bluuebunny/crossref_metadata_2025_split huggingface dataset:
Necrolytic migratory erythema: clinicopathologic study of 13 cases
Authors: Pujol Ramon M. , Wang Chin‐Yao Eric , El‐Azhary Rokea A. , Su W. P. Daniel , Gibson Lawrence E. , Schroeter Arnold L. 
Published: December 2003

AbstractBackground  The clinical mucocutaneous manifestations of glucagonoma syndrome are recognized easily when they occur in the classic pattern of acral or periorificial lesions evolving in recurrent crops, with an annular and migratory distribution, in a patient with diabetes mellitus who has had recent weight loss and anemia. Not infrequently, noncharacteristic clinical and histopathologic features are observed and, in these cases, the diagnosis of pancreatic neoplasm may be delayed.Aim  To review the clinical and histopathologic features of cutaneous manifestations of glucagonoma syndrome.Methods  The clinicopathologic features of 13 patients (eight women) with widespread or localized cutaneous eruption as a manifestation of islet cell pancreatic carcinoma with marked glucagon secretion (glucagonoma) were reviewed.Results  The definitive diagnosis of the cutaneous eruption was established at the time of diagnosis of the pancreatic neoplasm (three patients) or afterwards (10 patients). In nine patients, the mucocutaneous manifestations preceded the diagnosis of the pancreatic neoplasm by 1 month to 3 years (mean, 12 months). In only eight biopsy specimens were the histopathologic features considered to be suggestive or characteristic of necrolytic migratory erythema. Diffuse parakeratosis, that occasionally arose abruptly from normal epidermis, was observed in 12 biopsy specimens. By the time necrolytic migratory erythema was diagnosed, the pancreatic carcinoma had metastasized to the liver, regional lymph nodes, or bone in 12 patients.Conclusion  Increased awareness of the polymorphic mucocutaneous and nonspecific histopathologic features of glucagonoma syndrome is needed to avoid unnecessary delay in the diagnosis of this syndrome.
Erythema multiforme associated with phenytoin and cranial radiation therapy: A report of three patients and review of the literature
Authors: Ahmed Iftikhar , Reichenberg Jason , Lucas Allison , Shehan James M. 
Published: December 2003

AbstractBackground  Intracranial malignancies (primary and metastatic) are often complicated by seizure activity. Phenytoin (Dilantin) is typically employed as prophylactic anticonvulsant in this setting. Uncommonly, erythema multiforme (EM) can develop in such patients at the port site during or soon after cranial radiation and can rapidly progress to EM major. Herein, in addition to a comprehensive literature review of this entity, three additional patients are presented. The acronym ‘EMPACT’ is suggested (E: erythema; M: multiforme; associated with P: phenytoin; A: and; C: cranial, radiation; T: therapy) to best describe this disorder.Methods  An extensive review of the English medical literature through the National Library of Medicine (PUBMED) was performed to identify patients who had received or continued to receive radiation therapy while on phenytoin. A total of 24 patients were identified and clinical information of varying detail was available in all cases. Clinical and histological information on three additional patients seen at two institutions (Rochester Methodist Hospital, Rochester, MN, and Fairview‐University Medical Center, Minneapolis, MN) by the authors were also compiled.Results  The mean age was 44 years (range: 23–67) and no sexual predisposition was noted. All patients had taken phenytoin for variable time periods (range 16–80 days; mean: 40) and were on the medication when the skin lesions first appeared. These lesions developed within the port site during the radiation treatments (11 cases) or soon after (nine cases) its completion (mean: 16 days; range: 2–35). Subsequent disease evolution to EM major occurred in all cases (Stevens–Johnsons syndrome developed in 73% of patients). No relationship was identified between the extent and the severity of the skin lesions with the phenytoin and radiation dosages and with the histologic type and origin of the intracranial malignancy. None of the patients demonstrated the requisite features of the ‘Dilantin hypersensitivity syndrome’. Although, a systemic steroid taper was employed in 10 out of the 14 patients before the development of the skin lesions, the subsequent progression of the skin lesions was not influenced by the use of systemic steroid therapy. Complete recovery occurred in all but two patients typically within 1–8 weeks of discontinuation of phenytoin.Conclusions  The need for prophylactic anticonvulsant therapy especially utilizing phenytoin in patients undergoing cranial radiation therapy should be assessed on a case by case basis. If anticonvulsants are employed, then they must be administered with caution, and all cutaneous reactions developing subsequently within the radiation site must be promptly evaluated with a high index of suspicion for erythema multiforme.
Suggestion for the treatment of steatocystoma multiplex located exclusively on the face
Authors: Düzova Aylin Noyan , Şentürk Gonca Boztepe 
Published: December 2003

