bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Cleaning of the Environment Surrounding Patients in 36 Acute Care Hospitals
Authors: Carling Philip C. , Parry Michael M. , Rupp Mark E. , Po John L. , Dick Brian , Von Beheren Sandra ,   Healthcare Environmental Hygiene Study Group
Published: October 2008

Objective.The prevalence of serious infections caused by multidrug-resistant pathogens transmitted in the hospital setting has reached alarming levels, despite intensified interventions. In the context of mandates that hospitals ensure compliance with disinfection procedures of surfaces in the environment surrounding the patient, we implemented a multihospital project to both evaluate and improve current cleaning practices.Design.Prospective quasi-experimental, before-after, study.Setting.Thirty-six acute care hospitals in the United States ranging in size from 25 to 721 beds.Methods.We used a fluorescent targeting method to objectively evaluate the thoroughness of terminal room disinfection cleaning before and after structured educational and procedural interventions.Results.Of 20,646 standardized environmental surfaces (14 types of objects), only 9,910 (48%) were cleaned at baseline (95% confidence interval, 43.4-51.8). Thoroughness of cleaning at baseline correlated only with hospital expenditures for environmental services personnel (P = .02). After implementation of interventions and provision of objective performance feedback to the environmental services staff, it was determined that 7,287 (77%) of 9,464 standardized environmental surfaces were cleaned (P < .001). Improvement was unrelated to any demographic, fiscal, or staffing parameter but was related to the degree to which cleaning was suboptimal at baseline (P < .001).Conclusions.Significant improvements in disinfection cleaning can be achieved in most hospitals, without a substantial added fiscal commitment, by the use of a structured approach that incorporates a simple, highly objective surface targeting method, repeated performance feedback to environmental services personnel, and administrative interventions. However, administrative leadership and institutional flexibility are necessary to achieve success, and sustainability requires an ongoing programmatic commitment from each institution.
Clinical trial: sodium phosphate tablets are preferred and better tolerated by patients compared to polyethylene glycol solution plus bisacodyl tablets for bowel preparation
Authors: LICHTENSTEIN G. R. , GRANDHI N. , SCHMALZ M. , LOTTES S. R. , FORBES W. P. , WALKER K. , ZHANG B. 
Published: October 2008

SummaryBackground  Patient acceptance of bowel preparation can affect colon cancer screening compliance.Aim  To compare patient acceptance, preference and tolerability of 32‐sodium phosphate tablets vs. 2L polyethylene glycol solution plus 4 bisacodyl tablets for bowel preparation.Methods  A prospective, randomized, investigator‐blinded, multicentre trial was performed. Results were based on responses to a patient questionnaire.Results  411 patients (205 sodium phosphate; 206 polyethylene glycol plus bisacodyl) completed the study preparation and patient questionnaire prior to colonoscopy. More patients receiving sodium phosphate vs. polyethylene glycol plus bisacodyl found it easy to take (77% vs. 42%), reported it to be without taste (47% vs. 6%), found it easy to take with respect to volume of liquid prescribed (72% vs. 27%) and indicated they would take the same preparation again in the future (96% vs. 74%, P < 0.0001 for all). Fewer patients receiving sodium phosphate vs. polyethylene glycol plus bisacodyl had to take time off work or change ordinary activities to take the study preparation (18% vs. 52%, P < 0.0001). Nausea, vomiting, bloating and abdominal pain were reported less frequently with sodium phosphate (P < 0.0013).Conclusion  The 32‐tablet sodium phosphate dosing regimen was easier to take and better tolerated, when compared to 2L polyethylene glycol plus bisacodyl tablets for bowel preparation.
Colonic stent versus surgery for the management of acute malignant colonic obstruction: a decision analysis
Authors: SIDDIQUI A. , KHANDELWAL N. , ANTHONY T. , HUERTA S. 
Published: October 2008

