bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using a Nursing Minimum Data Set with older patients with dementia in an acute care setting
Authors: Park Myonghwa , Delaney Connie , Maas Meridean , Reed David 
Published: July 2004

Background.  Many older people with dementia are admitted to acute care settings suffering from comorbidities. These and their treatments can lead to confusion in these patients, adding to their existing cognitive deficits, and this may not be recognized by care staff. The care of such patients is complex and requires multidisciplinary team input. The purposes of the Nursing Minimum Data Set are to describe the nursing care of patients in a variety of settings and to establish comparability of nursing data across clinical populations, settings and time.Aims.  This paper reports a study to describe the characteristics of hospitalized older patients with dementia and nursing diagnoses and nursing interventions for these patients, and to identify trends in the nursing care provided over a 3‐year period using a Nursing Minimum Data Set from a community hospital in the United States of America.Methods.  Secondary data analysis was conducted in 2000 on a large clinical discharge data set containing Nursing Minimum Data Set elements. The sample included 597 elders with dementia among a total of 7772 older patients who were discharged between 1996 and 1998.Results.  The most common comorbidity was hypertension (n = 123, 21%), followed by cardiac dysrhythmias (n = 80, 13%). The most frequent nursing diagnoses were altered health maintenance (n = 419, 84%), knowledge deficit (n = 357, 71%), potential for injury (n = 242, 48%), potential for infection (n = 230, 46%), pain (n = 184, 37%), impaired physical mobility (n = 169, 34%), and altered thought process (n = 144, 29%). The most frequent interventions were discharge planning (n = 340, 68%), surveillance safety (n = 195, 39%), fall prevention (n = 175, 35%), teaching: disease process (n = 166, 33%), learning facilitation (n = 148, 30%), and infection protection (n = 147, 29%).Conclusions.  The results provide a description of nursing diagnoses and interventions for elders with dementia in an acute care setting using the Nursing Minimum Data Set framework. They identify the need to develop staff education programmes for individualized care of older patients with dementia. In addition, they support the need for continued work on linkage of the nursing care elements of the Nursing Minimum Data Set, including nursing diagnoses, nursing interventions, and nursing‐sensitive outcomes.
The ARIA/EAACI criteria for antihistamines: an assessment of the efficacy, safety and pharmacology of desloratadine
Authors: Bousquet J. , Bindslev‐Jensen C. , Canonica G. W. , Fokkens W. , Kim H. , Kowalski M. , Magnan A. , Mullol J. , Van Cauwenberge P. 
Published: July 2004

Background:  The definition of allergic rhinitis and the classification of its severity and treatment have advanced in recent years following the publication of the Allergic Rhinitis and its Impact of Asthma (ARIA) document. The ARIA and the European Academy of Allergology and Clinical Immunology (ARIA/EAACI) have published a set of recommendations that outline the pharmacological and clinical criteria to be met by medications commonly used in the treatment of allergic rhinitis.Methods:  An international group of experts met to assess the profile of the antihistamine, desloratadine, under the ARIA/EAACI criteria. Data on desloratadine were collected from peer‐reviewed clinical studies and review articles, which were corroborated and augmented by comprehensive public access documents from the European Medicines Evaluation Agency (EMEA).Results and conclusion:  Based on this systematic review, it was concluded that the efficacy, safety and pharmacology of desloratadine broadly meet the ARIA/EAACI criteria for antihistamines.
Analysis of the cardiovascular risk profile in stable kidney transplant recipients after 50% cyclosporine reduction*
Authors: Wong Waichi , Tolkoff‐Rubin Nina , Delmonico Francis L , Cardarelli Francesca , Saidman Susan L , Farrell Mary Lin , Shih Vivian , Winkelmayer Wolfgang C , Benedict Cosimi A , Pascual Manuel 
Published: July 2004

