bluuebunny/crossref_metadata_2025_split huggingface dataset:
UNRESOLVED ISSUES IN DIALYSIS: Extracorporeal Strategies for the Removal of Middle Molecules
Authors: Winchester James F. , Audia Patrick F. 
Published: March 2006

ABSTRACTUremic toxins with a molecular weight of less than 500 Da are classified as small nitrogenous waste products. They are highly water soluble, relatively homogeneous, and have no protein binding. Other uremic retention toxins differ significantly from the small nitrogenous metabolite class in molecular weight, heterogeneity, protein binding, and hydrophobicity. The European Uremic Toxin Work Group subdivided molecules into two categories: protein‐bound solutes and middle molecules. Middle molecules were defined as toxins in the molecular weight range of 500–60,000 Da, which exceeds the molecular weight of 2000 Da defined in the original middle molecule hypothesis. Under this new proposed definition, most of these middle molecules are low molecular weight peptides and proteins (LMWPs). This concise review focuses on LMWPs. The metabolism of LMWPs is described, including molecular weight, physical conformation, and charge. Factors influencing dialytic removal of LMWPs such as membrane characteristics, protein–membrane interactions, and solute removal mechanisms, as well as strategies to enhance clearance of these compounds are discussed.
UNRESOLVED ISSUES IN DIALYSIS: Inflammatory Biomarkers and Cardiovascular Risk: Association or Cause and Effect?
Authors: Rao Madhumathi , Jaber Bertrand L. , Balakrishnan Vaidyanathapuram S. 
Published: March 2006

ABSTRACTWith the current understanding that atherosclerosis is an inflammatory disorder, markers of the associated systemic inflammatory response have been extensively studied as predictors of cardiovascular disease. Recently the use of high‐sensitivity C‐reactive protein (hsCRP) has been proposed for risk assessment in individuals at intermediate risk of coronary heart disease. The traditional view of inflammatory biomarkers, including CRP, regards them as risk markers rather than risk factors. Either category of marker would serve a diagnostic role, monitor disease activity, and indicate the efficacy of therapy or changing prognosis. However a risk factor with a causal role would be a potential target for therapy. This review discusses the available evidence that argues for and against a causal role for inflammatory biomarkers, with specific reference to CRP, in the atherosclerotic process.
UNRESOLVED ISSUES IN DIALYSIS: Why Do Patients Sleep on Dialysis?
Authors: Gul Ambreen , Aoun Naim , Trayner Edwin M. 
Published: March 2006

ABSTRACTSleep‐associated symptoms and excessive daytime sleepiness are felt to be more common in dialysis patients. Several surveys conducted in this patient population have identified a prevalence of sleep disturbances in up to 80% of patients. This review article summarizes common disorders associated with sleep disturbances in dialysis patients, including sleep‐disordered breathing, restless legs syndrome, and major depression. Special attention is given to pathophysiological processes and effective approaches for the prevention and timely treatment of these conditions, which in turn reduces the substantial morbidity associated with sleep disturbances.
UNRESOLVED ISSUES IN DIALYSIS: Long‐Term Management of the Tunneled Venous Catheter
Authors: Liangos Orfeas , Gul Ambreen , Madias Nicolaos E. , Jaber Bertrand L. 
Published: March 2006

ABSTRACTDespite their propensity for significant complications, tunneled central venous catheters have become a common means of vascular access in the United States for patients requiring maintenance hemodialysis for end‐stage renal disease (ESRD). Reasons for their use include advanced patient age, peripheral vascular disease (arterial and venous), late referral for creation of vascular access, and more importantly, the lack of an interdisciplinary service line on vascular access among vascular surgeons, radiologists, and nephrologists. This review article summarizes complications commonly encountered in dialysis patients who use tunneled central venous catheters for vascular access—mainly thrombosis, stenosis, and infection. Special attention is given to novel approaches for the prevention of catheter‐associated infections. Effective prevention and timely treatment of common catheter‐associated complications can reduce the substantial morbidity associated with the use of these devices. However, these measures should not detract from the goal of avoiding or limiting the long‐term use of catheters, thereby optimizing vascular access management by ensuring the timely availability of functioning arteriovenous fistulas.
UNRESOLVED ISSUES IN DIALYSIS: Dialysis Modality and Dosing Strategy in Acute Renal Failure
Authors: Palevsky Paul M. 
Published: March 2006

