bluuebunny/crossref_metadata_2025_split huggingface dataset:
Local Implementation of Clinical Practice Guidelines and Continuous Quality Improvement: Challenges and Opportunities
Authors: Diamond Louis H. 
Published: March 2003

ABSTRACTImplementing clinical practice guidelines (CPGs), disease management programs, and quality improvement projects requires an understanding of the trends that will facilitate adoption at the local level. These trends include consumerism and the building of a national information technology infrastructure. The recommendations of the Presidential Advisory Commission on Consumer Protection and Quality in the Health Care Industry and the Institute of Medicine (IOM) report entitled “To Err Is Human: Building a Safer Health System” will frame developments and implementation. The relative roles and responsibilities of national entities, with coordination and integration of these activities with local efforts will need to be carefully orchestrated. Utilizing the Web to connect dialysis facilities, patients, and members of the health care delivery team has the potential to reap large benefits. Utilizing information technology at the point of care and retrospectively to improve decision making by all parties has the real potential to improve patient outcomes.Implementation of what at a local level? And what do we mean when local level is referred to? This article addresses these two questions and provides a framework for the engagement of patients, physicians, and members of the health care delivery team and organizations, at both the local and national levels, in improving patient outcomes. All have their roles, rights, and responsibilities. We are challenged to provide the right treatment, to the right patient, at the right time. And importantly, to provide the right information, to the right person, at the right time.
Noninfectious Causes of Cloudy Peritoneal Dialysate
Authors: Rocklin Michael A. , Teitelbaum Isaac 
Published: March 2003

ABSTRACTThe appearance of cloudy dialysate fluid in combination with the clinical manifestations of peritonitis usually heralds infectious peritonitis. Diagnosis is readily established in most cases by routine culture of the turbid dialysate. However, an occasional patient presents with culture‐negative, cloudy dialysate. After ruling out atypical infectious etiologies, a diverse set of aseptic causes remains in the differential diagnosis. Herein we review these causes and suggest an organizational scheme, based on identifying the cellular or noncellular constituent producing the dialysate turbidity, to facilitate appropriate diagnostic and therapeutic interventions.
Imaging Techniques in the Diagnosis of Dialysis‐Related Amyloidosis
Authors: Ketteler Markus , Koch Karl Martin , Floege Jürgen 
Published: March 2003

ABSTRACTβ2‐microglobulin amyloidosis (Aβ2M) is a major determinant of morbidity in patients on dialysis treatment. Symptoms of Aβ2M amyloid are mainly related to (peri‐)articular amyloid deposition. Imaging techniques [i.e., joint ultrasonography, X‐ray, computed tomography (CT), or magnetic resonance imaging (MRI) findings], as well as conventional bone scans, are helpful in the screening of local lesions but are relatively nonspecific and/or not sensitive enough. Scintigraphic techniques using radiolabeled serum amyloid P component (SAP) or the radiolabeled Aβ2M precursor protein, β2M, generate more specific results. Aβ2M deposits have been visualized in several long‐term hemodialysis patients by using 123I‐labeled SAP. However, this scan did not show tracer accumulation in some frequently involved sites such as hips or shoulders, and frequently labeled the spleen, which is usually spared from Aβ2M deposits. Improvements in technical sensitivity and specificity could be achieved by scanning with 131I‐labeled β2M: this technique detected tracer accumulations corresponding to the typical distribution pattern of Aβ2M. Further, both the radiation exposure and the optical resolution of this latter scan have been refined by substituting 111In for 131I. In a final step we generated recombinant human β2M (rhβ2M). While 111In rhβ2M again failed to show significant tracer accumulation over joint regions in patients on short‐term hemodialysis without evidence of Aβ2M, local tracer accumulations similar to those observed with natural, 111In‐labeled β2M could be demonstrated in long‐term hemodialysis patients with evidence of Aβ2M. In conclusion, scintigraphy for Aβ2M with 111In‐labeled rhβ2M provides a homogeneous and safe recombinant protein source and represents a suitable detection method of β2M amyloid deposits in dialysis patients.
Postprostatectomy External Beam Irradiation
Authors: Kaplan Irving , Jiroutek Michael , Henry D. Laury , Beard Clair J. , D'Amico Anthony V. 
Published: March 2003