AbstractBackground  Although there are numerous reports of different treatment methods, the long‐term management of steatocystoma multiplex remains difficult. In this article we describe a simple technique that we used to treat the cysts on the face of a patient.Methods  A 31‐year‐old male with steatocystoma multiplex located on the forehead and both temples was treated by inserting the tip of a needle and extirpating the contents, without removing the cyst wall.Results  The procedure was very well tolerated by the patient. There have been no complications during or following the procedure. There were no recurrences after 10 months of follow up.Conclusions  We suggest that this very simple technique is worth trying as a treatment of choice, especially for the management of facial lesions, where scaring is unacceptable.
Itraconazole in the treatment of seborrheic dermatitis: a new treatment modality
Authors: Baysal Vahide , Yildirim Mehmet , Ozcanli Cagnur , Ceyhan A. Murat 
Published: December 2003

AbstractBackground  Due to the high rate of recurrence, seborrheic dermatitis (SD) represents a therapeutic problem.Aim  To evaluate the role of oral itraconazole in the treatment of SD.Patients and methods  Thirty‐two patients with SD were enrolled in the study. All topical and oral treatments were stopped. The patients applied 1% hydrocortisone cream twice daily for 1 month. In addition, they took itraconazole, 200 mg/day, during the first week of the first month and then hydrocortisone cream was stopped and itraconazole (200 mg/day) was given on the first 2 days of the following 11 months. The patients were followed for 2 months without medicine. The severity score was measured at the initial evaluation, and at the first, 12th, and 14th months.Results  Twenty‐eight patients completed the study. There was a statistically significant decrease in the mean severity score at the first, 12th, and 14th months. On the final evaluation at the 12th month, 19 of the 28 patients showed a complete improvement, and three patients showed a slight improvement.Conclusions  This study indicates that itraconazole plays an important role in the treatment of SD.
Group work in the mental health field: researching outcome
Authors: McDermott Fiona 
Published: December 2003

This paper reviews outcome studies from groups facilitated for persons living with serious mental illness. Although the research base is limited (groups posing considerable methodological challenges), available studies show that, in general, group work is as effective as individual work, if not more so. This paper describes findings from studies of short‐term, long‐term and self‐help groups dealing with mood disorders, schizophrenia, eating disorders and borderline personality disorders over the last 10 years. The concept of ‘time‐effective’ group work is discussed as are the potentially harmful effects of group participation. The paper concludes by arguing that group work is an effective and less expensive treatment option that would benefit from further research to establish an evidence base, both for current practice and for the expansion of group work practice in the future.
Breakdown of foster care placement: carer perspectives and system factors
Authors: Gilbertson Robyn , Barber James G 
Published: December 2003

A crisis in foster care is suggested by many of the national and international published reports. One seemingly intractable problem is placement instability, particularly for adolescents with behavioural problems. A qualitative study of foster carers who had ended a placement because of the young person's disruptive behaviour (n = 19) was conducted to examine ways in which system shortcomings might be affecting placement outcomes. Data were collected on the process of placement deterioration, the incident(s) that precipitated the decision to end placement, formal carer support, and the carer's response to the breakdown. All placements fell into one of two categories: those that, with certain interventions, might have been sustained (n = 9); and those that, regardless of intervention, appear to have been unsustainable (n= 10). This study contributes to the alternative care literature by highlighting the potential of some faltering placements to be maintained and of some failed placements to be renegotiated.
A Placebo‐Controlled Trial of a Proprietary Extract of North American Ginseng (CVT‐E002) to Prevent Acute Respiratory Illness in Institutionalized Older Adults
Authors: Mcelhaney Janet E. , Gravenstein Stefan , Cole Sharon K. , Davidson Edward , O'neill Dennis , Petitjean Sharon , Rumble Barry , Shan Jacqueline J. 
Published: December 2003

