bluuebunny/crossref_metadata_2025_split huggingface dataset:
Review article: medical therapy for fistulizing Crohn's disease
Authors: BRESSLER B. , SANDS B. E. 
Published: October 2006

SummaryBackgroundFistulae will develop in approximately one‐third of patients with Crohn's disease. With an expected spontaneous healing rate of only 10%, fistulizing Crohn's disease requires a comprehensive strategy with a medical and possible surgical approach.AimTo summarize the current literature evaluating various medical options for treating patients with fistulizing Crohn's disease.MethodsA literature review was conducted using PubMed (search terms: Crohn's disease and fistula) and manual search of references among the identified studies and relevant review papers to identify papers that present data on medical treatment of fistulizing Crohn's disease.ResultsThe first line of medical therapy remains antibiotics (metronidazole and ciprofloxacin). Mercaptopurine and azathioprine are medications that are effective in treating fistulizing Crohn's disease. The current gold standard of medical treatment to induce and maintain remission for fistulizing Crohn's disease is infliximab. Used as induction therapy, infliximab produced a 62% clinical response, and a complete closure rate of 46%. A maintenance therapy trial demonstrated at 54 weeks, 46% of patients receiving infliximab continued to respond to treatment, compared with 23% in the placebo group (P = 0.001).ConclusionFurther research to find new therapies and to improve our existing medical treatment of fistulizing Crohn's disease is required.
Review article: altering the natural history of Crohn's disease – evidence for and against current therapies
Authors: VERMEIRE S. , VAN ASSCHE G. , RUTGEERTS P. 
Published: October 2006

SummaryBackgroundThe natural course of Crohn's disease is characterized by flare‐ups altered with periods of remission. The majority of Crohn's disease patients need surgery within 10 years of diagnosis. Major advances in treatment options over the past years have made our treatment goals more ambitious and modification of the natural course has become the ultimate endpoint.AimTo review the evidence of existing therapies for Crohn's disease for changing the natural history.MethodsA Medline search was undertaken by using ‘natural history’, ‘Crohn's disease’, ‘therapy’ (corticosteroids, azathioprine, methotrexate, infliximab and enteral feeding), ‘surgery’, ‘hospitalizations’ and ‘mucosal healing’.ResultsCorticosteroids do not alter the disease course and maintenance therapy with corticosteroids should be avoided given their side effects. The immunomodulators azathioprine and methotrexate heal the mucosa but their onset of action is slow. Infliximab therapy introduces rapid mucosal healing and is associated with decreased hospitalizations and surgical interventions. Despite the fact that immunomodulators and infliximab are effective in maintaining clinical and endoscopic remission, there is little hard evidence at present that these therapies alter the natural history of the disease. The main reason being the fact that these therapies have so far been used only in refractory patients and that early initiation in the right patient is crucial in order to change the disease course.ConclusionProspective studies should validate predictors of complicated disease and randomized studies in high‐risk groups should be performed to answer if early introduction of immunomodulators or biological therapies slows down disease progression and alters natural history.
Does Barrett's oesophagus develop over time in patients with chronic gastro‐oesophageal reflux disease?
Authors: STOLTEY J. , REEBA H. , ULLAH N. , SABHAIE P. , GERSON L. 
Published: October 2006