SummaryBackground  Acute colonic obstruction because of advanced colonic malignancy is a surgical emergency.Aim  To compare the clinical outcomes and cost‐effectiveness of endoscopic self‐expanding metal stent (SEMS) vs. surgery for emergent management of acute malignant colonic obstruction in patients with metastatic colorectal cancer over a 6‐month period.Methods  Decision analysis was used to calculate the cost‐effectiveness and success of two competing strategies in a hypothetical patient with metastatic colon cancer presenting with acute, malignant colonic obstruction: (i) emergent colonic stent (SEMS cohort); (ii) emergent surgical resection followed by diversion (surgery cohort).Results  Self‐expanding metal stent resulted in a success and a lower mortality rate when compared to surgery over a 6‐month period. Colonic SEMS was also associated with a lower mean cost per patient ($27 225 vs. $57 398). Mortality in the surgery group was 25 times that of the SEMS cohort. One‐ and two‐way sensitivity analyses identified SEMS as the dominant strategy.Conclusion  Colonic stent insertion is more effective and less costly than surgery for the management of colonic obstruction in patients with metastatic colon cancer.
Individualized population pharmacokinetic model with limited sampling for cyclosporine monitoring after liver transplantation in clinical practice
Authors: LANGERS P. , CREMERS S. C. L. M. , DEN HARTIGH J. , RIJNBEEK E. M. T. , RINGERS J. , LAMERS C. B. H. W. , HOMMES D. W. , VAN HOEK B. 
Published: October 2008

SummaryBackground  We recently developed and validated limited sampling models (LSMs) for cyclosporine monitoring after orthotopic liver transplantation based on individualized population pharmacokinetic models with Bayesian modelling.Aim  To evaluate LSM in practice, and to seek optimal balance between benefit and discomfort.Methods  In 30 stable patients, more than 6 months after orthotopic liver transplantation, previously switched from trough‐ to 2 h post‐dose (C2)‐monitoring, we switched to 3‐monthly LSM 0,1,2,3 h‐monitoring. During 18 months we evaluated dose, creatinine clearance, calculated area under the curve, intra‐patient pharmacokinetic variability and ability to assess systemic exposure by several previously validated LSMs.Results  Within patients, there was variability of cyclosporine‐area under the curve with the same dose (CV of 15%). Compared to C2‐monitoring, there was no significant difference in dose (P = 0.237), creatinine clearance (P = 0.071) and number of rejections. Some models showed excellent correlation and precision with LSM 0,1,2,3 h comparing area under the curves (0,2 h: r2 = 0.88; 0,1,3 h: r2 = 0.91; 0,2,3 h: r2 = 0.92, all P < 0.001) with no difference in advised dose.Conclusions  The limited sampling model, with only trough‐ and 2‐h sampling, yields excellent accuracy and assesses systemic exposure much better than C2 with less bias and greater precision. Considering the calculated intra‐patient variability, more precision is redundant, so LSM 0,2 h seems the optimal way of cyclosporine‐monitoring.
Review article: vaccination and viral hepatitis – current status and future prospects
Authors: KOFF R. S. 
Published: October 2008

SummaryBackground  Viral hepatitis is the most common cause of liver disease in the world. In the past 25 years, vaccines have become available for two of the five hepatitis viruses, and, where implemented, vaccination has become a key component of hepatitis prevention.Aims  To provide an update on recent advances in the use of current hepatitis vaccines and to examine progress in the development of vaccines for the remaining hepatitis viruses.MethodsA Medline search was undertaken to identify the recent relevant literature. Search terms included hepatitis vaccines, hepatitis vaccination and hepatitis A–E vaccines.Results  Dramatic vaccine‐induced declines in the incidence of both hepatitis A and B have occurred in the USA. Strategies to integrate hepatitis A vaccine into universal childhood immunization are being adopted. Similarly, strategies with the goal of eliminating transmission of hepatitis B have been promulgated. A vaccine for hepatitis E has been reported to be effective and safe, but progress in the development of vaccines for hepatitis C and D has been limited.Conclusion  During the next few decades, the goals of eliminating hepatitis A and B virus transmission may be reached in the USA and elsewhere.
Review article: the assessment of liver function using breath tests
Authors: ILAN Y. 
Published: October 2008

