bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of the Use of Central Venous Access Devices Within and Outside of the Intensive Care Unit: Results of a Survey Among Hospitals in the Prevention Epicenter Program of the Centers for Disease Control and Prevention
Authors: Climo Michael , Diekema Dan , Warren David K. , Herwaldt Loreen A. , Perl Trish M. , Peterson Lance , Plaskett Theresa , Price Connie , Sepkowitz Kent , Solomon Steve , Tokars Jerry , Fraser Victoria J. , Wong Edward 
Published: March 2006

AbstractObjective:To determine the prevalence of central venous catheter (CVC) use among patients both within and outside the ICU setting.Design:A 1-day prevalence survey of CVC use among adult inpatients at six medical centers participating in the Prevention Epicenter Program of the CDC. Using a standardized form, observers at each Epicenter performed a hospital-wide survey, collecting data on CVC use.Setting:Inpatient wards and ICUs of six large urban teaching hospitals.Results:At the six medical centers, 2,459 patients were surveyed; 29% had CVCs. Among the hospitals, from 43% to 80% (mean, 59.3%) of ICU patients and from 7% to 39% (mean, 23.7%) of non-ICU patients had CVCs. Despite the lower rate of CVC use on non-ICU wards, the actual number of CVCs outside the ICUs exceeded that of the ICUs. Most catheters were inserted in the subclavian (55%) or jugular (22%) site, with femoral (6%) and peripheral (15%) sites less commonly used. The jugular (33.0% vs 16.6%; P < .001) and femoral (13.8% vs 2.7%; P < .001) sites were more frequently used in ICU patients, whereas peripherally inserted (19.9% vs 5.9%; P < .001) and subclavian (60.7% vs 47.3%; P < .001) catheters were more commonly used in non-ICU patients.Conclusions:Current surveillance and infection control efforts to reduce morbidity and mortality associated with bloodstream infections concentrate on the high-risk ICU patients with CVCs. Our survey demonstrated that two-thirds of identified CVCs were not in ICU patients and suggests that more efforts should be directed to patients with CVCs who are outside the ICU.
Administrative Databases Provide Inaccurate Data for Surveillance of Long-Term Central Venous Catheter-Associated Infections
Authors: Wright Sharon B. , Huskins W. Charles , Dokholyan Rachel S. , Goldmann Donald A. , Platt Richard 
Published: March 2006

AbstractBackground:Efficient methods are needed to monitor infections associated with long-term central venous catheters (CVCs) in both inpatient and outpatient settings. Automated medical records and claims data have been used for surveillance of these infections without evaluation of their accuracy or validity.Objective:To determine the feasibility of using electronic records to identify CVC placement and design a system for identifying CVC-associated infections.Design and Setting:Retrospective cohort study at an HMO and two teaching hospitals in Boston, one adult (hospital A) and one pediatric (hospital B), between January 1991 and December 1997. Tunneled catheters, totally implanted catheters, and hemodialysis catheters were examined. Claims databases of both the HMO and the hospitals were searched for 10 CPT codes, 2 ICD-9 codes, and internal charge codes indicating CVC insertion. Lists were compared with each other and with medical records for correlation and accuracy.Patients:All members of the HMO who had a CVC inserted at one of the two hospitals during the study period.Results:There was wide variation in the CVC insertions identified in each database. Although ICD-9 codes at each hospital and CPT/ICD-9 combinations at the HMO found similar total numbers of CVCs, there was little overlap between the individuals identified (62% for hospital A with HMO and 4% for hospital B).Conclusion:Claims data from different sources do not identify the same CVC insertion procedures. Current administrative databases are not ready to be used for electronic surveillance of CVC-associated complications without extensive modification and validation.
Electronic Interpretation of Chest Radiograph Reports to Detect Central Venous Catheters
Authors: Trick William E. , Chapman Wendy W. , Wisniewski Mary F. , Peterson Brian J. , Solomon Steven L. , Weinstein Robert A. 
Published: March 2006

