bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of Hospital-Acquired Infections During Successive Surveillance Surveys Conducted at a University Hospital in The Netherlands
Authors: Hopmans T. E. M. , Blok H. E. M. , Troelstra A. , Bonten M. J. M. 
Published: March 2007

Objective.To monitor hospital-wide trends in the prevalence of hospital-acquired infections (HAIs) in order to identify areas where the risk of infection is increasing.Methods.Successive surveillance surveys were conducted twice yearly, from November 2001 until May 2004, to determine the prevalence of HAIs at 2 Dutch hospitals, using Centers for Disease Control and Prevention criteria.Results.In all, 340 HAIs were observed in 295 (11.1%) of 2,661 patients surveyed. The overall prevalence per survey varied from 10.2% to 15.6%, with no significant differences between successive surveys. In the surgical department, the prevalence of HAIs increased from 10.8 cases per 100 surgeries in November 2001 to 20.4 cases per 100 surgeries in May 2002. Further analysis revealed a high prevalence of surgical site infection among patients who had an orthopedic procedure performed. In the neurology-neurosurgery department, the prevalence increased from 13.0 cases per 100 patients in May 2002 to 26.6 cases per 100 patients in May 2003 and involved several types of infection. Further analysis retrieved exceptionally high incidences of infections associated with cerebrospinal fluid drainage. Specific infection control interventions were developed and implemented in both departments. The total cost of the surveys was estimated to be €9,100 per year.Conclusion.Successive performance of surveillance surveys is a simple and cheap method to monitor the prevalence of infection throughout the hospital and appeared instrumental in identifying 2 departments with increased infection rates.
Risk Adjustment for Surgical Site Infection After Median Sternotomy in Children
Authors: Kagen Jessica , Bilker Warren B. , Lautenbach Ebbing , Bell Louis M. , Coffin Susan E. , John Keith H. St. , Teszner Eva , Dominguez Troy , Gaynor J. William , Shah Samir S. 
Published: March 2007

Objective.To determine whether the National Nosocomial Infections Surveillance (NNIS) System risk index adequately stratified a population of pediatric patients undergoing cardiac surgery according to the risk of developing surgical site infection (SSI).Design.A retrospective, case-control study.Setting.An urban tertiary care children's hospital.Patients.Patients who had a median sternotomy performed between January 1,1995, and December 31, 2003, were eligible for inclusion in the study. For all case patients, medical records were reviewed to verify that all patients met the case definition for SSI. Control subjects were chosen randomly from among all patients who underwent median sternotomy during the study period who did not develop SSI.Results.Thirty-eight patients with SSI and 172 patients without SSI were included. One hundred six patients (50%) were male. The median patient age was 4 months. The sensitivity of the NNIS risk index with cutoff scores of 0 to 1 and 2 to 3 was 20%. The distribution of patients with SSI for an NNIS risk index score of 0 was 0%; for a score of 1, 80%; for a score of 2, 20%; and for a score of 3, 0%. The distribution of patients without SSI for a scores of 0 was 4%; for a score of 1, 87%; for a score of 2, 9%; and for a score of 3, 0%. The area under the receiver-operating characteristic curve (AUC) of the original NNIS risk index was 0.57. The modified risk indices did not perform significantly better, with an AUC range of 0.58 to 0.73.Conclusions.The NNIS risk index did not adequately stratify pediatric patients undergoing median sternotomy according to their risk of developing an SSI. Various modifications to the risk index yielded only slightly higher AUC values.
Predicting Clostridium difficile Toxin in Hospitalized Patients With Antibiotic-Associated Diarrhea
Authors: Peled Nir , Pitlik Silvio , Samra Zmira , Kazakov Arkadi , Bloch Yoram , Bishara Jihad 
Published: March 2007