SummaryBackgroundBarrett's oesophagus is present in 8–10% of patients with gastro‐oesophageal reflux disease (GERD).AimWe performed a cohort study to determine the incidence of Barrett's oesophagus in patients with chronic heartburn symptoms.MethodsWe identified patients, with GERD and/or Barrett's oesophagus between 1998 and 2004 by primary or secondary International Classification of Diseases (ICD‐9) codes of 530.81 and/or 530.2, who had two or more oesophagogastroduodenoscopies performed at least 6 months apart.ResultsWe screened 11 040 patients (41 390 random data entries by ICD‐9 code) and enrolled 515 (4.6%) GERD patients and 169 (1.5%) Barrett's oesophagus patients. The mean (±s.d.) number of oesophagogastroduodenoscopies in the GERD cohort was 3.2 ± 1.8 (range: 2–15) over 3.4 ± 2.2 (range: 0.5–11) years. None of the 412 (80%) GERD patients with non‐erosive disease developed Barrett's oesophagus over a mean follow‐up time of 3.4 ± 2.2 years (95% CI: 0–0.9%). Five (1%) of the 103 GERD patients with erosive oesophagitis developed subsequent Barrett's oesophagus. Fifty‐seven per cent of the GERD patients were on PPI therapy at the time of index endoscopy. None of the 169 Barrett's oesophagus patients had normal index oesophagogastroduodenoscopies within a mean retrospective time period of 4.5 ± 2.8 years (95% CI: 0–2%). Using the ICD‐9 code of 530.2 as a predictor of the presence of Barrett's oesophagus, the sensitivity was 79% with a specificity of 88%.ConclusionThe majority of patients with GERD do not appear to develop Barrett's oesophagus when it is not present on the index endoscopy.
Total spinal anaesthesia after an attempted brachial plexus block using the posterior approach
Authors: Grefkens J. M. , Bürger K. 
Published: October 2006

SummaryA 66‐year‐old patient scheduled for elective shoulder surgery underwent a brachial plexus block using the posterior approach. Shortly after injection of the local anaesthetic, he rapidly became unresponsive and apnoeic. We identify the possible reasons for this occurrence and discuss the place of the posterior approach in brachial plexus anaesthesia.
Effect of propofol on seizure‐like phenomena and electroencephalographic activity in children with epilepsy vs children with learning difficulties
Authors: Meyer S. , Shamdeen M. G. , Kegel B. , Mencke T. , Gottschling S. , Gortner L. , Grundmann U. 
Published: October 2006

SummaryThere is an ongoing debate as to whether propofol exhibits pro‐ or anticonvulsant effects, and whether it should be used in patients with epilepsy. We prospectively assessed the occurrence of seizure‐like phenomena and the effects of intravenous propofol on the electroencephalogram (EEG) in 25 children with epilepsy (mean (SD) age: 101 (49) months) and 25 children with learning difficulties (mean (SD) age: 52 (40) months) undergoing elective sedation for MRI studies of the brain. No child demonstrated seizure‐like phenomena of epileptic origin during and after propofol sedation. Immediately after stopping propofol, characteristic EEG changes in the epilepsy group consisted of increased beta wave activity (23/25 children), and suppression of pre‐existing theta rhythms (11/16 children). In addition, 16 of 18 children with epilepsy and documented EEG seizure activity demonstrated suppression of spike‐wave patterns after propofol sedation. In all 25 children with learning difficulties an increase in beta wave activity was seen. Suppression of theta rhythms occurred in 11 of 12 children at the end of the MRI study. In no child of either group was a primary occurrence or an increase in spike‐wave patterns seen following propofol administration. The occurrence of beta wave activity (children with learning difficulties and epilepsy group) and suppression of spike‐wave patterns (epilepsy group) were transient, and disappeared after 4 h. This study demonstrates characteristic, time‐dependent EEG patterns induced by propofol in children with epilepsy and learning difficulties. Our data support the concept of propofol being a sedative‐hypnotic agent with anticonvulsant properties as shown by depression of spike‐wave patterns in children with epilepsy and by the absence of seizure‐like phenomena of epileptic origin.
Comparison of forced‐air warming and electric heating pad for maintenance of body temperature during total knee replacement
Authors: Ng V. , Lai A. , Ho V. 
Published: October 2006

SummaryWe conducted a randomised controlled trial to compare the efficacy of forced‐air warming (Bair Hugger™, Augustine Medical model 500/OR, Prairie, MN) with that of an electric heating pad (Operatherm 202, KanMed, Sweden) for maintenance of intra‐operative body temperature in 60 patients undergoing total knee replacement under combined spinal‐epidural anaesthesia. Intra‐operative tympanic and rectal temperatures and verbal analogue score for thermal comfort were recorded. There were no differences in any measurements between the two groups, with mean (SD) final rectal temperatures of 36.8 (0.4) °C with forced‐air warming and 36.9 (0.4) °C with the electric pad. The heating pad is as effective as forced‐air warming for maintenance of intra‐operative body temperature.
A randomised controlled trial of the effect of continuous electronic physiological monitoring on the adverse event rate in high risk medical and surgical patients
Authors: Watkinson P. J. , Barber V. S. , Price J. D. , Hann A. , Tarassenko L. , Young J. D. 
Published: October 2006

