bluuebunny/crossref_metadata_2025_split huggingface dataset:
The value of inpatient pharmaceutical counselling to elderly patients prior to discharge
Authors: Al‐Rashed S. A. , Wright D. J. , Roebuck N. , Sunter W. , Chrystyn H. 
Published: March 2003

Aims  The use of medication and information discharge summaries (MIDS) has become a standard procedure in many hospitals. We have evaluated if these summaries, together with in‐patient pharmaceutical counselling backed up with a simple medicine reminder card, may help with the delivery of seamless pharmaceutical care.Methods  Elderly patients prescribed more than four items discharged to their own home received the standard discharge policy including a recently introduced MIDS and medicine reminder card. Each patient's GP was sent a copy on discharge. Pre‐discharge a pharmacist counselled study patients about their medicines and compliance. A research pharmacist visited patients in their home approximately 2–3 weeks and at 3 months post‐discharge to determine their drug knowledge, compliance, home medicine stocks and any healthcare related events.Results  Forty‐three study and 40 control patients completed both visits. Their mean (s.d.) ages were 80.2 (5,7) and 81.1 (5,8) years and they were prescribed 7.1 (1.8) and 7.1 (2.3) items, respectively. At visit 1 knowledge (P < 0.01) and compliance (P < 0.001) was better in the study group. At visit 2 compliance had improved in the study group (P < 0.001). Unplanned visits to the GP and readmission to hospital amongst the study group were 19 and 5, respectively, which were both significantly less (P < 0.05) than 27 and 13 in the control group. At visit 2 for the study group the 24 unplanned GP visits and three re‐admissions were significantly (P < 0.05) less than the respective 32 and 15 in the control group. At visit 1, two study group patients had altered their own medication compared with 10 control patients. At visit 2 these reduced to 0 and 4, respectively.Conclusions  In‐patient pharmaceutical counselling, linked to a medication and information discharge summary and a medicine reminder card, contributed to better drug knowledge and compliance together with reduced unplanned visits to the doctor and re‐admissions. A pharmaceutical domiciliary visit consolidated the improved healthcare outcomes.
Interaction between sotalol and albuterol after CABG: influence on postoperative arrhythmias and length of stay at an intensive care unit
Authors: Vader C. , Grouls R. , Van Gerven A. , Ackerman E. , Korsten H. , Schönberger J. , Ter Woorst F. , Botman C. , Leufkens H. 
Published: March 2003

Atrial fibrillation (AF) represents the most common arrhythmic complication of coronary artery bypass grafting (CABG). Incidence rates vary between 17% and 33% [1]. Peak incidence occurs 2 to 3 days postoperatively [2]. Postoperative AF has been associated with increases in total length of stay (LOS), costs, morbidity and mortality.The objective was to investigate if the pharmacodynamic interaction between albuterol and sotalol is associated with an increase in the incidence of AF and LOS in CABG‐patients at an Intensive Care Unit (ICU).The study was a retrospective nested, matched case‐control study carried out in the ICU of the Catharina Hospital, Eindhoven, The Netherlands, in the period 1998–2000.The subjects were patients hospitalised at an ICU after CABG, treated with sotalol with or without albuterol or albuterol/ipratropium bromide. Patients were matched by date of CABG, pre‐operative pulmonary function (Tiffeneau‐index >0.7) and pre‐operative CRASH score, a hospital score used as a prognostic value for post‐operative morbidity and mortality.The results were analyzed using the Intensive Care Information System (ICIS; INAD Computers & Software BV, Eindhoven) and the Cardio Reporting System of the Catharina Hospital, Eindhoven.Demographic characteristics of cases and controls (no statistically significant differences between both groups) are presented in Table 1.

Sotalol/albuterol

(n=217)
Sotalol  (n=350)

Age (years, mean±s.d.)
64.8 ± 9.7
62.9 ± 9.4

Sex (Male)
167 (77.0%)
258 (73.7%)

Aortaocclusion  (min, mean±s.d.)
46.8 ± 29.1
40.1 ± 23.8

Extra corporal circulation  (min, mean±s.d.)
66.1 ± 38.5
56.9 ± 32.4

CRASH score (median %  mortality, range)
5 (0–19)
4 (0–20)

The concurrent use of sotalol and albuterol led to an increased risk for postoperative atrial fibrillation (OR 6.2; 95% confidence interval: 2.3, 17.7). The Mantel‐Haenszel odds ratio, corrected for age, was 1.67 (Table 2). LOS was significantly increased.

