bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Comparison of How Generalists and Fellowship‐Trained Geriatricians Provide “Geriatric” Care
Authors: Phelan Elizabeth A. , Genshaft Scott , Williams Barbara , LoGerfo James P. , Wagner Edward H. 
Published: October 2008

OBJECTIVES: To determine whether outpatient care provided to older patients by fellowship‐trained geriatricians is distinguishable from that provided by generalists.DESIGN: Observational study.SETTING: Three primary care clinics of an academic medical center.PARTICIPANTS: Random sample of 140 adults aged 65 and older receiving primary care at one of the clinics.MEASUREMENTS: A medical chart review involving records of 69 patients receiving primary care from a fellowship‐trained geriatrician and 71 patients receiving primary care from a generalist (general internal medicine or family practice) was conducted; information pertaining to two practice behaviors relevant to the care of older adults—avoidance of inappropriate prescribing and proactive assessments for geriatric syndromes—was abstracted.RESULTS: Geriatricians scored 17.6 out of a possible 24 points, on average; generalists scored 14.2 (P<.001). Geriatricians scored higher than generalists on prescribing and geriatric syndrome assessments. In a linear regression model adjusting for patient age and number of comorbidities and clustering according to provider, provider specialty was strongly associated with overall score (β coefficient for specialty=6.75, P<.001; 95% confidence interval=4.57–8.94).CONCLUSION: The practice style of fellowship‐trained geriatricians caring for older adults appears to differ from that of generalists with regard to prescribing behavior and assessment for geriatric syndromes.
Correlation of Left Atrial Diameter by Echocardiography and Left Atrial Volume by Computed Tomography
Authors: HOF IRENE , ARBAB‐ZADEH ARMIN , SCHERR DANIEL , CHILUKURI KARUNA , DALAL DARSHAN , ABRAHAM THEODORE , LIMA JOAO , CALKINS HUGH 
Published: October 2008

Introduction:
For patients undergoing catheter ablation of atrial fibrillation (AF), left atrial size is a predictor of recurrence of AF during follow‐up. For this reason, major clinical trials have used a left atrial diameter (LAD) of more than 5.0 or 5.5 cm, assessed by echocardiography, as an exclusion criterion for patients deemed candidates for ablation of AF. However, whether LAD accurately reflects true left atrial size has not been systematically investigated. Therefore, the purpose of this study was to test the hypothesis that LAD, measured by echocardiography, accurately correlates to left atrial volume measured by computed tomography (CT).
Methods and Results:
We included 50 patients (mean age 56 ± 12 years, five female) with symptomatic AF (40% paroxysmal, 60% persistent), referred for catheter ablation. In each patient, transthoracic echocardiography was performed. Additionally, all patients underwent CT using a 64‐slice CT scanner. Left atrial volume was calculated by manually tracing left atrial area on each CT cross‐sectional image. Patients had a mean LAD measured by echocardiography of 4.5 ± 0.7 cm, ranging from 2.9 to 5.7 cm. Left atrial volume measured by CT ranged from 67 mL to 270 mL with a mean value of 146 ± 49 mL. A poor correlation was noted between LAD and left atrial volume, r = 0.49 (P < 0.001).
Conclusion:
LAD measured by echocardiography correlates poorly with left atrial volume measured by CT in patients with AF. As a result, selecting patients with AF for treatment with catheter ablation should not be based on an echocardiographic‐derived LAD alone.
Use of an Autologous Blood Recovery System during Emergency Pericardiocentesis in the Electrophysiology Laboratory
Authors: VENKATACHALAM K. L. , FANNING LISA J. , WILLIS ELAINE A. , BEINBORN DOUGLAS S. , BRADLEY DAVID J. , CHA YONG‐MEI , SHEN WIN‐KUANG , ASIRVATHAM SAMUEL J. , SINAK LAWRENCE J. , PACKER DOUGLAS L. , MUNGER THOMAS M. , SANTRACH PAULA J. , FRIEDMAN PAUL A. 
Published: October 2008

