bluuebunny/crossref_metadata_2025_split huggingface dataset:
Review article: the pathogenesis and management of eosinophilic oesophagitis
Authors: FURUTA G. T. , STRAUMANN A. 
Published: June 2006

SummaryBackgroundEosinophilic oesophagitis is a clinicopathological disease affecting both children and adults that is characterized by symptoms of gastro‐oesophageal reflux disease (feeding refusal, vomiting, heartburn, dysphagia and food impaction) and dense oesophageal eosinophilia both of which are unresponsive to proton pump inhibition.AimTo present a review of the recent literature examining the pathogenesis and treatments of eosinophilic oesophagitis.MethodsWe performed a PubMed search for eosinophilic oesophagitis, pathogenesis and treatments.ResultsTranslational and basic studies suggest that this disease is sparked by food or by aeroallergens. To date, effective treatments include systemic/topical corticosteroids, specific food elimination or an elemental diet. While several studies identified oesophageal strictures as potential complications of unbridled eosinophilia, the natural history of the disease is still not certain. Recent studies suggest a role for interleukin‐5 and eotaxin‐3 in the pathogenesis of eosinophilic oesophagitis and suggest an impact of future targeted therapeutic agents.ConclusionsEosinophilic oesophagitis represents a immune‐mediated disease of undetermined pathogenesis. While many patients develop clinicopathological findings following ingestion of foods, others do not. Natural history studies will be critical to defining future treatment paradigms.
Validation of administrative data used for the diagnosis of upper gastrointestinal events following nonsteroidal anti‐inflammatory drug prescription
Authors: ABRAHAM N. S. , COHEN D. C. , RIVERS B. , RICHARDSON P. 
Published: June 2006

SummaryAimsTo validate veterans affairs (VA) administrative data for the diagnosis of nonsteroidal anti‐inflammatory drug (NSAID)‐related upper gastrointestinal events (UGIE) and to develop a diagnostic algorithm.MethodsA retrospective study of veterans prescribed an NSAID as identified from the national pharmacy database merged with in‐patient and out‐patient data, followed by primary chart abstraction. Contingency tables were constructed to allow comparison with a random sample of patients prescribed an NSAID, but without UGIE. Multivariable logistic regression analysis was used to derive a predictive algorithm. Once derived, the algorithm was validated in a separate cohort of veterans.ResultsOf 906 patients, 606 had a diagnostic code for UGIE; 300 were a random subsample of 11 744 patients (control). Only 161 had a confirmed UGIE. The positive predictive value (PPV) of diagnostic codes was poor, but improved from 27% to 51% with the addition of endoscopic procedural codes. The strongest predictors of UGIE were an in‐patient ICD‐9 code for gastric ulcer, duodenal ulcer and haemorrhage combined with upper endoscopy. This algorithm had a PPV of 73% when limited to patients ≥65 years (c‐statistic 0.79). Validation of the algorithm revealed a PPV of 80% among patients with an overlapping NSAID prescription.ConclusionsNSAID‐related UGIE can be assessed using VA administrative data. The optimal algorithm includes an in‐patient ICD‐9 code for gastric or duodenal ulcer and gastrointestinal bleeding combined with a procedural code for upper endoscopy.
Disturbed bowel habits in patients with non‐ulcer dyspepsia
Authors: HAMMER J. , TALLEY N. J. 
Published: June 2006

