bluuebunny/crossref_metadata_2025_split huggingface dataset:
CLINICAL MALIGNANCY RISK OF GIST ASSESSED BY ENDOSCOPIC ULTRASONOGRAPHY
Authors: Ohashi Shinji , Okamura Shozo , Urano Fumihiro , Maeda Matsuyoshi , Goto Hidemi , Niwa Yasumasa 
Published: September 2006

Background:  The aim of the present study was to analyze clinicopathological findings in primary gastrointestinal stromal cell tumors (GIST) and to determine the clinical factors that indicate higher risk potential.Methods:  Forty‐seven patients with primary GIST were enrolled, and their clinical, endosonographic ultrasonography (EUS), microscopic and immunohistochemical findings were evaluated. Risk categorization of GIST was made on histological tumor size and the mitotic rate.Results:  EUS features (a larger diameter, an irregular border, and cystic areas) were significantly correlated with higher risk and unfavorable prognosis. Pathological features (tumor size > 50 mm, > 10 mitoses per 50 high‐power fields (HPF), necrosis, and high‐risk category) were significant unfavorable prognostic factors. However, some high‐risk GIST less than 50 mm in diameter did not have any cystic areas, an irregular border on EUS images. Among GIST that measured 50 mm or less on EUS, tumors with rapid growth and a change of internal echo (more inhomogeneity) were higher risk, while tumors that did not grow and showed no change of a homogeneous internal echo were lower risk.Conclusions:  EUS parameters (a larger diameter, an irregular border, and cystic areas) indicate high‐risk potential. Tumor growth rate and change of internal echo pattern will be a helpful prognosticator, especially for asymptomatic and incidentally detected small GIST, where the classical EUS high‐risk parameters come up against limiting factors.
IDIOPATHIC BENIGN STRICTURES OF THE EXTRAHEPATIC BILE DUCT: RESULTS OF ENDOSCOPIC THERAPY
Authors: Sharma Barjesh Chander , Agarwal Naresh , Agarwal Anil , Sakhuja Puja , Sarin Shiv Kumar 
Published: September 2006

Background:  Idiopathic, benign, non‐traumatic, non‐inflammatory strictures of bile ducts are rare. We report cases with benign non‐traumatic, non‐inflammatory strictures of bile ducts diagnosed on histopathology of endoscopic tissue specimens and managed with endoscopic therapy.Methods:  Eight patients with benign non‐traumatic, non‐inflammatory strictures of bile ducts were studied. Diagnosis of benign stricture was based on imaging studies (ultrasound and CT scanning), normal CA 19–9 levels, negative brush cytology and histopathology, endoscopic retrograde cholangiopancreatography (ERCP) and no evidence of malignancy on follow up. Endoscopic balloon dilatation of stricture was performed and biliary stent was placed.Results:  Median age was 42 years and five patients were males. Clinical presentation included jaundice (5), abdominal pain (7), fever (2) and pruritus (6). Liver function tests and imaging studies revealed features of obstructive jaundice. ERCP revealed smooth concentric and tapering stricture in all patients. Brush cytology and histopathological specimen revealed cubocolumnar epithelium surrounded by fibrous tissue without inflammation and negative for malignant cells. All patients got relief of fever, jaundice, pain and pruritus after balloon dilatation and stenting. Symptoms completely resolved in a median of 24 days. Liver function tests normalized in a median of 36 days. Follow up ERCP after 6 months did not show evidence of stricture and stent could be removed successfully in all patients. Thereafter, for a median follow up of 19 months, patients remained asymptomatic and their liver function tests and ultrasound were normal.Conclusions:  Benign strictures of extrahepatic bile ducts can be non‐traumatic and non‐inflammatory without any cause and can be managed successfully with endoscopic balloon dilatation and biliary stenting.
CARDIOVASCULAR TOLERANCE IN UNSEDATED UPPER GASTROINTESTINAL ENDOSCOPY: PROSPECTIVE RANDOMIZED COMPARISON BETWEEN TRANSNASAL AND CONVENTIONAL ORAL PROCEDURES
Authors: Mori Akihiro , Fushimi Nobutoshi , Asano Takayuki , Maruyama Takako , Ohashi Noritsugu , Okumura Shoji , Inoue Hiroshi , Takekoshi Shodo , Friedman Scott L. , Okuno Masataka 
Published: September 2006