Background: A significant proportion of patients will be found to have extracapsular disease and/or detectable prostate specific antigen (PSA) values after radical prostatectomy. The role of postoperative radiotherapy to the prostatic tumor bed remains controversial. Methods: Ninety patients were treated at the Joint Center for Radiation Therapy after radical prostatectomy. The medium dose to prostatic fossa was 64.0 Gy. Medium follow‐up was 28.9 months (from time of prostatectomy). Failure after radiotherapy is defined as a persistently detectable PSA level or the development of a detectable PSA level after radiotherapy. None of the patients received androgen ablative therapy until documented postradiotherapy failure. Presurgical PSA levels, Gleason score, pathological findings at surgery, and preradiotherapy PSA levels were analyzed as predictors of PSA failure. Results: A presurgical PSA of >20.0 ng/ml is associated with PSA failure after radiotherapy (p = 0.0239). Preoperative Gleason score, PSA at time of radiotherapy or pathological findings at surgery do not predict for subsequent PSA failure. Conclusion: Postprostatectomy radiotherapy to the prostatic fossa is unlikely to provide long‐term PSA‐defined, disease‐free survival for patients who undergo prostatectomy with a presurgical PSA of >20 ng/ml. Regardless of findings at surgery, these patients have a high rate of developing PSA failure.
Understanding Barriers to the Early Detection of Prostate Cancer Among Men of Lower Socioeconomic Status
Authors: Dale William , Sartor Oliver , Davis Terry , Bennett Charles L. 
Published: March 2003

ABSTRACTObjectives: Prostate cancer accounted for more than 180,000 new cases and almost 40,000 deaths in the United States in 1998. Higher rates of mortality have been noted among racial minorities and lower socioeconomic status groups, primarily because of advanced stage of cancer at presentation. Understanding barriers toward early detection of prostate cancer may help diminish these variations.Materials and Methods: Thirty‐two focus group sessions with individuals of lower socioeconomic status addressed attitudes toward physical examinations, prostate cancer, and sources of health‐care information. Barriers to early detection were identified, based on transcripts that were analyzed using the Health Belief Model.Results: Most men of lower socioeconomic status viewed physical examinations negatively, with barriers including time, monetary costs, negative impressions of the prostate examination, and lack of belief in early detection. Among the minority of men who had had prostate examinations, they typically did so as part of examinations for chronic medical conditions or because of employer requirements for routine check‐ups. The rectal examination was viewed very negatively because of concerns of physical pain, social embarrassment, and uncertain value. Fear and fatalism regarding prostate cancer were expressed by the majority of attendees. With respect to sources of health information, men typically received health‐care information from the media, with television being the most common source. No significant differences in barriers to early detection efforts were observed between focus groups composed of white versus African American poor men.Conclusions: The Health Belief Model provides a framework for evaluating the perceptions of men of lower socioeconomic status toward the early detection of prostate cancer. Negative perceptions regarding physical examinations and skepticism about the value of early detection were major barriers to the early detection of prostate cancer. Targeted strategies directed at each of these barriers are needed to improve the rates of early detection in men of lower socioeconomic status.
Bacillus Calmette‐Guerin Immunotherapy Significantly Prolongs Survival of Animals with Prostate Cancer
Authors: Lamm Donald L. , Riggs Dale R. , Donley David , White Justin , Yeater Rachel , Bryner Randy W. 
Published: March 2003