Abstract:  Background:  Long‐term use of cyclosporine (CsA) contributes to post‐transplant cardiovascular disease (CVD). Hence, a reduction in CsA dosage in kidney transplant recipients (KTR) may improve long‐term outcomes. We analyzed the effects of 50% CsA dose reduction on the CVD risk profile in stable KTR.Method:  Thirty‐one KTR on a regimen of CsA, prednisone and mycophenolate mofetil (MMF) were studied. Patients were randomized to either a) continue their previously determined CsA dose (control group, n = 15) or b) lower their CsA dose by 50% (CsA reduction group, n = 16). Renal function, blood pressure, lipid profile, plasma homocysteine (HCY), C‐reactive protein (CRP), fibrinogen, and uric acid were compared at baseline and at 6 months.Results:  At 6 months, there was a significant improvement in allograft function, systolic blood pressure, number of anti‐hypertensive medications and serum uric acid levels in the CsA reduction group. No significant decrease in plasma HCY, CRP, fibrinogen or improvement in lipid profile was found. In contrast, in the Control group, there was a significant increase in HCY, uric acid, and triglycerides. No acute rejection occurred in either group.Conclusions:  A greater reduction in CsA dose could further improve CVD risk profiles, although this may increase the risk of acute or subclinical rejection.
Thromboelastography used to assess coagulation during treatment with molecular adsorbent recirculating system
Authors: Doria Cataldo , Mandalà Lucio , Smith Jan D , Caruana Giuseppe , Scott Victor L , Gruttadauria Salvatore , Magnone Mario , Marino Ignazio R 
Published: July 2004

Abstract:  Coagulopathy is a life‐threatening complication of liver cirrhosis. We describe the effect of molecular adsorbent recirculating system (MARS), a cell‐free dialysis technique, on the blood coagulation of cirrhotic patients.From February 2002 to July 2002, nine patients – five males (55.5%) and four females (44.4%), age 47–70 yr (median 56) – underwent 12 courses (4–7 sessions each) of MARS. Patients were treated for the following indications: six (66.6%) acute‐on‐chronic hepatic failure, three (33.3%) intractable pruritus. Platelet count, prothrombin time (PT), international standardized ratio and thromboelastography were measured before and after each MARS session. Coagulation factors II, V, VII, VIII, IX, X, XI, XII, XIII, von Willebrand, lupus anticoagulant, protein C, protein S, antithrombin III, plasminogen, α2 antiplasmin, d‐dimer, fibrin monomers, complement, and C1 inactivator were measured before and at the end of each MARS treatment.We found a statistically significant difference (p < 0.05) in the platelet count, PT, all the thromboelastograph variables (reaction and constant time, α angle, and maximal amplitude), factor VIII, von Willebrand, and d‐dimer, when measured before and after MARS.Previous reports have shown amelioration of blood coagulation following MARS treatments. However, we document that MARS induces coagulopathy through a platelet‐mediated mechanism, whereby platelet may be mechanically destroyed during the passage of blood through the filters and lines. An alternative postulated mechanism is an immune‐mediated platelet disruption – coagulopathy.
Cost‐effectiveness of post‐transplantation quality of life intervention among kidney recipients
Authors: Chang Cyril F , Winsett Rebecca P , Osama Gaber A , Hathaway Donna K 
Published: July 2004

Abstract:Background: The purpose was to demonstrate the cost‐effectiveness of an experimental post‐transplant care program designed to improve kidney transplant recipients’ quality of life (QoL). The intervention program integrated a three‐pronged interdisciplinary approach emphasizing: (i) proactive, patient‐initiated care to prevent transplant‐related morbidities, (ii) employment/vocational counseling, and (iii) enhancement of social support.Methods: A cost‐effectiveness analysis of a clinical trial was performed comparing QoL and costs in two groups: a retrospective cohort (n = 30) and those who received the experimental interventions (n = 150). Data were collected at baseline, 6 and 12 months. The number of quality‐adjusted ‘treatment‐free days’ was used as the primary outcome. The costs included those for direct intervention, direct inpatient and outpatient post‐transplant health care, and indirect out‐of‐pocket expenses borne by patients.Results: Patients in the intervention group had more quality‐adjusted treatment‐free days (289 vs. 272 and statistically significant) and lower cost per patient (although not statistically significant). Further, the superior outcome was delivered at an incremental cost of $29 per quality‐adjusted treatment‐free day. A one‐way sensitivity analysis confirmed the robustness of the results.Conclusion: The experimental post‐transplant care program is both effective and cost‐effective; the superior results are attributed to improved QoL.
Genotype prevalence, viral load and outcome of hepatitis B virus precore mutant infection in stable patients and in patients after liver transplantation
Authors: Ben‐Ari Ziv , Ashur Yaffa , Daudi Nili , Shmilovitz‐Wiess Hemda , Brown Marius , Sulkes Jaqueline , Klein Athalia , Mor Eytan , Tur‐Kaspa Ran , Shouval Daniel 
Published: July 2004

