with Abnormal Glioneuronal Proliferation
Authors: Wong Michael 
Published: September 2007

Summary Malformations of cortical development (MCDs) are increasingly recognized as causes of medically intractable epilepsy. In order to develop more effective, rational therapies for refractory epilepsy related to MCDs, it is important to achieve a better understanding of the underlying mechanisms of epileptogenesis, but this is complicated by the wide variety of different radiographic, histopathological, and molecular features of these disorders. A subset of MCDs share a number of characteristic cellular and molecular abnormalities due to early defects in neuronal and glial proliferation and differentiation and have a particularly high incidence of epilepsy, suggesting that this category of MCDs with abnormal glioneuronal proliferation may also share a common set of primary mechanisms of epileptogenesis. This review critically analyzes both clinical and basic science evidence for overlapping mechanisms of epileptogenesis in this group of disorders, focusing on tuberous sclerosis complex, focal cortical dysplasia with balloon cells, and gangliogliomas. Specifically, the role of lesional versus perilesional regions, circuit versus cellular/molecular defects, and nonneuronal factors, such as astrocytes, in contributing to epileptogenesis in these MCDs is examined. An improved understanding of these various factors involved in epileptogenesis has direct clinical implications for optimizing current treatments or developing novel therapeutic approaches for epilepsy in these disorders.
Utility of Magnetoencephalography in the Evaluation of Recurrent Seizures after Epilepsy Surgery
Authors: Mohamed Ismail S , Otsubo Hiroshi , Ochi Ayako , Elliott Irene , Donner Elizabeth , Chuang Sylvester , Sharma Rohit , Holowka Stephanie , Rutka James , Snead O. Carter 
Published: September 2007

Summary
Purpose: To study the role of magnetoencephalography (MEG) in the surgical evaluation of children with recurrent seizures after epilepsy surgery.
Methods: We studied 17 children with recurrent seizures after epilepsy surgery using interictal and ictal scalp EEG, intracranial video EEG (IVEEG), MRI, and MEG. We analyzed the location and distribution of MEG spike sources (MEGSSs) and the relationship of MEGSSs to the margins of previous resections and surgical outcome.
Results: Clustered MEGSSs occurred at the margins of previous resections within two contiguous gyri in 10 patients (group A), extended spatially from a margin by ≤3 cm in three patients (group B), and were remote from a resection margin by >3 cm in six patients (group C). Two patients had concomitant group A and C clusters. Thirteen patients underwent second surgeries. IVEEG was used in four patients. Six of seven patients with group A MEGSS clusters did not require IVEEG for second surgeries. Follow‐up periods ranged from 0.6 to 4.3 years (mean: 2.6 years). Eleven children, including eight who became seizure‐free, achieved Engel class I or II.
Conclusion: Our data demonstrate the utility of MEG for evaluating patients with recurrent seizures after epilepsy surgery. Specific MEGSS cluster patterns delineate epileptogenic zones. Removing cluster regions adjacent to the margins of previous resections, in addition to removing recurrent lesions, achieves favorable surgical outcome. Cluster location and extent identify which patients require IVEEG, potentially eliminating IVEEG for some. Patients with remotely located clusters require IVEEG for accurate assessment and localization of the entire epileptogenic zone.
Treatment of Dementia in Community‐Dwelling and Institutionalized Medicare Beneficiaries
Authors: Gruber‐Baldini Ann L. , Stuart Bruce , Zuckerman Ilene H. , Simoni‐Wastila Linda , Miller Ram 
Published: September 2007

OBJECTIVES: To establish nationally representative estimates of the use of agents to treat Alzheimer's disease and related dementias (ADRDs) and related behavioral symptoms in Medicare beneficiaries and to describe medication use according to residential status and other patient characteristics.DESIGN: Cross‐sectional prevalence study.SETTING: Community and various long‐term care (LTC) settings.PARTICIPANTS: Twelve thousand six hundred ninety‐seven beneficiaries from the 2002 Medicare Current Beneficiary Survey (MCBS), of whom 11,593 were community dwelling and 1,104 resided in various LTC settings.MEASUREMENTS: ADRDs were identified according to International Classification of Diseases, Ninth Revision, codes in Medicare claims and self‐ and proxy reports. Medication use was derived from self‐reports (community) and extracts of facility medication administration records (LTC).RESULTS: In 2002, an estimated 3.4 million Medicare beneficiaries were diagnosed with ADRDs (8.1%), of whom 58.9% resided in the community (prevalence rate=5.1%) and 41.1% resided in LTC facilities (prevalence rate=57.2%). Use of antidementia drugs was similar across settings, with 24.7% of subjects with dementia in the community and 26.3% of those in LTC receiving prescriptions for donepezil, galantamine, or rivastigmine. Use of haloperidol was comparable (and low) in both settings. Use of atypical antipsychotics, especially risperidone, olanzapine, and quetiapine, was much higher in LTC residents (21.0%, 11.9%, and 7.1%, respectively) than in the community (5.1%, 4.0%, and 2.3%).CONCLUSION: The prevalence of ADRDs in LTC settings is much larger than in the community, but there is little difference in the proportions receiving antidementia drugs, although LTC residents are more likely to be treated with atypical antipsychotics (risperidone, olanzapine, and quetiapine), presumably for behavioral symptoms.
Symptom Experience of Dying Long‐Term Care Residents
Authors: Hanson Laura C. , Eckert J. Kevin , Dobbs Debra , Williams Christianna S. , Caprio Anthony J. , Sloane Philip D. , Zimmerman Sheryl 
Published: September 2007