Objective.Clostridium difficile infection is implicated in 20%-30% of cases of antibiotic-associated diarrhea. Studying hospitalized patients who received antibiotic therapy and developed diarrhea, our objective was to compare the clinical characteristics of patients who developed C. difficile–associated diarrhea (CDAD) with those of patients with a negative result of a stool assay for C. difficile toxin.Methods.A prospective study was done with a cohort of 217 hospitalized patients who had received antibiotics and developed diarrhea. Patients with CDAD were defined as patients who had diarrhea and a positive result for C. difficile toxin A/B by an enzyme immunoassay of stool. The variables that yielded a significant difference on univariate analysis between patients with a positive assay result and patients with a negative assay result were entered into a logistic regression model for prediction of C. difficile toxin.Setting.A 900-bed tertiary care medical center.Results.Of 217 patients, 52 (24%) had a positive result of assay for C. difficile toxin A/B in their stool. The logistic regression model included impaired functional capacity, watery diarrhea, use of a proton pump inhibitor, use of a histamine receptor blocker, leukocytosis, and hypoalbuminemia. The area under the receiver operating characteristic curve for the model as a predictor of a positive result for the stool toxin assay was 0.896 (95% confidence interval, 0.661-1.000; P<.001), with 95% specificity and 68% sensitivity.Conclusions.Our results may help clinicians to predict the risk of CDAD in hospitalized patients with antibiotic-associated diarrhea, to guide careful, specific empirical therapy, and to direct early attention to infection control issues.
Phylogeny of Macroptilium (Leguminosae): morphological, biochemical and molecular evidence
Authors: Espert Shirley M. , Drewes Susana I. , Burghardt Alicia D. 
Published: March 2007

Abstract Macroptilium (Benth.) Urban (Phaseoleae, Papilionoideae, Leguminosae) is an American genus of legumes, belonging to subtribe Phaseolinae along with other economically important genera, such as Vigna Savi and Phaseolus L. (the common bean genus). Cladistic analyses based on morphological, biochemical (storage seed proteins) and molecular (nuclear and plastid DNA sequences) data were performed on the 18 species currently ascribed to the genus, exploring several character weighting strategies. Equal weights, implied weighting and different transversion/transition costs were applied. The three data sets were first analyzed with separate partitions, and then combined into a single matrix. This study is the first one to analyze all the species of the genus from a cladistic point of view. In all the most parsimonious trees obtained, Macroptilium is monophyletic with excellent support values. Two monophyletic clades are recovered in almost all the analyses. Both are compound by nine species, and they constitute two sections of Macroptilium. Several interspecific relationships inside the genus are discussed.© The Willi Hennig Society 2007.
Temporary epicardial pacing after cardiac surgery: a practical review
Authors: Reade M. C. 
Published: March 2007

SummaryThe first part of this two‐part review discussed the indications for various types of epicardial pacing systems and an overview of the routine care of a pacemaker‐dependent patient. Dual chamber temporary pulse generators now feature many of the refinements developed initially for use in permanent pacemakers. Few of these are utilised in the immediate postoperative period, often solely due to lack of familiarity with all but basic functions. The second part of the review deals with the selection of pacing modes. Troubleshooting real and apparent pacemaker malfunctions, including manual adjustment of parameters such as the AV interval, post atrial refractory period and upper rate limit, to avoid over‐ and undersensing, cross‐talk and pacemaker‐mediated tachycardia will also be addressed.
Risk factors associated with bleeding during and after percutaneous dilational tracheostomy*
Authors: Beiderlinden M. , Eikermann M. , Lehmann N. , Adamzik M. , Peters J. 
Published: March 2007

SummaryWe evaluated the effect of pre‐operative coagulation status on the incidence of acute and chronic bleeding in 415 consecutive patients undergoing percutaneous dilational tracheostomy. The incidence of acute bleeding was independent of the coagulation variables tested. The risk of chronic bleeding was higher with an activated partial thromboplastin time above 50 s (OR 3.7 (95% CI 1.1–12.7); NNT 18.4 (95% CI 9.0–∞); p = 0.04), a platelet count below 50 × 109 l−1(OR 5.0 (95% CI 1.4–17.2); NNT 12.3 (95% CI 6.2–833.3); p = 0.01) and in the presence of two or more abnormal coagulation variables (OR 9.5 (95% CI 2.3–34.7); NNT 6.2 (95% CI 3.2–68); p = 0.002). Low‐dose heparin treatment did not significantly increase the risk of chronic bleeding.
Internal jugular vein compression to assess the correct placement of an epidural catheter in postpartum women*
Authors: Chilvers J. , Geoghegan J. , Moore P. , Shah J. 
Published: March 2007

