bluuebunny/crossref_metadata_2025_split huggingface dataset:
Generalized Lichen Nitidus
Authors: Al‐Mutairi Nawaf , Hassanein Ayman , Nour‐Eldin Osama , Arun Joshi 
Published: March 2005

Abstract:  Lichen nitidus is a rare chronic condition of unknown etiology. Generalized lichen nitidus is even rarer. We report here a 5‐year‐old girl who had multiple, asymptomatic, discrete, 1 to 2 mm flesh‐colored, shiny, flat, papules on her face, upper limbs, and thighs with relative sparing of the trunk. Resolution of these papular lesions was followed by hyperpigmented macules in those areas. Histopathologic examination of a papular lesion revealed a localized granulomatous lymphohistiocytic infiltrate in an expanded dermal papilla with thinning of overlying epidermis and downward extension of the rete ridges at the lateral margin of the infiltrate, producing a typical “claw clutching a ball” picture, confirming our clinical diagnosis of lichen nitidus. The pigmented macules showed melanin pigmentation on histology. There was no response to oral astemizole treatment for 3 months. However, the lichen nitidus lesions resolved spontaneously without any further treatment over the next year, leaving behind a prominent pigmentary disturbance.
A Practical Approach for the Use of Oral Isotretinoin for Infantile Acne
Authors: Barnes Cheryl J. , Eichenfield Lawrence F. , Lee Jungho , Cunningham Bari B. 
Published: March 2005

Abstract:  Infantile acne is a rare occurrence. It is more common in boys and predominately occurs on the cheeks in infants between the ages of 1 and 16 months. Clinically, the lesions range from comedones to inflammatory papulopustules to cysts. Successful therapies include topical tretinoin, benzoyl peroxide and topical and oral erythromycin. For more serious cases, oral isotretinoin (Accutane) has been reported to successfully treat recalcitrant infantile cystic acne. We describe two additional patients with infantile cystic acne treated successfully with oral isotretinoin. The dose of isotretinoin used ranged from 0.2 mg/kg/day to 1.5 mg/kg/day. The treatment duration varied from 5 to 14 months. Careful monthly monitoring is recommended because of the many side effects reported with isotretinoin. Practical tips for the administration of oral isotretinoin in infants are reviewed.
Feasible Model for Prevention of Functional Decline in Older People: Municipality‐Randomized, Controlled Trial
Authors: Vass Mikkel , Avlund Kirsten , Lauridsen Jørgen , Hendriksen Carsten 
Published: March 2005

Objectives: To investigate the effect of an educational program for preventive healthcare professionals in routine primary care on functional ability, nursing home admissions, and mortality in older adults.Design: A prospective, controlled 3‐year follow‐up study (1999–2001) in primary care with randomization and intervention at the municipality level and outcomes measured at the individual level in two age cohorts.Setting: Primary care.Participants: Of 81 eligible municipalities in four counties, 34 agreed to participate. A total study population of 5,788 home‐dwelling subjects aged 75 and 80 were asked to participate. Written consent was obtained from 4,060 persons (70.1%), of whom 2,104 were living in 17 intervention municipalities and 1,956 were living in 17 matched control municipalities.Intervention: Intervention municipality visitors received ongoing education, and local general practitioners were introduced to a short geriatric assessment program early in the study period. Control municipalities visitors and general practitioners received no education.Measurements: At the 3‐year follow‐up, the outcome measures of mortality and nursing home admissions were obtained from all, and the outcome measure of functional ability was obtained from 3,383 (95.6%) of 3,540 surviving participants.Results: Education improved functional ability (odds ratio=1.20, 95% confidence interval (CI)=1.01–1.42, P=.04) in intervention municipality participants, notably in the 80‐year‐olds. There were no differences in mortality (relative risk (RR)=1.06, 95% CI=0.87–1.28, P=.59) or rates of nursing home admissions after 3 years (RR=0.74, 95% CI=0.50–1.09, P=.13). Subjects aged 80 benefited from accepting and receiving in‐home assessment with regular follow‐ups.Conclusion: A brief, feasible educational program for primary care professionals helps preserve older people's functional ability.
High Prevalence of Chlamydia Pneumoniae Antibodies and Increased High‐Sensitive C‐Reactive Protein in Patients with Vascular Dementia
Authors: Yamamoto Hideki , Watanabe Takuya , Miyazaki Akira , Katagiri Takashi , Idei Tsunenori , Iguchi Takashi , Mimura Masaru , Kamijima Kunitoshi 
Published: March 2005