Background:  The utility of transnasal esophagogastroduodenoscopy (EGD) using ultrathin endoscopy has previously been described by analyzing subjective information and comparing it to conventional oral EGD. Limited information is available regarding the advantageous use of nasal EGD when assessed by reliable objective data.Methods:  A total of 927 patients undergoing unsedated EGD between June 2004 and May 2005 were enrolled. We used a partially randomized patient‐centered study design in order to exclude a bias of the patient’s preference. Patients were divided into four groups. Patients who preferred oral or nasal EGD underwent endoscopy according to their preference (preferred group). Patients without preference were randomly assigned to oral and nasal EGD (randomized group). Pulse, blood pressure (BP) and peripheral blood oxygen saturation (SpO2) were monitored during the procedure. Acceptability of EGD was also assessed by an acceptance score and the rate of willingness to repeat the same procedure.Results:  Oral and nasal EGD were performed in 325 and 387 patients, respectively, in the preferred group, and 81 and 77 cases, respectively, in the randomized group. Nasal EGD was incomplete in 57 patients. Increases in BP were significantly lower in nasal EGD than in oral endoscopy in both the randomized and preferred groups, whereas no significant difference was found in the increment of pulse between the groups. Changes in SpO2 were minimal in either procedure. Analyses of patient acceptability showed favorable evaluation of nasal EGD in both randomized and preferred groups.Conclusions:  Nasal EGD appears to be less stressful to the cardiovascular system. Patient’s acceptability also supports its usefulness unless difficulties in transnasal insertion are encountered.
EFFECTIVENESS OF CYTODIAGNOSIS WITH PANCREATIC DUCT LAVAGE FLUID FOR PANCREATIC DUCTAL CARCINOMA: NEW SAMPLING TECHNIQUE
Authors: Imamura Tsunao , Takeshita Rie , Koyama Rikako , Okuda Chikao , Takeuchi Kazuo , Matsuda Masamichi , Hashimoto Masashi , Watanabe Goro , Yoshida Hitoshi , Imawari Michio 
Published: September 2006

Background:  Pancreatic carcinoma is one of the most lethal cancers. Because pancreatic carcinoma is still very difficult to diagnose in its early stage, many of these patients will be considered unsuitable for surgery. If a cytological diagnosis is obtained at initial endoscopic retrograde cholangiopancreatography (ERCP), suitable treatment will be initiated without delay.Methods:  To increase the number of exfoliated cells from the pancreatic duct, we devised a new technique, pancreatic duct lavage fluid (PDLF), following bronchoalveolar lavage fluid. The present paper reports the effectiveness of cytological examination using PDLF in the diagnosis of pancreatic carcinoma. We examined 18 pancreatic carcinoma cases. After the endoscopic retrograde pancreatography (ERP), PDLF was collected from a double‐lumen catheter inserted into the main pancreatic duct. Saline injected from the lumen for the injection, and PDLF was aspirated from the other lumen for the guidewire at the same time. The cytological examination was performed using PDLF.Results:  Exfoliated cells were more frequently found in PDLF from all patients. In 15 cases (83%), cytological examination of PDLF revealed positive cytological results as the diagnosis of pancreatic carcinoma.Conclusion:  Cytological examination using PDLF has a high sensitivity for detection of pancreatic carcinoma. The new examination, PDLF, is simple, safe and effective, so we expect PDLF to become widely popular.
Effects of care pathways on stroke care practices at regional hospitals
Authors: Read S. J. , Levy J. 
Published: September 2006

