bluuebunny/crossref_metadata_2025_split huggingface dataset:
The carbohydrate‐deficient transferrin test in hospital practice
Authors: BATEY R. G. , MADSEN G. 
Published: October 2005

AbstractWe report an experience in two hospital populations of the use of a commercially available kit for the detection of carbohydrate‐deficient transferrin (CDT). Patients from a drug and alcohol unit and a gastroenterology clinic at two hospitals were selected for the study. Sera were used from blood samples collected for routine biochemical assays. All patients had a specific alcohol history taken by one clinician and CDT results were correlated with reported alcohol intake by the patient and where relevant by their relatives. Sensitivity and specificity of the CDT assay were calculated using an alcohol intake of 60 g/day as the cut‐off point for detection of heavy drinking. The CDT assay had a specificity of 95%, a sensitivity of 80% and a 90% positive and 89% negative predictive value. The severity and type of liver disease had little influence on the CDT result and a high alcohol intake was the only predictor of a raised CDT concentration. The assay provided information not available from routine investigations in some patients and also proved useful in monitoring patients over periods of up to 4 years. The test has a role in the evaluation of patients in a hospital practice where routine histories of alcohol intake may lack sensitivity and where other diseases may cause routine liver tests to be unreliable.
Systematic reviews and their application to research in speech and language therapy: a response to T. R. Pring's ‘Ask a silly question: two decades of troublesome trials’ (2004)
Authors: Garrett Zoe , Thomas James 
Published: October 2005

AbstractBackground: The advent of evidence‐based healthcare has seen a rise in the use of systematic reviews to bring together the findings from research studies. The use of systematic reviews in speech and language therapy (SLT) was criticized in this journal in 2004 by T. R. Pring. It was claimed that their findings are misleading due to the potential inclusion of biased data, and uninformative due to a lack of detail in the reporting of interventions. It is argued that outcome research should be carried out in a series of phases in which small‐scale research precedes large‐scale research. This, it is argued, is most likely to demonstrate statistically significant effects and also help to ensure that therapies become sufficiently defined so that clinicians can apply them in practice.Aims: This paper argues that the above criticism of systematic reviews is based on a narrow conception of their capabilities: on the popular misapprehension that all systematic reviews answer effectiveness questions using only experimental studies and contain meta‐analyses. Different methods for systematic reviews are described and their application within clinical outcome research is discussed with reference to a phased structure for empirical enquiry.Main Contribution: Systematic reviews seek to identify and synthesize information within a given topic area. They are used to answer a wide range of research questions and the studies they include are not limited exclusively to experimental designs. Methods of synthesis can include both statistical approaches, such as meta‐analysis, and ‘qualitative’ approaches, such as meta‐ethnography and thematic analysis. Knowledge of the current state of research is essential for a sequentially phased approach within outcome research to operate. Since systematic reviews are summaries of research activity, they can provide this knowledge and should therefore be considered a valuable tool within outcome research.Conclusions: A systematic review using ‘qualitative’ and/or statistical methods for combining studies can be carried out within or across any of the phases within outcome research. Far from being uninformative, this can help bring together what is, and what is not, known and indicate the kinds of therapies that may be beneficial in the clinical setting and therapies which would benefit from further research and development.
Fifteen-year risk of major coronary events predicted by Holter ST-monitoring in asymptomatic middle-aged men
Authors: Stagmo Martin , Juul-Möller Steen , Israelsson Bo 
Published: October 2005