SummaryWe investigated whether the increase in epidural pressure produced by jugular compression could be used as a test for correct placement of epidural catheters in 20 postpartum women who had good epidural analgesia during labour. We measured the epidural pressure by using the epidural catheter as a manometer, and measured the rise in the meniscus in response to jugular vein compression whilst the epidural catheter was still in the epidural space. The catheter was then withdrawn until the tip lay just outside the epidural space and the response to jugular vein compression reassessed. In all subjects, jugular vein compression produced a rise in the meniscus only whilst the catheter tip lay in the epidural space. Jugular compression is a useful test for confirming the correct placement of the epidural catheter.
Avoidance of phrenic nerve paresis during continuous supraclavicular regional anaesthesia*
Authors: Cornish P. B. , Leaper C. J. , Nelson G. , Anstis F. , McQuillan C. , Stienstra R. 
Published: March 2007

SummaryThis study sought to determine whether it is possible reliably to avoid phrenic nerve block using the bent needle technique for continuous supraclavicular brachial plexus anaesthesia. In a prospective study, 100 patients undergoing a variety of upper extremity surgical procedures were studied. Ultrasound examinations of the patients' diaphragms were performed after insertion of an anaesthetic block, and were repeated a day later with the analgesic block working. Three phrenic nerve blocks were detected in different patients. Factors were identified in all three cases that we think contributed to the phrenic nerve blocks. We think it is possible to provide continuous supraclavicular regional anaesthesia and analgesia for a wide range of upper extremity operations without phrenic nerve blockade.
Postoperative analgesia requirements at home after inguinal hernia repair: effects of wound infiltration on postoperative pain*
Authors: Ausems M. E. , Hulsewé K. W. , Hooymans P. M. , Hoofwijk A. G. 
Published: March 2007

SummaryThe aim of this study was to evaluate our postoperative pain protocol after ambulatory herniorrhaphy and to determine how infiltration with local anaesthetics would add to our management of postoperative pain. Two groups of 60 patients, scheduled for herniorrhaphy, received wound infiltration with 20 ml levobupivacaine 0.5% or saline 0.9%. Postoperatively, the patients regulated their own analgesic consumption and registered VAS scores, use of analgesics and side‐effects in a diary for 5 days. The median time to first analgesic, the pain visual analogue scale scores, number of patients using no analgesic and the use of analgesic medication were significantly lower in the levobupivacaine group in the first 24 h, but not thereafter. Most patients used acetaminophen in the first 5 days after surgery and occasionally diclofenac. Only a minority used tramadol. Our multimodal pain protocol achieved reasonable results at rest, but a considerable number of patients experienced moderate to severe pain with movement.
Major complications of epidural analgesia after surgery: results of a six‐year survey
Authors: Christie I. W , McCabe S. 
Published: March 2007

SummaryWe performed a retrospective case note review to identify the major complications of epidural analgesia occurring after surgery at our hospital. By cross‐referencing the radiology, microbiology and patient information management system databases, we identified patients who had undergone either spinal magnetic resonance imaging or a lumbar puncture within 60 days of surgery in the period from January 2000 to December 2005. Review of these case notes identified six cases of epidural abscess, three of meningitis and three of epidural haematoma. Symptoms of epidural abscess or meningitis developed a median of 5 days after epidural catheter removal. Methicillin‐resistant Staphylococcus aureus was the predominant pathogen. Epidural haematoma symptoms developed while the epidural catheter was in place. These symptoms were initially attributed to the epidural infusion. Diagnostic delays contributed to adverse neurological outcome in three patients. This study suggests that leg weakness is a critical monitor of spinal cord health. A national database is needed to establish a more accurate estimate of the incidence of major complications and to identify relevant risk factors.
Tracheal intubation via the Classic™ and Proseal™ laryngeal mask airways: a manikin study using the Aintree Intubating Catheter
Authors: Blair E. J. , Mihai R. , Cook T. M. 
Published: March 2007