AF  present
AF  absent
LOS ICU  (days (median), range)

Sotalol/albuterol
18
199
1 (0–47)

Sotalol
5
345
1 (0–5)

The concurrent use of sotalol and albuterol leads to an increased risk for postoperative AF and is associated with an increased LOS at the ICU of our hospital.
Basal cell carcinoma: are early appointments justifiable?
Authors: Gordon P.M. , Cox N.H. , Paterson W.D. , Lawrence C.M. 
Published: March 2003

Abstract
In the U.K., patients with suspected skin tumours are usually referred from a general practitioner to a hospital-based dermatologist for treatment. The urgency of such referrals is currently a topic of political importance. We have studied case record data from 162 patients with basal cell carcinoma (BCC) to establish the relevance of referrals routinely being considered urgent. At presentation, mean tumour size (maximum dimension) was 7·4 mm (median 10) and mean duration of BCC was 20·5 months (median 12). There was no correlation (all P &gt; 0·05) between tumour size and patient age (r = 0·1325), tumour size and duration (r = 0·4433), or tumour size and interval between referral and hospital consultation (r = 0·0695). If the slow growth rate of the average BCC is assumed to be linear, a reduction in referral interval from the mean value of 10·7 weeks in our patients down to the U.K. government target of 2 weeks would equate to a size difference in BCC of 0·7 mm, which is not therapeutically significant. Individual BCCs with rapid growth or other features of concern may require urgent referral, but evidence from our patients and from other studies is that this is not routinely necessary.
Measuring the activity of the disease in patients with cutaneous lupus erythematosus
Authors: Parodi A. , Massone C. , Cacciapuoti M. , Aragone M.G. , Bondavalli P. , Cattarini G. , Rebora A. 
Published: March 2003

Abstract
The Systemic Lupus Activity Measure (SLAM) is a system proposed by rheumatologists to measure disease activity in their patients with systemic lupus erythematosus (LE). It involves scoring a group of clinical symptoms and laboratory findings, the maximum possible score being 84. In systemic LE, the mid-point is between 9 and 12. We applied SLAM to 176 patients with cutaneous LE. Ninety-seven had localized discoid LE (L-DLE), 59 had disseminated discoid LE (D-DLE) and 20 had subacute cutaneous LE (SCLE). Eighty-five patients had low activity disease (0–4 points), 72 mildly active disease (5–9 points), 15 moderately active disease (10–14 points) and only four had very active disease (≥ 15 points). The most frequent lesions in patients who scored more than 10 points were photosensitivity, cicatricial alopecia, Raynaud’s phenomenon and oral ulcers. Fifty patients were followed up for more than 5 years (mean follow-up 9 years). Nine of these had an increased SLAM score. Seven had L-DLE, one D-DLE and one SCLE. Seven of the 50 patients had photosensitivity, five cicatricial alopecia, five non-cicatricial alopecia, two Raynaud’s phenomenon and two oral ulcers. Three patients who started with L-DLE evolved to D-DLE. The SLAM system is useful in the monitoring of disease activity in patients with cutaneous LE. Over time, even L-DLE patients may develop active disease. Photosensitivity, alopecia, oral ulcers and Raynaud’s phenomenon seem to herald a worse prognosis.
Macroscopic and microscopic mucinosis in chronicsclerodermoid graft-versus-host disease
Authors: Ameen M. , Russell-Jones R. 
Published: March 2003

Abstract
Secondary cutaneous mucinosis is a well-recognized feature of connective tissue diseases such as lupus erythematosus and dermatomyositis. We report the first three cases of dermal mucinosis in association with severe chronic cutaneous graft-versus-host disease of the sclerodermoid variety. One patient had clinical changes due to abundant mucin accumulation within the papillary dermis (mucinoma). In the other two patients histological examination revealed extensive deposits of mucin predominantly within the reticular dermis. The microscopic appearances were striking, with numerous vacuolated spaces interspersed between collagen bundles. We speculate that this appearance is the result of ground substance becoming trapped within grossly sclerodermoid connective tissue.
Cerebriform nodular amelanotic metastases of malignant melanoma: a challenge in differential diagnosis of a rare variant
Authors: Assmann A. , Farthmann B. , Burkhardt O. , Dippel E. , Orfanos C.E. , Blume-Peytavi U. 
Published: March 2003