Abstract:  Objective:  The precore mutant is detectable in most Israeli patients with persistent hepatitis B virus (HBV) infection. The aim of this study was to determine the prevalence of HBV genotypes, viral load and outcome of precore mutant infection in stable patients and in patients after liver transplantation.Methods:  The prevalence of HBV genotype and viral load were investigated in 81 patients with HBV precore mutant infection. Of these, 50 patients (40 males, 10 females; mean age 43.4 ± 11.0 yr) underwent liver transplantation and were serum HBV DNA‐negative by hybridization at the time of transplantation. Patients received long‐term HBV immunoprophylaxis and immunosuppression, and lamivudine in cases of graft HBV recurrence. The remaining 31 patients were stable, with serum anti‐HBe‐positivity. Genotypes were tested by restriction fragment length polymorphism of an S gene amplicon. Precore mutations were studied with an INNO‐LiPA probe assay.Results:  Follow‐up was 46.6 ± 37.7 months. Most of the transplanted group was of Middle Eastern origin (53.6%); the remainder were from Eastern Europe (21.4%), Western Europe and the USA (10.8%), Africa (7.1%), and Asia (7.1%). In the transplanted group, the pre‐transplant HBV genotype D was the most prevalent (96%), while genotype A was found in only 4%. Eleven patients (22%) developed recurrent HBV infection post‐transplantation. There were no differences in genotype distribution between patients with graft reinfection or lamivudine resistance and patients without recurrence. Mean viral load at recurrence was 148.4 × 106 ± 60.4 × 106 copies/mL. The stable group had a similar origin and HBV genotype prevalence, but a lower mean viral load of 12.4 × 106 ± 29.4 × 106 copies/mL (p = 0.007). The prevalence of mutations at the precore region and codon 28 was similar in both groups.Conclusions:  The chronic precore mutant HBV‐infected patients were characterized as follows: (i) genotype D was the most frequent genotype, (ii) the HBV genotype distribution was similar in patients with stable infection and after liver transplantation, (iii) viral load at recurrence was significantly higher than in stable infection, and (iv) HBV genotype was unrelated to the development of recurrence or lamivudine resistance in the tested population.
Postural hand tremor before and following liver transplantation and immunosuppression with cyclosporine or tacrolimus in patients without clinical signs of hepatic encephalopathy
Authors: Paul Friedemann , Müller Jörg , Christe Walter , Steinmüller Thomas , Poewe Werner , Wissel Jörg 
Published: July 2004

Abstract:  Objective:  To assess tremor characteristics and severity in patients with severe liver disease without hepatic encephalopathy and following orthotopic liver transplantation (LTX) and immunosuppresion (IS) with cyclosporin A (CsA) or tacrolimus (FK 506).Methods:  A total of 35 consecutive patients were included into the prospective study and serum levels of CsA (n = 29) or FK 506 (n = 6) were monitored following LTX. Tremor characteristics and severity were assessed by two‐blinded raters before and following LTX. In addition, accelerometric recordings were taken before and after LTX, and compared with 16 normal controls without tremor and without clinical signs of hepatic encephalopathy or liver disease. Accelerometry was performed while sitting in a comfortable chair with the forearms supported and included rest and postural condition with and without weight load (500 g) on each hand. Kolmogorov–Smirnov test, paired t‐test and t‐test for independent samples were used for statistical analysis.Results:  The clinical rating revealed no rest but a mild postural hand tremor before LTX with a significant increase following LTX (p < 0.001). After LTX the mean score of postural tremor was significantly (p < 0.05) higher in patients with plasma levels of >850 ng CsA/ml compared with patients with lower levels. Patients and normal controls showed comparable mean peak frequencies of rest and postural hand tremor. The mean amplitude of postural hand tremor was significantly higher in patients before and after LTX compared with controls. In the majority of patients (89%) and controls (88%), the dominant tremor frequency decreased significantly (>1.5 Hz) when applying a weight load on each hand.Conclusion:  The present study is the first to describe hand tremor characteristics in patients with severe liver disease without clinical signs of hepatic encephalopathy and in patients following LTX and IS. Compared with normal controls the patients showed a significant postural hand tremor prior and post‐LTX and an increase of mean tremor amplitude following LTX and CsA/FK 506 treatment. The decrease of the dominant tremor frequency with weight load and an increase of tremor amplitude with higher plasma levels of CsA are both indicative of an enhanced physiological or toxic tremor.
Evaluation of 84 elderly donors in renal transplantation
Authors: Rigotti Paolo , Baldan Nicola , Valente Marialuisa , Scappin Sabrina , Furian Lucrezia , Cadrobbi Roberto , Marchini Francesco , Ancona Ermanno 
Published: July 2004