SummaryBackground  Hepatologists have long sought to develop a test for assessing liver function, but this aim has been stalled by the complexity of the liver and its diverse functions. Results of metabolic tests, including breath tests, correlate with clinical and histological parameters of patients with liver disorders; however, these tests tend to be cumbersome and impractical for everyday use. The recent development of a real‐time, point‐of‐care liver function breath test has made it straightforward to assess the metabolic function of the liver.Aim  To review the available data on the use of breath tests for assessing liver reserve in various conditions and their application in various clinical hepatology settings.Results  The 13C‐methacetin breath test enables accurate follow‐up of patients with acute or chronic liver damage, where overall hepatic function is significantly suppressed by known causes of liver disorders, including acute, sub‐acute or chronic conditions. The metabolic breath test can detect both gradual and spontaneous improvements in liver function and the effects of treatment.Conclusions  Breath testing that provides continuous quantification of methacetin metabolism may be a sensitive tool for the diagnosis and follow‐up of patients with liver disorders.
Clinical trial: acupuncture vs. doubling the proton pump inhibitor dose in refractory heartburn
Authors: DICKMAN R. , SCHIFF E. , HOLLAND A. , WRIGHT C. , SARELA S. R. , HAN B. , FASS R. 
Published: October 2008

SummaryBackground  The current standard of care in proton pump inhibitor failure is to double the proton pump inhibitor dose, despite limited therapeutic gain.Aims  To determine the efficacy of adding acupuncture vs. doubling the proton pump inhibitor dose in gastro‐oesophageal reflux disease patients who failed symptomatically on proton pump inhibitors once daily.Methods  Thirty patients with classic heartburn symptoms who continued to be symptomatic on standard‐dose proton pump inhibitors were enrolled into the study. All participants underwent upper endoscopy while on proton pump inhibitors once daily. Subsequently, patients were randomized to either adding acupuncture to their proton pump inhibitor or doubling the proton pump inhibitor dose over a period of 4 weeks. Acupuncture was delivered twice a week by an expert.Results  The two groups did not differ in demographic parameters. The acupuncture + proton pump inhibitor group demonstrated a significant decrease in the mean daytime heartburn, night‐time heartburn and acid regurgitation scores at the end of treatment when compared with baseline, while the double‐dose proton pump inhibitor group did not demonstrate a significant change in their clinical endpoints. Mean general health score was only significantly improved in the acupuncture + proton pump inhibitor group.Conclusion  Adding acupuncture is more effective than doubling the proton pump inhibitor dose in controlling gastro‐oesophageal reflux disease‐related symptoms in patients who failed standard‐dose proton pump inhibitors.
Hospitalization for gastrointestinal adverse events attributable to the use of low‐dose aspirin among patients 50 years or older also using non‐steroidal anti‐inflammatory drugs: a retrospective cohort study
Authors: RAHME E. , NEDJAR H. , BIZZI A. , MORIN S. 
Published: October 2008

SummaryBackground  Use of aspirin with non‐steroidal anti‐inflammatory drugs increases the risk of gastrointestinal ulcers; however, it is not clear if this risk varies with the non‐steroidal anti‐inflammatory drug used.Aim  To assess the risk of gastrointestinal hospitalizations attributable to aspirin in patients 50 years or older also using non‐steroidal anti‐inflammatory drugs.Methods  Administrative data of patients 50 years or older who received a non‐steroidal anti‐inflammatory drug or acetaminophen prescription between 1998 and 2004 were used.Results  Study patients received 7 412 992 non‐steroidal anti‐inflammatory drug prescriptions and 5 614 044 acetaminophen prescriptions among which 23% and 32%, respectively, were dispensed to aspirin users. Time‐dependent Cox regression models revealed that, compared to patients using acetaminophen (without aspirin), the adjusted hazard ratio (95% CI) among non‐users of aspirin were: rofecoxib 1.3 (1.2, 1.5), celecoxib 0.7 (0.6, 0.8), diclofenac 1.5 (1.2, 1.7), ibuprofen 0.9 (0.6, 1.4), naproxen 2.5 (2.1, 3.0) and piroxicam 1.5 (0.8, 2.8); among users of aspirin: rofecoxib 3.2 (2.8, 3.7), celecoxib 1.8 (1.5, 2.1), diclofenac 2.8 (2.2, 3.5), ibuprofen 1.4 (0.8, 2.7), naproxen 2.2 (1.6, 3.0) and piroxicam 2.0 (0.8, 5.4). The risk attributable to aspirin varied from none with naproxen to 61% (53%, 68%) with celecoxib.Conclusion  The increase in gastrointestinal hospitalization attributable to aspirin differed with the non‐steroidal anti‐inflammatory drug used, and seemed higher with cyclo‐oxygenase‐2 inhibitors than with non‐selective non‐steroidal anti‐inflammatory drugs.
Evidence of allelic heterogeneity for associations between the NOD2/CARD15 gene and ulcerative colitis among North Indians
Authors: JUYAL G. , AMRE D. , MIDHA V. , SOOD A. , SEIDMAN E. , THELMA B. K. 
Published: October 2008