AbstractObjective:To evaluate whether a natural language processing system, SymText, was comparable to human interpretation of chest radiograph reports for identifying the mention of a central venous catheter (CVC), and whether use of SymText could detect patients who had a CVC.Design:To identify patients who had a CVC, we performed two surveys of hospitalized patients. Then, we obtained available reports from 104 patients who had a CVC during one of two cross-sectional surveys (ie, case-patients) and 104 randomly selected patients who did not have a CVC (ie, control-patients).Setting:A 600-bed public teaching hospital.Results:Chest radiograph reports were available from 124 of the 208 participants. Compared with human interpretation, SymText had a sensitivity of 95.8% and a specificity of 98.7%. The use of SymText to identify case- and control-patients resulted in a sensitivity of 43% and a specificity of 98%. Successful application of SymText varied significantly by venous insertion site (eg, a sensitivity of 78% for subclavian and a sensitivity of 3.7% for femoral). Twenty-six percent of the case-patients had a femoral CVC.Conclusions:Compared with human interpretation, SymText performed well in interpreting whether a report mentioned a CVC. In patient populations with less frequent CVC placement in femoral veins, the sensitivity for CVC detection likely would be higher. Applying a natural language processing system to chest radiograph reports may be a useful adjunct to other data sources to automate detection of patients who had a CVC.
Helicobacter pylori and Infantile Hypertrophic Pyloric Stenosis
Authors: Dahshan Ahmed , Donovan Kevin G. , Halabi Issam M. , Ranne Richard , Li Mary , Illig William P. 
Published: March 2006

ABSTRACTBackground:Recently, it has been suggested that Helicobacter pylori might be a cause of some cases of infantile hypertrophic pyloric stenosis (IHPS) in infancy on the basis of its epidemiologic and clinical features. We performed this study to evaluate the possible relationship between IHPS and H. pylori.Design:In consecutive infants with IHPS, we performed upper gastrointestinal endoscopy with biopsy before pyloromyotomy. The endoscopic appearance of the pylorus was noted to validate endoscopic features of IHPS.Results:Sixteen infants, 15 male, 14 white, mean age 42 days, range 21 to 104 days, were studied. The index case had chronic active gastritis on biopsy with organisms suspicious for H. pylori. Four others had chronic active gastritis, six more had focal or mild chronic gastritis, five were normal, and none had H. pylori on histology or immune histochemical staining in selected cases. All patients had negative rapid urease test. Most common endoscopic findings of IHPS were thickened prominent asymmetric pyloric folds and pin‐hole pylorus that could not be intubated by the pediatric endoscope.Conclusion:H. pylori was not specifically identified in our patients with IHPS. The presence of H. pylori‐like organisms in the gastric mucosa in our index case and finding of chronic active gastritis in several others may indicate the possibility of an acquired infectious etiology for IHPS.
Decreased Peroxisome Proliferator Activated Receptor α Is Associated with Bile Duct Injury in Cystic Fibrosis Transmembrane Conductance Regulator−/− Mice
Authors: Pall Harpreet , Zaman Munir M. , Andersson Charlotte , Freedman Steven D. 
Published: March 2006

ABSTRACTBackground:Primary sclerosing cholangitis (PSC) is associated with mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. As proof of concept that CFTR dysfunction plays a role in PSC, induction of colitis in cftr−/− mice results in bile duct injury that can be prevented by pretreatment with docosahexaenoic acid (DHA).Objectives:Determine whether 1) CFTR dysfunction in cftr−/− mice through a reduction in peroxisome proliferator activated receptor (PPAR)α or γ leads to bile duct injury and 2) whether DHA prevents bile duct injury through an increase in PPAR.Methods:Cftr−/− and wild‐type (WT) mice were treated with dextran sodium sulfate (DSS) to induce colitis with or without pretreatment with oral DHA. PPARα and γ as well as tumor necrosis factor (TNF)α were analyzed in liver tissue. PPARα−/− mice were also treated with DSS and histology examined.Results:PPARγ mRNA levels were low, with DSS suppressing mRNA levels equally in WT and cftr−/− mice. PPARα levels were no different between cftr−/− and WT litter mates by reverse‐transcription polymerase chain reaction. After DSS, WT mice showed a 9.3‐fold increase in PPARα mRNA levels and increased nuclear localization compared with no DSS (P < 0.05), with no increase seen in cftr−/− mice. This was not caused by changes in TNFα. DHA treatment led to 7.0‐fold increase in PPARα mRNA levels in cftr−/− mice (P < 0.01). PPARα−/− mice treated with DSS did not develop bile duct injury, indicating that PPARα alone is not sufficient to cause bile duct inflammation.Conclusion:DSS induced bile duct injury in cftr−/− mice is associated with a defect in PPARα expression, which is reversed by DHA.
Functional Gastrointestinal Disorders in African American Children in Primary Care
Authors: Uc Aliye , Hyman Paul E. , Walker Lynn S. 
Published: March 2006