OBJECTIVES:To describe the end‐of‐life symptoms of nursing home (NH) and residential care/assisted living (RC/AL) residents, compare staff and family symptom ratings, and compare how staff assess pain and dyspnea for cognitively impaired and cognitively intact residents.DESIGN:After‐death interviews.SETTING:Stratified random sample of 230 long‐term care facilities in four states.PARTICIPANTS:Staff (n=674) and family (n=446) caregivers for dying residents.MEASUREMENTS:Interview items measured frequency and severity of physical symptoms, effectiveness of treatment, recommendations to improve care, and staff report of assessment.RESULTS:Decedents' median age was 85, 89% were white, and 77% were cognitively impaired. In their last month of life, 47% had pain, 48% dyspnea, 90% problems with cleanliness, and 72% symptoms affecting intake. Problems with cleanliness, intake, and overall symptom burden were worse for decedents in NHs than for those in RC/AL. Treatment for pain and dyspnea was rated very effective for only half of decedents. For a subset of residents with both staff and family interviews (n=331), overall ratings of care were similar, although agreement in paired analyses was modest (kappa=−0.043–0.425). Staff relied on nonverbal expressions to assess dyspnea but not pain. Both groups of caregivers recommended improved application of treatment and increased staffing to improve care.CONCLUSION:In NHs and RC/AL, dying residents have high rates of physical symptoms and need for more‐effective palliation of symptoms near the end of life.
Prevalence of Anemia in the Nursing Home: Contribution of Chronic Kidney Disease
Authors: Robinson Bruce , Artz Andrew S. , Culleton Bruce , Critchlow Cathy , Sciarra Angela , Audhya Paul 
Published: September 2007

OBJECTIVES: To assess the independent contribution of chronic kidney disease (CKD) and age to anemia in older nursing home residents.DESIGN: Retrospective.SETTING: Skilled nursing facility.PARTICIPANTS: Nursing home residents with records in the Beverly Healthcare Data Warehouse who were admitted to a nursing home between January 1, 2002, and December 31, 2003; were alive as of January 31, 2004; and had hemoglobin and serum creatinine (SCr) values available for analysis.MEASUREMENTS: Prevalence of anemia (hemoglobin <13 g/dL for men and <12 g/dL for women) and CKD (estimated glomerular filtration rate <60 mL/min per 1.73 m2, according to Modification of Diet in Renal Disease criteria) and the contribution of CKD and age to the prevalence of anemia.RESULTS: Six thousand two hundred resident records were analyzed (70% female, 85% Caucasian). Overall, 59.6% of residents were anemic, and 43.1% had CKD, and residents with CKD were more likely to have anemia (64.9% with vs 55.7% without CKD; odds ratio (OR)=1.47, 95% confidence interval (CI)=1.33–1.63). Although older age was associated with lower hemoglobin values primarily in residents without CKD (Spearman rank correlation coefficient (r)=−0.10, P<.001), age had no association with hemoglobin in CKD (Spearman r=0.01, P=.60). The greater risk of anemia in the presence of CKD persisted in each age category (OR=2.07, 95% CI=1.53–2.80, aged 65–74; OR=1.44, 95% CI=1.21–1.70, aged 75–84; and OR=1.35, 95% CI=1.15–1.57, aged ≥85).CONCLUSION: Overall, these results suggest that CKD contributes more strongly than older age to the high prevalence of anemia in older nursing home residents.
Three‐Year Change in Inflammatory Markers in Elderly People and Mortality: The Invecchiare in Chianti Study
Authors: Alley Dawn E. , Crimmins Eileen , Bandeen‐Roche Karen , Guralnik Jack , Ferrucci Luigi 
Published: September 2007