SummaryFibreoptic‐assisted tracheal intubation with an Aintree Intubating Catheter via a dedicated airway is sometimes recommended when conventional tracheal intubation fails. This study compares the use of the Classic™ and Proseal™ laryngeal mask airways (LMA) for this purpose in a manikin. Twenty‐five anaesthetists of all grades performed two intubations with each device. The overall success rate was 95%. The procedure took < 90 s in all cases and < 60 s in 88% of patients. The speed of intubation increased from the first to fourth attempt and between the first and second attempt with each device (p < 0.001). Allowing for the learning effects observed with each device, there was no statistically significant difference found when comparing speed of intubation with the two devices (p > 0.05). There was no significant difference between the devices with regard to ease of advancement of the fibrescope or the view of the vocal cords with the Aintree Intubating Catheter. Four failures occurred with the LMA Classic and one with the LMA Proseal. Subjective comments favoured the LMA Proseal (p < 0.05), although the clinical importance of these comments is difficult to determine. This study has shown that, in a manikin, fibreoptic guided intubation via an LMA Proseal is at least as easy and reliable as through an LMA Classic. In view of the potential advantages of the LMA Proseal for airway rescue and management of the difficult airway, this study suggests a clinical evaluation of the use of the combination of an LMA Proseal and an Aintree Intubating Catheter in patients is justified.
Peri‐operative management of an adult patient with type 2N von Willebrand's disease scheduled for coronary artery bypass graft
Authors: Gerling V. , Lahpor J. R. , Buhre W. 
Published: March 2007

SummaryWe describe a patient with type 2N von Willebrand's disease scheduled for elective coronary artery bypass graft for severe three‐vessel coronary artery disease with involvement of the left main stem. He was given a pre‐operative bolus of 3000 IU factor VIII/Willebrand factor concentrate (∼ 40 IU.kg−1), followed by a continuous infusion of 3 IU.h−1 (228 IU.h−1) before undergoing coronary surgery with full heparinisation and cardiopulmonary bypass. There were no intra‐operative bleeding complications and only one unit of packed red blood cells was required postoperatively. Thromboprophylaxis with low‐molecular weight heparin and aspirin was given and the infusion of factor VIII/von Willebrand factor concentrate continued for 2 days. As a result of haematological monitoring, heparin therapy was changed from prophylactic to therapeutic on day 5–6 and stopped on day 7.
Portal venous gas – case report and review of the literature
Authors: Mohammed A. H. , Mohammed A. H. , Khot U. P. , Thomas D. 
Published: March 2007

SummaryA 74‐year‐old man with chronic renal failure was admitted to the renal unit with non‐specific symptoms and positive blood cultures. He later deteriorated and was admitted to the Intensive Care Unit with septic shock, respiratory failure and deranged liver function. Initial improvement was followed by abdominal distension and discomfort. Portal venous gas (PVG) and thrombosis were diagnosed on computed tomography. A conservative line of management was adopted. Improvement was soon followed by deterioration with septic shock. Extensive portal venous gas and free intra‐abdominal gas were now evident on repeat computed tomography. The patient was too unwell to withstand surgery and a decision was made not to escalate therapy. He died on day 16. Portal venous gas is not a disease; it is a diagnostic clue in patients who may be harbouring an intra‐abdominal catastrophe. Successful management of these cases requires early identification of the underlying pathology and can range from simple observation to extensive surgical intervention.
Plasticity of predation behaviour as a putative driving force for parasite life‐cycle dynamics: the case of urban foxes andEchinococcus multilocularistapeworm
Authors: HEGGLIN D. , BONTADINA F. , CONTESSE P. , GLOOR S. , DEPLAZES P. 
Published: March 2007