Objectives: To determine the relationships between Chlamydia pneumoniae infection, carotid atherosclerosis, and dyslipidemia in patients with vascular dementia (VaD) and Alzheimer's disease (AD).Design: Case control study.Setting: Showa University Karasuyama Hospital, Tokyo, Japan.Participants: One hundred twenty‐four elderly subjects: 31 with VaD, 61 with AD, and 32 age‐matched controls without dementia.Mesurements: Presence of antibodies to C. pneumoniae (immunoglobulin G (IgG) and IgA), the serum concentrations of high‐sensitive C‐reactive protein (hs‐CRP) and atherogenic lipoproteins, and the carotid artery intima‐media thickness (IMT) and plaques were determined.Results: Age; body mass index; systolic and diastolic blood pressures; and fasting plasma glucose, hemoglobin A1c, high‐density lipoprotein cholesterol, and apolipoprotein A‐I, B, and E concentrations did not differ significantly between the three groups, but the mean IMT and frequency of atherosclerotic plaques in the carotid arteries, as well as the serum concentrations of low‐density lipoprotein cholesterol (LDL‐C), lipoprotein(a), and lipid peroxides were significantly greater in VaD patients than in AD patients or nondemented controls. Hs‐CRP concentrations and prevalence of C. pneumoniae IgG and IgA antibodies also were significantly higher in VaD patients than in AD patients and nondemented controls. Multiple logistic regression analysis revealed that carotid IMT and plaques, LDL‐C, lipid peroxides, hs‐CRP, and IgG and IgA C. pneumoniae seropositivity were independent risk factors for VaD.Conclusion: These results suggest that carotid atherosclerosis, atherogenic lipoproteins, and C. pneumoniae infection (as documented by the IgG and IgA seropositivity together with increased hs‐CRP) may be VaD risk factors.
A Multifactorial Intervention Program Reduces the Duration of Delirium, Length of Hospitalization, and Mortality in Delirious Patients
Authors: Lundström Maria , Edlund Agneta , Karlsson Stig , Brännström Benny , Bucht Gösta , Gustafson Yngve 
Published: March 2005

Objectives: To investigate whether an education program and a reorganization of nursing and medical care improved the outcome for older delirious patients.Design: Prospective intervention study.Setting: Department of General Internal Medicine, Sundsvall Hospital, Sweden.Participants: Four hundred patients, aged 70 and older, consecutively admitted to an intervention or a control ward.Intervention: The intervention consisted of staff education focusing on the assessment, prevention, and treatment of delirium and on caregiver‐patient interaction. Reorganization from a task‐allocation care system to a patient‐allocation system with individualized care.Measurements: The patients were assessed using the Organic Brain Syndrome Scale and the Mini‐Mental State Examination on Days 1, 3, and 7 after admission. Delirium was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria.Results: Delirium was equally common on the day of admission at the two wards, but fewer patients remained delirious on Day 7 on the intervention ward (n=19/63, 30.2% vs 37/62, 59.7%, P=.001). The mean length of hospital stay±standard deviation was significantly lower on the intervention ward then on the control ward (9.4±8.2 vs 13.4±12.3 days, P<.001) especially for the delirious patients (10.8±8.3 vs 20.5±17.2 days, P<.001). Two delirious patients in the intervention ward and nine in the control ward died during hospitalization (P=.03).Conclusion: This study shows that a multifactorial intervention program reduces the duration of delirium, length of hospital stay, and mortality in delirious patients.
Determinants of Self‐Management Strategies to Reduce Out‐of‐Pocket Prescription Medication Expense in Homebound Older people
Authors: Sharkey Joseph R. , Ory Marcia G. , Browne Barry A. 
Published: March 2005