Background Ambulatory electrocardiogram monitoring (Holter) with ST-analysis as a measure of myocardial ichemia has in populations with coronary heart disease been shown to predict major coronary events: death, myocardial infarction or coronary revascularization. There has, however, been conflicting evidence regarding the usefulness of this technique in identification of healthy subjects with increased risk for coronary heart disease. The aim of this study was to assess if Holter monitoring with ST-analysis could be used to predict future major coronary events in asymptomatic middle-aged men with a defined aggregation of traditional risk factors for coronary heart disease. Methods One hundred and fifty-five asymptomatic participants from the city of Malmö, Sweden, with known levels of conventional cardiovascular risk factors underwent Holter monitoring for analysis of transient ST-segment depression at the age of 55 years. Fifteen years after the Holter monitoring, hospital records, diagnosis and death registries were revisited for major coronary events. Results An ST-segment depression of 1 mm or greater (0.1 mV) was considered significant for myocardial ischemia and was found in 54 of the 155 men. There were no significant differences in risk factors in the two groups at baseline. The 15-year incidence of a first major coronary event was significantly higher in men with ST-segment depression (39%) than in men without ST-segment depression (20%) ( P < 0.015). A Holter electrocardiogram could predict future major coronary events with a positive and negative predictive value of 35 and 80%, respectively. Conclusions Holter monitoring can be used as a complement to conventional risk factor evaluation in deciding whether or not to treat risk factors for CHD in asymptomatic subjects.
Recognizing and managing patients with irritable bowel syndrome
Authors: Croghan Anne , Heitkemper Margaret M. 
Published: October 2005

PurposeTo address the diagnosis and clinical management of irritable bowel syndrome (IBS) and provide a discussion of the available serotonergic agents.Data sourcesRecent studies examining the pathophysiology of IBS.ConclusionsDiagnostic testing may be required in the subset of patients with IBS who present with alarm symptoms, or “red flags,” suggestive of underlying organic disease. An important role has been suggested for the neurotransmitter serotonin in both gut motility and visceral pain sensitivity.Implications for practiceA diagnosis of IBS is largely based on symptoms; therefore, effective clinician–patient communication and careful attention to details of patient presentation, history, and physical examination are essential.
The use of personal digital assistants by nurse practitioner students and faculty
Authors: Stroud Sally D. , Erkel Elizabeth A. , Smith Carol A. 
Published: October 2005

PurposeTo describe the prevalence and patterns of use of personal digital assistants (PDAs) by nurse practitioner (NP) students and faculty, examine relationships between patterns of use of PDAs and demographic characteristics of NP students and faculty, and describe patterns of use of PDAs that support evidence‐based practice (clinical scholarship).Data sourcesResponses to a 20‐item questionnaire administered via electronic or postal mail from 227 NP students and faculty.ConclusionsA majority (67%) of the participants used PDAs. Use was higher among men (82%) than women (64%) (p < .05). On average, respondents who used a PDA (N = 153) had been using it just over a year (M = 13 months). Respondents reported using a PDA most days of the week (M = 5 days). The top three medical software programs identified by respondents as the most useful in clinical practice were ePocrates Rx (82%), Griffith's 5‐Minute Clinical Consult (26%), and MedCalc (22%). Most participants (96%) related that PDA use supported clinical decision making.Implications for practicePersonal digital assistants may facilitate the application of evidence‐based knowledge to practice. However, until there is evidence that PDA software is valid and reliable, clinicians should continue to use a multitude of references to assure the quality and safety of care provided.
Homocysteine and cardiovascular disease: A review of current recommendations for screening and treatment
Authors: Chamberlain KarenL. 
Published: October 2005

PurposeTo review the literature for, and provide advanced practice nurses (APNs) with, current recommendations for screening and treatment of hyperhomocysteinemia.Data sourcesMedscape literature search of selected research studies and related journal articles.ConclusionsWhile data from most epidemiologic studies support the argument that hyperhomocysteinemia is an independent risk factor for cardiovascular disease, the debate continues as to when screening and treating patients is appropriate. The consensus is that more randomized controlled trials are needed to further study the benefits of routine screening and the efficacy of treating hyperhomocysteinemia.Implications for practiceUntil the results of ongoing clinical trials are available, APNs should follow the American Heart Association guidelines for screening for elevated levels of homocysteine and continue to promote a well‐balanced diet that includes foods rich in folic acid as part of health promotion through primary prevention.
When cure is care: Diagnosis and management of pulmonary arterial hypertension
Authors: Widmar Brian 
Published: October 2005