SummaryBackgroundEmerging medications for non‐ulcer‐dyspepsia, such as the serotonin‐receptor modulators, also affect bowel habits by altering colonic transit. If drugs that alter colonic function were to prove useful in non‐ulcer dyspepsia, knowledge of baseline bowel habit disturbances would be potentially critical.AimTo estimate the rate of non‐ulcer dyspepsia patients with clinically relevant constipation or diarrhoea potentially precluding use of motility agents.MethodsConsecutive patients with non‐ulcer dyspepsia (n = 79), gastro‐oesophageal reflux disease (n = 135) and organic upper gastrointestinal disease (upper gastrointestinal disease; n = 36) completed a validated symptom questionnaire evaluating predominant bowel habits in the last year.ResultsPrevalence of constipation was higher in non‐ulcer dyspepsia (34%) than in gastro‐oesophageal reflux disease (P = 0.01) and organic upper gastrointestinal disease (P = 0.01), prevalence of alternating diarrhoea/constipation (24%) and diarrhoea (22%) was similar, while prevalence of normal bowel habits was significantly less in non‐ulcer dyspepsia (20%; P = 0.01 vs. gastro‐oesophageal reflux disease and P < 0.01 vs. organic upper gastrointestinal disease). Constipation was particularly frequent in ulcer‐like and dysmotility‐like non‐ulcer dyspepsia, while prevalence of diarrhoea was lowest in dysmotility‐like non‐ulcer dyspepsia. A normal bowel habit was equally uncommon in male (21%) and female non‐ulcer dyspepsia patients (20%).ConclusionsOnly one of five non‐ulcer dyspepsia patients had normal bowel habits based on clinical symptoms; constipation is particularly prevalent. Patients with functional dyspepsia who are prescribed motility altering drugs should be evaluated by taking a thorough bowel habit history.
Systematic review: the impact of gastro‐oesophageal reflux disease on work productivity
Authors: WAHLQVIST P. , REILLY M. C. , BARKUN A. 
Published: June 2006

SummaryBackgroundGastro‐oesophageal reflux disease has wide‐ranging effects on patients’ lives.AimTo review systematically the effects of gastro‐oesophageal reflux disease on work productivity.MethodsStudies of gastro‐oesophageal reflux disease and work productivity were identified in a systematic literature search and their results were valued in US dollars using the human capital method. Work productivity loss was defined as absence from work (absenteeism) plus reduced effectiveness while working (presenteeism).ResultsEight eligible studies were included. Reported work productivity loss among individuals with gastro‐oesophageal reflux disease ranged from 6% to 42% and was primarily because of presenteeism (6–40%) rather than absenteeism (<1% to 7%). Reported losses were greatest in patients experiencing sleep disturbance because of gastro‐oesophageal reflux disease, and lowest in individuals from the general population taking appropriate prescription medication. Work productivity impairment correlated with symptom severity and responded to acid‐suppressive therapy. Assuming a 40‐h working week and average wages in the US, the weekly mean productivity loss per employee with gastro‐oesophageal reflux disease can be estimated between 2.4 ($62) and 16.6 h ($430), depending on the population studied.ConclusionsGastro‐oesophageal reflux disease has a substantial impact on employee productivity, primarily by impairing productivity while working. Further studies are needed to confirm that this impact can be decreased by acid‐suppressive therapy.
The impact of organ failures and their relationship with outcome in intensive care: analysis of a prospective multicentre database of adult admissions
Authors: Nfor T. K. , Walsh T. S. , Prescott R. J. 
Published: June 2006

SummaryThe database of a multicentre cohort study was analysed to determine the impact of intensive care unit (ICU) organ failures and their association with ICU mortality using sequential organ failure assessment (SOFA). A consecutive sample of 873 adult patients with a non‐neurological diagnosis was identified. SOFA scores were measured every 24 h of ICU stay. The odds of ICU death within 7 days doubled (95% CI 1.3–2.9) for a 5‐unit increase in total SOFA score at admission, p < 0.001. However ICU death after 7 days was not associated with total SOFA score at admission, p = 0.36. Compared to patients with a day 6 total SOFA score = 5, there was a 1‐unit (95% CI 0.8–3.1) increase in the odds ratio of ICU death after 7 days with every 5‐unit increase in SOFA score on day 6, p = 0.009. Continuous assessments of organ failures during an ICU admission are more useful than scores measured at admission to determine outcome and to compare ICUs.
Basic airway management by junior doctors: assessment and training on human apnoeic subjects in the anaesthetic room*
Authors: Kidner K. , Laurence A. S. 
Published: June 2006