ABSTRACTMany fundamental aspects of the management of renal replacement therapy (RRT) in acute renal failure (ARF) remain unresolved. While data from multiple studies support the initiation of RRT, in the absence of other indications, when the BUN has reached a level of approximately 90–100 mg/dl, there are conflicting data regarding the benefit of earlier initiation of renal support. The relative efficacy of the various RRT modalities is uncertain. Despite growing utilization, a survival benefit or greater recovery of renal function has not been demonstrated for continuous renal replacement therapy (CRRT) as compared to conventional intermittent hemodialysis (IHD). Optimal dosing strategies are also poorly defined. While there is increasing evidence that more intensive renal support is associated with better outcomes in ARF, an optimal Kt/Vurea and treatment frequency for IHD remain to be established. Similarly, although data suggest that continuous venovenous hemofiltration (CVVH) should be dosed at no less than 35 ml/kg/hr (postdilution), confirmation of this dosing strategy and validation for other modalities of CRRT are required.
Interventional Nephrology in Puerto Rico
Authors: Leon Francisco Torre , Bermudez Carlos Rivera , Hernandez Victor , Silva Jose , Delpin Eduardo Santiago 
Published: March 2006

ABSTRACTVascular access is emerging as a critical issue for hemodialysis patients in Puerto Rico. In more than 50% of the hemodialysis patients, tunneled hemodialysis catheters are the sole access for providing dialysis therapy. Most disturbing is the fact that a significant number of these catheters are nontunneled temporary catheters, sometimes placed in the subclavian vein. These facts have contributed significantly to the morbidity and mortality seen in chronic dialysis patients. In addition, many cases of early or late dysfunction of arteriovenous access are not detected and treated in a timely manner due to the lack of a comprehensive vascular access program for end‐stage renal disease (ESRD) patients. In fact, monitoring programs to identify and detect vascular access dysfunction are virtually nonexistent in many chronic dialysis units. Even when diagnosed, it is not treated in a timely fashion. Recently literature has shown that procedure‐related delays in the treatment of patients with renal disease can be minimized and nephrology care more efficiently delivered by a nephrologist trained in nephrology‐related procedures. In an effort to optimize the care of our ESRD patients, we took the initiative to develop an interventional nephrology program that effectively deals with vascular access‐related procedures in a timely manner. This approach has minimized delays, decreased hospitalizations and the use of temporary catheters, and improved the medical care of our chronic dialysis patients. So far we have performed more than 400 procedures in the 6 months since the initiation of the program. In this article we describe our initial experience with interventional nephrology in Puerto Rico.
Salvage of Problematic Peritoneal Dialysis Catheters
Authors: Asif Arif , Gadalean Florin , Vieira Cristovao F. , Hogan Renee , Leon Carlos , Merrill Donna , Ellis Renee , Amador Amarilys , Broche Osmany , Bush Barbara , Con Treras Gabriel , Pennell Phillip 
Published: March 2006