PurposeThe purpose of this article is to provide nurse practitioners with an understanding of the pathophysiology of pulmonary arterial hypertension (PAH) disease, clinical manifestations, diagnostic evaluation, drug therapy, strategies for health promotion, and relevant care issues for patients and families.Data sourcesSelected clinical and research articles, as well as current government guidelines.ConclusionsSymptoms expressed are more apparent as PAH disease progresses, leaving fewer treatment options in advanced disease stages. New drugs are currently being tested for the treatment of PAH; however, the costs of many of the currently approved treatments may be prohibitive.Implications for practiceEarlier recognition of disease symptoms leads to prompt initiation of diagnostic evaluation and referral to specializing medical centers. Upon referral, specialty centers may begin appropriate treatment regimens earlier in the disease process, which could improve clinical outcomes and quality of life.
An examination of ethnic differences in cigarette smoking intention among female teenagers
Authors: Hanson Mary Jane S. 
Published: October 2005

PurposeTo describe and compare predictors of cigarette smoking intention, as defined by the theory of planned behavior, among African American, Puerto Rican, and non‐Hispanic white female teenagers.Data sourcesA convenience sample of 430 English‐speaking female teenagers (141 African American, 146 Puerto Rican, and 143 non‐Hispanic white teenagers), aged 13–19 years, who were patients at family planning clinics in eastern Pennsylvania. The data were obtained through a self‐administered questionnaire.ConclusionsRegression analyses demonstrated attitude, subjective norm, and perceived behavioral control predicted 70% of the variance in smoking intention in African American, 69% in Puerto Rican, and 88% in non‐Hispanic white teenagers. In addition, ethnic group differences were identified. For African Americans, smoking intention was mediated principally by perceived behavioral control, whereas for Puerto Rican and non‐Hispanic white teenagers, attitudes were the greatest predictor of intention to smoke. Moreover, non‐Hispanic white smokers had a stronger intention to smoke than either the African American or Puerto Rican smokers.Implications for practiceCigarette smoking is the leading preventable cause of death in the United States, with the majority of smokers initiating the habit in their teen years. Nurse practitioners are in key positions to counsel young women about the dangers of smoking. The identification of cultural‐specific predictors of smoking will assist in the development of tailored antismoking messages.
Histiocytosis and bone: experience from one major Sydney teaching hospital
Authors: Geevasinga N. , Jeremy R. , Crombie C. M. , Manolios N. 
Published: October 2005

Abstract Langerhans cell histiocytosis (LCH) has diverse presentations which can bring it before all physicians regardless of specialty. A retrospective audit was undertaken at Westmead Hospital, Sydney, Australia, to ascertain the incidence, epidemiology and clinical features of patients with LCH over a 10‐year period (1994–2004). A total of 12 patients was identified (six male, six female). Eleven patients had involvement of the skeletal system, three of the patients had pulmonary LCH and only one patient presented with soft tissue involvement (nose and antrum). Three patients had diabetes insipidus. Our results are consistent with that noted in the published literature and confirm the low incidence, diverse nature of presentation and the differing treatment strategies available for this rare and yet interesting condition. (Intern Med J 2005; 35: 622–625)
Linezolid‐induced dyserythropoiesis: chloramphenicol toxicity revisited
Authors: Dawson M. A. , Davis A. , Elliott P. , Cole‐Sinclair M. 
Published: October 2005

Abstract We report here two cases of dyserythropoietic anaemia associated with long‐term linezolid use that share striking similarities to chloramphenicol‐associated myelotoxicity. (Intern Med J 2005; 35: 626–628)
Triglycerides + high‐density‐lipoprotein‐cholesterol dyslipidaemia, a coronary risk factor in elderly women: the CArdiovascular STudy in the ELderly
Authors: Mazza A. , Tikhonoff V. , Schiavon L. , Casiglia E. 
Published: October 2005