Objectives: To compare a proprietary extract of American ginseng, CVT‐E002, with placebo in preventing acute respiratory illness (ARI) in an institutional setting during the influenza season.Design: Two randomized, double‐blind, placebo‐controlled trials conducted late in the 2000 (8 week) and 2000–2001 (12 week) influenza seasons.Setting: Long‐term care setting that included nursing home and assisted living at three sites.Participants: Eighty‐nine (2000) and 109 (2000–2001) enrolled subjects, average age 81 and 83.5, respectively; 74% women. Approximately 90% had received influenza vaccine in each of the 2 years.Intervention: Oral twice‐daily administration of a proprietary ginseng extract, CVT‐E002, 200 mg or placebo.Measurements: ARI was defined as two new respiratory symptoms or one with a constitutional symptom. Confirmation of viral ARI was by culture (influenza or respiratory syncytial virus (RSV)) or serology for influenza. Laboratory safety monitoring was done at 0, 4, and 8 or 12 weeks.Results: An intent‐to‐treat analysis of pooled data corrected for drug exposure time showed that the incidence of laboratory‐confirmed influenza illness (LCII) was greater in placebo‐ (7 cases/101 subjects) than CVT‐E002‐treated (1/97) groups (odds ratio (OR)=7.73, P=.033). Combined data for LCII and RSV illness were also greater in placebo‐ (9/101) than CVT‐E002‐treated (1/97) groups (OR=10.50, P=.009), for an overall 89% relative risk reduction of ARI in the CVT‐E002 group.Conclusion: CVT‐E002 was shown to be safe, well tolerated, and potentially effective for preventing ARI due to influenza and RSV.
Outcomes and Costs Among Seniors Requiring Hospitalization for Community‐Acquired Pneumonia in Alberta
Authors: Carriere Keumhee C. , Jin Yan , Marrie Thomas J. , Predy Gerry , Johnson David H. 
Published: December 2003

Objectives: To determine the age‐specific rates of hospital discharge, cost per day, and overall in‐hospital 1‐ and 4‐year mortality for seniors who required hospitalization for the treatment of community‐acquired pneumonia (CAP).Design: Retrospective analysis of two administrative health service databases.Setting: Province of Alberta, Canada.Participants: Residents of Alberta aged 18 and older.Measurements: Hospital abstracts and vital statistics from April 1, 1994, to March 31, 1999, were analyzed, and mortality and cost outcomes statistically modeled by regression.Results: There were 8,500 annual hospital discharges for CAP costing more than $40 million per year. The overall in‐hospital all‐cause mortality rate was 12%, and the 1‐year mortality rate was 26%. The mean age of pneumonia cases increased (P<.000) from 62.8 in 1994/1995 to 67.2 in 1998/1999. The proportion of hospital discharges in those aged 85 and older was 13% in 1994/1995, increasing to 18% in 1998/1999 (P<.000). The age‐specific hospital discharge rate and length of hospitalization increased with age. After adjustment for other factors using modeling, it was found that the relative risk (RR) of in‐hospital and 1‐year mortality increased with age, the RR of using special medical care and higher‐than‐average daily hospital cost decreased with age, and the RR of greater‐than‐average daily hospital cost was not associated with an increase in comorbidity. Total costs per hospital stay were similar in patients aged 85 and older to those in patients aged 65 to 74, despite a one‐third longer length of stay, which was consistent with reduced use of special medical care in those aged 85 and older.Conclusion: The increased use of hospital resources for CAP in the setting of an aging population may have been partially avoided because of limitations in care provided for seniors aged 85 and older.
Antibiotic Treatment of Acute Respiratory Tract Infections in the Elderly: Effect of a Multidimensional Educational Intervention
Authors: Gonzales Ralph , Sauaia Angela , Corbett Kitty K. , Maselli Judith H. , Erbacher Kathleen , Leeman‐castillo Bonnie A. , Darr Carol A. , Houck Peter M. 
Published: December 2003