AbstractObjectives: Bacillus Calmette‐Guerin (BCG) is the treatment of choice for carcinoma in situ of the bladder, but its application to other cancers is very limited. The current study evaluates the effect of intralesional BCG in the PA3 rat prostate cancer model.Materials and Methods: One hundred five rats were randomized to four groups. Each group received 1 × 106 PA3 cells subcutaneously on experiment Day 0. On experimental Day 7, the groups received the first of six weekly treatments. Treatments consisted of saline solution, BCG 1 × 104 colony‐forming units (cfu), BCG 1 × 105 cfu, and BCG 1 × 106 cfu. All animals were monitored for tumor growth throughout the duration of the experiment.Results: Animals receiving treatments with BCG 1 × 106 cfu exhibited the greatest reduction in tumor volume ([mean ± SD] 4130.0 ± 1738.3 mm3; p = 0.0738), followed by those receiving BCG 1 × 104 cfu (4527.6 ± 1932.7 mm3; p = 0.1093) and BCG 1 × 105 cfu (4838.2 ± 1889.9 mm3; p = 0.5218), compared to those receiving the saline solution control (5445.0 ± 3119.5 mm3). Animal survival on Day 60 after transplantation was significantly increased in the group receiving BCG 1 × 106 cfu (19 [73.1%] of 26 animals; p = 0.0326) when compared to those receiving the saline solution control (12 [44%] of 27 animals). Treatment with BCG 1 × 105 cfu (11 [42.3%] of 26 animals survived; p = 0.5479) and BCG 1 × 104 cfu (13 [50%] of 26 animals survived; p = 0.4484) also reduced survival compared to the saline solution control, but not to the level of significance.Conclusions: The consistent reduction in tumor growth and animal mortality in animals receiving intralesional BCG demonstrates antitumor activity in this aggressive model of prostate cancer. The greatest efficacy was seen with the highest dose of BCG, suggesting that higher doses may be optimal in this model. BCG immunotherapy of prostate cancer warrants clinical evaluation.
Selected Factors Associated with Students' Perceptions of Threat in the Community
Authors: Morin Karen H. , Hayes Evelyn R. , Carroll Mary , Chamberlain Barbara 
Published: March 2003

Abstract This study assessed nursing students' perceptions of threat in the community from the beginning to the completion of their first formal community health nursing course (inclusive of specific community health content associated with relevant clinical experience) and determined how perceptions of threat differed by residential zone and by type of program (generic day, generic weekend/evening, or R.N.). Undergraduate nursing students were sampled from eight National League for Nursing Accrediting Commission (NLNAC) accredited baccalaureate schools. Completed pretest data were obtained for 345 students. Completed post‐test data were obtained for 274 students. Paired data were available for 197 students.

Generally, students were comfortable when the environment was assessed within the context of daylight before and after the course. Students were not as comfortable with the environment when assessed within the context of nighttime either before they started the community course or after they completed it.

Students continue to perceive that the community environment presents limited threats, particularly when viewed from the perspective of time of day. Because the community educational experience is not restricted to baccalaureate education (Cahill et al., 1998), nor is it conceptualized as a singular experience (Mellon & Nelson, 1998), the challenge to faculty is to enhance student learning by preparing them in such a manner that they assess their community environment for threats and practice safely within that environment. The use of the Environmental Comfort Scale III, including the open‐ended question, may be one way to achieve this challenge.
A New Treatment for Endotoxemia with Direct Hemoperfusion by Polymyxin Immobilized Fiber
Authors: Hanasawa Kazuyoshi , Tani Tohru , Oka Totaro , Yoshioka Toyakazu , Endo Yoshihiro , Horisawa Masahiro , Nakane Yoshihiro , Kodama Masahi , Teramoto Kazuo , Nishiumi Shiro 
Published: March 2003

Abstract: Guest Editor's Introduction: Endotoxins, which consist of lipopolysaccharides (LPS), are known to be a pathogenic substance in patients with septic shock. Since Nolan reported endotoxin adsorption by ion exchange resin and activated charcoal, the search for more effective adsorbents were continued and have lead to the development of polymyxin B immobilized fibers. Polymyxin B is a cationic antibiotic agent which interacts with acidic phospholipids and LPL by electrostatic force. This paper was the first report written in English regarding polymixin B immobilized fibers. The adsorbent is now known as Toraymyxin PMX‐20R and manufactured by Toray Co. This paper was published in Therapeutic Apheresis: A Critical Look, Y. Nosé, P.S. Malchesky, and J,W. Smith eds., ISAO Press, page 167–170 (1984).A new method of preparing polymyxin B fixed to insoluble fiber (PMX‐F) was developed. PMX‐F (1 g) was detoxified with 0.5–4.8 mg of lipopolysaccharides (LPS) as endotoxin (ET) in a batch system. Fixed polymyxin B(PX) was found to be firmly attached to fiber even after washing with isotonic saline or endotoxin solution. Toxicological study of the mortality of mice after injection of PMX‐F‐treated ET indicated that 24% (5 of 21) of the treated group survived, whereas 100% (21 of 21) of the untreated group died. In ex vivo experiments, direct hemoperfusion (DHP) by PMX‐F was performed for ET‐injected canine. Only 12.5% (1 of 8) survived in the control group, but 83% (10 of 12) survived in the group receiving DHP with PMX‐F. Mortality in the treated group decreased remarkably. The results thus indicate the efficacy of PMX‐F in neutralizing ET.
Population Growth, Fecundity, and Survivorship in Recovering Populations of Bighorn Sheep
Authors: Singer Francis J. , Williams Elizabeth , Miller Michael W. , Zeigenfuss Linda C. 
Published: March 2003

