bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are patients’ sedation preferences at gastroscopy influenced by preceding patients’ decisions?
Authors: Olithselvan A. , McIntyre A. S. , Gorard D. A. 
Published: November 2004

SummaryBackground : When patients choose sedation or no sedation for gastroscopy, it is unknown whether the decision and experience of preceding patients on the same endoscopy list influence such decisions.Aim : To address this question in an endoscopy unit, where pre‐ and postprocedure patients are free to communicate.Methods : The order and sedation decisions of 503 out‐patients attending diagnostic gastroscopy lists were analysed. One hundred patients completed a preprocedural questionnaire about sedation preferences.Results : Three hundred and fifteen (63%) patients chose no sedation. Men were more likely to be unsedated, 170 (72%), than women 158 (59%) (χ2 = 9.1, P < 0.01). Age did not influence decisions. If the first patient on an endoscopy list requested sedation, 36% of subsequent patients were also sedated. This was similar to 38% of subsequently sedated patients on lists where the first patient was unsedated. Similar proportions of subsequent patients requested sedation when comparing lists where the first two patients were both sedated or both unsedated and when comparing lists where the first three patients were all sedated or all unsedated. Ninety per cent of the patients completing preprocedural questionnaires had made sedation choices before arrival; the remaining undecided patients had unsedated endoscopies.Conclusions : Patients’ sedation decisions are not influenced by preceding patients’ decisions. Most patients attending for out‐patient gastroscopy have already decided about sedation.
Meta‐analysis: a randomized trial of peginterferon plus ribavirin for the initial treatment of chronic hepatitis C genotype 4
Authors: Khuroo Mohammad S. , Khuroo Mehnaaz S. , Dahab Salim T. 
Published: November 2004

SummaryBackground: Guidelines for treatment of patients infected with hepatitis C virus genotype 4 are not available.Aim: To perform a meta‐analysis of randomized controlled trials comparing peginterferon plus ribavirin with interferon plus ribavirin treatment in treatment‐naïve patients infected with chronic hepatitis C virus genotype 4.Methods: The outcome measure was sustained virologic response. The measure of association employed was relative risk calculated by the random‐effect model, with heterogeneity, sensitivity and subgroup analyses.Results: Of the 565 studies screened, six randomized controlled trials including 424 patients (peginterferon plus ribavirin 219, interferon plus ribavirin 205) were analysed. Duration of therapy was 1 year in all trials. Sustained virological response obtained with peginterferon plus ribavirin (55%) was significantly higher than with interferon plus ribavirin (30%) [relative risk, 1.71 (95% confidence interval, 1.15–2.56);P = 0.0088]. In the subgroup analyses, sustained virological response in trials using standard‐dose ribavirin (1000 or 1200 mg/day) was 72% as against 45.8% in trials using low‐dose ribavirin (800 mg/day) (P = 0.01). Further sub‐group analyses for treatment duration, body weight, viral load and cirrhosis could not be performed because of lack of relevant data.Conclusion: Treatment‐naïve patients infected with hepatitis C virus genotype 4 should be treated with peginterferon plus standard‐dose ribavirin for 1 year, with an expected sustained virological response rate of 72%.
Personal view: cost and benefit of medical rituals in gastroenterology
Authors: Sonnenberg A. 
Published: November 2004

SummaryBackground : Unable to resolve a medical problem, gastroenterologists occasionally choose an ineffectual intervention instead. The elusive path to effectual management becomes substituted with an ineffectual but readily available medical ritual. The term ‘ritual’ refers to the utilization of an ineffectual intervention with little chances of achieving a medically relevant goal.Aim : The aim of the article is to analyse the cost–benefit relationship of rituals in gastroenterology and the reasons why gastroenterologists utilize them.Methods : Ritualistic disease management is described in terms of medical decision and threshold analysis.Results : If the perceived benefit of a ritual exceeds its cost, the ineffectual path becomes more attractive than expectant management or doing nothing. To engage in an ineffectual intervention, the threshold probability for success needs to exceed its cost–benefit difference divided by the benefit associated with success. In choosing an ineffectual intervention, doctors tend to underestimate the true costs of a ritual and overestimate its probability of success. The availability of an effectual path leads to more stringent conditions for the benefit associated with an ineffectual path.Conclusions : A better understanding of their economical underpinnings should lead to more restricted utilization of rituals in gastroenterology, especially, in situations where they drain scarce resources disproportionately to their perceived benefit.
Influence of socioeconomic status on the quality of prescribing in the elderly – a population based study
Authors: Odubanjo Enitan , Bennett Kathleen , Feely John 
Published: November 2004