SummaryWe conducted a randomised controlled trial of mandated five‐channel physiological monitoring vs standard care, in acute medical and surgical wards in a single UK teaching hospital. In all, 402 high‐risk medical and surgical patients were studied. The primary outcome was the proportion of patients experiencing one or more major adverse events, including urgent staff calls, changes to higher care levels, cardiac arrests or death, in 96 h following randomisation. Secondary outcomes were the proportion of patients requiring acute treatment changes, and the 30‐day and hospital mortality. In the 96 h following randomisation, 113 (56%) patients in the monitored arm and 116 (58%) in the control arm (OR 0.94, 95% CI 0.63–1.40, p = 0.76) had a major event. An acute change in treatment was necessary in 107 (53%) monitored patients and 101 (50%) control patients (OR 0.55, 95% CI 0.87–1.29). Thirty‐four (17%) monitored patients and 35 (17%) control patients died within 30 days. Thirteen patients in the control group received full five‐channel monitoring at the request of the ward staff. We conclude that mandated electronic vital signs monitoring in high risk medical and surgical patients has no effect on adverse events or mortality.
An evaluation of protocolised weaning on the duration of mechanical ventilation*
Authors: Blackwood B. , Wilson‐Barnett J. , Patterson C. C. , Trinder T. J. , Lavery G. G. 
Published: October 2006

SummaryUsing a before and after study design, we compared protocolised weaning from mechanical ventilation with usual non‐protocolised practice in intensive care. Outcomes (duration of mechanical ventilation, duration of intubation, intensive care stay) and complications (re‐intubations, tracheostomy, mortality) were compared between baseline (Phase I) and following implementation of protocolised weaning (Phase II). Over the same period, we collected data in a second (reference) unit to monitor practice changes over time. In the intervention unit, outcomes were longer in Phase II compared with Phase I (all p < 0.005). When adjusted for admission APACHE II score and diagnostic category, only intensive care stay remained significantly longer (p = 0.002). There were significantly more tracheostomies in Phase II (p = 0.004). The reference unit demonstrated no statistically significant differences in study outcomes or complications between Phases. Protocolised weaning did not reduce the duration of mechanical ventilation and was not associated with an increased rate of re‐intubation or intensive care unit mortality.
A comparison of nerve stimulator guided paravertebral block and ilio‐inguinal nerve block for analgesia after inguinal herniorrhaphy in children
Authors: Naja Z. M. , Raf M. , El Rajab M. , Daoud N. , Ziade F. M. , Al Tannir M. A. , Lönnqvist P. A. 
Published: October 2006

SummaryThe aim of this study was to compare the efficacy of nerve stimulator guided paravertebral block with ilio‐inguinal nerve block in children undergoing inguinal herniorrhaphy. Eighty children were randomly allocated to receive either paravertebral block or ilio‐inguinal nerve block. Each block was evaluated in terms of intra‐operative haemodynamic stability, postoperative pain scores at rest, on movement and during activity, requirement for supplemental analgesia and parental satisfaction. Haemodynamic stability was maintained significantly better during sac traction in the paravertebral block group (p < 0.005). Pain scores and analgesic consumption were significantly lower in the paravertebral block group during the postoperative follow‐up period (p < 0.05). Parental satisfaction (93%vs 69%) and surgeon satisfaction (93%vs 64%) were significantly higher in the paravertebral block group (p < 0.05). Paravertebral blockade improved and prolonged postoperative analgesia, and was associated with greater parental and surgeon satisfaction when compared to ilio‐inguinal nerve block.
Vinorelbine‐based salvage chemotherapy for therapy‐refractory aggressive leukaemias
Authors: Uckun Fatih M. , Morar Sanda , Qazi Sanjive 
Published: October 2006