Autotransfusion during Pericardiocentesis. Introduction: Emergency pericardiocentesis during electrophysiology procedures is often associated with significant aspiration of pericardial blood, requiring transfusion. We sought to assess the feasibility of urgent use of an autologous blood recovery system in the electrophysiology laboratory to autotransfuse blood aspirated from the pericardium.
Methods and Results:
We retrospectively analyzed Mayo Clinic electrophysiology records for patients who had ablation procedure‐related pericardial effusions requiring emergency pericardial drainage during an 8‐month period. An autologous blood recovery system was used during pericardiocentesis to separate and clean packed red blood cells from the pericardial aspirate. These cells were returned acutely to the patient intravenously. The procedural safety, aspirated and autotransfused volumes, and efficacy of this approach were evaluated. During the study period, nine patients underwent pericardial drainage with autotransfusion using a cell‐salvage instrument during electrophysiology procedures. The mean aspirated volume was 1,078 mL, with a mean autotransfused volume of 390 mL. For four patients, all with aspirated volumes of 1,100 mL or less, autotransfusion alone was sufficient to maintain hemodynamic stability and avoid allogeneic transfusion. One patient required surgical intervention because of ongoing pericardial bleeding. The ablation procedure was completed after aspiration in two patients. No procedural complications related to the use of the cell‐salvage system occurred.
Conclusion:
Autologous blood recovery during pericardiocentesis is safe, convenient, and feasible. With early use it may decrease or eliminate the need for allogeneic blood transfusion and, in selected cases, may permit completion of the ablation procedure. (J Cardiovasc Electrophysiol, Vol. 20, pp. 280‐283, March 2009)
Autonomic Elements within the Ligament of Marshall and Inferior Left Ganglionated Plexus Mediate Functions of the Atrial Neural Network
Authors: LIN JIAXIONG , SCHERLAG BENJAMIN J. , NIU GUODONG , LU ZHIBING , PATTERSON EUGENE , LIU SHAOWEN , LAZZARA RALPH , JACKMAN WARREN M. , PO SUNNY S. 
Published: October 2008

Ligament of Marshall and Atrial Neural Network. Objectives: We sought to systematically investigate the role of the ligament of Marshall (LOM) and inferior left ganglionated plexi (ILGP) in modulating electrophysiological functions.
Methods:

The following structures were exposed in 36 dogs: (1) LOM, (2) superior left GP (SLGP) near the junction of left superior pulmonary vein (LSPV) and left atrium, (3) ILGP near the left inferior pulmonary vein‐atrial junction, (4) anterior right GP (ARGP) near the sino‐atrial node, and (5) inferior right GP (IRGP) at the junction of inferior vena cava and atria. High frequency stimulation (HFS; 0.6‐8.0 V, 20 Hz, 0.1 msec in duration) was applied to the LOM, SLGP, ILGP, ARGP, IRGP, or vagosympathetic trunk. Ventricular rate (VR) during atrial fibrillation (AF) was compared before and after ablation of GP in different sequences.
Results:

ARGP + ILGP ablation but not ARGP ablation alone eliminated the VR slowing response induced by LOM stimulation, suggesting that all the autonomic innervation from the LOM to AV node passes the ILGP. LOM ablation attenuated the VR slowing response caused by SLGP or left vagosympathetic stimulation, suggesting that LOM modulates the autonomic innervation between the AV node and the left vagosympathetic trunk or SLGP. ARGP attenuated while ARGP + ILGP ablation eliminated the VR slowing response induced by left vagosympathetic stimulation, suggesting that both ARGP and ILGP modulate the AV nodal innervation of the extrinsic and intrinsic cardiac autonomic nervous system (ANS).
Conclusion:

The LOM and ILGP function as the “integration centers” that modulate the autonomic interactions between extrinsic and intrinsic cardiac ANS on AV nodal function.
(J Cardiovasc Electrophysiol, Vol. 20, pp. 318‐324, March 2009)
Pulmonary Vein Stenting for the Treatment of Acquired Severe Pulmonary Vein Stenosis after Pulmonary Vein Isolation: Clinical Implications after Long‐Term Follow‐Up of 4 Years
Authors: NEUMANN THOMAS , KUNISS MALTE , CONRADI GUIDO , SPERZEL JOHANNES , BERKOWITSCH ALEXANDER , ZALTSBERG SERGEY , WOJCIK MACIEJ , ERKAPIC DAMIR , DILL THORSTEN , HAMM CHRISTIAN W. , PITSCHNER HEINZ‐F. 
Published: October 2008