ABSTRACTObjective:To determine the prevalence of functional gastrointestinal disorders (FGIDs) in a primary care setting and to assess the usefulness of pediatric Rome criteria.Methods:The Questionnaire on Pediatric Gastrointestinal Symptoms (QPGS) assessing the pediatric Rome criteria was administered to 243 school‐age children visiting a general pediatric clinic for annual school physicals. Pearson χ2 statistics were used to determine the association of various demographic factors with FGIDs.Results:All children were African American, 47.7% were girls, and the mean ± standard deviation age of the group was 10.7 ± 3.9 years. QPGS detected 52 children (21.4%) with FGID. Diagnoses included aerophagia (6), abdominal migraine (1), cyclic vomiting syndrome (2), functional dyspepsia (2), functional abdominal pain syndrome (1), functional constipation (39) and functional fecal retention (1). Thorough clinical evaluation identified 47 (19.3%) children with FGIDs. Five of the children (2.1%) identified as having FGID on QPGS were felt not to have FGID by the examining physician. Children with FGIDs were not different from healthy children in age, insurance, parent's education, employment or number of children in the family. FGIDs were more common in girls (29/47 girls, P = 0.028). Children with FGIDs tended to live in single‐parent households and miss school more often than children without FGIDs (P = 0.08).Conclusions:Functional gastrointestinal disorders are common among African American children and adolescents in a primary care setting and predominantly affect girls. Symptom‐based criteria are useful in the diagnosis of pediatric FGIDs.
The Stereospecific Triacylglycerol Structures and Fatty Acid Profiles of Human Milk and Infant Formulas
Authors: Straarup Ellen Marie , Lauritzen Lotte , Faerk Jan , Høy (Deceased) Carl‐Erik , Michaelsen Kim F. 
Published: March 2006

ABSTRACTBackground:The stereospecific structures of the triacylglycerol molecules in human milk differ from that of cow's milk and vegetable oils, which are the fat sources used in infant formula. In human milk, palmitic acid (16:0) is predominantly esterified in the sn2 position, whereas vegetable oils or cow's milk fat contain most of their 16:0 in the outer positions of the triacylglycerol molecules. Furthermore, human milk contains long‐chain polyunsaturated fatty acids, which are not present in either cow's milk or vegetable oils.Methods:By standard lipid analysis procedures, we examined the triacylglycerol structures and fatty acid profiles of fats from 28 infant formulas or formulas for special indications available in the Danish market from 1999 to 2003.Results:The total fatty acid compositions of the formulas showed a 16:0 content almost similar to human milk, whereas the content in the sn2 position was considerably lower. The content of oleic acid was found to be equal to or higher than in human milk in 21 of 28 formulas, whereas the content in the sn2 position was higher in all but one formula. Most formulas had linoleic acid levels considerably above that of human milk. Long‐chain polyunsaturated fatty acids (arachidonic acid and docosahexaenoic acid) were present in all preterm formulas, but only in 3 of the term formulas.Conclusion:We found that most of the examined infant formulas, both preterm and term as well as special formulas, had stereospecific structures and fatty acid profiles that differed considerably from that of human milk.
Usefulness of an Assessment Score to Predict Early Stopping of Exclusive Breast‐feeding
Authors: Giannì M. L. , Vegni C. , Ferraris G. , Mosca F. 
Published: March 2006