AbstractThe single greatest obstacle to the restoration of large, healthy, populations of bighorn sheep (Ovis canadensis) in the western United States is epizootic outbreaks of bronchopneumonia that may kill 20–100% of the animals in populations. Although the species is capable of rapid initial growth rates following restoration into new habitat (λ = 1.23–1.30 have been observed), these rates of increase are typical only a few years following the release of a population, and then most populations either decline to extirpation or remnant status (<30 animals) or remain at <100 individuals. We studied the fecundity and survivorship of three increasing, and three declining and suspected diseased, populations of bighorn sheep (the latter were subjected to outbreaks of bronchopneumonia) located in or near several large national parks in the western United States from 1991 to 1996. Titers verified both population categories were exposed to the bacteria Pasteurella haemolytica serotypes 3; 4; and 3, 4, 10; Moraxella sp., and parainfluenza‐3 and bluetongue (BT) viruses. Pregnancy rates of adult ewes were not different in increasing or decreasing populations (pooled rate = 0.93; p = 0.57), but pregnancy rates of yearlings were lower (0.00 for decreasing vs. 0.33 for increasing populations), initial production of lambs and annual recruitment of lambs was lower (0.14, decreasing vs. 0.66, p < 0.05). Adult survival was lower during the first year of an epizootic, 0.62, in one population, but recovered to 0.85 by the second and subsequent years. Survival of adult rams was variable in diseased populations; in two populations rams appeared to be disproportionately impacted, but in a third population rams survived better during the epizootic. In all the increasing park (unhunted) populations, adult ram survival (0.94 ± 0.01) was higher than adult ewe survival (0.89 ± 0.02) (p = 0.10), in contrast to published information from hunted populations where ram survival was lower. Removal of about 20% of one population for restorations severely impacted one declining population. Removals of 12–20% appeared to be excessive and were not readily compensated for in the Canyonlands National Park desert bighorn population. Disease was a significant limiting factor to restoration of bighorn sheep in the study areas; six of 11 total recovering populations we monitored closely were negatively influenced by apparent disease at some time during our observations.
Valuation of Nature in Conservation and Restoration
Authors: Swart Jacques A. A. , Van Der Windt Henny J. , Keulartz Jozef 
Published: March 2003

AbstractValuation of nature is an important aspect of nature conservation and restoration. Understanding valuation in a broad sense may contribute to conservation strategies since it may lead to better support from society. In this article we propose a model of valuation with respect to conservation and restoration of nature. According to the model, valuation of nature can be characterized by a “valuation approach,” consisting of ecological, ethical and aesthetic perspectives. Such an approach includes scientific and normative aspects and leads to a particular claim of conservation. In this paper we discuss different perspectives, and accordingly, we sketch three main types of these valuation approaches. Political and policy issues with respect to nature conservation and restoration are considered in terms of this model.
Spatial and Temporal Considerations in Restoring Habitat for Wildlife
Authors: George T. Luke , Zack Steve 
Published: March 2003