AbstractBackground: Our previous work identified deficiencies in stroke care practices at regional hospitals in comparison to standards suggested by published stroke care guidelines. These deficiencies might be improved by the implementation of clinical pathways. The aim of this study was to assess changes in acute stroke care practices following the implementation of stroke care pathways at four regional Queensland hospitals.Methods: The medical records of two cohorts of 120 patients with a discharge diagnosis of stroke or transient ischaemic attack were retrospectively audited before and after implementation of stroke care pathways to identify differences in the use of acute interventions, investigations and secondary prevention strategies.Results: Following pathway implementation there were clinically important, but not statistically significant, increases in the rates of swallow assessment, allied health assessment (significant for occupational therapy, P = 0.04) and use of deep vein thrombosis prevention strategies (also significant, P = 0.006). Fewer patients were discharged on no anti‐thrombotic therapy (statistically significant in the subgroup of patients with atrial fibrillation, P = 0.02). Only 37% of the patients audited were actually enrolled on the pathway. Among this subgroup there were significant increases in the rates of swallow assessment (first 24 h, P = 0.01; any time during admission, P = 0.0001), allied health assessments (all P < 0.05), estimation of blood glucose level (P = 0.0015) and the use of deep vein thrombosis prevention strategies (P = 0.0003).Conclusion: Stroke care pathways appear to improve the process of care. Whether this influences outcomes such as mortality, functional and neurological recovery, the incidence of complications, length of stay or the cost of care was beyond the scope of this study and will require further examination.
Patients with acute myocardial infarction have an inaccurate understanding of their risk of a future cardiac event
Authors: Broadbent E. , Petrie K. J. , Ellis C. J. , Anderson J. , Gamble G. , Anderson D. , Benjamin W. 
Published: September 2006

AbstractBackground: Accurate perceptions of future cardiac risk are important to ensure informed treatment choices and lifestyle adaptation in patients following myocardial infarction (MI). The aim of this study was to investigate whether risk perceptions of patients with MI were accurate compared with an established clinical risk model.Methods: Seventy‐nine consecutive patients with acute MI admitted to the Coronary Care Unit, Auckland Hospital, completed a questionnaire assessing risk perceptions. Clinical data were used to calculate patients’ Thrombolysis In Myocardial Infarction (TIMI) risk scores, a validated predictive model of prognosis. The main outcome measures were the associations between perceived risk, TIMI risk scores and troponin T.Results: Patients’ risk perceptions showed no correlation with thrombolysis in myocardial infarction risk scores (r = −0.06; P = 0.61) or with troponin T (r = −0.07; P = 0.53). Patients’ risk perceptions were not significantly associated with age or sex, and were not significantly higher in those who had experienced a previous MI, a family history of coronary heart disease, diabetes or smokers. Higher perceived risk was significantly associated with a number of illness perceptions, including worse consequences of the MI and lower beliefs in the benefit of treatment. Patients who overestimated their risk were more anxious than other patients (F(2, 73) = 22.97; P = 0.0001).Conclusion: Patients with MI ideas about their personal risk of future MI are not congruent with their clinical risk assessments. Inpatient hospital care appears to be unsuccessful in communicating prognosis effectively to patients. Improving the accuracy of risk perceptions may help decrease unnecessary cardiac anxiety and invalidism in some patients and prompt risk‐reducing behaviours in others.
Tauopathies: classification and clinical update on neurodegenerative diseases associated with microtubule‐associated protein tau
Authors: Williams D. R. 
Published: September 2006

AbstractThe majority of neurodegenerative diseases are characterized by the deposition of insoluble protein in cells of the neuromuscular system. Advances in molecular neuropathology have allowed a classification system of neurodegenerative diseases based on this protein accumulation. Microtubule‐associated tau is one protein that has important functions in healthy neurons, but forms insoluble deposits in diseases now known collectively as tauopathies. Tauopathies encompass more than 20 clinicopathological entities, including Alzheimer’s disease, the most common tauopathy, progressive supranuclear palsy, Pick’s disease, corticobasal degeneration and post‐encephalitic parkinsonism. There are important clinical, pathological, biochemical and genetic similarities in the range of these diseases and they have helped to advance our understanding of the aetiological factors that initiate neurodegeneration and tau accumulation. This review examines the important clinical features of the most prevalent tauopathies and the molecular and pathological features that underpin the classification system.
Safety of iron polymaltose given as a total dose iron infusion
Authors: Newnham E. , Ahmad I. , Thornton A. , Gibson P. R. 
Published: September 2006