Objectives: To determine the extent to which homebound older people adopt strategies to reduce out‐of‐pocket prescription medication cost and the factors associated with level of cost‐related medication management.Design: Cross‐sectional study.Setting: Home‐delivered meals programs in four North Carolina counties.Participants: Random sample of 222 home‐delivered meal recipients aged 60 and older.Measurements: The use of six different management strategies to reduce medication expenses was reported at the in‐home assessment. Associations between level of cost‐related medication management and sample characteristics, drug coverage, behaviors to cope with out‐of‐pocket medication expense, and payment difficulty were examined.Results: Forty‐five (20.3%) participants used one or more behaviors that restricted medication use; another 47 (21.2%) used one or more strategies to reduce out‐of‐pocket medication cost. Using medication restriction to reduce medication expense was more likely in older people who had difficulty paying for medications (odds ratio (OR)=8.2, 95% confidence interval (CI)=1.4–50.3), or used a strategy to cope with out‐of‐pocket expenses (choose food or medications (OR=5.1, 95% CI=1.7–15.7) or borrowed money or had another person pay for medications (OR=5.5, 95% CI=2.6–11.6)). Income, drug coverage, and medication use (prescribed and over‐the‐counter) increased the likelihood of having increased difficulty paying for medications.Conclusion: Clinicians should attempt to identify patients who are at risk for medication restriction and develop strategies for minimizing any unintended consequences of cost‐related medication management behaviors. Provider‐patient communication should include discussion of medication cost and appropriate medication management strategies.
Dissemination of an Evidence‐Based Multicomponent Fall Risk‐Assessment and ‐Management Strategy Throughout a Geographic Area
Authors: Baker Dorothy I. , King Mary B. , Fortinsky Richard H. , Graff Louis G. , Gottschalk Margaret , Acampora Denise , Preston Jeanette , Brown Cynthia J. , Tinetti Mary E. 
Published: March 2005

Objectives: To report on the penetration of, and identified barriers to and facilitators of, efforts to incorporate evidence‐based fall risk assessment and management into clinical practice throughout a defined geographic area.Design: Dissemination project.Setting: North central Connecticut.Participants: Hospitals, home care agencies, primary care providers, and outpatient rehabilitation facilities.Intervention: Multiple professional behavior‐change strategies were used to encourage providers to incorporate evidence‐based fall assessment and management into their practices.Measurements: Penetration of dissemination efforts over 36 months; barriers and facilitators identified by provider working groups during the first 2 years of the project.Results: All seven hospitals and 26 home care agencies in the area, 119 of 130 rehabilitation facilities, and 138 of 212 primary care offices participated. Most provider working groups expressed similar barriers and facilitating factors. Reported barriers specific to fall risk management included lack of awareness of fall morbidity and preventability, perceived lack of expertise and Medicare coverage, inadequate referral patterns among providers, and lack of a federal mandate for physicians. Facilitating factors specific to falls included the opportunity to market new services and to develop new networks of professional relationships across disciplines and the Medicare mandate that home care agencies focus on functional outcomes.Conclusion: Dissemination efforts showed notable successes as well as challenges. Although many of the barriers were general to diffusing new practices, several were specific to fall assessment and management that span disciplines and sites. Project results have implications for efforts to diffuse evidence‐based practices for multifactorial geriatric conditions such as falls.
There Is Hope for the Future: National Survey Results Reveal that Geriatric Medicine Fellows Are Well‐Educated in End‐of‐Life Care
Authors: Pan Cynthia X. , Carmody Sharon , Leipzig Rosanne M. , Granieri Evelyn , Sullivan Amy , Block Susan D. , Arnold Robert M. 
Published: March 2005

Objectives: To assess the status of geriatric medicine (GM) fellows' training experiences in end‐of‐life care via self‐report.Design: Anonymous surveys completed by mail, Web access, and telephone.Setting: U.S. accredited GM fellowship training programs.Participants: Two hundred ninety‐six surveys were sent to graduating GM fellows in 1‐ and 2‐year programs across the Unites States.Measurements: Measurements assessed self‐reported attitudes, quantity and quality of end‐of‐life care education, preparation to provide care, and perceived value of caring for dying patients.Results: Response rate was 74%. Ninety‐five percent or more of respondents held positive views about physicians' responsibility and ability to help dying patients. Seventy percent of fellows had completed a rotation focused on end‐of‐life care. Fellows who had done such rotations rated their end‐of‐life care education as highly as their overall geriatrics training. Fellows frequently received teaching in many end‐of‐life care topics, with lower rates of teaching how to say goodbye and responding to requests for assisted suicide. Overall, fellows felt well prepared to care for dying patients. Four factors independently predicted such preparedness: having had a palliative or end‐of‐life care rotation, being female, having been taught how to say goodbye to patients, and perceiving that it is important to attending physicians that fellows learn to care for dying patients.Conclusion: GM fellows feel their end‐of‐life care education is excellent and feel prepared to take care of dying patients. It is critical that geriatricians in training have access to and take advantage of palliative and end‐of‐life care rotations.
Soluble CD163 and interleukin‐6 are increased in aqueous humour from patients with endothelial rejection of corneal grafts
Authors: Funding Mikkel , Vorum Henrik , Nexø Ebba , Moestrup Søren Kragh , Ehlers Niels , Møller Holger Jon 
Published: March 2005