ABSTRACTPeritoneal dialysis (PD) is a markedly underutilized modality for permanent renal replacement therapy in the United States owing to a low rate of patient referral and high rate of patient dropout or transfer to hemodialysis. One cause for patient loss from PD is problematic PD catheters that often are removed rather than being subjected to simple surgical salvage procedures. We report three patients with problematic catheters and our approach to their management. The first patient developed erosion of the skin overlying the portion of the catheter between the deep and superficial cuffs after 6 months of PD. The second patient developed extrusion of the superficial cuff after 4 years of PD. The third patient demonstrated a localized abscess at the incision site for catheter insertion after 3 years of PD. Other than a mild superficial exit site infection and localized abscess in the second and third patient, respectively, there were no associated infections of the catheter tunnel and cuff or of the peritoneal cavity as determined by either clinical examination, ultrasound evidence of fluid collection, or cultures and white blood cell counts. All three cases were managed successfully by interventional nephrology on an outpatient basis and under local anesthesia without either catheter removal or placement of a new PD catheter. It was possible to continue uninterrupted PD in the first and third patients, while the second patient had temporary hemodialysis to allow for complete healing of the surgical wound. We conclude that in selected cases simple interventions can salvage problematic PD catheters and maintain patients on PD.
ASDIN Clinical Case Focus: Cause for Inadequate Clearance: Hemodialysis Catheter Migration into the Coronary Sinus
Authors: Brucculeri Michael , Licht Jonah , Serur David , Cheigh Jhoong 
Published: March 2006

ABSTRACTComplications associated with central dialysis catheters prove to be an important source of morbidity that challenge patients and clinicians alike. While thrombosis, stenosis, and infection remain the most common threats to functioning central dialysis catheters, malposition of such devices may similarly result in serious consequences. Despite advanced techniques used to confirm initial catheter placement, the very nature of these catheters entails frequent manipulation for vascular access and therefore they may migrate after repeated use. When compared with the loss of patency and infection, complications involving malposition or migration may present in a more insidious fashion, such as a gradual decline in achievable blood flow rate or observed clearance over time. We describe a patient who acutely developed both clinical and biochemical evidence of inadequate clearance after several months of suboptimal catheter function. When the central dialysis catheter was examined fluoroscopically, it was found to have migrated into the coronary sinus.
The Dynamic Nature of Mobility Disability in Older Persons
Authors: Gill Thomas M. , Allore Heather G. , Hardy Susan E. , Guo Zhenchao 
Published: March 2006

OBJECTIVES:To determine the rates of clinically meaningful transitions in mobility disability; evaluate how these transitions differ according to age, sex, and physical frailty; and depict the duration of the resulting episodes of mobility disability.DESIGN:Prospective cohort study.SETTING:General community in greater New Haven, Connecticut, from March 1998 to October 2004.PARTICIPANTS:Seven hundred fifty‐four community‐living older persons, aged 70 and older, who were nondisabled (i.e., required no personal assistance) in four activities of daily living.MEASUREMENTS:Mobility disability, defined as the inability to walk one quarter of a mile and to climb a flight of stairs, respectively without personal assistance, was assessed every month for up to 5 years.RESULTS:For both mobility tasks, rates per 1,000 person‐months were higher for transitions from no disability to intermittent disability (34.7 for walking one quarter of a mile and 17.4 for climbing a flight of stairs), intermittent to continuous disability (52.0 and 42.5), continuous to intermittent disability (35.4 and 31.5), and intermittent to no disability (68.6 and 85.4) than for other transitions. Older age, female sex, and physical frailty were associated with greater likelihood of transition to states of greater disability and lower likelihood of regaining independent mobility.CONCLUSION:Mobility disability in older persons is a highly dynamic process, characterized by frequent transitions between states of independence and disability. Programs designed to enhance independent mobility should focus not only on the prevention of mobility disability but also on the restoration and maintenance of independent mobility in older persons who become disabled.
The Effect of Emergency Department Crowding on the Management of Pain in Older Adults with Hip Fracture
Authors: Hwang Ula , Richardson Lynne D. , Sonuyi Tolulope O. , Morrison R. Sean 
Published: March 2006