SummaryWe assessed the airway management skills of 20 junior doctors on patients in the anaesthetic room, using a self‐inflating bag with digital flowmeter to measure exhaled tidal volume. Following induction of anaesthesia the junior doctor attempted to ventilate the patient's lungs with five breaths. If two of these breaths were > 250 ml the assessment was completed. If not, a period of instruction was given followed by a further five‐breath assessment. Eight doctors did not need further training; of these, six were senior house officers and seven had been on an Advanced Life Support course. Twelve doctors required instruction and re‐assessment. Four were senior house officers and two had been on an Advanced Life Support course. They showed some improvement following the instruction period but never reached the standard of the other eight. Validated courses improve resuscitation skills but hands‐on training in the anaesthetic room can also be of benefit in maintaining these skills.
The effect of peribulbar block with ropivacaine on bi‐hemispheric cerebral oxygen saturation in aged patients
Authors: Fodale V. , Di Pietro R. , Ferreri F. , Tescione M. , Russo G. , Santamaria S. , Praticò C. 
Published: June 2006

SummaryWe evaluated the effects of peribulbar block for eye surgery on bi‐hemispheric regional cerebral oxygenation (rSO2) of aged patients. In 66 adult patients, peribulbar block was performed using ropivacaine 10 mg.ml−1 with hyaluronidase 100 IU.ml−1. Cerebral oxygenation was monitored using continuous non‐invasive, near‐infrared spectroscopy. The rSO2 data on the side where the eye block was performed were evaluated as eye block side values, whereas the data recorded on the other side were taken as control values. Mean rSO2 values on the side where regional block was performed were not significantly different from control values (p > 0.05). Nevertheless, in several patients, a slight desaturation in the cerebral hemisphere on the block side was detected. Therefore, in aged patients, peribulbar block with ropivacaine does not significantly modify bi‐hemispheric rSO2, but rSO2 monitoring during peribulbar block should be a field of future research in aged patients with brain injury or disease.
Monitoring cardiac output using the femoral and radial arterial pressure waveform
Authors: De Wilde R. B. P. , Breukers R. B. G. E. , Van Den Berg P. C. M. , Jansen J. R. C. 
Published: June 2006

SummaryThis study was performed to determine the interchangeability of femoral artery pressure and radial artery pressure measurements as the input for the PiCCO system (Pulsion Medical Systems, Munich, Germany). We studied 15 intensive care patients following cardiac surgery. Five‐second averages of the cardiac output derived from the femoral artery pressure (COfem) were compared to 5‐s averages derived from the radial artery pressure (COrad). One patient was excluded due to problems in the pattern recognition of the arterial pressure signal. In the remaining 14 patients, 14 734 comparative cardiac output values were analysed. The mean sample time was 88 min, range [30–119 min]. Mean (SD) COfem was 6.24 (1.1) l.min−1 and mean COrad 6.23 (1.1) l.min−1. Bland‐Altman analysis showed an excellent agreement with a bias of − 0.01 l.min−1, and limits of agreement from 0.60 to − 0.62 l.min−1. If changes in CO were > 0.5 l.min−1, the direction of changes in COfem and COrad were equal in 97% of instances. We conclude that femoral artery pressure and radial artery pressure are interchangeable as inputs for the PiCCO device.
Characteristics and mortality of severe hyponatraemia – a hospital‐based study
Authors: Gill Geoffrey , Huda Bobby , Boyd Alice , Skagen Karolina , Wile David , Watson Ian , Van Heyningen Charles 
Published: June 2006