AimsTo compare the quantity and quality of prescribing, using prescribing indicators, between the relatively deprived and the relatively affluent patients over 70 years old in primary care.MethodsWe examined the General Medical Services (GMS) scheme prescribing data for the Eastern region in Ireland for all patients aged 70 years or more (n = 95 055) during July 2001–December 2002. Prescribing indicators applied to the prescription data to evaluate drugs prescribed to each patient were classified as: (1) descriptive, e.g. number of drug items/patient; (2) indicators assessing potentially harmful prescribing; (3) evidence‐based indicators, e.g. secondary prevention therapy in those with ischaemic heart disease (IHD). Results are expressed as odds ratio (OR) and 95% confidence intervals for comparison of prescribing between the relatively deprived and affluent cohorts, adjusted for age and gender (CI) using logistic regression analysis.ResultsThe relatively deprived cohort was more likely to receive a greater number of drugs (5.2 vs. 4.5, P < 0.0001), more generic products (P = 0.01) and be exposed to major polypharmacy (≥ five drugs) compared with monotherapy (OR = 1.58; 95% CI = 1.52,1.64, P < 0.0001). They were more likely to receive potentially harmful drugs such as cerebral vasodilators (OR = 1.52; 1.38,1.69), long‐acting sulphonylurea (OR = 1.43; 1.20,1.72), potentially interacting agents such as angiotensin converting enzyme (ACE) inhibitor and potassium sparing diuretic (OR = 1.78; 1.48,2.15). In terms of evidence‐based prescribing, the relatively deprived cohort with IHD was less likely to receive secondary prevention therapies such as statins (OR = 0.82; 0.74, 0.90) and beta blockers (OR = 0.85; 0.77,0.93).ConclusionsThese results show that suboptimal prescribing is more prevalent among the relatively deprived cohort and suggests the differences observed in the quality of prescribing between these patient groups may be related to their socioeconomic status.
MDR1 haplotypes derived from exons 21 and 26 do not affect the steady‐state pharmacokinetics of tacrolimus in renal transplant patients
Authors: Mai Ingrid , Perloff Elke S. , Bauer Steffen , Goldammer Mark , Johne Andreas , Filler Guido , Budde Klemens , Roots Ivar 
Published: November 2004

AimThis retrospective study investigated the influence of MDR1 haplotypes derived from the polymorphisms 2677G > T (exon 21) and 3435C > T (exon 26) on the pharmacokinetics of the immunosuppressant drug tacrolimus in 73 renal transplant patients.MethodsBased on both variants of SNPs 2677 and 3435, four different haplotypes and eight different genotypes were identified in the study sample. Tacrolimus trough concentrations (C0) were compared between different SNP variants and genotypes, as well as between carriers and noncarriers of each haplotype. Additionally, CYP3A5 genotype (6956G > A) was determined.ResultsNo significant differences were observed between groups. Differences in mean tacrolimus C0 values between carriers and noncarriers of each haplotype ranged from −0.04 µg/litre (95% confidence interval: −0.53 to 0.60) to −23 µg/litre (−1.07 to 1.53). No association was found between CYP3A5*1/*3 genotype and tacrolimus Co concentractions.Conclusion MDR1 haplotypes derived from the SNPs 2677G > T (exon 21) and 3435C > T (exon 26) do not influence the pharmacokinetics of tacrolimus in renal transplant patients.
Comparison of gentamicin dose estimates derived from manual calculations, the Australian ‘Therapeutic Guidelines: Antibiotic’ nomogram and the SeBA‐GEN and DoseCalc software programs
Authors: Mohan Mitali , Batty Kevin T. , Cooper Jennifer A. , Wojnar‐Horton Richard E. , Ilett Kenneth F. 
Published: November 2004