AbstractAn audit of the in‐hospital safety and tolerability of 401 infusions of iron polymaltose in 386 patients has shown no cases of anaphylaxis or other cardiorespiratory compromise. The infusion was terminated prematurely because of adverse events in six patients (1.6%). No adverse events occurred within the first 15 min of the infusion. Premedication (in 24%) was not associated with fewer adverse events. Fear of anaphylaxis should not inhibit the use of total dose iron infusion and the practices of premedication and of medical supervision during the first 15 min of the infusion should be abandoned.
Etanercept in severe active rheumatoid arthritis: first Australian experience
Authors: Perera L. C. , Tymms K. E. , Wilson B. J. , Shadbolt B. , Brook A. S. , Dorai Raj A. K. , Khoo K. B. K. 
Published: September 2006

AbstractBackground: Etanercept reduces disease activity in adults with chronic rheumatoid arthritis (RA) who are resistant to other therapies. Medicare Australia Pharmaceutical Benefit Scheme subsidized treatment (since August 2003) restricts etanercept availability to a most drug‐resistant RA population. The aim of the study was to assess the efficacy of etanercept in this unique group after 12 months of therapy.Methods: A prospective study of the first 50 consecutive private practice, adult RA patients whom were commenced on etanercept. The primary efficacy measures included short form 36 scores, Disease Activity Score 28, American College of Rheumatology (ACR) response improvement in per cent and the ACR individual core set components at baseline, 3 and 12 months. Analysis was by intention to treat.Results: There was significant improvement in all mean short form 36 component scores (P < 0.05) and all ACR core set component scores (P < 0.05) comparing 12 months to baseline. The disease activity score 28 also significantly fell from baseline at both 3 and 12 months (P < 0.05). The ACR 20% response significantly improved (P < 0.05) both at baseline to 3 months 92% (81.2, 96.9) and to 12 months 80% (67.0, 88.8). Serious adverse events occurred in 16%. At 12 months 88% completed treatment.Conclusion: Etanercept therapy will, by 3 and 12 months, significantly improve the short form 36, disease activity score 28, ACR 20% response and core set components. Our results are similar to international studies using etanercept in efficacy and tolerance despite our cohort being more resistant to preceding drug therapy. Etanercept offers this unique active severe refractory late RA Australian population a new therapeutic option to control their disease.
Strongyloides stercoralis: risks posed to immigrant patients in an Australian tertiary referral centre
Authors: Einsiedel L. , Spelman D. 
Published: September 2006

AbstractBackground: Strongyloides stercoralis is a nematode human parasite with a global prevalence that is able to maintain a prolonged infestation by means of its autoinfective life cycle. Immunosuppression may result in a life‐threatening hyperinfection syndrome. Recent changes in migration have resulted in the arrival of many immigrants from endemic areas. As to whether physicians are alert to the risks of strongyloidiasis in these patient groups is unclear. The aim of the study was to assess the risks posed by chronic strongyloidiasis in patients presenting to a tertiary referral centre and the need for screening of immigrant patients before immunosuppression.Methods: The study comprised a retrospective review of cases of strongyloidiasis presenting to the Alfred Hospital, Melbourne. Thirty‐three cases were diagnosed by either positive serology or faecal microscopy between January 1998 and January 2005. The medical records for 29 cases were examined with regard to demographics, clinical features and complications.Results: Two major groups were identified: immigrants (17) and returned travellers (11). Six immigrants, but no returned traveller, developed a hyperinfective syndrome. Five immigrants received immunosuppressive therapies before developing symptoms of hyperinfection and this was complicated by life‐threatening sepsis in two patients. Diagnosis was frequently delayed in the immigrant group who were significantly more likely to present with respiratory symptoms. Four immigrants and two returned travellers were treated with corticosteroids for symptoms that were probably related to larval migration.Conclusion: Before giving immunosuppressive therapies, patients with a history of potential exposure must be investigated for strongyloidiasis and consideration given to empirical treatment.
Continuing professional development for rural physicians: an oxymoron or just non‐existent?
Authors: McLean R. 
Published: September 2006