SummaryBackground  Three common disease susceptibility variants in the NOD2 gene are associated with inflammatory bowel disease in Caucasians, but not in Asians.Aim  To screen for NOD2 variants and examine susceptibility for inflammatory bowel disease in North Indians.Methods  A case–control study was carried out in Punjab, India. Confirmed cases of ulcerative colitis and Crohn’s disease and healthy controls matched for age (±10 years) and ethnicity were studied. Besides genotyping the three disease susceptibility variants (SNP8, SNP12 and SNP13), all 12 exons were resequenced to determine other potential single nucleotide polymorphisms.Results  Two hundred and ninety‐eight ulcerative colitis, 25 Crohn’s disease and 262 controls were investigated. Median age (range) at diagnosis was 39 (7–78) years for ulcerative colitis and 40 (32–58) years for Crohn’s disease. All three disease susceptibility variants were either monomorphic or rare in the population. Sequencing (n = 30) revealed two single nucleotide polymorphisms: SNP5 (268 Pro/Ser) and rs2067085 (178 Ser/Ser). The frequency of SNP5 was higher among ulcerative colitis (17% vs. 12% in controls, P = 0.016) and Crohn’s disease cases (20% vs. 12%, P = 0.28). SNP5 carriers had elevated risks for ulcerative colitis (OR = 1.72, 95% CI = 1.17–2.52, P = 0.005).Conclusions  The absence of known inflammatory bowel disease susceptibility variants and potential associations between SNP5 and ulcerative colitis in North Indians suggests the presence of allelic heterogeneity for ulcerative colitis susceptibility.
Relevance of mild ineffective oesophageal motility (IOM) and potential pharmacological reversibility of severe IOM in patients with gastro‐oesophageal reflux disease
Authors: FORNARI F. , BLONDEAU K. , DURAND L. , REY E. , DIAZ‐RUBIO M. , DE MEYER A. , TACK J. , SIFRIM D. 
Published: October 2008

SummaryBackground  Several studies showed high prevalence of ineffective oesophageal motility (IOM) in gastro‐oesophageal reflux disease (GERD) and suggested an important role for ineffective oesophageal motility in increased acid exposure. However, impedance‐manometric studies proposed that only severe ineffective oesophageal motility might affect oesophageal clearance.Objectives  (i) To re‐assess the relevance of mild IOM in GERD and (ii) to test the reversibility of IOM.Methods  Oesophageal motility, clearance and acid exposure were assessed in 191 GERD patients: 99 without IOM; 58 with mild IOM (30–80% ineffective contractions) and 34 with severe IOM (>80% ineffective contractions). In 30 patients with oesophagitis, the potential reversibility of IOM was evaluated with edrophonium intravenously.Results  Patients with mild IOM had identical oesophageal clearance and acid exposure in comparison with those without IOM. Patients with severe IOM had a higher probability of prolonged supine clearance and acid exposure [odds ratio: 2.88 (1.16–7.17); 2.48 (0.99–6.17)]. This effect was independent of the presence of hiatal hernia and male sex. Severe IOM could be transiently reverted in 55% of patients.Conclusions  Mild IOM does not affect oesophageal clearance. Only severe IOM is associated with prolonged clearance and acid exposure, particularly in supine periods. The edrophonium test might be useful to predict severe IOM response to prokinetic medications.
Clinical, subclinical and potential autoimmune diseases in an Italian population of children with coeliac disease
Authors: GUARISO G. , CONTE S. , PRESOTTO F. , BASSO D. , BROTTO F. , POZZA L. VISONÀ DALLA , PEDINI B. , BETTERLE C. 
Published: October 2008