OBJECTIVES: To evaluate the effect of emergency department (ED) crowding on assessment and treatment of pain in older adults.DESIGN: Retrospective review of ED records from a prospective cohort study.SETTING: Urban, academically affiliated, tertiary medical center.PARTICIPANTS: One hundred fifty‐eight patients, aged 50 and older, evaluated and hospitalized from the ED with hip fracture.MEASUREMENTS: Patient‐related risk factors: age, sex, nursing home residence, ED triage status, dementia, Acute Physiology in Age and Chronic Health Evaluation II physiological score, and RAND comorbidity score. ED crowding risk factors: ED census and mean length of stay. Outcomes: documentation of pain assessment, time to pain assessment, time to pain treatment, patients reporting pain receiving analgesia, and meperidine use.RESULTS: Mean age was 83 (range 52–101), 81.0% of patients complained of pain, mean time to pain assessment was 40 minutes (range 0–600), time to treatment was 141 minutes (range 10–525), and mean delay to treatment was 122 minutes (range 0–526). Of those with pain, 35.9% received no analgesia, 7.0% received nonopioids, and 57.0% received opioids. Of those receiving opioids, 32.8% received meperidine. ED crowding at census levels greater than 120% bed capacity was significantly associated with a lower likelihood of documentation of pain assessment (P=.05) and longer times to pain assessment (P=.01).CONCLUSION: Older adults with hip fracture are at risk for underassessment of pain, considerable delays in analgesic administration after pain is identified, and treatment with inappropriate analgesics (e.g., meperidine) in the ED. Higher levels of ED census are significantly associated with poorer pain management.
Parental risk attitudes and caries‐related behaviours among immigrant and western native children in Oslo
Authors: Skeie Marit S. , Riordan Paul J. , Klock Kristin S. , Espelid Ivar 
Published: March 2006

Abstract –  Objectives:  Immigrant children make up a large proportion of the school populations in many western cities. It is likely that their parents have different attitudes and knowledge of dental health than resident populations, and thus provide a challenge to public dental services. This study sought to map existing disparities in oral health among immigrant and western native children in Oslo and to identify differences in parental, cultural and ethnic beliefs and attitudes towards oral health and caries‐related behaviours.Methods:  Caries was recorded of 735 children (3‐ and 5‐year olds), supplemented with radiographs among 5‐year olds. Their parents responded to a questionnaire.Results:  Immigrant background, consumption of sweet drinks at bed and social status were the dominant caries risk indicators among the 3‐year olds. Among the 5‐year olds, the caries risk indicators were immigrant background, parental indulgence, attitude to diet, attitude to oral hygiene, social status and age starting toothbrushing. Being an immigrant was closely associated with higher caries prevalence and experience. Parental attitudes to oral hygiene, diet and indulgence, and caries‐related behaviours distinguished immigrants from western natives.Conclusions:  The results suggest that immigrant groups in western societies require different information packages, modified strategies for forming oral hygiene habits and attitudes related to dental care of children, and encouragement to exercise discipline on factors known to be risks for oral health. These strategies must recognize that immigrants and western natives attach different levels of importance to oral health and dental parameters. It should be paid extra attention to some caries high‐risk subgroups.
Using patient self‐report data to evaluate orofacial surgical outcomes
Authors: Atchison Kathryn A. , Shetty Vivek , Belin Thomas R. , Der‐Martirosian Claudia , Leathers Richard , Black Edward , Wang Jianming 
Published: March 2006