Objectives: To measure and improve antibiotic use for acute respiratory tract infections (ARIs) in the elderly.Design: Prospective, nonrandomized controlled trial.Setting: Ambulatory office practices in Denver metropolitan area (n=4 intervention practices; n=51 control practices).Participants: Consecutive patients enrolled in a Medicare managed care program who were diagnosed with ARIs during baseline (winter 2000/2001) and intervention (winter 2001/2002) periods. A total of 4,270 patient visits were analyzed (including 341 patient visits in intervention practices).Intervention: Appropriate antibiotic use and antibiotic resistance educational materials were mailed to intervention practice households. Waiting and examination room posters were provided to intervention office practices.Measurements: Antibiotic prescription rates, based on administrative office visit and pharmacy data, for total and condition‐specific ARIs.Results: There was wide variation in antibiotic prescription rates for ARIs across unique practices, ranging from 21% to 88% (median=54%). Antibiotic prescription rates varied little by patient age, sex, and underlying chronic lung disease. Prescription rates varied by diagnosis: sinusitis (69%), bronchitis (59%), pharyngitis (50%), and nonspecific upper respiratory tract infection (26%). The educational intervention was not associated with greater reduction in antibiotic prescription rates for total or condition‐specific ARIs beyond a modest secular trend (P=.79).Conclusion: Wide variation in antibiotic prescription rates suggests that quality improvement efforts are needed to optimize antibiotic use in the elderly. In the setting of an ongoing physician intervention, a patient education intervention had little effect. Factors other than patient expectations and demands may play a stronger role in antibiotic treatment decisions in elderly populations.
Healthy Elderly People Lack Neutrophil‐Mediated Functional Activity to Type V Group B Streptococcus
Authors: Amaya Rene A. , Baker Carol J. , Keitel Wendy A. , Edwards Morven S. 
Published: December 2003

Objectives: To determine the function of capsular polysaccharide (CPS)‐specific immunoglobulin‐G (IgG) and neutrophils from older adults in increasing ingestion and killing of type V group B Streptococcus (GBS).Design: Cross‐sectional study.Setting: Outpatient clinic at Baylor College of Medicine.Participants: The subjects were 40 healthy, community‐dwelling adults aged 65 and older from Houston, Texas.Measurements: The serum level of type V GBS CPS‐specific IgG was measured using an enzyme‐linked immunosorbent assay. Functional activity was evaluated using an opsonophagocytosis assay.Results: Sera from four subjects promoted efficient neutrophil‐mediated phagocytosis and killing of type V GBS (mean log10 reduction±standard deviation in colony‐forming units (cfu)=1.51±0.39). Each had serum CPS‐specific IgG concentrations exceeding 1 μg/mL. Sera from 36 subjects did not promote neutrophil‐mediated functional activity (mean log10 reduction in cfu=−0.09±0.06; P=.025). Only one of these 36 had a CPS‐specific IgG concentration exceeding 1 μg/mL. When pooled sera from young adults given type V GBS conjugate vaccine was added at CPS‐specific IgG concentrations of 4 μg/mL or 0.4 μg/mL, sera from all subjects promoted neutrophil‐mediated killing of type V GBS. No impairment was evident in the neutrophil function of elderly subjects when it was compared with that of young adults.Conclusion:  CPS‐specific IgG and neutrophils from healthy older adults function to ingest and kill type V GBS, but these antibodies are not present in sufficient amounts in most individuals. Further studies should determine whether a type V GBS vaccine induces functionally active antibodies in older people.
Effect of Do‐Not‐Resuscitate Orders on Hospitalization of Nursing Home Residents Evaluated for Lower Respiratory Infections
Authors: Zweig Steven C. , Kruse Robin L. , Binder Ellen F. , Szafara Kristina L. , Mehr David R. 
Published: December 2003