Abstract.Purpose:  To evaluate soluble CD163 (sCD163) as a new marker of macrophage activity in aqueous humour from patients with corneal rejection and to investigate correlations between sCD163, the CD163 inducing interleukin‐6 (IL‐6), and albumin; to investigate whether increases in sCD163 and IL‐6 levels in aqueous humour were results of intra‐ or extraocular production, and to investigate the impact of sCD163 and IL‐6 levels on graft outcome. Methods:  Aqueous humour was obtained from 19 patients with endothelial rejection of corneal grafts, seven cataract patients and five cataract patients with uncomplicated corneal grafts. The presence of sCD163 was investigated by immunoprecipitation and immunoblotting. The concentrations of sCD163, IL‐6 and albumin were measured by ELISA. Results:  Soluble CD163 was detected in aqueous humour from patients with corneal rejection. Soluble CD163, IL‐6 and albumin were significantly increased in aqueous humour from patients with corneal rejection when compared with control patients. When normalizing sCD163 and IL‐6 with albumin, the differences between rejection patients and control groups became insignificant for sCD163 but remained significant for IL‐6. Neither IL‐6 nor sCD163 were related to the outcome of the corneal rejection. Conclusions:  Both sCD163 and IL‐6 are present in high levels in aqueous humour from patients with rejection of corneal grafts. Our data suggest that IL‐6 is produced locally, whereas sCD163 is at least partly derived from influx from plasma.
Topical dorzolamide increases pericentral visual function in age‐related maculopathy: pilot study findings with short‐wavelength automated perimetry
Authors: Remky Andreas , Weber Anke , Arend Oliver , Sponsel William Eric 
Published: March 2005

Abstract.Purpose:  Numerous studies have confirmed the enhancement of ocular circulation by carbonic anhydrase inhibitors (CAIs). Topical CAI treatment with dorzolamide averts the significant pericentral visual function loss accompanying retinal and choroidal vasoconstriction during acute hyperventilation‐induced hypocapnia. This study was designed to discern whether dorzolamide might similarly enhance macular function in patients with age‐related maculopathy (ARM). Methods:  In a masked, placebo‐controlled study, 40 patients with ARM and acuity > 20/50 were randomized to receive either dorzolamide or placebo for 12 weeks, thrice daily. After pre‐study perimetric training, pericentral function (mean sensitivity) was quantified using Humphrey 10–2 short‐wavelength automated perimetry (SWAP), before and after 12 weeks of topical therapy. Results:  Dorzolamide‐treated eyes demonstrated a significant increase in mean sensitivity of + 1.55 dB (p = 0.04); placebo‐treated eyes showed no significant change (+ 0.58 dB; p = 0.10). Given the non‐significant increase of mean sensitivity in the placebo‐treated group, fewer than 100 subjects per group would be required to afford > 70% power to yield a significant direct comparative difference between treatment and placebo in a prospective, randomized study of equally short duration. Conclusions:  This study demonstrated a significant increase in short‐wavelength sensitivity in ARM with dorzolamide and the lack thereof with placebo. These encouraging pilot study data suggest a potential role for topical CAIs in ARM patients, and establish objective parameters for prospective studies to further evaluate the effects of dorzolamide in ARM.
Clinical outcomes of phacoemulsification cataract surgery in diabetes patients: visual function (VF‐14), visual acuity and patient satisfaction
Authors: Mozaffarieh Maneli , Heinzl Harald , Sacu Stefan , Wedrich Andreas 
Published: March 2005