Abstract
High variability of the clinical appearance of malignant melanoma (MM) and its metastases render the differential diagnosis of solid amelanotic tumours difficult. We report a 71-year-old woman with several unusual cutaneous tumours of cerebriform morphology, suggesting skin metastases from occult internal cancer. Histopathological findings and thorough investigations, however, revealed a late-stage metastatic MM. We discuss the differential diagnosis of skin metastases of various origin and underline the difficulties for early detection of MM.
Mucosal human papillomavirus types in squamous cell carcinomas of the uterine cervix and subsequently on fingers
Authors: Forslund O. , Nordin P. , Hansson B.G. 
Published: March 2003

Abstract
Human papillomavirus (HPV), especially type 16, is causally involved in the pathogenesis of anogenital cancer. There is an increasing number of reports of HPV infections in squamous cell carcinoma (SCC) of the fingers. A search of the Swedish cancer register covering the period 1958–94 inclusive for women with a history of genital and upper extremity SCC revealed 63 cases. Archival material from both cervical and cutaneous lesions was traced and analysed for the presence of HPV DNA in 32 of these patients. A newly developed ‘neighbour primer’ polymerase chain reaction (PCR) for HPV 16 DNA, aimed at overcoming the obstacle of cross-linked target DNA, was shown to be superior to conventional general and type-specific HPV PCR tests. HPV DNA was significantly more frequently found in digital tumours than in tumours at other cutaneous sites of the upper extremities [67% (10 of 15) vs. 7% (three of 43); P &lt; 0·001]. Among 13 patients with a history of both cervical and finger SCC, HPV 16 was found in cervical samples from seven patients. From five of these seven patients, HPV 16 was also present in the corresponding finger lesions. The results support the hypothesis of a possible transmission of patients’ genital HPV infections to fingers.
Widespread cutaneous necrosis occurring in association with the antiphospholipid syndrome: a report of two cases
Authors: Creamer D. , Hunt B.J. , Black M.M. 
Published: March 2003

AbstractThe antiphospholipid syndrome is an acquired prothrombotic state where thrombosis and/or pregnancy loss is related to the presence of antiphospholipid antibodies. Cutaneous necrosis secondary to intravascular thrombosis of small dermal vessels is a recognized but rare association with antiphospholipid syndrome. We report two patients with high circulating levels of anticardiolipin antibodies who developed widespread cutaneous necrosis as the first clinical manifestation of the antiphospholipid syndrome. The exact mechanism by which antiphospholipid antibodies mediate thrombosis is uncertain; however, proposed mechanisms of activity include endothelial cell activation, altered endothelial production of prostacyclin, activation of platelets, and modulation of the protein C and S pathways.
Humic acid reduces protein‐C‐activating cofactor activity of thrombomodulin of human umbilical vein endothelial cells
Authors: Yang Hsin‐Ling , Hseu You‐Cheng , Lu Fung‐Jou , Tsai Horng‐Der 
Published: March 2003

Humic acid in the drinking water of blackfoot disease endemic areas in Taiwan has been implicated as one of the aetiological factors of the disease. For this report we examined the effects of humic acid on the expression of thrombomodulin (TM) cofactor activity by cultured human umbilical vein endothelial cells (HUVEC).Incubation of HUVEC with humic acid (HA) isolated from the drinking water, as a synthetic humic acid polymer (SHA) or with commercial HA, resulted in a dose‐dependent reduction of cell surface thrombomodulin activity. Characterization of the mechanism by which humic acid reduced the protein C activation indicated that inhibition was not caused by production or release of a protein C inhibitor. Kinetic analysis showed that binding affinities of TM to thrombin and of TM–thrombin complex to protein C was unchanged upon humic acid treatment. However, the cell surface TM activity was reduced by humic acid, which functions as an irreversible noncompetitive inhibitor of thrombin binding. Down‐regulation of TM was inhibited by non‐selective protein kinase C inhibitors and a selective inhibitor. These results suggest that protein kinase C is intricately involved in HA‐induced TM down‐regulation. Down‐regulation of TM was also inhibited by free radical scavengers. All these changes occurred in the absence of significant cytotoxic effect.In conclusion, our results suggest that HA induces down‐regulation of TM by directly increasing permeability of the cell membrane, thus causing elevation in [Ca2+]i. This species functions as a second messenger to activate protein kinase C, and/or Ca‐dependent enzymes eventually inducing down‐regulation of TM. Attenuation of vascular endothelial cell TM cofactor activity by humic acid may play a role in the humic acid‐induced thrombotic vascular disorders of blackfoot disease.
Effect of the MTHFRC677T variant on risk of venous thromboembolism: interaction with factor V Leiden and prothrombin (F2G20210A) mutations
Authors: Brown Karen , Luddington Roger , Baglin Trevor 
Published: March 2003