Pulmonary Vein Stenting. Introduction: Severe pulmonary vein stenosis (PVS) after catheter ablation of atrial fibrillation (AF) is a well‐recognized complication with a further reported incidence of 1.3%. The preferred therapy for symptomatic PVS is pulmonary vein (PV) angioplasty, but this treatment modality is followed by restenosis in 44–70%. Whether there is additional long‐term benefit from PVS stenting is uncertain. The aim of this study was the evaluation of the long‐term success after PV stenting of severe stenosis.
Methods and Results:
Ten patients (pts) with 13 PVS were prospectively evaluated. PV stenting was performed with Palmaz Genesis stents. Magnetic resonance imaging (MRI), lung perfusion scans, and CT‐scans were performed before, directly after, and every 12 months thereafter. Primary endpoint of the study was the occurrence of restenosis after PV stenting. After a median follow‐up of 47.7 (IQRs 25/75 47.2–48.5) months, the primary endpoint was achieved in 3 out of 13 PVs (23% of the treated PVs). We observed two in‐stent restenosis 2 and 4 years after PV stenting. These pts experienced onset of dyspnea some weeks before. After an additional balloon angioplasty, the in‐stent restenosis was resolved. In one asymptomatic patient, we observed an occlusion of the PV stent 13 months poststenting. Normalization of lung perfusion was noted 4 years after PV stenting versus directly poststenting in all pts without in‐stent restenosis (n = 7).
Conclusion:
PVS stenting with stent sizes ≥10 mm seems to be an adequate therapy modality for treatment of severe acquired PVS. Late in‐stent restenosis after PVS stenting can occur. The normalization of the initially disturbed lung perfusion scan is possible and remains stable, even 4 years after PVS stenting. (J Cardiovasc Electrophysiol, Vol. 20, pp. 251‐257, March 2009)
Basic mechanisms governing solute and fluid transport in hemodialysis
Authors: MISRA Madhukar 
Published: October 2008

AbstractHemodialysis (HD) is primarily a diffusion‐based transfer of small solutes. Diffusion is dependent on Fick's law. Convective removal, used mainly for removal of excess plasma water by ultrafiltration, also removes larger molecular‐weight solutes by the process of solvent drag. A number of physicochemical factors operative on the blood and the dialysate side impact solute and water removal during HD. A comprehensive yet brief discussion of these 2 basic processes operative in HD is presented in this article.
The role of dialyzer membrane flux in bio‐incompatibility
Authors: DAVENPORT Andrew 
Published: October 2008

AbstractDialyzer membrane flux is currently defined according to β2‐microglobulin (a middle molecule) clearance. Traditionally, high flux membranes were synthetic, and caused less inflammatory reaction in the extracorporeal circuit, compared with standard low‐flux cuprophan bio‐incompatible dialyzers. Initial reports suggested improved patient outcomes in acute renal failure when noncuprophan dialyzer membranes were used. However, over time these positive observations have not been substantiated. As the price differential between these dialyzer membrane types has become marginal, more high‐flux dialyzers are now used in routine clinical practice. Two multicenter trials have recently reported a survival advantage for high‐flux dialyzers. Whether this is directly consequent upon the choice of dialyzer membrane, or related to improvements in dialysate water quality, or changes in other clinical practices remains to be determined.
Type I (sporadic) porphyria cutanea tarda in a hemodialysis patient: A case report
Authors: TARWATER Kurt , MISRA Shamita , MISRA Madhukar 
Published: October 2008

AbstractA hemodialysis patient with hepatitis C virus infection developed painful blisters on her hands that burst spontaneously. She was found to have serum porphyrin levels >2000 nmol/L. A punch biopsy revealed subepidermal blistering with festooning of dermal papillae associated with a mixed inflammatory infiltrate. Based on the clinical, biochemical, and histologic findings, a diagnosis of porphyria cutanea tarda was made. Treatment was started with twice‐weekly phlebotomy and oral hydroxychloroquine and significant clinical improvement resulted.
Extreme hyperglycemia with ketoacidosis and hyperkalemia in a patient on chronic hemodialysis
Authors: GUPTA Arvin , ROHRSCHEIB Mark , TZAMALOUKAS Antonios H. 
Published: October 2008