OBJECTIVES: To describe changes in interleukin‐6 (IL‐6) and C‐reactive protein (CRP) and to determine how changes are related to mortality in elderly people.DESIGN: Prospective cohort study.SETTING: Two communities in the Tuscany region of Italy.PARTICIPANTS: Randomly selected residents aged 65 and older who participated in the first two waves of data collection (N=736).MEASUREMENTS: Two serum measurements of IL‐6 and CRP taken 3 years apart. Mortality was observed for the 3 years after the second measurement; 79 deaths were observed in 2,079 person‐years.RESULTS: Correlations indicated marginal to moderate stability in IL‐6 and CRP, with clinical categories remaining relatively stable over time. Baseline levels were not related to mortality between follow‐up Years 3 and 6, but increases in IL‐6 and CRP predicted 3‐ to 6‐year mortality. Controlling for follow‐up IL‐6 and CRP attenuated the relationship between inflammatory changes and mortality, but increases in CRP continued to increase odds of mortality. After controlling for sociodemographic characteristics, biological risk factors, health behaviors, and disease at both times, increases in CRP, but not IL‐6, were related to mortality. Odds of death were more than three times as great in subjects in whom any CRP increase was observed (odds ratio=3.10, 95% confidence interval=1.25–7.68) as in subjects with stable or declining CRP.CONCLUSION: CRP and IL‐6 levels within individuals vary over time, and increases in CRP are associated with greater mortality risk. Three‐year changes in inflammatory markers are better predictors of mortality than baseline measures.
Association Between Aspects of Oral Health–Related Quality of Life and Body Mass Index in Community‐Dwelling Older Adults
Authors: Makhija Sonia K. , Gilbert Gregg H. , Litaker Mark S. , Allman Richard M. , Sawyer Patricia , Locher Julie L. , Ritchie Christine S. 
Published: September 2007

OBJECTIVES: To investigate whether underweight, normal‐weight, overweight, and obese older adults differ in aspects of their oral health–related quality of life (OHRQoL).DESIGN: Cross‐sectional study using a 54‐item OHRQoL questionnaire.SETTING: Five counties in central Alabama: Jefferson and Tuscaloosa (urban), and Hale, Bibb, and Pickens (rural).PARTICIPANTS: The 291 subjects were recruited from participants in the University of Alabama at Birmingham Study of Aging, a longitudinal study of mobility. Participants ranged in age from 65 to 90 (60.5% women, 50.5% non‐Hispanic white, and 50.5% rural).MEASUREMENTS: Participants completed an in‐home interview about their OHRQoL using a 54‐item questionnaire and were classified into four categories of body mass index (BMI) (<20.0 (underweight), 20.0–24.9 (normal), 25.0–29.9 (overweight), and ≥30.0 (obese)). Multivariate analyses were used to examine associations between BMI and OHRQoL, adjusting for age, race, sex, depression, education, perceived income, comorbidity score, life‐space mobility, and physical activity level.RESULTS: The results suggested that a parabolic effect existed, with strongest associations occurring in the underweight and obese categories. With the normal BMI group as the reference group, obese participants were more likely to avoid eating foods they would like to eat, overweight participants were less likely to cook foods differently and reported better chewing ability, and underweight persons were more likely to limit foods they eat because of mouth dryness.CONCLUSION: Objective measures may not accurately reflect peoples' perceptions; therefore, OHRQoL determined according to response to subjective questions is important to properly assess a patient's overall health status. Older adults who are under‐ or overweight should be evaluated for oral health conditions that may affect their nutritional status.
A Comparative Study of Community‐ and Nursing Home‐Acquired Empyema Thoracis
Authors: El Solh Ali A. , Alhajjhasan Ahmad , Ramadan Fadi H. , Pineda Lilibeth A. 
Published: September 2007

OBJECTIVES: To compare the clinical presentation, microbiological features, and outcomes of patients with community‐acquired empyema (CAE) with those of patients with nursing home‐acquired empyema (NHAE).DESIGN: A retrospective observational study.SETTING: Three tertiary care centers.PARTICIPANTS: One hundred fourteen patients admitted from the community and 55 patients transferred from nursing homes.MEASUREMENTS: Baseline sociodemographic information, activities of daily living, Charlson Comorbidity Index score, and clinica, and microbiologic data were obtained. Outcome was assessed at hospital discharge and 6 months postdischarge.RESULTS: Patients admitted from nursing homes had a delayed presentation, with dyspnea, weight loss, and anemia as the predominant manifestation. Patients with CAE presented more acutely, with fever, cough, and chest pain. Anaerobic organisms were more commonly isolated from patients with NHAE. The success rate of nonsurgical intervention was significantly lower for the NHAE patients than for the CAE group (39% vs 63; P=.01). In‐hospital mortality was not significantly different between the two groups (NHAE, 18%; CAE, 8%; P=.09). In a Cox regression analysis, preadmission functional status (hazard ratio (HR)=1.26, 95% confidence interval (CI)=1.19–1.4; P<.001) and surgical intervention (HR=0.47, 95% CI=0.24–0.92; P=.03) were the only variables highly correlated with long‐term outcome.CONCLUSION: Patients admitted with NHAE have distinctly different clinical and microbiological presentation from that of patients with CAE. Because of the delayed presentation in patients with NHAE, medical treatment alone may be associated with higher rate of failure. Surgical therapy should be considered for selected cases, with the aim of improving long‐term survival.
Profile of Cognitive Impairment in Chronic Heart Failure
Authors: Vogels Raymond L.C. , Oosterman Joukje M. , Van Harten Barbera , Scheltens Philip , Van Der Flier Wiesje M. , Schroeder‐Tanka Jutta M. , Weinstein Henry C. 
Published: September 2007