Odds ratios for the MTHFRC677T variant were determined in a large case–control study of 558 unselected patients with venous thromboembolism and 500 control subjects. The odds ratios for MTHFRC677T heterozygosity and homozygosity were 1.07 (95%CI 0.84–1.36) and 0.71 (95%CI 0.48–1.03). In patients with the factor V Leiden or the F2G20210A mutations there was no apparent increase in risk of venous thromboembolism due to the MTHFRC677T polymorphism.Thrombophilia testing should not include genotyping for the MTHFRC677T polymorphism.
Mechanisms involved in the antiplatelet activity of Escherichia coli lipopolysaccharide in human platelets
Authors: Sheu  , Hung  , Kan  , Lee  , Yen  
Published: March 2003

In this study, Escherichia coli lipopolysaccharide (LPS) dose‐dependently (100–300 μg/ml) and time‐dependently (10–60 min) inhibited platelet aggregation in human platelets stimulated by agonists. LPS also dose‐dependently inhibited the phosphoinositide breakdown and the intracellular Ca+2 mobilization in human platelets stimulated by collagen. LPS (300 μg/ml) also significantly inhibited the thromboxane A2formation stimulated by collagen in human platelets. Moreover, LPS (100–300 μg/ml) dose‐dependently decreased the fluorescence of platelet membranes tagged with diphenylhexatrience. In addition, LPS (200 and 300 μg/ml) significantly increased the formation of cyclic GMP but not cyclic AMP in platelets. LPS (200 μg/ml) also significantly increased the production of nitrate within a 30 min incubation period. Rapid phosphorylation of a platelet protein of Mr 47 000, a marker of protein kinase C activation, was triggered by phorbol‐12‐13‐dibutyrate (PDBu, 50 n
M). This phosphorylation was markedly inhibited by LPS (200 μg/ml) within a 30 min incubation period.These results indicate that the antiplatelet activity of LPS may be involved in two important pathways. (1) LPS may induce conformational changes in the platelet membrane, leading to change in the activity of phospholipase C. (2) LPS also activated the formation of nitric oxide (NO)/cyclic GMP in human platelets, resulting in inhibition of platelet aggregation. Therefore, LPS‐mediated alteration of platelet function may contribute to bleeding diathesis in septicaemic and endotoxaemic patients.
Bioactive substances in buffy‐coat‐derived platelet pools stored in platelet‐additive solutions
Authors: Edvardsen Lisbeth , Taaning Ellen , Mynster Tommie , Hvolris Jesper , Drachman Ole , Nielsen Hans JØrgen 
Published: March 2003

We studied extracellular accumulation in buffy‐coat‐derived platelet pools suspended in platelet additive solutions (PAS). 20 platelet pools were prepared from buffy coats of 60 donors and stored in either PAS I (n = 10) or PAS II (n = 10). Samples were drawn from the donors to determine the normal range of histamine, plasminogen activator inhibitor 1 (PAI‐1), myeloperoxidase (MPO) and interleukin (IL)‐6. After preparation samples were collected on days 0, 5 and 7 from the 20 platelet pools respectively, to determine extracellular accumulation of the same substances. Extracellular histamine, PAI‐1 and MPO were detected in significant levels (P < 0.0001) immediately after preparation of the platelet pools. Only the extracellular level of PAI‐1 increased significantly during storage from day 0 to day 7 (P < 0.01). After preparation and storage to day 7 IL‐6 was found in only three of the 20 platelet pools.Even though platelets were prepared by the buffy‐coat method, to produce a low leucocyte count and thereby low cytokine (IL‐6) content, there was still significant contamination by other bioactive substances.
Diamond‐Blackfan anaemia in the Italian population
Authors: Ramenghi U. , Garelli E. , Valtolina S. , Campagnoli M. F. , Timeus F. , Crescenzio N. , Mair M. , Varotto S. , D'Avanzo M. , Nobili B. , Massolo F. , Mori P. G. , Locatelli F. , Gustavsson P. , Dahl N. , Dianzani I. 
Published: March 2003

