bluuebunny/crossref_metadata_2025_split huggingface dataset:
Critical care management and outcome of severe Pneumocystis pneumonia in patients with and without HIV infection
Authors: Monnet Xavier , Vidal-Petiot Emmanuelle , Osman David , Hamzaoui Olfa , Durrbach Antoine , Goujard Cécile , Miceli Corinne , Bourée Patrice , Richard Christian 
Published: February 2008

Abstract
Background
Little is known about the most severe forms of Pneumocystis jiroveci pneumonia (PCP) in HIV-negative as compared with HIV-positive patients. Improved knowledge about the differential characteristics and management modalities could guide treatment based on HIV status.

Methods
We retrospectively compared 72 patients (73 cases, 46 HIV-positive) admitted for PCP from 1993 to 2006 in the intensive care unit (ICU) of a university hospital.

Results
The yearly incidence of ICU admissions for PCP in HIV-negative patients increased from 1993 (0%) to 2006 (6.5%). At admission, all but one non-HIV patient were receiving corticosteroids. Twenty-three (85%) HIV-negative patients were receiving an additional immunosuppressive treatment. At admission, HIV-negative patients were significantly older than HIV-positive patients (64 [18 to 82] versus 37 [28 to 56] years old) and had a significantly higher Simplified Acute Physiology Score (SAPS) II (38 [13 to 90] versus 27 [11 to 112]) but had a similar PaO2/FiO2 (arterial partial pressure of oxygen/fraction of inspired oxygen) ratio (160 [61 to 322] versus 183 [38 to 380] mm Hg). Ventilatory support was required in a similar proportion of HIV-negative and HIV-positive cases (78% versus 61%), with a similar proportion of first-line non-invasive ventilation (NIV) (67% versus 54%). NIV failed in 71% of HIV-negative and in 13% of HIV-positive patients (p < 0.01). Mortality was significantly higher in HIV-negative than HIV-positive cases (48% versus 17%). The HIV-negative status (odds ratio 3.73, 95% confidence interval 1.10 to 12.60) and SAPS II (odds ratio 1.07, 95% confidence interval 1.02 to 1.12) were independently associated with mortality at multivariate analysis.

Conclusion
The yearly incidence of ICU admissions for PCP in HIV-negative patients in our unit increased from 1993 to 2006. The course of the disease and the outcome were worse in HIV-negative patients. NIV often failed in HIV-negative cases, suggesting that NIV must be watched closely in this population.
Milk fat globule EGF factor 8 in the serum of human patients of systemic lupus erythematosus
Authors: Yamaguchi Hiroshi , Takagi Junichi , Miyamae Takako , Yokota Shumpei , Fujimoto Takashi , Nakamura Shinobu , Ohshima Shiro , Naka Tetsuji , Nagata Shigekazu 
Published: February 2008

AbstractMouse milk fat globule epidermal growth factor 8 (MFG-E8), which is secreted by a subset of activated macrophages, binds to apoptotic cells by recognizing phosphatidylserine and promotes their engulfment. Many apoptotic cells are left unengulfed in the germinal centers of the spleen in MFG-E8−/− mice, and these mice develop an autoimmune disease resembling human systemic lupus erythematosus (hSLE). Here, we report that hMFG-E8 bound to phosphatidylserine and an integrin αvβ3 complex. Increasing concentrations of MFG-E8 generated a bell-shaped response curve for the efficiency of phagocytosis. That is, in NIH3T3 and MFG-E8−/− thioglycollate-elicited peritoneal macrophages that do not express MFG-E8, hMFG-E8 enhanced engulfment at low concentrations but inhibited it at high concentrations. On the other hand, hMFG-E8 dose-dependently inhibited the engulfment of apoptotic cells by MFG-E8+/+ thioglycollate-elicited peritoneal macrophages, indicating that an excess of MFG-E8 has an inverse effect on the engulfment of apoptotic cells. To investigate the role of MFG-E8 in human disease, we generated two mAb against MFG-E8 and screened human blood samples for MFG-E8 using an ELISA. We found that some childhood-onset and adult SLE patients carried a significant level of MFG-E8 in their blood samples. These results suggested that the aberrant expression of MFG-E8 is involved in the pathoetiology of some cases of hSLE.
Regulation of Fat-Stimulated Neurotensin Secretion in Healthy Subjects
Authors: Drewe Juergen , Mihailovic Svetlana , D'Amato Massimo , Beglinger Christoph 
Published: February 2008