SummaryObjective  To determine the characteristics, causes and outcome of severe hyponatraemia (< 125 mmol/l) in hospitalized patients, and to identify mortality predictors.Design   Prospective case controlled study of sequentially presenting patients with a serum sodium (Na) < 125 mmol/l.Patients and methods  One hundred and four hyponatraemic and 104 randomly chosen normonatraemic (Na > 135 mmol/l) adult patients were studied. We measured hospital mortality and days in hospital, diagnoses, drug history and cause of hyponatraemia. Na was recorded at admission, as well as the closest level measured before death or discharge. In addition, the lowest Na was recorded (if this was not at admission).Results  Hyponatraemic patients were older (mean age ± 1 SD 69 ± 14 years) than controls (61 ± 16 years, P < 0·001), but of similar sex ratio. On admission, Na in the hyponatraemic group was 125 ± 7 mmol/l compared with 139 ± 3 mmol/l in controls (P < 0·0001), but fell to 120 ± 4 mmol/l before rising at discharge to 131 ± 7 mmol/l (all changes P < 0·001). Overall mortality was 27% in hyponatraemic patients compared with 9% in controls (P = 0·009), and length of admission was also greater (16 ± 12 vs. 13 ± 11 days, P < 0·005). Mortality was greater in patients whose Na levels fell during admission (34%vs. 16%, P < 0·05), and these patients appeared to have an excess of diuretic‐induced and possibly iatrogenic hyponatraemia.Conclusions  Severe hyponatraemia in hospital patients is associated with prolonged admissions and significantly increased mortality compared with normonatraemic patients. A particular group at high risk of death are those whose Na levels fall after admission. They may represent a ‘sicker’ group, and deserve increased monitoring and surveillance.
Using a 1‐D mixing model to assess the potential impact of year‐to‐year changes in weather on the habitat of vendace (Coregonus albula) in Bassenthwaite Lake, Cumbria
Authors: GEORGE D. G. , BELL V. A. , PARKER J. , MOORE R. J. 
Published: June 2006

Summary1. Bassenthwaite Lake in Cumbria is one of only two English lakes containing a population of vendace (Coregonus albula). The spatial distribution and survival of this fish is strongly influenced by the temperature and oxygen content of the water. In summer, this fish moves into deeper, colder water but avoids areas where the oxygen content is low.2. In recent years, there has been a dramatic decline in the number of vendace found in the lake, a trend that may have been exacerbated by a succession of warm summers. Bassenthwaite only becomes stably stratified during calm, warm periods when a significant proportion of the deep water becomes anoxic.3. Here, a one dimensional (1‐D) process‐based temperature‐oxygen model is used to simulate the year‐to‐year variations in the severity of these ‘extreme events’. The model is validated using field measurements acquired in the 1990s and used to predict the range of depths accessible to the vendace.4. An empirical, weather‐driven model is then used to ‘hindcast’ the mixing characteristics of the lake in the 1980s and estimate the proportion of the habitat lost during warm, calm summers. These simulations show that periods of stable thermal stratification have become increasingly common in recent years. In the 1980s, only one ‘extreme event’ was identified but four such events were recorded in the 1990s.5. The results are discussed in relation to the conservation status of the species and the potential effect of climate change on its survival in the English Lake District.
Variation in probability of first reproduction of Weddell seals
Authors: HADLEY GILLIAN L. , ROTELLA JAY J. , GARROTT ROBERT A. , NICHOLS JAMES D. 
Published: June 2006

Summary

For many species, when to begin reproduction is an important life‐history decision that varies by individual and can have substantial implications for lifetime reproductive success and fitness.
We estimated age‐specific probabilities of first‐time breeding and modelled variation in these rates to determine age at first reproduction and understand why it varies in a population of Weddell seals in Erebus Bay, Antarctica. We used multistate mark–recapture modelling methods and encounter histories of 4965 known‐age female seals to test predictions about age‐related variation in probability of first reproduction and the effects of annual variation, cohort and population density.
Mean age at first reproduction in this southerly located study population (7·62 years of age, SD = 1·71) was greater than age at first reproduction for a Weddell seal population at a more northerly and typical latitude for breeding Weddell seals (mean = 4–5 years of age). This difference suggests that age at first reproduction may be influenced by whether a population inhabits the core or periphery of its range.
Age at first reproduction varied from 4 to 14 years, but there was no age by which all seals recruited to the breeding population, suggesting that individual heterogeneity exists among females in this population.
In the best model, the probability of breeding for the first time varied by age and year, and the amount of annual variation varied with age (average variance ratio for age‐specific rates = 4·3%).
Our results affirmed the predictions of life‐history theory that age at first reproduction in long‐lived mammals will be sensitive to environmental variation. In terms of life‐history evolution, this variability suggests that Weddell seals display flexibility in age at first reproduction in order to maximize reproductive output under varying environmental conditions. Future analyses will attempt to test predictions regarding relationships between environmental covariates and annual variation in age at first reproduction and evaluate the relationship between age at first reproduction and lifetime reproductive success.
How the west was once: vegetation change in south‐west Queensland from 1930 to 1995
Authors: Bradd Witt G. , Luly Jon , Fairfax Russell J. 
Published: June 2006