AbstractA patient on hemodialysis for end‐stage renal disease secondary to diabetic nephropathy was admitted in a coma with Kussmaul breathing and hypertension (232/124 mmHg). She had extreme hyperglycemia (1884 mg/dL), acidosis (total CO2 4 mmol/L), hyperkalemia (7.2 mmol/L) with electrocardiographic abnormalities, and hypertonicity (330.7 mOsm/kg). Initial treatment with insulin drip resulted in a decrease in serum potassium to 5.3 mmol/L, but no significant change in mental status or other laboratory parameters. Hemodialysis of 1.75 hours resulted in rapid decline in serum glucose and tonicity and rapid improvement of the acidosis, but no change in mental status, which began to improve slowly after the hemodialysis was stopped, but with ongoing treatment with continuous insulin infusion. The rate of decline in tonicity during hemodialysis (14.5 mOsm/kg/h) was high, raising concerns about neurological complications. In this case, extreme hyperglycemia with ketoacidosis, hyperkalemia, and coma developing in a hemodialysis patient responded to insulin infusion. Monitoring of the clinical status and the pertinent laboratory values is required to assess the need for other therapeutic measures including volume and potassium replacement and emergency dialysis. The indications for and risks of emergency dialysis in this setting are not clearly defined.
Advanced Medical Simulation Applications for Emergency Medicine Microsystems Evaluation and Training
Authors: Kobayashi Leo , Overly Frank L. , Fairbanks Rollin J. , Patterson Mary , Kaji Amy H. , Bruno Eric C. , Kirchhoff Michael A. , Strother Christopher G. , Sucov Andrew , Wears Robert L. 
Published: October 2008

AbstractParticipants in the 2008 Academic Emergency Medicine Consensus Conference “The Science of Simulation in Healthcare: Defining and Developing Clinical Expertise” morning workshop session on developing systems expertise were tasked with evaluating best applications of simulation techniques and technologies to small‐scale systems in emergency medicine (EM). We collaborated to achieve several objectives: 1) describe relevant theories and terminology for discussion of health care systems and medical simulation, 2) review prior and ongoing efforts employing systems thinking and simulation programs in general medical sectors and acute care medicine, 3) develop a framework for discussion of systems thinking for EM, and 4) explore the rational application of advanced medical simulation methods to a defined framework of EM microsystems (EMMs) to promote a “quality‐by‐design” approach. This article details the materials compiled and questions raised during the consensus process, and the resulting simulation application framework, with proposed solutions as well as their limitations for EM systems education and improvement.
Toward a Definition of Teamwork in Emergency Medicine
Authors: Fernandez Rosemarie , Kozlowski Steve W. J. , Shapiro Marc J. , Salas Eduardo 
Published: October 2008

AbstractThe patient safety literature from the past decade emphasizes the importance of teamwork skills and human factors in preventing medical errors. Simulation has been used within aviation, the military, and now health care domains to effectively teach and assess teamwork skills. However, attempts to expand and generalize research and training principles have been limited due to a lack of a well‐defined, well‐researched taxonomy. As part of the 2008 Academic Emergency Medicine Consensus Conference on “The Science of Simulation in Healthcare,” a subset of the group expertise and group assessment breakout sections identified evidence‐based recommendations for an emergency medicine (EM) team taxonomy and performance model. This material was disseminated within the morning session and was discussed both during breakout sessions and via online messaging. Below we present a well‐defined, well‐described taxonomy that will help guide design, implementation, and assessment of simulation‐based team training programs.
Does Team Training Work? Principles for Health Care
Authors: Salas Eduardo , DiazGranados Deborah , Weaver Sallie J. , King Heidi 
Published: October 2008

AbstractTeamwork is integral to a working environment conducive to patient safety and care. Team training is one methodology designed to equip team members with the competencies necessary for optimizing teamwork. There is evidence of team training’s effectiveness in highly complex and dynamic work environments, such as aviation and health care. However, most quantitative evaluations of training do not offer any insight into the actual reasons why, how, and when team training is effective. To address this gap in understanding, and to provide guidance for members of the health care community interested in implementing team training programs, this article presents both quantitative results and a specific qualitative review and content analysis of team training implemented in health care. Based on this review, we offer eight evidence‐based principles for effective planning, implementation, and evaluation of team training programs specific to health care.
Advanced Waterborne Maintenance and Salvage Operations for the Royal Navy
Authors: BLAIR IAN , RICHARDS DAVID 
Published: October 2008