Abstract
Context: Cholecystokinin (CCK) and neurotensin are stimulated during meal intake by the presence of fat in the small intestine. The sequence of events suggests that fat hydrolysis is crucial for triggering the release.
Objective: The aim of this study was to investigate whether CCK mediated the effect of intraduodenal (ID) fat on neurotensin secretion via CCK-1 receptors.
Setting: This was a single center study; 34 male volunteers were studied in consecutive, randomized, double-blind, cross-over studies.
Subjects and Methods: CCK and neurotensin release were quantified in: 1) 12 subjects receiving an ID fat infusion with or without 60 mg orlistat, an irreversible inhibitor of gastrointestinal lipases, in comparison to vehicle; 2) 12 subjects receiving ID long chain fatty acids (C18s), ID medium chain fatty acids, or ID vehicle; and 3) 10 subjects receiving ID C18 with and without the CCK-1 receptor antagonist dexloxiglumide or ID vehicle plus iv saline (placebo). Hormone concentrations were measured by specific RIA systems.
Results: ID fat induced a significant increase in CCK and neurotensin concentrations (P &lt; 0.001–0.002). Inhibition of fat hydrolysis by orlistat abolished both effects. C18 stimulated CCK and neurotensin release (P &lt; 0.001, respectively), whereas medium chain fatty acid was ineffective. Dexloxiglumide administration partially blocked the effect of C18 on neurotensin; the effect was only present in the first phase of neurotensin secretion.
Conclusions: Generation of C18 through hydrolysis of fat is a critical step for fat-induced stimulation of neurotensin in humans; the signal is in part mediated via CCK release and CCK-1 receptors.
Increased Plasma Osteoprotegerin Concentrations Are Associated with Indices of Bone Strength of the Hip
Authors: Samelson Elizabeth J. , Broe Kerry E. , Demissie Serkalem , Beck Thomas J. , Karasik David , Kathiresan Sekar , Kiel Douglas P. 
Published: February 2008

Abstract
Objective: Osteoprotegerin (OPG) is an important regulator of bone turnover through its effects on osteoclastogenesis, yet findings from previous studies of circulating OPG and commonly measured bone indices in humans have been conflicting. We conducted a cross-sectional study to evaluate the association between plasma OPG and femoral neck (FN) bone density (BMD) and geometry in a large cohort of women and men.
Design: Participants included 1379 postmenopausal women and 1165 men, aged 50–89 yr (mean, 64 yr), in the Framingham Offspring Study. Dual x-ray absorptiometry was used to evaluate FN BMD and geometry (bone width, section modulus, and cross-sectional area at the narrow neck region). Plasma OPG concentrations were measured by ELISA. Sex-specific analysis of covariance was used to calculate means and assess linear trend in BMD and geometry values across OPG quartiles, adjusted for confounders.
Results: OPG concentrations were greater in women than men, increased with age, and were greater in smokers and those with diabetes and heart disease. Multivariable-adjusted mean FN BMD in women increased from the lowest to the highest OPG quartile (trend, P &lt; 0.01). However, no linear trend between FN BMD and OPG was observed in men (trend, P = 0.34). Section modulus and bone width increased with OPG in men (trend, P &lt; 0.01), whereas no association between hip geometry indices and OPG was observed in women.
Conclusion: Higher OPG concentration may indicate greater skeletal strength in women and men, possibly through reducing bone loss in women and increasing periosteal apposition in men.
Fabrication of a Shear Force-based Ion-selective Capillary Probe for Scanning Electrochemical Microscopy
Authors: Yamada Hiroshi , Ikuta Yuuya , Koike Tohru , Matsue Tomokazu 
Published: February 2008