Abstract:  Background:  The use of elderly donors (ED) and dual kidney transplantation (DKT) procedures have become common in clinical practice. A correct evaluation of kidneys from ED is crucial to avoid unsuccessful transplantation or the use of DKT when a single transplant (ST) would be equally successful. The aim of this investigation was to assess the role of renal biopsy (RB) in the assessment of kidneys from ED.Patients and methods:  A total of 84 ED aged ≥ 60 yr were evaluated. In 19 cases, the kidneys were not used, mainly because of atherosclerotic vascular lesions. A histological score (HS) from 0 to 12 was awarded, considering the proportion of glomerulosclerosis, tubular atrophy, interstitial fibrosis, and arterial and arteriolar narrowing. On the basis of the HS, 37 donors were selected for 40 ST and 21 for DKT, three were discarded. All recipients received triple‐drug therapy based on calcineurin inhibitors, mycophenolate mofetil and steroids.Results:  Primary non‐function was observed in three of 40 ST and one of 21 DKT. Acute tubular necrosis occurred in 22/40 ST and in 11/21 DKT. Acute rejection occurred in 16/40 ST and four of 21 DKT. Renal function was satisfactory in both groups, with 1‐yr S‐Cr = 171 umol/L and 137 umol/L, respectively in the ST and DKT groups. One‐year patient survival was 92% in ST and 100% in DKT; 1‐yr graft function was 87% in ST and 95% in DKT.Conclusion:  The histological assessment of kidneys from ED enables a correct selection of kidneys for ST or DKT and prevents the transplantation of high‐risk kidneys.
An open randomized study comparing immunosuppression therapy initiated before or after kidney transplantation in haploidentical living recipients
Authors: Câmara Niels Olsen S. , Dias Mônica Felizardo L. , Pacheco‐Silva Alvaro 
Published: July 2004

Abstract:  Background:  Acute rejection is the most important risk factor for graft survival. Although many centers start immunosuppressive therapy days before the surgery in living donors, there is no systematic study concerning the possible advantages of this procedure. In this open randomized study, we compared the efficacy and safety of administration of cyclosporine (CSA; Neoral®) and azathioprine before renal transplantation with the administration of the same schema after transplantation, in HLA haploidentical grafts.Methods:  Sixty renal transplant recipients of an HLA haploidentical allograft from living donors were randomized in two groups: (A) patients that started immunosuppression 3 d before transplantation (n = 30) and (B) those who started the drug schema on the first day after surgery (n = 30). We analyzed the incidence and severity of acute rejection, graft function and infection during the first 3 months after transplantation.Results:  The group of patients who started immunosuppression before had a mean trough level of CSA (299.70 ± 154.03 ng/mL) in the expected range for an efficacious prevention of acute rejection at the surgery day. Thirteen patients (43.3%) in each group had acute rejection during the follow up (p = 1.00). Two grafts losses (3.3%) occurred, one in each group. Both groups had similar 3‐month rejection‐free graft survival (56.7 and 56.3%). The incidence of infection was also statistical comparable between groups A and B (56.7 vs. 46.7, p = 0.430). Graft function was similar in patients from both groups.Conclusions:  Pre‐transplant administration of immunosuppression did not reduce the incidence or severity of acute rejection episodes during the first 3 months of transplantation. Immunosuppressive drugs administered before engraftment did not increase the incidence of graft dysfunction or infection.
Four‐year follow‐up of a prospective randomized trial of mycophenolate mofetil with cyclosporine microemulsion or tacrolimus following liver transplantation
Authors: Fisher Robert A , Stone James J , Wolfe Luke G , Rodgers Cheryl M , Anderson Melodie L , Sterling Richard K , Shiffman Mitchell L , Luketic Velimer A , Contos Melissa J , Scott Mills A , Ferreira‐Gonzalez Andrea , Posner Marc P 
Published: July 2004