AbstractThe Salvage and Marine Operations Integrated Project Team (S&MO IPT) is the principal authority in the UK Ministry of Defence (MoD) charged with providing Salvage, Blue Water Towing, Specialist Moorings, and Heavy Lift Expertise to the UK Armed Forces. It has recently become the MoD center of expertise for In Water Maintenance & Repair (IWMAR). UMC International Plc is a commercial enterprise specializing in the development and execution of waterborne maintenance both on commercial and military vessels worldwide. UMC is part of the V. Holdings Group, the world's largest marine service provider, offering comprehensive through life support to a fleet of almost 1,000 vessels. A unique partnering of industry and the UK MoD has led to the expansion of waterborne and underwater maintenance, providing the Royal Navy (RN) with significant opportunities for cost reduction, increased periods between dockings and enhanced platform availability. This paper discusses the various technologies developed for both waterborne maintenance of the RN fleet and specific tasks undertaken by the S&MO IPT.
Carrier Team One: Making Decisions “Mindful that a Carrier Must Last 50 Years”
Authors: BLANTON GERALD B. 
Published: October 2008

AbstractFor more than 10 years, Carrier Team One has effectively coordinated cross‐organizational process reviews to improve the execution of carrier maintenance availabilities. As noted in the Team One charter, these improvement efforts are “mindful that a carrier must last 50 years.” In recognizing the challenges of a 50‐year service life, Team One has adopted principles intended to ensure that an as yet unborn chief engineer on USS George H.W. Bush (CVN 77) can maintain high levels of ship material readiness in 2050. This paper reviews the “50‐year” principles that influence Carrier Team One efforts, focusing on three such principles. This paper does not suggest that the submarine and surface communities do not observe similar principles; undoubtedly, they do. And admittedly, these principles are interrelated, but are reviewed separately to emphasize each principle's contribution to improving carrier availabilities. The three principles are:

Core values—how a 50‐year service life influences decision making.
Process focus—how a 50‐year service life influences long‐term improvement methodologies.
Technical focus—how a 50‐year service life influences technical improvement decisions.

In examining these principles, the paper will consider their long‐term contributions to carrier readiness and their influences on Team One's efforts to improve carrier maintenance.
Shipboard Maintenance: What Do Surface Warfare Officers Need to Know—and When Do They Need to Know It?
Authors: SYDOW KENNETH R. 
Published: October 2008

AbstractAs the Navy has moved into the 21st century and the War on Terror has unfolded, the challenges to ship maintenance management have never been greater. These challenges include: a continuing high operating tempo compounded by less predictable schedules and coupled with fewer, shorter scheduled opportunities to conduct maintenance; a fleet of fewer albeit more capable—and therefore more complex—ships; a trend toward smaller, perhaps less stable crews to operate and maintain the ships; and continuing competition for the available budget dollars between operations and maintenance, as well as between current and future readiness concerns. In an era of “operations focused maintenance,” what is the role of the Surface Warfare Officer (SWO) in managing their shipboard maintenance? What do they need to know, and when do they need to know it? This paper addresses these questions and related issues and offers, where applicable, some near‐term and long‐term recommendations for improvement.
Use of the Rotational Path Removable Partial Denture Concept in a Kennedy Class II Patient: A Case Report
Authors: DONOVAN TERRY 
Published: October 2008

ABSTRACTThis case report describes the treatment of a patient with Sjogren's syndrome who was missing all of the posterior teeth in the maxillary left arch. Implants were contraindicated for this patient because of a chronic sinus infection. Various removable prosthodontic options were considered, and the patient was ultimately treated very conservatively with a rotational path removable partial denture (RPD). This approach required no tooth preparation other than bonding a resin composite cingulum rest on the maxillary left canine. The use of the rotational path RPD eliminated any unsightly clasp assembly display and provided a satisfactory esthetic result.CLINICAL SIGNIFICANCEThe rotational path removable partial denture is an underutilized option for the esthetic replacement of missing teeth. It should be considered as an option in both tooth‐borne and Kennedy Class II situations.
Multiple Cuspal‐Coverage Direct Composite Restorations: Functional and Esthetic Guidelines
Authors: DELIPERI SIMONE , BARDWELL DAVID N. 
Published: October 2008

ABSTRACTMany factors contribute to the achievement of clinical success with direct posterior composite restorations: (1) analysis of the occlusion and opposing dentition, (2) complete excavation of dental caries, (3) analysis of residual tooth structure, (4) control of polymerization stresses by using appropriate layering and curing techniques, (5) occlusal force equilibration, and (6) patient compliance to maintain good oral health. The goal of this paper was to provide a clinical protocol for the direct restoration of severely damaged posterior teeth, analyzing the benefit and limits of a similar procedure.CLINICAL SIGNIFICANCEThis paper is intended to introduce specific esthetic and functional guidelines for the placement of cusp‐capping restorations using resin‐bonded composite.