AimTo compare gentamicin dose estimates from four predictive methods.MethodsA retrospective study was conducted, comprising patients at Fremantle Hospital who received gentamicin therapy and had at least one gentamicin serum concentration reported. A manual calculation method, the Australian ‘Therapeutic Guidelines: Antibiotic’ (TGA) nomogram and the SeBA‐GEN and DoseCalc software packages were compared. SeBA‐GEN dose estimates were regarded as the reference standard.ResultsThere were 64 males and 30 females with mean age of 58 ± 16 years. In patients with moderate renal impairment (CLCr = 30–60 ml min−1; n = 21), mean dose estimates using DoseCalc and the manual calculation method were comparable to SeBA‐GEN but the mean TGA nomogram dose (230 mg; 95% confidence interval 179, 281) was significantly lower than SeBA‐GEN (286 mg; 261, 311; P = 0.002; one‐way RM anova). In patients with mild renal impairment (CLCr = 60–90 ml min−1; n = 48), DoseCalc (392 mg; 367, 427) was comparable to SeBA‐GEN (377 mg; 362, 392). Although the manual method (341 mg; 306, 376; P = 0.007) and the TGA nomogram (335 mg; 302, 368; P < 0.001) estimates were significantly lower than SeBA‐GEN, the practical difference was modest.ConclusionsSeBA‐GEN and DoseCalc are generally comparable for estimation of gentamicin doses in patients with renal impairment. The ‘Therapeutic Guidelines: Antibiotic’ nomogram is a valid approach to dosage estimation, but only when used in patients with normal renal function. Simple manual calculations are a suitable alternative in patients with renal impairment.
Adsorption of oxacalcitriol by polysulphone haemodialyser in patients with secondary hyperparathyroidism
Authors: Tsuruoka Shuichi , Yamamoto Hisashi , Ioka Takashi , Ando Hitoshi , Saito Tetsuo , Fujimura Akio 
Published: November 2004

AimsThis study was undertaken to evaluate removal of 22‐oxacalcitriol (OCT), an active and intravenously used vitamin D3 analogue with less calcaemic activity, by polysulphone haemodialyser in vivo and in vitro. We further compared the pharmacodynamic efficacy [suppression of intact parathyroid hormone (iPTH)] when given intravenously either during or at the end of the haemodialysis.Methods(i) Drug clearance by the polysulphone dialyser was measured during a single continuous infusion (5 µg) for 30 min into the arterial side of the dialyser in end‐stage renal failure patients with secondary hyperparathyroidism (n = 7). (ii) The drug adsorption by the hollowfibre membrane during incubation for 30 min was measured in vitro. (iii) To evaluate efficacy, the drug was given (i.v. bolus) during or at the end of haemodialysis for 4 weeks in a cross‐over fashion with a washout period of 8 weeks (n = 9). Serum Ca2+, phosphate (P) and iPTH concentrations just before the initiation of the dialysis were monitored every week.Results(i) OCT was significantly cleared by the polysulphone haemodialyser, but the clearance declined in a time‐dependent manner to approach zero at 30 min. Arterial (at the place between the drug infusion site and the haemodialyser column) drug concentrations did not change during the infusion (mean = 2064 ± 233 pg ml−1). Venous (just after the dialyser) drug concentrations at 10 min after the infusion were significantly lower than those of the arterial side (mean = 784 ± 84 pg ml−1); however, they increased with time and reached those of the arterial side at 30 min. (ii) In vitro, OCT was adsorbed by the membrane. The amount of adsorption was concentration‐dependent and was lower in the presence of human serum (55 ± 4% without and 23 ± 4% with serum at 600 pg ml−1 of OCT). (iii) Although serum Ca2+ and P increased and iPTH decreased by both treatment regimens (i.e. OCT administered either during or at the end of haemodialysis), these changes did not significantly differ. Mean differences (and 95% confidence interval) of Ca2+, P, and iPTH at the end of the trial were 0.03 (−0.04, 0.09) mm, 0.41 (−0.43, 1.26) mg dl−1 and 38 (−42, 88) pg ml−1, respectively.ConclusionOCT is adsorbed by polysulphone dialyser in vitro and in vivo. However, the pharmacodynamic effectiveness was largely independent of the administration regimen of OCT given either during or at the end of haemodialysis.
Comparison of tincture of opium and methadone to control opioid withdrawal in a Thai treatment centre
Authors: Jittiwutikarn Jaroon , Ali Robert , White Jason M. , Bochner Felix , Somogyi Andrew A. , Foster David J. R. 
Published: November 2004