Abstract:  Background:  This is a 4‐yr follow‐up of a trial using mycophenolate mofetil (MMF) induction in orthotopic liver transplantation (OLT). The goal of this study was to evaluate a multidrug approach that would reduce both early and long‐term morbidity related to immunosuppression while maintaining an acceptable freedom from rejection.Methods:  This was a prospective, randomized, intent to treat study designed to compare the primary endpoints of rejection and infection, and secondary endpoints of liver function, renal function, bone marrow function, cardiovascular risk factors, and the recurrence of hepatitis C. Ninety‐nine consecutive patients with end stage liver disease who underwent OLT were randomized to receive either cyclosporine microemulsion (N) (50 patients) or tacrolimus (FK) (49 patients) starting on postoperative day 2, with MMF and an identical steroid taper begun preoperatively.Results:  Ninety of 99 patients (N 46, FK 44) completed the 4‐yr follow‐up. The overall 4‐yr patient and graft survivals were 93 and 89%, respectively. There was no significant difference in 4‐yr patient (N 96% vs. FK 90%, p = ns) or graft (N, 90% vs. FK, 88%, p = ns) survival between groups. The 4‐yr rejection rate was not significantly different in either arm (N = 34%, FK = 24%; p = 0.28). There were no differences in infection rates in either arm. The patients with hepatitis C had no differences in the viral titers or Knodell biopsy scores between groups. However, in the hepatitis C subgroup (37 patients), the FK patients had a significantly lower rejection rate (p = 0.0097) and a significantly lower clinically recurrent hepatitis C rate (p = 0.05) than the N patients. No difference was seen in the percent of patients weaned off of steroids after 4 yr (N 51%, FK 49%). There were no differences in the incidences of diabetes mellitus and hypertension. When renal dysfunction was analyzed, a significant difference in the number of patients whose creatinine had increased twofold since transplant was seen (N 63%, FK 38%, p = 0.04).Conclusions:  Use of MMF induction and maintenance following OLT in conjunction with either N or FK and an identical steroid taper, resulted in an acceptable long‐term incidence of rejection and infection, without an increase in long‐term graft or patient morbidity.
Increased arterial stiffness in cyclosporine‐treated lung transplant recipients early after transplantation
Authors: Silverborn Martin , Ambring Anneli , Nilsson Folke , Friberg Peter , Jeppsson Anders 
Published: July 2004

Abstract:Background:  The majority of patients undergoing solid organ transplantation develop hypertension, to which cyclosporine (CsA)‐induced peripheral vasoconstriction may contribute. We hypothesized that CsA‐treated transplant recipients have an increased basal vascular tone and an altered response to nitric oxide. To test this hypothesis arterial resistance, non‐endothelial dependent relaxation and arterial stiffness were investigated in CsA‐treated lung transplant recipients within 18 months after transplantation.Methods:  In study 1, forearm blood flow (FBF) was measured by venous occlusion plethysmography at baseline and during glyceryl trinitrate (GTN) and N(G)‐monomethyl‐l‐arginine acetate (l‐NMMA) infusion in seven lung transplant recipients and nine healthy subjects. In study 2, arterial stiffness in carotid (CCA) and radial artery (RA) was measured by ultrasound (echo‐tracking) in 10 lung transplant recipients, 12 healthy subjects and six patients waiting for lung transplantation.Results:  Basal FBF (3.1 ± 0.2 vs. 3.0 ± 0.3 mL/min, p = 0.79) and forearm arterial resistance (36 ± 3 vs. 33 ± 3 mmHg/mL/min, p = 0.60) did not differ between transplant recipients and controls. GTN infusion increased and l‐NMMA decreased blood flow equally in both groups. Transplant recipients had increased arterial stiffness compared to both pre‐transplant patients and healthy subjects (CCA stiffness index 11.7 ± 1.1 vs. 8.5 ± 0.2 and 8.6 ± 0.6, p < 0.05 both; RA stiffness index 14.7 ± 1.5 vs. 8.9 ± 1.3 and 10.6 ± 0.7, p < 0.05 both).Conclusions:  Forearm blood flow and arterial resistance did not differ between healthy subjects and cyclosporine‐treated lung transplant recipients early after transplantation. Increased arterial stiffness was demonstrated in transplant recipients, which may have implications for future development of transplant hypertension.
Afferent and Efferent Connections of the Nucleus Geniculatus Lateralis Ventralis Demonstrated by WGA‐HRP in the Chick
Authors: Hu M. , Naito J. , Chen Y. , Ohmori Y. , Fukuta K. 
Published: July 2004

SummaryFibre connections of the chick nucleus geniculatus lateralis ventralis (GLv) were investigated using the axonal tracing method with wheat germ agglutinin conjugated to horseradish peroxidase (WGA‐HRP). After an injection of WGA‐HRP into the GLv, many labelled neurons were observed in layer i of the stratum griseum et fibrosum superficiale (SGFS) in the ipsilateral tectum opticum (TO) and in the nucleus lentiformis mesencephali (LM). In the TO‐GLv projection, cells of origin were located in the deeper part of layer i of the TO and were topographically distributed along the direction from the rostrodorsal part to the caudoventral part of the TO relating to a rostrocaudal axis of the GLv. In the LM‐GLv connection, the dorsal and ventral parts of the LM connected reciprocally with the rostral and caudal halves of the GLv, respectively. In contrast, in the GLv efferent connection, labelled axon terminals spread widely in the ipsilateral area pretectalis without any clear topographical arrangement.