Abstract.Purpose:  To evaluate the visual outcomes (visual acuity [VA] and visual function) after phacoemulsification cataract surgery in patients with diabetic retinopathy (DR), and assess patient satisfaction with final surgical outcome. Methods:  This prospective study comprised 74 eyes of 74 patients with different stages of DR. One surgeon (AW) performed all cataract surgery in a standardized fashion. Patients were assessed using the VF‐14 (Visual Function‐14) questionnaire. The following groups of patients were compared: those with no apparent retinopathy; those with mild non‐proliferative DR (NPDR); those with severe NPDR, and those with proliferative DR (PDR). Visual acuity and visual function questionnaire (VF‐14) responses were recorded preoperatively and 3 months postoperatively, during which the non‐operated fellow eye showed no progression in retinopathy. Results:  Improvements in visual outcomes were significantly higher in groups 1 and 2 compared to groups 3 and 4 (Tukey−Kramer, p < 0.001). Comparisons between groups 1, 2 and 3, 4 showed significant differences in improvements in VA (Tukey−Kramer, p < 0.01), yet no statistically significant differences in functional (VF‐14) improvements emerged between these groups. Conclusions:  Patients with more advanced levels of DR showed no functional improvements despite improvements in VA. This emphasizes the relevance of patient education prior to surgery. In particular, it should be explained to patients with more advanced DR that, although surgery may be required, their functional improvement may be limited.
Metamorphopsia after successful retinal detachment surgery: an optical coherence tomography study
Authors: Wang Yi , Li Shi‐ying , Zhu Meidong , Chen Shao‐jun , Liu Yong , Men Xiao‐hong , Gillies Mark , Larsson Jörgen 
Published: March 2005

Abstract.Purpose:  To investigate the findings in optical coherence tomography (OCT) in eyes with metamorphopsia after scleral buckling surgery for macula‐off retinal detachment. Methods:  A total of 46 patients (46 eyes) with macula‐off retinal detachment were prospectively studied 2 months after successful scleral buckling surgery. Patients were examined with the Amsler grid, fundus biomicroscopy and OCT. Results:  At the 2 month follow‐up, 31/46 (67%) patients had metamorphopsia; 24/31 (77%) of these patients had an abnormal macular structure on OCT and 7/31 (23%) showed a normal macula. However, of the 15 patients in the non‐metamorphopsia group, 4/15 (27%) had an abnormal macula and 11/15 (73%) had a normal macula (p = 0.0015). The most common finding on OCT was neurosensory retinal detachment. Conclusions:  Metamorphopsia after scleral buckling surgery in macula‐off detachment is more common in patients in whom abnormal macular structure is seen on the OCT scan compared to those showing a normal macular structure. Neurosensory retinal detachment is the most common pathology in these patients.
YAG curios #2: Nd:YAG laser treatment following suction posterior capsulorhexis
Authors: Jayaram Hari , Uppal Gurmit , Hugkulstone Charles E. 
Published: March 2005

Abstract. Suction posterior capsulorhexis (SPC) is a relatively new technique for creating a posterior capsulorhexis. We present a case series of seven patients who required Nd:YAG laser treatment 27 months after SPC. No patient had pre‐existing risk factors for increased postoperative inflammation and all received a one‐piece polymethylmethacrylate intraocular lens placed in‐the‐bag. Although it reduces the need for Nd:YAG laser treatment, SPC, like the more usual forceps posterior capsulorhexis, does not completely eliminate it.
Comparison of lidocaine 2% gel versus retrobulbar anaesthesia for implantation of Ahmed glaucoma drainage
Authors: Rebolleda Gema , Muñoz‐Negrete Francisco J. , Benatar Jacobo , Corcostegui Juan , Alonso Nieves 
Published: March 2005

Abstract.Purpose:  To compare patient comfort and the efficacy of lidocaine 2% gel versus retrobulbar anaesthesia for Ahmed glaucoma implant surgery. Patients and Methods:  This prospective study included 32 eyes of 32 patients scheduled to undergo implantation of an Ahmed glaucoma drainage device for refractory glaucoma in one institution, randomized to receive either topical lidocaine 2% gel or retrobulbar anaesthesia. Sixteen eyes were randomized to each group. Patient assessment of pain was recorded during delivery of anaesthesia, during surgery and after surgery, using a visual analogue pain scale. The need for additional anaesthesia during tissue manipulation was recorded. Surgeon assessments of operative conditions, patient co‐operation and intraoperative complications were also recorded. Results:  The patients in the retrobulbar group reported significantly more discomfort during administration of the anaesthetic agent than the patients in the topical anaesthesia group (p = 0.000). There was no significant difference in patient‐reported pain scores intraoperatively (p = 0.317) or postoperatively (p = 0.875). Surgeon assessment showed similar levels of patient co‐operation in both groups (p = 0.615). The overall operating conditions were overwhelmingly positive in each group (p = 0.186). The mean duration of surgery was significantly longer in the topical group compared with the retrobulbar group (p = 0.049). Conclusions:  Lidocaine 2% gel is a safe alternative to retrobulbar anaesthesia for Ahmed drainage implant surgery and avoids the significantly greater pain associated with the administration of retrobulbar anaesthesia. It provides a reasonably safe and comfortable surgical environment and is well tolerated by patients.