Abstract
A shear force-based ion-selective probe for scanning electrochemical microscopy was fabricated for the imaging of localized potassium ions. A solution of dibenzo-18-crown-6/1,2-dichloroethane was added to a pulled capillary which was contact with a tuning fork attached to a piezoelectric buzzer. 10 μm of a Nafion island on glass was imaged, and the topography and current image originating from localized potassium ion concentration were obtained.
Implementing a Balanced Scorecard as a Strategic Management Tool in a Long-Term Care Organization
Authors: Schalm Corinne 
Published: February 2008

Background The Capital Care Group, the largest public sector continuing care organization in Canada, had no ready access to information on its own performance and therefore was limited in its pursuit of evidence-informed decisionmaking. To remedy this, it was decided to introduce a balanced scorecard. Assessment of problem A literature review was conducted together with interviews with 10 other health care organizations which had implemented balanced scorecards. With this information, a workshop was held that resulted in a framework and about 120 potential indicators. Subsequently the number of indicators was reduced to 29, using pre-determined criteria. Results Development of a corporate balanced scorecard facilitated executive strategic thinking and clarified the organization's strategic direction. In parallel, scorecards were developed at the level of care centres. These had a common core of indicators, plus some site-specific ones. Development of the corporate scorecard took three years and an additional six months for the care centre scorecards. Strategies for change A formal implementation plan has been accepted by the executive team. Key to this is communicating to staff the role of scorecards for strategic management and not just performance measurement. Traditional thinking needs to change from a short-term operational focus to long-term strategy. In addition, champions need to be identified in each care centre and they need to be networked together. Finally, the scorecard is being integrated into existing operational management as a routine component together with resources to support its use. Lessons and messages The balanced scorecard has focused on its role as a strategic management tool. The indicators and dimensions need to be customized to the organization. Senior management must be seen to be driving its introduction. It is worth spending sufficient time developing and implementing a scorecard rather than trying to rush its introduction. The scorecard needs to be integrated with existing management processes and sufficient resources must be assigned. However, success will ultimately depend on the culture of the organization being appropriate and receptive.
Bridging the Gap between Primary and Secondary Care: Use of a Clinical Pathway for the Investigation and Management of Deep Vein Thrombosis
Authors: Campbell Samuel , Macdonald Michael , Carr Brendan , Anderson David , Mackinley Robert , Cairns Susan 
Published: February 2008

Background Clinical processes that span the boundary between primary and secondary care often suffer from poor standardization of practice and lines of communication. One example is the clinical management of suspected deep vein thrombosis (DVT). Making or excluding the diagnosis can be complex. Tools to investigate DVT were not available to family physicians so patients had to be referred to the hospital emergency department and endure a long wait which could exacerbate the condition. In addition, urgent referrals to the ultrasound department disrupted the scheduled list of patients. Assessment of problem A team of stakeholders including all relevant specialties and professions from primary and secondary care was established. After reviewing the literature and interviewing those involved in delivering care, an evidence-based scoring system to calculate the clinical probability of a DVT was adopted and introduced as part of a clinical pathway from primary to secondary care. Its introduction was based on the Plan, Do, Study, Act (PDSA) cycle. Results In the first year after the introduction of the clinical pathway, 70% of family physicians had used it and were very satisfied. Patients found it efficient (75%) with 96% very satisfied or satisfied. The waiting time in the emergency department fell from a mean of 379 minutes to 285 minutes. Although the incidence of initial investigations (D-Dimer tests) increased by 42%, the proportion of patients undergoing a subsequent ultrasound test found to have a DVT was unchanged (14%). This suggested the level of suspicion of a DVT in the community had risen. Referrals to the hospital's DVT clinic increased by 14% overall, driven partly by a large increase in those who had come from the new clinical pathway from primary care. Lessons and messages Key lessons include the importance of including all relevant stakeholders and the benefits of using PDSA to make rapid changes during implementation. We are now seeking to extend the use of the clinical pathway to other hospitals and more family physicians. In addition, the clinical pathway approach will be applied to other conditions and interventions. We have demonstrated how a multidisciplinary group of stakeholders in a clinical care process can develop and introduce a clinical pathway that allows smooth transit of patients over the barriers between different sectors of the health care system and between independent disciplines. We have also demonstrated the use of untapped non-physician potential in the system to safely facilitate patient care.
Moving to a Culture of Safety in Community Home Health Care
Authors: Stevenson Lynn , McRae Cora , Mughal Waqar 
Published: February 2008