(See editorial comments by Dr. Joan Teno on pp 159–160) Objectives: To determine resident and facility characteristics associated with do‐not‐resuscitate (DNR) orders and to test the effect of DNR orders on hospitalization of acutely ill nursing home (NH) residents with lower respiratory tract infections (LRIs).Design: Prospective cohort.Setting: Thirty‐six NHs (almost 4,000 residents) in central and eastern Missouri in the Missouri Lower Respiratory Infection study.Participants: NH residents with a LRI (n=1031).Measurements: Data were obtained from new Minimum Data Set evaluations, resident examination, and chart review. Associations between resident, physician, and facility characteristics and the presence of a DNR order and hospitalization within 30 days from evaluation for an LRI were analyzed.Results: Sixty percent of subjects had a DNR order, and 2% had a do‐not‐hospitalize order. Resident characteristics associated with a DNR order included older age, white race, having a surrogate decision‐maker, NH residence for longer than 3 years, and more‐impaired cognition. Residents with DNR orders were more likely to live in facilities with more licensed beds, a lower proportion of Medicaid recipients, and a higher prevalence of influenza vaccination. After controlling for potential confounders, residents with a DNR order before the acute illness episode were significantly less likely to be hospitalized (adjusted odds ratio=0.69, 95% confidence interval=0.49–0.97).Conclusion: DNR orders independently reduce the risk of hospitalization for LRI and may function as a marker for undocumented care limitations or as a mandate to limit care (unrelated to resuscitation) in NH residents with LRI.
Nutrition Risk Factors for Survival in the Elderly Living in Canadian Long‐Term Care Facilities
Authors: Allard Johane P. , Aghdassi Elaheh , Mcarthur Margaret , Mcgeer Allison , Simor Andrew , Abdolell Mohamed , Stephens Derek , Liu Barbara 
Published: December 2003

Objectives: To determine the role of nutritional parameters in influencing the risk of mortality in institutionalized elderly.Design: A prospective cohort study in which subjects had several nutritional parameters measured at baseline and were followed for 19 months. Time to death and mortality were recorded starting immediately after enrollment.Setting: Fourteen long‐term care facilities (LTCFs).Participants: Four hundred eight elderly long‐term care residents aged 60 and older who resided in the facility for more than 6 weeks.Measurements: At baseline, knee height, weight, mid‐arm circumference (MAC), skin‐fold thickness, and fat‐free mass using bioelectric impedance analysis were measured. Covariates included demographic factors, length of stay in the facility, functional status, and medical diagnoses. Cox proportional hazards regression analysis was used to identify independent predictors of mortality. Results are reported as mean±standard error of the mean (SEM).Results: Overall, mortality rate was 28.4%. Univariate predictors included male sex, body mass index, MAC, and triceps skin fold. In multivariate analysis, male sex (hazard ratio (HR)=1.7, 95% confidence interval (CI)=1.2–2.7, P=.0096) and MAC less than 26 cm were significantly associated with increased risk of mortality (HR=4.8, 95% CI: 2.8–8.3, P<.0001).Conclusion: Among this elderly population living in LTCFs, MAC is the best nutritional predictor of mortality.
Metabolic Markers of Cobalamin Deficiency and Cognitive Function in Normal Older Adults
Authors: Garcia Angeles A. , Haron Yafa , Evans Lisa R. , Smith Matthew G. , Freedman Morris , Roman Gustavo C. 
Published: December 2003

Objectives: To investigate the relationship between metabolic markers of cobalamin deficiency and cognitive function in normal older adults.Design: Cross‐sectional study.Setting: Queen's University and St. Mary's of the Lake Hospital, Kingston, Ontario, Canada.Participants: Two hundred eighty‐one cognitively normal, community‐dwelling participants aged 65 and older.Measurements: Serum cobalamin, red blood cell folate, methylcitric acid, homocysteine, and methylmalonic acid were determined. Cognitive instruments included the California Verbal Learning Test, Mattis Dementia Rating Scale, and the Stroop Neuropsychological Screening Inventory (Stroop).Results: Serum levels of methylcitric acid had a significant negative correlation with recall, learning, and discriminability (factor 1) of the California Verbal Learning Test after adjusting for age and sex (β=−0.138, P=.019). Subjects with elevated methylcitric acid had significantly lower scores (factor 1) than subjects with normal methylcitric acid (P<.01). Bivariate analysis showed significant correlations between levels of homocysteine and the Stroop score and between cobalamin, methylmalonic acid, and homocysteine and some scores of the California Verbal Learning Test, but these relationships did not remain significant after multivariate analysis. Subjects with high homocysteine (tHcy) had lower Stroop scores than subjects with normal tHcy (P<.05). No biochemical parameters were associated with the Mattis Dementia Rating Scale scores.Conclusion: This study indicates that, in normal elderly subjects, some cognitive scores are related to serum methylcitric acid and possibly homocysteine.