Abstract Background:  The relationship between serum triglycerides (TG) level and the risk of coronary heart disease (CHD) mortality remains controversial.Aims:  To evaluate whether TG level is a risk factor for CHD in elderly people from general population, and to look for interactions between TG and other risk factors.Methods:  3257 subjects aged ≥ 65 years followed up for 12 years from the CArdiovascular STudy in the ELderly. Blood tests and anthropometric measurements were performed. Continuous items were divided into quintiles and, for each quintile, adjusted hazard ratio (HR) with 95% confidence interval (CI) for CHD mortality was derived by genders from Cox analysis.Results:  In women, the HR of being in the fifth rather than in the first quintile of TG was 2.45 (CI 1.48−3.51). In turn, high‐density‐lipoprotein cholesterol (HDL‐C) inversely predicted CHD mortality; the HR of being in the first rather than in the fifth quintiles of HDL‐C was 1.52 (CI 1.24−2.36). The risk of CHD mortality further increased up to 3.81 (CI 1.62−5.43) when high TG and low HDL‐C were combined. No predictive role for either TG or HDL‐C was detected in men.Conclusions:  TG and HDL‐C were independent predictors of CHD mortality in elderly women. The combination high TG + low HDL‐C quadrupled the risk of CHD mortality in this gender only. (Intern Med J 2005; 35: 604−610)
Fermented mushroom milk‐supplemented dietary fibre prevents the onset of obesity and hypertriglyceridaemia in Otsuka Long‐Evans Tokushima fatty rats
Authors: Jeon B. S. , Park J. W. , Kim B. K. , Kim H. K. , Jung T. S. , Hahm J. R. , Kim D. R. , Cho Y. S. , Cha J. Y. 
Published: October 2005

Aim:  Fermented milk product containing edible mushroom water extracts (mushroom yogurt; MY) has been reported to have glycaemic control and triglyceride‐lowering effects in streptozotocin (STZ)‐induced diabetic rats and Zucker diabetic fatty (ZDF) rats. Here, we investigated how MY‐supplemented dietary fibre (10 and 20%, v/w) influences the onset of obesity and hypertriglyceridaemia in Otsuka Long‐Evans Tokushima fatty (OLETF) rats.Methods:  The OLETF rats were fed a powdered chow diet supplemented with MY at the levels of 10 (v/w) and 20% for 6 weeks from 10 weeks of age, but the OLETF control rats were not supplemented. Their weight, fat distribution and lipid profile have been determined.Results:  The body weights in MY‐fed rats were reduced compared with the control rats. The perirenal fat was decreased in both MY groups, but the visceral and epididymal fats reduced only in the MY 20% group. The concentrations of serum triglyceride and non‐esterified fatty acid in MY‐fed rats were decreased in a dose‐dependent manner. However, the levels of other serum lipid profiles [total cholesterol, low‐density lipoprotein cholesterol, and high‐density lipoprotein cholesterol] were comparable among all rats.Conclusion:  Antiobesity and triglyceride lowering by MY‐supplemented dietary fibre in OLETF rats might have resulted from the synergistic effect of components in the fermented mushroom‐milk product.
X‐PERT: weight reduction with orlistat in obese subjects receiving a mildly or moderately reduced‐energy diet. Early response to treatment predicts weight maintenance
Authors: Toplak H. , Ziegler O. , Keller U. , Hamann A. , Godin C. , Wittert G. , Zanella M.‐T. , Zúñiga‐Guajardo S. , Van Gaal L. 
Published: October 2005