AimsTo evaluate the effectiveness of oral tincture of opium (TOP) and methadone to control opioid withdrawal in patients in northern Thailand.MethodsOpen label, parallel group study in an inpatient facility compared 15 former heroin users receiving methadone 5–20 mg 12 hourly with 15 former opium smokers receiving TOP (3.33–10 mg morphine equivalents 12 hourly). At 0, 1, 3 and 8 h, blood, withdrawal scores and subjective opioid effects were collected.ResultsThere was a reciprocal association between withdrawal scores/direct subjective opioid effects and plasma (R)‐methadone, but not plasma morphine, concentrations. Withdrawal scores at the time of dosing were higher in the TOP patients (9.1 ± 3) than in the methadone patients (4.5 ± 4.6) and in the TOP patients were significantly (P = 0.001) attenuated at 3 and 8 h.ConclusionsAt the doses used, TOP was inferior to methadone in suppressing withdrawal. It could prove to be a cost effective and valuable drug, but only after dose size and frequency are further investigated.
A randomized, double‐blind, placebo controlled trial of melatonin add‐on therapy in epileptic children on valproate monotherapy: effect on glutathione peroxidase and glutathione reductase enzymes
Authors: Gupta Madhur , Gupta Yogendra Kumar , Agarwal Sarita , Aneja Satinder , Kohli Kamlesh 
Published: November 2004

AimsTo compare the effect of add‐on melatonin with placebo on the antioxidant enzymes (glutathione peroxidase and glutathione reductase) in epileptic children on valproate monotherapy.MethodsIn a double‐blind, randomized, placebo controlled trial, the effect of add‐on melatonin administration on the antioxidant enzymes in epileptic children on valproate (VPA) monotherapy was assessed. A total of 31 patients met the entry criteria. 16 patients were randomly allocated to receive add‐on melatonin, and 15 to receive add‐on placebo. Blood samples (5 ml) were collected just before the morning dose of valproate for baseline values of glutathione peroxidase and glutathione reductase enzymes, and then after 14 days of add‐on melatonin/placebo. Blood was then centrifuged at 3500 r.p.m., serum separated and stored in deep freezer at −20 °C until assay of glutathione reductase. Heparinized blood was collected and stored at −20 °C in eppendorfs in the deep freezer for assay of glutathione peroxidase. All activity assays were performed on the Ames (Technicon) RA 50 chemistry analyser.ResultsFifteen patients in the add‐on melatonin group and 14 patients in the add‐on placebo group were finally assessed. There was an increase in the activity of antioxidant enzymes, glutathione peroxidase (GSH‐Px) and glutathione reductase (GSSG‐Rd), in the add‐on melatonin (MEL) group as compared with a reduction in the same in the add‐on placebo group (P). After the addition of melatonin/placebo in the respective groups, there was a 7.5% decrease in GSH‐Px in the valproate + placebo group, whereas a 11.9% increase in the valproate + melatonin group was observed, the difference between the groups being not statistically significant (P = 0.29). On administration of melatonin/placebo, the post‐treatment concentrations of GSSG‐Rd in the valproate + placebo group decreased from 92.0 U l−1 to 67.0 U l−1 and increased from 82.0 U l−1 to 113.0 U l−1, in the valproate + melatonin group, respectively, the difference between them being statistically significant (P = 0.05). The percentage change in the values of GSSG‐Rd in the two groups was statistically significant (P = 0.005).ConclusionsMelatonin exerts neuroprotection due to its antioxidant, antiexcitotoxic and free radical scavenging properties within the central nervous system. Melatonin, thus, as an adjunct, can be a putative neuroprotector in conditions involving oxidative stress like epilepsies.
Point of care testing for INR monitoring: where are we now?
Authors: Murray E. T. , Fitzmaurice D. A. , McCahon D. 
Published: November 2004

SummaryPoint of care (POC, or near patient) testing for measurement of the international normalized ratio (INR) has facilitated the devolution of service delivery from the traditional hospital outpatient setting. However it must be undertaken within the confines of safe practice involving quality control procedures. The evaluation of INR POC tests should be closely related to the clinical issues of management and, specifically, improving the quality of care. One benefit of POC testing is in the increased motivation that some practitioners feel, being able to perform diagnostic tests without sending samples to a laboratory. POC for INR testing within primary care eliminates the delay in waiting for the result to be processed by the hospital laboratory, and the subsequent delay in informing the patient of their dosing advice. This review describes the utilization of POC testing outside the laboratory setting to develop models of care for oral anticoagulation management.
Inhibitors in congenital coagulation disorders
Authors: Key Nigel S. 
Published: November 2004