AbstractThere is geographic maldistribution of physicians across Australia and their professional isolation, particularly in relation to continuing professional development, is a definite problem. It tends to be worse in smaller centres where there is no critical mass that allows for peer support. Although some academic research has been carried out concerning the needs of rural GP, none has targetted rural specialists. Several activities, including the Commonwealth‐funded Support Scheme for Rural Specialists, have been well received and other initiatives, including the rural clinical schools and university departments of rural health, are beginning to provide an infrastructure that will help overcome the professional isolation through the use of innovative technologies such as interactive videoconferencing. This is being used to deliver RACP initiatives such as the basic physician trainee lecture series and the potential for vertical integration of training in rural settings which offer some promise to address the rural workforce shortage in the years to come.
‘Right’ way to ‘do’ illness? Thinking critically about positive thinking
Authors: McGrath C. , Jordens C. F. C. , Montgomery K. , Kerridge I. H. 
Published: September 2006

AbstractExhortations to ‘be positive’ accompany many situations in life, either as a general injunction or in difficult situations where people are facing pressure or adversity. It is particularly evident in health care, where positive thinking has become an aspect of the way people are expected to ‘do’ illness in developed society. Positive thinking is framed both as a moral injunction and as a central belief system. It is thought to help patients cope emotionally with illness and to provide a biological benefit. Yet, the meanings, expectations and outcomes of positive thinking are infrequently questioned and the risks of positive thinking are rarely examined. We outline some of the latter and suggest that health professionals should exercise caution in both ‘prescribing’ positive thinking and in responding to patients and carers whose belief systems and feelings of obligation rest on it.
Self‐Regulated Learning and New Literacies: an experience at the University of Barcelona
Authors: WILLEM CILIA , AIELLO MARTÍN , BARTOLOMÉ ANTONIO 
Published: September 2006

This article summarises the findings from an evaluation of a Media Literacy course at the University of Barcelona. It focuses on some aspects of Self‐Regulation and on the learning environment used by students. The students’ learning processes were embedded in an eLearning project, in which students analysed the representation of immigrants and ethnic minorities in the media.Key findings are the usefulness of this particular Technology‐Enhanced Learning Environment (TELE), and its specific settings regarding Self‐Regulated Learning (SRL). Students self‐regulated their learning processes, in that they were working in a blended learning environment. However, their acquired media literacy skills seem to be fostered by the TELE rather than by the self‐regulation mechanisms.Throughout the article, special attention is paid to the conceptual framework of digital and media literacy, and the specific competences related to them.
Self‐Regulated Learning and Open Writing
Authors: BAGGETUN RUNE , WASSON BARBARA 
Published: September 2006

In our study, we describe a situation where students take ownership of their learning and, on their own initiative, use digital tools actively in their learning activities. In our research we were interested in students who used weblogs and in the dynamic relationship between students and the weblogs they create. In particular, we were interested in how self‐regulated learning was facilitated both by the technology that enables the creation of the weblogs, and in the content, or open writings, that are posted on the weblog.The article begins with an introduction to weblogs. We then present the results of the analysis of the affordances of weblogs to facilitate self‐regulated learning. We used a category system developed by experts from the universities of Aalborg, Amsterdam and Bergen to structure our study of the weblogs which we received from Bergen students. One of our most interesting findings was that students’ reflection on both their own learning and access to other’s reflections on their learning was a powerful tool to collectively develop a conceptual understanding of a topic. We could call this collective self‐regulation.