AbstractAn accumulated body of theory and empirical evidence suggests that habitat selection by animals is a scale‐dependent, hierarchical process. Hierarchy theory predicts that habitat suitability is influenced by the interaction of factors at multiple spatial scales from the microsite to the landscape and that higher‐order factors impose constraints at lower levels. For instance, large‐scale factors such as landscape context may make a site unsuitable for a species even if the vegetation structure and composition are appropriate. In addition, the spatial arrangement of habitat elements at all scales must be considered when planning restoration efforts. For example, the presence of snags does not ensure that the site will be suitable for snag‐dependent species. The size, age, and spacing of snags and their juxtaposition to other habitat elements must also be considered. Finally, all habitats are dynamic, and therefore the ecological processes that contribute to those dynamics must be maintained or suitable substitutes included in the recovery plan. When considering restoring habitat for wildlife, we recommend that managers: (1) identify the wildlife species they want to target for restoration efforts, (2) consider the size and landscape context of the restoration site and whether it is appropriate for the target species, (3) identify the habitat elements that are necessary for the target species, (4) develop a strategy for restoring those elements and the ecological processes that maintain them, and (5) implement a long‐term monitoring program to gauge the success of the restoration efforts.
Herpetofaunal Responses to Restoration Treatments of Longleaf Pine Sandhills in Florida
Authors: Litt Andrea R. , Provencher Louis , Tanner George W. , Franz Richard 
Published: March 2003

AbstractThe hypothesis that habitat restoration will provide for community reestablishment and the creation of habitat heterogeneity was examined with regards to the herpetofauna of longleaf pine sandhills in northwest Florida. The herpetofaunal response to restoration was examined in fire‐suppressed, hardwood‐dominated areas treated with (1) spring fire; (2) felling or girdling; or (3) a granular form of the herbicide hexazinone. No‐treatment controls were also included. Felling or girdling and herbicide plots were burned for fuel reduction two dormant seasons after initial treatment application. Additionally, data were collected in frequently burned reference sandhills to establish the target condition or restoration goal. Vegetation variables and herpetofaunal capture rates were compared among control and treatment areas. Two similarity indices were utilized to compare treatments and controls with reference sites, to examine restoration success. Restoration treatment effects were observed through reduced hardwood densities. Litter composition varied among control and treatment plots, with leaf litter being highest in areas lacking recent fire. Capture rates of some herpetofaunal species varied significantly among treatment plots. In 1997 similarity indices showed that spring‐burned and felling or girdling plots were more similar to the reference sandhills than the other plots. Treated plots were not significantly different from controls in 1998, a year of a severe drought.
Nitrogen Farming: Harvesting a Different Crop
Authors: Hey Donald L. 
Published: March 2003

AbstractThe streams of North America convey excessive amounts of nitrate‐nitrogen, the effects of which range from eutrophication of local surface waters to hypoxia in the Gulf of Mexico. The vast majority of the nitrate load can be attributed to agricultural sources. The diffuse nature of these sources defies the more traditional treatment strategies. The concrete and steel structures of point‐source control are impractical and economically unfeasible. An alternative solution is needed. One possibility is “nitrogen farming.” Nitrogen farms could employ restored wetlands in floodplains and on bottomlands to remove the excess nitrate‐nitrogen and, at the same time, provide the landowner an alternative crop. A means of buying and selling the harvest will be necessary to initiate nitrogen farming. The market could be similar to those for corn and soybeans. It would encourage landowners to enter or leave nitrogen farming depending on the price of nitrogen credits and the efficiency of their farm unit. The concept of nitrogen farming is applied to the Illinois River watershed.
Revegetation and its Effect on the Ground‐Dwelling Beetle Fauna of Matiu‐Somes Island, New Zealand
Authors: Watts Corinne H. , Gibbs George W. 
Published: March 2003

AbstractA study of beetle (Coleoptera) communities was conducted in three revegetated sites of different ages (5, 17, and 100 years) and in a remnant coastal habitat dominated byMuehlenbeckia complexa(a liane) on Matiu‐Somes Island, Wellington Harbor, New Zealand. The 25‐ha island has had a 110‐year history as a pastoral agricultural quarantine station. Beetles were surveyed from May 1997 to April 1998 using pitfall traps. We collected a total of 3,430 adult beetles from 78 beetle species belonging to 22 families. Various environmental factors influencing the distribution of beetles in revegetated habitats were investigated. The most important factors were canopy height and canopy density (functions of vegetation age). Overall, results suggest that as habitat/vegetational heterogeneity increases at a site, beetle diversity and abundance also increase. Thus, older replanted sites contained a greater species richness and abundance of beetles than newly replanted sites. Revegetation is, thus, successfully facilitating the establishment and recolonization of the beetle fauna on Matiu‐Somes Island.