ABSTRACTExclusive breast‐feeding is recommended during the first 6 months of life. Use of simple indicators to predict early stopping of exclusive breast‐feeding may be desirable in clinical practice. A breast‐feeding assessment evaluated at discharge and including maternal age, previous breast‐feeding experience, latching difficulty, and breast‐feeding interval could be useful.
Trade Liberalization in Agriculture in Developed Nations and Incidence of Child Labour in a Developing Economy
Authors: Chaudhuri Sarbajit , Dwibedi Jayanta Kumar 
Published: March 2006

AbstractThis paper is an attempt to analyse the consequence of trade liberalization in agriculture in the developed countries on the incidence of child labour in a developing economy in terms of a three‐sector general equilibrium model with informal sectors. Adult labour and child labour are substitutes for each other in the two informal sectors of the economy and are used together apart from capital in producing two exportable commodities. The interesting result that appears from the analysis is that agricultural trade liberalization in the developed countries may be effective in bringing down the incidence of child labour in the system. The paper substantiates the desirability of trade liberalization in agriculture in the developed nations from the perspective of the developing economies for reasons other than welfare improvement.
Money Demand in an EU Accession Country: A VECM Study of Croatia
Authors: Cziráky Dario , Gillman Max 
Published: March 2006

AbstractThe paper estimates the money demand in Croatia using monthly data from 1994 to 2002. A failure of the Fisher equation is found, and adjustment to the standard money‐demand function is made to include the inflation rate as well as the nominal interest rate. In a two‐equation cointegrated system, a stable money demand shows rapid convergence back to equilibrium after shocks. This function performs better than an alternative using the exchange rate instead of the inflation rate as in the ‘pass‐through’ literature on exchange rates. The results provide a basis for inflation rate forecasting and suggest the ability to use inflation targeting goals in transition countries during the EU accession process. Finding a stable money demand also limits the scope for central bank ‘inflation bias’.
Monitor‐induced tachycardia in a patient with a rate‐responsive pacemaker
Authors: Houtman S. , Rinia M. , Kalkman C. 
Published: March 2006

SummaryA patient with a ventricle‐paced, ventricle‐sensed and inhibited, respiratory rate‐responsive pacemaker presented for orthopaedic surgery. She had been operated upon recently without any adverse effects. In the recovery unit her electrocardiograph showed a paced ventricular tachycardia of about 140 beats.min−1 without any other adverse sign or symptom. Although this tachycardia initially decreased to 70 beats.min−1 after about 30 min, it later rose again to 140 beats.min−1. A pacemaker technician was consulted, who suggested that there may be interference between the bioelectric impedance signals of the patient monitoring system that was being used to measure respiratory rate and the pacemaker's own measurement systems.
Involving users in the design of a system for sharing lessons from adverse incidents in anaesthesia
Authors: Sharma S. , Smith A. F. , Rooksby J. , Gerry B. 
Published: March 2006

SummaryIn this qualitative study using observation and interviews, 10 anaesthetists from five Departments of Anaesthesia in the North‐West region of England were enlisted to participate in the design of an online system to allow the sharing of critical incidents. Respondents perceived that existing schemes had differing and sometimes conflicting aims. Reporting was used for reasons other than simply logging incidents in the interests of promoting patient safety. No existing scheme allowed the lessons learned from incidents to be shared between members of the professional group from which they arose. Using participants' suggestions, we designed a simple, secure, anonymous system favouring free‐text description, intended to enable the on‐line sharing and discussion of selected incidents. Seven incidents were posted during the 6‐month pilot period. The practitioners in our study valued the opportunity to share and discuss educational incidents ‘horizontally’ within their community of practice. We suggest that large‐scale reporting systems either incorporate such a function or allow other systems that permit such sharing to co‐exist.
Orthogonal search‐based rule extraction for modelling the decision to transfuse
Authors: Etchells T. A. , Harrison M. J. 
Published: March 2006