AbstractAim  Conflicting perceptions of past and present rangeland condition and limited historical data have led to debate regarding the management of vegetation in pastoral landscapes both internationally and in Australia. In light of this controversy we have sought to provide empirical evidence to determine the trajectory of vegetational change in a semi‐arid rangeland for a significant portion of the 20th century using a suite of proxy measures.Location  Ambathala Station, approximately 780 km west of Brisbane, in the semi‐arid rangelands of south‐western Queensland, Australia.Methods  We excavated stratified deposits of sheep manure which had accumulated beneath a shearing shed between the years 1930 and 1995. Multi‐proxy data, including pollen and leaf cuticle analyses and analysis of historical aerial photography were coupled with a fine resolution radiocarbon chronology to generate a near annual history of vegetation on the property and local area.Results  Aerial photography indicates that minor (< 5%) increases in the density of woody vegetation took place between 1951 and 1994 in two thirds of the study area not subjected to clearing. Areas that were selectively or entirely cleared prior to the 1950s (approximately 16% of the study area) had recovered to almost 60% of their original cover by the 1994 photo period. This slight thickening is only partially evident from pollen and leaf cuticle analyses of sheep faeces. Very little change in vegetation is revealed over the nearly 65 years based on the relative abundances of pollen taxonomic groups. Microhistological examination of sheep faeces provides evidence of dramatic changes in sheep diet. The majority of dietary changes are associated with climatic events of sustained above‐average rainfall or persistent drought. Most notable in the dietary analysis is the absence of grass during the first two decades of the record.Main conclusions  In contrast to prevailing perceptions and limited research into long‐term vegetation change in the semi‐arid areas of eastern Australia, the record of vegetation change at the Ambathala shearing shed indicates only a minor increase in woody vegetation cover and no decrease in grass cover on the property over the 65 years of pastoral activity covered by the study. However, there are marked changes in the abundance of grass cuticles in sheep faeces. The appearance and persistence of grass in sheep diets from the late 1940s can be attributed to the effects of periods of high rainfall and possibly some clearing and thinning of vegetation. Lower stock numbers may have allowed grass to persist through later drought years. The relative abundances of major groups of plant pollen have not changed significantly over the past 65 years.
Who do they think they are? Undergraduate perceptions of the definition of supernumerary status and how it works in practice
Authors: McGowan Brian 
Published: June 2006

Aims and objectives.  The aim of this study was threefold and was based on three research questions; how did students define supernumerary status, how was it implemented in practice and what effect did it have on them?Background.  Whilst there has been much debate about supernumerary status and its value to nursing practice and education there has been little work carried out from the student's point of view.Design.  The study was qualitative in nature.Methods.  Focus group interviews were the method of choice based on the premise that the interaction between students/participants would generate rich experiential data.Results.  Nine themes were generated that addressed the three questions asked. The themes to emerge from the category definition of supernumerary status were: not counted in the staff numbers and lack of student preparation. The themes to emerge from the category implementation of supernumerary status were: leadership style, experiences of mentorship, an extra pair of hands and not allowed to study. The themes to emerge from the category effect of supernumerary status were: their learning was enhanced, feelings of being used and reduction in self‐confidence.Conclusions.  There is a need to review what is meant or indeed expected from students who are supernumerary and increased clarity is required about what it is supposed to achieve.Relevance to clinical practice.  The status of student nurses in practice has a direct link to the quality of the work they produce. This has a domino effect that may have far reaching consequences. Making sure that they are clear about what is expected of them from the outset will reduce confusion and allow them to move forward with skills acquisition and building their experience.