Abstract –  Objectives:  This study analyzes results of 336 patients treated for mandible fractures at King/Drew Medical Center in South Central Los Angeles, California from August 1996 to December 2001. Subjects were enrolled in a prospective study to evaluate the association between patient's subjective evaluation and objective clinical evaluations on three surgical outcome measures following orofacial surgery.Methods:  Subjects were assessed at four time periods – hospital discharge, 10 days post‐discharge, 1 month post‐discharge and 6 months post‐discharge. Three outcome measures were utilized to represent perceived health and oral health‐related quality of life – General Oral Health Assessment Index (GOHAI); Mental Health Inventory (MHI‐5); and a single‐item self‐reported health status measure.Results:  GOHAI scores at 1 month (mean = 31.5, SD = 9.5) were not substantially higher than at 10 days (mean = 28.6, SD = 8.8), but scores did improve substantially by 6 months (mean = 42.6, SD = 10.6). Mean mental health scores ranged from 17.7 at 10 days to 18.0 at 1 month and 18.6 at 6 months. Mean self‐reported health status score were approximately 2.2 at all recalls, describing health as ‘good.’ A longitudinal growth curve analysis of GOHAI scores over four time periods indicated a significantly higher average intercept for the maxillomandibular fixation (MMF) treatment group (29.67) than in the rigid internal fixation (RIF) treatment group (25.38). Meanwhile, the increase in GOHAI scores over time was significantly greater in the RIF group than in the MMF group, resulting in scores being comparable between groups after 6 months.Conclusions:  By implication, patients with MMF self‐report fewer problems in the early days after placement of the intra‐arch wire compared with patients with RIF.
Availability of fluoride from meals given to kindergarten children in Brazil
Authors: Buzalaf Marília Afonso Rabelo , Pinto Camila Silva , Rodrigues Maria Heloísa Corrêa , Levy Flávia Mauad , Borges Aline Somadossi , Furlani Tatiana Almeida , Cardoso Vanessa Eid da Silva 
Published: March 2006

Abstract –  Objectives:  The aim of this study was to evaluate the amount of fluoride supplied daily in the meals given in 44 public kindergarten schools in Bauru, Brazil. In addition, the fluoride concentration of water supplies and its impact on the amount of fluoride found in the meal samples were also investigated.Methods:  Meal samples and water were collected during 2 weeks (10 working days) in public kindergarten schools. Samples of meals were homogenized with known volumes of deionized water. Fluoride present in meal samples was analyzed with the ion‐specific electrode (Orion 9609), after hexamethyldisilazane‐facilitated diffusion. Fluoride in water samples was analyzed with the same electrode, after buffering with TISAB II. All the analyses were made in duplicate.Results:  Fluoride analyzed (mean ± SD) was 0.50 ± 0.20 μg/ml, ranging from nondetectable to 1.42 μg/ml for water samples (n = 424) and 0.067 ± 0.059 mg, ranging from 0.007 to 0.580 mg for meal samples (n = 431). A weak but significant correlation was observed between the amount of fluoride in meals and fluoride concentration in water supplies (r = 0.139, P = 0.0042).Conclusions:  Despite the seemingly small role played by school meals in the total daily fluoride intake, they can contribute to the total fluoride intake of children on a chronic basis, when in association with other fluoride products. Additionally, the impact of fluoridated public water supply on the final fluoride concentration of the school meals analyzed may be regarded as low.
Oral health‐related quality of life and periodontal status
Authors: Ng Sam K. S. , Leung W. Keung 
Published: March 2006

Abstract –  Background:  As patient‐centered approaches become more popular, increasing attention is being given to assess the effects of various human health situations on an individual's overall quality of life (QoL). Measures have been used in dentistry to study the effects of orthodontic treatment and oral surgery, but so far little has been reported about the effects of periodontal disease.Objective:  This study assessed the impact of periodontal health status on QoL.Methods:  A subsample of 767 subjects were selected from a community study (n = 1000) which investigated the association between psychological factors and clinical periodontal attachment level (CAL). The sample included subjects with full‐mouth mean CAL ≤2 mm (healthy/low periodontal attachment loss group), and subjects with full‐mouth mean CAL >3 mm (high/severe periodontal attachment loss group). The subjects were requested to complete the Chinese short‐form version of Oral Health Impact Profile (OHIP‐14S) and a checklist of self‐reported periodontal symptoms during the previous 12 months.Results:  A total of 727 subjects (95%) completed the questionnaire. The OHIP‐14S and subscale scores were significantly associated with six of seven of the self‐reported periodontal symptoms. A comparison of the mean OHIP‐14S scores of the healthy/low and the high/severe periodontal attachment loss groups revealed significant differences in respect of the subscales of functional limitation, physical pain, psychological discomfort, physical and psychological disabilities.Conclusion:  This study demonstrates a significant association between oral health‐related QoL and periodontal disease.