SummaryThis study examined the ability of the semi‐synthetic vinca alkaloid, Vinorelbine/Navelbine, to cause apoptotic death in freshly obtained primary leukaemia cells from 53 patients with haematological malignancies, including 22 patients with acute lymphoblastic leukaemia (ALL), 24 patients with chronic lymphocytic leukaemia (CLL), three patients with chronic myeloid leukaemia in blast crisis (CML‐BC) and four patients with acute myeloid leukaemia (AML). Vinorelbine caused apoptosis in primary leukaemia cells from 42 (79%) of these leukaemia patients. Objective responses, including complete remission (CR) and CR with incomplete haematological recovery, were achieved in 12 of 17 (71%) patients with aggressive and therapy‐refractory leukaemias, including five of nine patients with relapsed ALL, three of three patients with CML‐BC and four of five patients with rapidly progressive CLL, who were treated with a vinorelbine‐based salvage chemotherapy regimen. Drug sensitivity profiling of multidrug‐resistant primary cancer cells using apoptosis assays revealed a significant association between Vinorelbine sensitivity in vitro and the likelihood of an objective clinical response to Vinorelbine‐based chemotherapy. Vinorelbine‐sensitivity testing of primary leukaemia cells might help tailor Vinorelbine‐based salvage regimens to those patients who are most likely to respond.
Effects of heat‐processing regime, pH, water activity and their interactions on the behaviour of Listeria monocytogenes in ground pork. Modelling the boundary of the growth/no‐growth areas as a function of pH, water activity and temperature
Authors: Zuliani Véronique , Lebert Isabelle , Garry Pascal , Vendeuvre Jean‐Luc , Augustin Jean‐Christophe , Lebert André 
Published: October 2006

SummaryThe influence of four heat‐processing regimes and a storage phase on the behaviour of Listeria monocytogenes in ground pork was studied. The effects of pH and water activity (aw) were also tested. During the heat process phase, aw, the heat‐processing regime and its interactions with pH or aw, had a significant effect on the behaviour of L. monocytogenes. During the storage phase, all parameters tested and their interactions had significant effects. Nevertheless, the area in which the growth of L. monocytogenes was observed at the end of the experiment was not influenced by the heat‐processing regime tested. On the contrary, pH, aw and their interactions had significant effects on Listeria behaviour. The boundary of the growth area delimited by environmental conditions where growth was higher than 1.0 Log CFU g−1 from those where growth was lower than this limit was correctly predicted by Augustin's model.
Developing an advanced nurse practitioner service in emergency care: attitudes of nurses and doctors
Authors: Griffin Miriam , Melby Vidar 
Published: October 2006

Aim.  This paper reports a study to determine the attitudes of nurses, doctors and general medical practitioners towards the development of an advanced nurse practitioner service within an emergency department.Background.  The role of advanced nurse practitioner in emergency care has emerged in a number of countries, and has brought with it confusion about titles, role boundaries, clinical accountability and educational requirements. Initially, the role resulted from a need for healthcare professionals to provide a service to the increased numbers of patients presenting to hospital with less urgent problems. Since then, the service has evolved to one where nurse practitioners provide high‐quality and cost‐effective care to persons who seek help for non‐urgent, urgent or emergent conditions in a variety of emergency care settings. However, little research could be identified on the attitudes of relevant nursing and medical staff towards the development of this role.Methods.  A questionnaire survey was carried out, and a 29‐item Likert rating scale was developed to measure attitudes. Along with some demographic variables, two open‐ended questions were added to allow respondents to elaborate on what they perceived as benefits and difficulties associated with an advanced nurse practitioner service. All general practitioners, emergency nurses and emergency doctors in one health board in the Republic of Ireland were targeted, and 25 emergency nurses, 13 emergency doctors and 69 general practitioners were approached to take part. Data were collected in February 2004.Findings.  An overall response rate of 74·8% was achieved. All respondents were positive towards the development of an advanced nurse practitioner service, with general practitioners being less positive. The principal differences appeared between general practitioners and hospital emergency care staff.Conclusion.  There is a need for a multidisciplinary approach to the planning of advanced nurse practitioner services. To achieve multiprofessional acceptance, an accredited and standardized education programme is required, and this must address existing role boundaries.
What makes a good midwife? An integrative review of methodologically‐diverse research
Authors: Nicholls Lynn , Webb Christine 
Published: October 2006