SummaryData from an audit relating to transfusion decisions during intermediate or major surgery were analysed to determine the strengths of certain factors in the decision making process. The analysis, using orthogonal search‐based rule extraction (OSRE) from a trained neural network, demonstrated that the risk of tissue hypoxia (ROTH) assessed using a 100‐mm visual analogue scale, the haemoglobin value (Hb) and the presence or absence of on‐going haemorrhage (OGH) were able to reproduce the transfusion decisions with a joint specificity of 0.96 and sensitivity of 0.93 and a positive predictive value of 0.9. The rules indicating transfusion were: 1. ROTH > 32 mm and Hb < 94 g.l−1; 2. ROTH > 13 mm and Hb < 87 g.l−1; 3. ROTH > 38 mm, Hb < 102 g.l−1 and OGH; 4. Hb < 78 g.l−1.
Haemodynamic and catecholamine stress responses to the Laryngeal Tube‐Suction Airway and the Proseal Laryngeal Mask Airway
Authors: Dahaba A. A. , Prax N. , Gaube W. , Gries M. , Rehak P. H. , Metzler H. 
Published: March 2006

SummarySupraglottic airway devices such as the ProSeal Laryngeal Mask AirwayTM (PLMA) and Laryngeal Tube‐SuctionTM Airway (LTS) that provoke the least stress responses could be beneficial in many situations, especially in patients with cardiovascular disease. We compared the haemodynamic and catecholamine stress response of the LTS and PLMA in a randomised study of 36 patients. Mean arterial pressure, heart rate, epinephrine and norepinephrine levels were all reduced following induction of anaesthesia with no significant differences between the two groups. Following insertion of LTS, mean arterial pressure, heart rate, epinephrine and norepinephrine levels increased to pre‐induction levels. However, following the insertion of the PLMA, mean arterial pressure, heart rate, epinephrine and norepinephrine levels remained significantly lower than pre‐induction values. Mean arterial pressure, heart rate and epinephrine were significantly greater in the LTS group than in the PLMA group. We conclude that the LTS produces a greater and more sustained haemodynamic and catecholamine stress response than does the PLMA.
The changing practice of thoracic epidural analgesia in the United Kingdom: 1997–2004
Authors: Pennefather S. H. , Gilby S. , Danecki A. , Russell G. N. 
Published: March 2006

SummaryThe clinical governance framework and medico‐legal climate in the United Kingdom has changed significantly in the past 7 years. We used a postal questionnaire to survey thoracic epidural practice in the United Kingdom in 1997 and repeated this survey in 2004. The response rate to both surveys was 59–60%. There has been considerable change in respect of taking specific consent for thoracic epidural analgesia (24% in 1997, 74% in 2004), awake epidural cannulation (40% in 1997, 84% in 2004), availability of an acute pain service (47% in 1997, 95% in 2004) and HDU‐only nursing of patients (63% in 1997, 30% in 2004). Of the 2004 respondents, < 1% used the newer, less toxic local anaesthetics, 49% would consider inserting a thoracic epidural in patients receiving clopidogrel, and 34% would consider inserting a thoracic epidural in patients receiving both aspirin and clopidogrel. A central register of thoracic epidural complications would assist in further developing practice.
Keeping close: mothering with serious mental illness
Authors: Montgomery Phyllis , Tompkins Catherine , Forchuk Cheryl , French Susan 
Published: March 2006

Aim.  The aim of this paper is to describe the experiences of mothers with serious mental illness from their perspectives and how they attempted to manage their mothering circumstances.Background.  The desire to mother in women with serious mental illness is increasingly acknowledged by healthcare professionals. For these women, mothering is often framed as a pathological problem needing professional intervention. Yet little is known about mothering and illness from the perspectives of the mothers themselves.Method.  Using Glaser's grounded theory approach and both purposive and theoretical sampling, interviews were conducted with 20 mothers who were receiving treatment for mental health problems. The data were collected in 2002.Findings.  We found the core category of Keeping close described mothers’ efforts to have meaningful relationships with their children in the context of illness and suffering. To this end, mothers chose strategies that would hide illness for the sake of protecting their roles and their children. These strategies – masking, censoring speech, doing motherwork and seeking help – served to imitate ideal perceptions of mothering while making illness invisible to their children. Mothering in illness, however, became a vortex of contradictions, resulting in mothers ‘hitting bottom’, a point in time when they realized they could not keep close via pretences. To return to the valued place of mother, they sought treatment, hoping to learn how to be with their children authentically.Conclusion.  To assist mothers with serious mental illness, healthcare professionals must be sensitive to the social and cultural context in which they mother in order to create healthier possibilities for nurturing their children.