Objective Community home health care workers and their clients are faced with a mixture of occupational health and safety challenges that are not typically experienced by health care providers or patients in the acute care sector. The aim of this project was to explore the concept of safety in community home health in one health care authority in British Columbia. Methods A participatory action research approach was employed to explore staff and client safety risks in this environment. In the first phase, three focus groups were held with staff (n 5 39) and the data analysed to identify themes. These were validated by additional focus groups. In the second phase, interviews were held with staff followed by chart reviews. Finally, in phase three, an interdisciplinary working group developed a risk identification tool for staff which was subsequently piloted. The exploration focused on answering the following questions: What constitutes safety in community home health care? What are the priority areas for action in relation to safety? What type of risk identification would be most helpful to community health workers to prepare them adequately to meet their clients’ and their own safety needs? Results Risk themes identified included: poor communication, acute care staff not understanding the needs of community staff, working alone, mobility, medication concerns, lack of pre-screening of clients’ homes, and community health workers accepting a high degree of risk. Conclusions Findings suggest that typical notions of safety and risk in acute care are not easily translated into the community sector, that staff and clients’ safety concerns are intertwined, and staff require better and more timely information from acute care staff when patients are discharged home.
Advancing Employee Engagement Through a Healthy Workplace Strategy
Authors: Seymour Andrea , Dupré Kathryne 
Published: February 2008

Background In recent years, there has been increased focus on improving the quality of the working lives of staff in health care organizations. Research shows that improvements can be achieved through a comprehensive organizational approach to workplace health. Improved worker engagement is a realizable outcome of such an approach, provided that it is based on reliable and relevant data and is tailored to the specific environment in which it is being implemented. Assessment of problem An intervention project was designed to develop an organization-wide approach to employee workplace health. A comprehensive health risk assessment was undertaken, along with a staff survey on workplace culture, individual health practice and environmental effects on physical health. Results In general, the findings present a positive picture of the culture and factors that influence psychological wellbeing. However, improvement is needed in some areas: satisfaction is only marginally outweighing stress, and musculoskeletal disorders account for much absenteeism. Employee health needs include weight management, improving fitness and nutrition, and decreasing coronary risk. Strategies for change Results have prompted this organization to pursue the development of a Healthy Workplace Policy that will be used as a filter for all other policies relating to workplace culture, environment and practice, and have provided the impetus and focus to review the organization of employee health services. Lessons learned Three major administrative activities are necessary to move from planning to sustained action: ensure adherence of all staff to any policy derived from a health risk assessment; ensure staff feel proposed changes are relevant and important; and create a road map to guide the development of a strategic and an implementation plan. The findings outlined in this report can be addressed by organizations that are willing to commit to a comprehensive approach to workplace health.
Is Public Health Ready for a Professional Practice Framework?
Authors: Cava Maureen 
Published: February 2008

Objective To develop a framework for professional practice for a large urban public health unit in Canada. Methods The project involved a literature search, key informant interviews, an environmental scan and focus groups. Results Analysis and synthesis led to recommendations for the development of discipline-specific Professional Practice Leaders (PPL) and an Interprofessional Practice Leaders Network. The latter meets to discuss cross-cutting practice issues and is chaired by the chief executive officer of the health unit, the Medical Officer of Health. The one-year evaluation has demonstrated that this initiative has worked well in practice. It is a flexible framework which provides new leadership opportunities and gives staff valuable input into decisionmaking on practice issues. It is also a more efficient use of staff resources, including a comprehensive approach to solving problems and in breaking down silos between programs. Communication and collaboration between disciplines has increased. Conclusion The initiative was evaluated successfully after the pilot year. In going forward areas to review include the time allotment for the PPL, communication between the PPL, the respective Program Director and the entire department, and expanding professional development opportunities for the PPL.
Accuracy of a Provincial Prescription Database for Assessing Medication Adherence in Heart Failure Patients
Authors: Dahri Karen , Shalansky Stephen J , Jang Linda , Jung Leon , Ignaszewski Andrew P , Clark Catherine 
Published: February 2008