SummaryThe development of inhibitory ‘allo’ antibodies to a deficient coagulation factor is arguably now the most severe and important complication of clotting factor concentrate exposure in haemophilia and other congenital coagulation disorders. Furthermore, development of an inhibitor to the factor VIII or factor IX transgene product remains a significant concern in gene therapy protocols for haemophilia. Although the development of an inhibitor does not usually change the rate, initial severity or pattern of bleeding, it does compromise the ability to manage haemorrhage in affected individuals, resulting in a greater rate of complications, cost and disability. The purpose of this review is to summarize current understanding of the epidemiology, immunobiology, laboratory evaluation and management of inhibitors arising in patients with congenital coagulation disorders. An attempt has been made to focus on recent advances in the immunology of inhibitors, and to speculate on their potential clinical application.
T‐cell post‐transplantation lymphoproliferative disorders after cardiac transplantation: a single institutional experience
Authors: Draoua H. Y. , Tsao Lawrence , Mancini Donna M. , Addonizio Linda J. , Bhagat Govind , Alobeid Bachir 
Published: November 2004

SummaryPost‐transplantation lymphoproliferative disorders (PTLDs) are a well‐recognized and potentially life‐threatening complication of solid organ transplantation. While the vast majority of PTLDs are B‐cell lymphoproliferations, T‐cell PTLDs are rarely seen. Among 898 patients receiving cardiac transplants between 1990 and 2003, 34 patients (3·8%) developed PTLDs with two (0·2%) T‐cell PTLDs, 31 (3·5%) B‐cell PTLDs and one (0·1%) natural killer cell PTLD. An additional three cases of T‐cell PTLD were identified among all cardiac transplant patients followed at our institution. These T‐cell PTLDs comprised a heterogeneous group of Epstein–Barr virus negative lymphoproliferations that developed late after transplantation and followed an aggressive course.
von Willebrand factor cleaving protease (ADAMTS‐13) and ADAMTS‐13 neutralizing autoantibodies in 100 patients with thrombotic thrombocytopenic purpura
Authors: Peyvandi Flora , Ferrari Silvia , Lavoretano Silvia , Canciani Maria Teresa , Mannucci Pier Mannuccio 
Published: November 2004

SummaryThe congenital or acquired deficiency of the von Willebrand factor (VWF) cleaving protease, ADAMTS‐13 has been specifically associated with a diagnosis of thrombotic thrombocytopenic purpura (TTP), a microangiopathy characterized by the formation of occlusive platelet thrombi. The mechanisms of TTP were investigated in 100 patients diagnosed on the basis of the presence of at least three of the following: thrombocytopenia, haemolytic anaemia, elevated serum levels of lactate dehydrogenase and neurological symptoms. Plasma levels of ADAMTS‐13 were severely reduced (<10% of normal) in 48%, moderately reduced (between 10% and 46%) in 24% and normal (>46%) in 28%. A neutralizing antibody was the cause of the deficiency in 38% of the cases, with a higher prevalence of this mechanism (87%) in the 48 patients with severely reduced ADAMTS‐13. Double heterozygosity for a 29 base pair (bp) deletion and a nucleotide insertion and homozygosity for a 6 bp deletion in the ADAMTS13 gene were identified only in two patients born from consanguineous marriages. In conclusion, this study indicated that ADAMTS‐13 was normal in nearly one‐third of patients with TTP and that ADAMTS‐13 deficiency was not associated with the presence of neutralizing antibodies in more than half of the patients.
Low‐intensity warfarin reduces thrombin generation and fibrin turnover, but not low‐grade inflammation, in men at risk of myocardial infarction
Authors: MacCallum Peter K. , Rudnicka Alicja R. , Rumley Ann , Meade Tom W. , Lowe Gordon DO 
Published: November 2004

SummaryIn the Thrombosis Prevention Trial (TPT), low‐intensity warfarin reduced the risk of first coronary events only when the achieved international normalized ratio (INR) was ≥1·4. To validate the likely mechanism of action of low‐intensity warfarin we measured its effects on plasma markers of thrombin generation, fibrin turnover and low‐grade inflammation in TPT participants. d‐dimer and prothrombin fragment F1·2 levels were lower at INRs ≥1·4 (P = 0·02 and 0·03 respectively); levels fell as INR increased (P for trend 0·04 and 0·002 respectively). C‐reactive protein did not vary with INR. The efficacy of warfarin is related to reductions in thrombin generation and fibrin turnover.