SummaryParasite transmission frequently depends on an intermediate host species being subject to predation by a definitive host. We hypothesized that the population dynamics of this type of parasite would be affected by plasticity of the predation behaviour of the final host.The zoonotic tapewormEchinococcus multilocularisLeuckart is transmitted to foxes (Vulpes vulpesL.) by predation on infected rodents. One possible mechanism underlying the significant decrease in the prevalence ofE. multilocularisin red foxes observed towards the centre of Zurich (Switzerland) is that the relative abundance of intermediate hosts varies between different urbanized habitats.The water vole,Arvicola terrestris schermanL., which is the major intermediate host, was less abundant in urban compared with peri‐urban areas, due to both a reduced availability of suitable habitats and lower numbers within those habitats. Stomach content analyses indicated that foxes in urban areas consumed more anthropogenic food but preyed less frequently on rodents – and those rodents taken belonged to species less susceptible toE. multilocularisinfection.We conclude that the functional response of final hosts to changes in supply of intermediate hosts and alternative food sources can significantly affect the transmission dynamic of dixenous parasites, such as this zoonotic tapeworm.
The effect of the renewal of calcium hydroxide paste on the apexification and periapical healing of teeth with incomplete root formation
Authors: Felippe M. C. S. , Felippe W. T. , Marques M. M. , Antoniazzi J. H. 
Published: March 2007

AbstractAim  To evaluate the influence of renewing calcium hydroxide paste on apexification and periapical healing of teeth in dogs with incomplete root formation and previously contaminated canals.Methodology  Forty premolars from four 6‐month‐old dogs were used. After access to the root canals and complete removal of the pulp, the canal systems remained exposed to the oral environment for 2 weeks. Canal preparation was then carried out using Hedströem files, under irrigation with 1% sodium hypochlorite, 1 mm short of the radiographic apex. After drying, the canals of one premolar in each dog were left empty (group 4‐control), and those of the other nine teeth in each animal were filled with a calcium hydroxide‐propylene glycol paste. All teeth were restored with reinforced zinc oxide cement (IRM) or IRM and amalgam (group 4). The paste was renewed and the teeth restored again 1 week later. Then, the nine teeth in each animal were divided into three experimental groups: group 1 – paste not changed; group 2 – paste renewed every 4 weeks for 5 months; and group 3 – paste renewed after 3 months had elapsed. The teeth were restored with IRM and amalgam (groups 1 and 3) or IRM (group 2). The animals were killed 5 months later, and blocks of the teeth and surrounding tissues were submitted to histological processing. The sections were studied to evaluate six parameters: apical calcified tissue barrier, inflammatory reaction, bone and root resorption, paste extrusion and microorganisms. Results of experimental groups were analysed by Kruskal–Wallis nonparametric tests and by the test of proportions. The critical value of statistical significance was 5%.Results  Significant differences (P < 0.05) were found in relation to the presence of bone resorption and paste in the periradicular area, the formation of a calcified tissue barrier at the apex, and the intensity of the apical inflammatory reaction. Bone resorption was more evident in group 1 (medicament not changed), and the presence of paste in the periodontal tissues was more common in groups 2 and 3. Renewal of the paste reduced the intensity of the inflammatory reaction (groups 2 and 3), but the formation of apical calcified tissue was more noticeable in the teeth where the paste had not been renewed.Conclusions  Replacement of calcium hydroxide paste was not necessary for apexification to occur, however, it did reduce significantly the intensity of the inflammatory process. Monthly renewal of calcium hydroxide paste reduced significantly the occurrence of apexification.
Continued root formation of a pulpless permanent incisor following root canal treatment: a case report
Authors: Safi L. , Ravanshad S. 
Published: March 2007

AbstractAim  To present a case of a pulpless permanent incisor that continued root formation following root canal treatment.Summary  A healthy 8‐year‐old girl with a history of dental trauma resulting in a coronal fracture involving enamel, dentine and pulp was referred by her general dental practitioner for treatment and evaluation of tooth 21. The tooth had a necrotic pulp and periapical rarefaction was evident radiographically. The canal was prepared, dressed with Ca(OH)2 and then filled with a rolled gutta percha cone and Roth's root canal sealer.A radiograph exposed eight years post‐treatment, showed evidence of continued apical formation.Key learning points

Teeth with necrotic pulps and periapical rarefaction may show evidence of continued apical formation after root canal treatment.
Hertwig's epithelial root sheath may be more resistant than expected to trauma and infection.