OBJECTIVES: To determine the frequency and pattern of cognitive dysfunction in outpatients with chronic congestive heart failure (CHF) and to identify the corresponding demographic and clinical correlates.DESIGN: Case‐control study.SETTING: Outpatient clinic in a community hospital.PARTICIPANTS: Sixty‐two outpatients with CHF, 53 controls diagnosed with cardiovascular disease uncomplicated by CHF (cardiac controls), and 42 healthy controls were investigated.MEASUREMENTS: Neuropsychological assessment included tests of mental speed, executive function, memory, language, and visuospatial function. Composite z‐scores for five cognitive domains and mean z‐score for overall cognitive performance were computed. The cutoff score to indicate cognitive impairment was defined as the overall healthy participants' cognitive z‐score minus 2 standard deviations. Independent demographic and clinical predictors of cognitive impairment were identified using linear regression analysis.RESULTS: Patients with CHF showed a pattern of general cognitive impairment, including impairment of executive function, memory, language, mental speed, and attention. Twenty‐five percent (P=.04) of patients with CHF were classified as cognitively impaired, compared with 15% of the cardiac controls and 4% of the healthy controls. Independent predictors of cognitive impairment in patients with CHF were estimated intelligence, New York Heart Association class, and presence of the apolipoprotein (Apo)E ɛ4 allele.CONCLUSION: Cognitive dysfunction is relatively common in patients with CHF, with deficits being most prominent in the domains of executive function, memory, language, and mental speed. Disease severity and ApoE genotype are likely to be important determinants for cognitive impairment in patients with chronic CHF.
Effect of Heat Treatment on Fracture Toughness (KIC) and Microstructure of a Fluorcanasite‐Based Glass‐Ceramic
Authors: Oh Won‐suck , Zhang Nai‐Zheng , Anusavice Kenneth J. 
Published: September 2007

Purpose:
The purpose of this study was to test the hypothesis that the increase in fracture toughness of a fluorcanasite‐based glass‐ceramic is a linear function of crystal volume fraction.
Materials and Methods:
A total of 60 specimen bars (20 × 5 × 2 mm3) were cut from parent glass blocks, polished, annealed, randomly divided into six groups, nucleated at 680°C/4 hr, and crystallized at the following temperatures and times: (1) 850°C/0.5 hr, (2) 850°C/1 hr, (3) 850°C/3 hr, (4) 750°C/6 hr, (5) 800°C/6 hr, or (6) 850°C/6 hr. Indentation flaws were produced by a microhardness indenter at the center of one surface, and the prepared specimens were subjected to three‐point flexure loading with the severely flawed surface under tension at a crosshead speed of 0.5 mm/min. Flexural strength and fracture toughness (KIC) were calculated based on the indentation‐strength technique. Crystal volume fraction (Vc) was determined by quantitative stereology of scanning electron images of each group of ceramic specimens. Statistical analysis was performed using ANOVA and Duncan's multiple comparison test (α= 0.05).
Results:
The mean KIC and Vc values ranged from 2.7 to 3.9 MPa m1/2 and 37% to 71% within the crystallization temperature range of 750 to 850°C. Five statistical subsets of groups 1, 2/4, 3, 5, and 6 were determined as a function of crystallization temperature and holding time (Duncan's multiple comparison analysis; α= 0.05). The lowest and highest KIC and Vc values were associated with Groups 1 (850°C/0.5 hr) and 6 (850°C/6 hr), respectively. Fracture toughness increased linearly as a function of crystal volume fraction (correlation coefficient R2= 0.67). The fracture toughness increased by 45% when the crystal volume fraction increased by 92%.
Conclusions:
Mean KIC values increased as a linear function of crystal volume fraction in a fluorcanasite‐based glass‐ceramic within the crystallization temperature range of 750 to 850°C and at isothermal crystallization time range of 0.5 to 6 hours. The control of crystallization temperature and isothermal holding time should be optimized to generate tougher, more reliable ceramic prostheses in the shortest period of time.