Background: British Columbia's central prescription database, PharmaNet, is often used for both clinical and research applications. However, PharmaNet details prescription transactions, not actual medication consumption, resulting in many potential sources of inaccuracy when the information is assumed to reflect population or individual drug utilization. Objective: To assess the accuracy of PharmaNet for adherence assessment in patients with heart failure who are taking β-blockers. Methods: A 6-month prospective, longitudinal assessment of adherence to the prescribed β-blocker regimen was carried out using both PharmaNet data and the Medication Event Monitoring System (MEMS) for each patient enrolled. The limit of agreement between the 2 adherence assessment methods was assessed using the Bland-Altman approach. Results: Fifteen of 58 patients initially enrolled in the study were excluded, most due to misuse of MEMS or failure to return the MEMS vial despite thorough follow-up. For the 43 patients included in the final analysis, mean ± SD adherence was 97.8 ± 11.8% when assessed by PharmaNet and 97.1 ± 7.3% when MEMS was used. However, the limit of agreement, reported as the mean of the differences ± 2SD, was 6.8 ± 18.5%, indicating a moderate-to-high level of agreement between the 2 methods when the confidence interval is taken into consideration. Conclusions: These results suggest that PharmaNet data accurately reflect medication adherence for most patients. The MEMS system proved unreliable in several cases, illustrating the difficulty of identifying a gold standard for adherence assessment.
Reduced Argatroban Doses After Coronary Artery Bypass Graft Surgery
Authors: Hoffman William D , Czyz Yvonne , McCollum David A , Hursting Marcie J 
Published: February 2008

Background: The Food and Drug Administration–approved argatroban dose for heparin-induced thrombocytopenia (HIT) is 2 μg/kg/min (0.5 μg/kg/min in hepatic impairment), adjusted to achieve activated partial thromboplastin time (aPTT) 1.5–3 times baseline. Recent data suggest that reduced doses are required after cardiovascular surgery. Objective: To characterize dosing requirements, aPTTs, factors affecting dosage, and clinical outcomes in patients administered argatroban after coronary artery bypass graft (CABG) surgery. Methods: Charts of 39 patients who underwent CABG surgery and were administered argatroban postoperatively for laboratory-confirmed HIT (n = 25), antibody-negative suspected HIT (n = 10), or previous HIT requiring anticoagulation (n = 4) were retrospectively reviewed. Patient characteristics, argatroban dosing information, aPTTs (target range 45–90 sec), and outcomes were summarized. Regression analyses explored potential effectors of dosage. Results: Patient features, argatroban dosing patterns, and aPTTs were similar among groups. Many patients had laboratory evidence of some hepatic and/or renal dysfunction (median [range] bilirubin 1.0 [0.3–8.0] mg/dL, creatinine clearance 47 [18–287] mL/min). Overall, median argatroban doses were 0.5 μg/kg/min initially and 0.6 μg/kg/min during therapy (median duration 5.3 days). After argatroban initiation, aPTTs were greater than 90 seconds at first assessment in 4 patients (3 with abnormal hepatic function test results) initially administered 0.5, 1, 2, and 2 μg/kg/min, respectively. Within approximately 16 hours of therapy, 33 (85%) patients achieved consecutive therapeutic aPTTs. No association was detected between mean dose during therapy and preoperative ejection fraction, routine hepatic or renal function test results (other than blood urea nitrogen [BUN]), or surgery type. A clinically insignificant association existed between dose and BUN: there was an approximately 0.15 μg/kg/min dose decrease for each 10 mg/dL BUN increase. One patient developed thrombosis, 1 underwent finger amputation, 7 died (5 after argatroban cessation), and 4 had significant bleeding. Conclusions: These findings suggest that reduced initial argatroban doses (eg, 0.5 μg/kg/min), adjusted to achieve therapeutic aPTTs, provide rapid, adequate anticoagulation in postoperative CABG patients with presumed or previous HIT. Prospective study of reduced initial dosing in this setting is warranted.