Diamond‐Blackfan anaemia (DBA) is a congenital disease characterized by defective erythroid progenitor maturation; 30% of patients have congenital malformations. The link between these malformations and defective erythropoiesis is unclear: a defect in a molecule acting both on embryo development and haemopoiesis has been proposed. Inheritance is autosomal dominant in most familial cases, but recessive families have also been reported. Many cases are sporadic. A DBA locus has been mapped on chromosome 19q13.2 (Gustavsson et al, 1997), but several families unlinked to this locus have also been reported (Gustavsson et al, 1998).This paper presents clinical, epidemiological and molecular data for DBA in the Italian population. Segregation analysis of 19q markers in patients with DBA showed exclusion of this locus in 5/12 families with inherited DBA. There was evidently locus heterogeneity for DBA in this population. A new microdeletion was identified in one patient. Other families, in which DBA segregates concordantly with the 19q critical region, suggest incomplete penetrance and expressivity of the DBA gene.
Coexistence of normal and clonal haemopoiesis in aplastic anaemia patients treated with immunosuppressive therapy
Authors: Piaggio  , Podestà  , Pitto  , Sessarego  , Figari  , Fugazza  , Benvenuto  , Bruno  , Van Lint  , Truini  , Frassoni  , Bacigalupo  
Published: March 2003

Cytogenetic abnormalities and paroxysmal nocturnal haemoglobinuria (PNH) phenotype are frequent findings in aplastic anaemia patients treated with immunosuppressive therapy (IST). In this study we investigated whether the appearance of clonal haemopoiesis influences patient outcome and survival. 97 patients entered this study and were followed from the onset of the disease for a median follow‐up (FU) of 53 months. 93% are alive, 56% achieved complete remission, 30% partial remission, both transfusion independent, and 14% did not respond. Three groups were identified: (A) patients without evidence of emerging clones (71/97); (B) patients who acquired chromosomal abnormalities (13/97); (C) patients who showed low expression of glycosyl phosphatidylinositol anchored proteins (GPI‐AP) (PNH phenotype) at presentation or later (16/97). Three patients showed both PIG‐AP deficiency and chromosomal abnormalities. The actuarial survival of patients without clonal haemopoiesis (n = 71) at 6 years was 95%, for patients with chromosomal abnormalities (n = 13), 88%, and for patients with PIG‐AP deficiency (n = 16), 89%. There was no difference in the probability of becoming transfusion independent in the three groups (93%, 92% and 88% respectively).This study confirmed that a proportion of severe aplastic anaemia (SAA) patients exhibit clonal markers during the time after IST, often coexisting with cytogenetically or phenotypically normal haemopoiesis. There was no significant clinical impact of these abnormalities on transfusion independence and survival at the median follow‐up of 4 years.
Automated CD61 immunoplatelet analysis of thrombocytopenic samples
Authors: Kunz D. , Kunz W. S. , Scott C. S. , Gressner A. M. 
Published: March 2003

Revision of the current decision point for prophylactic platelet transfusion in thrombocytopenic patients requires the availability of a method that is able to provide accurate platelet counts to as low as 1 × 109/l. This study is the first to evaluate the immunoplatelet method (CD61‐Imm) of the haematological analyser Cell‐Dyn 4000 in direct comparison with the flow cytometric procedure. Additionally CD61‐Imm results were compared with CD4000 optical (Plto) counts in the ranges 20–547 × 109/l (n = 127) and 1–35 × 109/l (n = 107). The immunoplatelet and Plto results were in good agreement between 20 × 109/l and 547 × 109/l, but for samples of < 25 × 109/l the Plto tended to overestimate the counts. We determined the limits of detection (LD) and quantification (LLQ) for all three methods using standard statistical procedures. The LD for the flow cytometric CD41a method was 0·02 × 109/l compared with 0·009 × 109/l and 1·73 × 109/l for the CD61‐Imm and Plto methods respectively. The LLQCV = 15% for the CD41a method was 1·8 × 109/l compared with 1·6 × 109/l and 18·0 × 109/l for the CD61‐Imm and Plto procedures. In conclusion, (i) the CD61‐Imm method performance is at least equivalent to the reference flow cytometric method, and (ii) in severe thrombocytopenia the CD61‐Imm count is superior to the Plto count.