Aim:  To determine the effect of two different levels of energy deficit on weight loss in obese patients treated with orlistat.Methods:  Patients (n = 430) were randomized in a 1‐year, multicentre, open‐label, parallel group study conducted at 23 hospital centres and university medical departments worldwide. Obese outpatients (body mass index 30–43 kg/m2) aged 18–70 years with a body weight of ≥90 kg and a waist circumference of ≥88 cm (women) or ≥102 cm (men) were treated with orlistat 120 mg three times daily plus a diet that provided an energy deficit of either 500 or 1000 kcal/day for 1 year. Orlistat treatment was discontinued in patients who did not achieve ≥5% weight loss after assessment at 3 and 6 months. The primary outcome measure was change in body weight from baseline at week 52.Results:  Reported mean difference in energy intake between the two groups (500–1000 kcal/day deficit) at weeks 24 and 52 was actually 111 and 95 kcal/day respectively. Of the 430 patients involved in the study, 295 achieved ≥5% weight loss at both 3 and 6 months. In this population, at week 52, weight loss from baseline was similar for patients randomized to either the 500 or the 1000 kcal/day deficit diet (−11.4 kg vs. −11.8 kg, respectively; p = 0.778). After 12 months of treatment with orlistat, 84% (n = 118/141) and 85% (n = 131/154) of patients in the 500 and 1000 kcal/day deficit groups, respectively, achieved ≥5% weight loss, and 50% (n = 70/141) and 53% (n = 82/154) of patients, respectively, achieved ≥10% weight loss. Patients in both the diet treatment groups showed similar significant improvements in blood pressure, lipid levels and waist circumference at week 52.Conclusions:  Treatment with orlistat was associated with a clinically beneficial weight loss, irrespective of the prescribed dietary energy restriction (−500 or −1000 kcal/day). Patients who achieved ≥5% weight loss at 3 months achieved long‐term, clinically beneficial weight loss with orlistat plus either diet. Therefore, identifying patients who lose at least 5% weight after 3 months and who maintain this weight loss up to 6 months is a valuable treatment algorithm to select patients who will benefit most from orlistat treatment in combination with diet.
Occurrence of cirrhosis‐related complications is a time‐dependent prognostic predictor independent of baseline model for end‐stage liver disease score
Authors: Huo Teh‐Ia , Lin Han‐Chieh , Lee Fa‐Yauh , Hou Ming‐Chih , Lee Pui‐Ching , Wu Jaw‐Ching , Chang Full‐Young , Lee Shou‐Dong 
Published: October 2005

Abstract: Background: The model for end‐stage liver disease (MELD) is used to prioritize cirrhotic patients awaiting liver transplantation. Many cirrhosis‐related complications are indications for transplantation but are not included in MELD. This study investigated the impact of these complications on survival and association with MELD.Methods: The mortality risk of cirrhosis‐related complications, including bleeding esophageal varices, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome and hepatic decompensation, was analyzed using a time‐dependent Cox regression model in 227 cirrhotic patients.Results: A total of 281 episodes of complications occurred in 142 (63%) patients. Patients who died had a significantly higher baseline MELD score compared with those who survived (14.5±4.5 vs 12.8±3.9, P=0.004). There was no significant difference in the MELD score between patients with and without the occurrence of complications (13.6±4.3 vs 12.9±4.0, P=0.093). Patients with a higher baseline MELD score tended to develop early complications (ρ=−0.598, P< 0.001). Using the Cox regression model, the risk ratio of mortality was 4.9 (95% confidence interval: 3.9–6.3, P< 0.0001) for each additional episode of complication.Conclusions: The mortality risk increases as the number of complication episodes increases. While patients with repeated complications have a poor outcome, they do not necessarily have a higher baseline MELD score and could be down‐staged in the MELD era.
Healthcare Utilization of Nursing Home Residents: Comparison Between Decedents and Survivors
Authors: Bercovitz Anita , Gruber‐Baldini Ann L. , Burton Lynda C. , Hebel J. Richard 
Published: October 2005

Objectives: To determine whether residents who die while in the nursing home have higher healthcare utilization than survivors and whether the utilization in the periods before death varies with length of stay in the nursing home.Design: Descriptive, longitudinal study comparing medical service use of residents who died during the study period with that of residents who remained alive in the facility.Setting: Fifty‐nine nursing homes in Maryland. Data were collected between 1992 and 1995.Participants: A random sample of 1,195 residents.Measurements: Rates of hospitalization, emergency department visits, and medical visits in aggregate and in an initial 30‐day and subsequent 90‐day intervals after admission to the nursing home.Results: Residents who died during the 2‐year study period had significantly greater mean rates of utilization of all types of health care than residents who were not discharged from the nursing home, even when controlling for dementia diagnosis, age, functional status, and number of comorbid conditions. Those who died within a month of admission had significantly more emergency department and medical visits than those who died after a longer stay.Conclusion: The pattern of high healthcare utilization before death is consistent with studies of the overall Medicare population that show an increase in Medicare expenditures in the period before death.