SummaryBackground Several studies have suggested a link between coeliac disease and other autoimmune diseases.Aim To compare the presence of autoimmune disease in children with coeliac disease and in controls.Methods When coeliac disease was diagnosed, 267 children were evaluated for clinical autoimmune disease (with signs/symptoms), subclinical autoimmune disease (with autoantibodies and subclinical impairment of the target organ) or potential autoimmune disease (with autoantibodies only) and compared with 220 healthy controls. 170 coeliac disease patients were followed up for a mean 47 ± 31 months, in complete remission on a gluten‐free diet. Ninety‐nine controls were followed up for 45 ± 33 months.Results When coeliac disease was diagnosed, 71 (27%) children had autoimmune disease vs. 1% among the controls (P < 0.001): 31 had clinical autoimmune disease and 40 had subclinical or potential autoimmune disease.During the follow‐up, the clinical autoimmune disease cases slightly decreased from 12% to 11%, while the potential autoimmune disease cases increased from 14% to 21%. Of the 99 controls, none had any variation in their autoantibody profile.Conclusions Gluten‐free diet does not modify the natural history of autoimmunity in patients with coeliac disease. However, gluten‐free diet seems to produce a favourable effect on the previously present clinical autoimmune disease and to prevent the development of new clinical autoimmune disease, but does not affect the onset of potential autoimmunity, which tends to increase with time.
Clinical trial: persistent gastro‐oesophageal reflux symptoms despite standard therapy with proton pump inhibitors – a follow‐up study of intraluminal‐impedance guided therapy
Authors: BECKER V. , BAJBOUJ M. , WALLER K. , SCHMID R. M. , MEINING A. 
Published: October 2008

SummaryBackground  Persistent gastro‐oesophageal reflux disease (GERD), despite proton pump inhibitor (PPI) therapy, is a common problem. Combined pH/impedance monitoring (pH/MII) enables detection of reflux episodes.Aim  To identify patients with objective episodes of persistent reflux and second, to evaluate the effect of modified therapy based on the results of pH/MII.Methods  In all, 143 patients were examined with pH/MII because of GERD‐symptoms resistant to PPI‐therapy. Patients with pathological pH/MII (group 1) and with normal results (group 2) were identified. Therapy modifications were evaluated after a minimum follow‐up of 3 months.Results  In 56 of 143 (39.1%) patients, pathological findings in pH/MII were identified. Therapy was escalated in 33/52 patients (group 1) and in 30/71 patients (group 2). Escalating therapy led to symptomatic relief in 90.9% of the patients in group 1 and 43.3% of the patients in group 2 (P < 0.001).Conclusions  GERD symptoms refractory to PPI‐therapy could be objectively identified with pH/MII in almost 40% of all patients. Furthermore, escalating anti‐reflux therapy if pH/MII was pathological is associated with a significantly higher rate of successful treatment compared to the patients with normal findings. Therefore, pH/MII facilitates a more focussed therapeutical approach to patients with PPI‐resistant GERD.
The epidemiology and virology of hepatitis C virus genotype 5 in central France
Authors: ABERGEL A. , UGHETTO S. , DUBOST S. , BONNY C. , AUBLET‐CUVELIER B. , DELAROCQUE‐ASTAGNEAU E. , BAILLY J. L. , BOMMELAER G. , CASANOVA S. , DELTEIL J. , DENY P. , LAURICHESSE H. , ODENT‐MALAURE H. , ROUSSEL J. , PEIGUE‐LAFEUILLE H. , HENQUELL C. 
Published: October 2008

SummaryBackground  We previously reported high prevalence of hepatitis C virus genotype 5a (HCV 5) (14%) in Central France.Aim  To identify the risk factors associated with HCV5 infection and to characterize local HCV5 lineages.Method  A case‐control study and phylogenetic analysis were conducted.Results  In all, 131 HCV5 and 343 HCV non 5 infected patients were enrolled. No HCV5 patient was born in sub‐Saharan Africa and only two were injection drug user. HCV5 contamination was associated with living in a rural area called Vic le Comte (VLC) in non‐transfused patients (OR = 17.7), with transfusion in patients living outside VLC (OR = 3.8) and with receiving injections in patients from VLC (OR = 3.1). More than 80% of the patients from outside VLC were contaminated by transfusion and those from VLC mainly by an iatrogenic factor – injections performed before 1972 by the local physician. Phylogenetic analysis of HCV5 isolates evidenced no distinct genetic cluster, but close relationships between the isolates of spouse pairs and between blood donors and recipients.Conclusions  Our results suggest that HCV5 spread in our district by iatrogenic route before 1972 and then via transfusion to the whole district. Collaborative studies are underway to study viral sequences from different parts of Africa and Europe to estimate the origin of our HCV 5a strains.