Aim. This paper reports an integrative review aimed at answering the question: ‘What makes a good midwife?’Background. A research‐based definition of a good midwife which can be used as an operational definition in research and as a basis for curriculum development could not be found. Research in nursing has identified that patients and nurses may give different responses when asked about the most important aspects of nurses’ contribution to care. It is also possible that views of how to define a good midwife might differ.Methods. A four‐stage systematic review process was used, consisting of protocol development, carrying out the search, appraisal/analysis of the papers retrieved, and synthesis of the information. The initial search covered the period from 1993 and used the keywords ‘midwi*’, ‘nurse‐midwi*’ and ‘good’. This was later extended to include the terms ‘exemplary’, ‘excellent’ and ‘superb’ as synonyms of ‘good’, and ‘bad’ as its antonym. The integrative review was descriptive and focussed on extracting from the papers the findings that contributed to answering the research question.Findings. Thirty‐three research‐based papers were included in the review, and these had used a range of approaches and methods. Eight key concepts were derived from the data: attributes of a midwife, education, research, what a midwife does, care organization, other professionals, partners and an international perspective.Conclusion. Having good communication skills made the greatest contribution to being ‘a good midwife’, while being compassionate, kind, supportive (affective domain), knowledgeable (cognitive domain) and skilful (psychomotor domain) also made major contributions. Being involved in education and research were necessary requirements, and midwives’ abilities to treat women as individuals, adopt a caring approach, and ‘be there’ for women were essential. A good midwife can compensate for poor management systems, but women should be able to choose who provides their care, and partners should be involved in this care.
A test of the vicariance hypothesis of western North American freshwater biogeography
Authors: Liu Hsiu‐Ping , Hershler Robert 
Published: October 2006

AbstractAim The biogeography of western North American freshwater molluscs has traditionally been attributed to vicariance associated with late Tertiary rearrangement of landscape based on distributional evidence and the putatively limited dispersal ability of these organisms. We examined the phylogeography of a widely ranging western springsnail (Pyrgulopsis wongiHershler, 1989) to test this hypothesis and evaluate the relative importance of vicariance and dispersal in structuring the distribution of this species.Location Southwestern Great Basin (California and Nevada), United States of America.Method Two mitochondrial genes (COI, NDI) were sequenced for 28 populations ofP. wongispanning its entire geographic range, which consists of 10 topographically closed drainage basins. We also sequenced eight closely related congeners, as well as the type species of the closely related eastern North American genusFloridobiaHershler & Thompson, 2002, which was used as the outgroup. Phylogenies based on the combined data set were obtained using several methods, and networks for each gene were generated as an additional means of examining relationships among haplotypes. Partitioning of haplotype variation was studied usingamova, migration between populations was estimated using a coalescent‐based method (mdiv), and divergence times were inferred using a locally calibrated molecular clock andmdiv.Results Pyrgulopsis wongiis subdivided into narrowly localized and widely distributed lineages that diverged in the Pleistocene, well after the inception of the contemporary regional landscape. While large ΦSTvalues and the localized geographic distributions of most haplotypes imply absence or negligible contemporary dispersal of this spring‐dwelling snail, the pattern of phylogeographic structuring, presence of a few widespread haplotypes, and results of themdivanalyses suggest geologically recent dispersal across drainage divides.Main conclusions Phylogeography ofP. wongiconflicts with the traditional vicariance model as it is not structured by the contemporary landscape and is instead indicative of geologically recent dispersal. In the absence of evidence that dispersal of this species occurred through surface water connections during the relevant (Quaternary) time frame, we conjecture that spread may have instead been mediated by transport on waterfowl or via upland stream capture. The non‐concordance between phylogeography and landscape reported in this and other recent studies ofPyrgulopsissuggests that members of this diverse and imperiled genus should not be managed using ana priori, ‘watershed as conservation unit’ approach.