bluuebunny/crossref_metadata_2025_split huggingface dataset:
Critical Effect of Helicobacter pylori Infection on the Effectiveness of Omeprazole for Prevention of Gastric or Duodenal Ulcers Among Chronic NSAID Users
Authors: Graham David Y. 
Published: March 2003

AbstractBackground. The recently reported OMNIUM and ASTRONAUT NSAID ulcer prevention trials using omeprazole to prevent endoscopic ulcer recurrence among chronic NSAID users suggested superiority over misoprostol or ranitidine.Aim. To test the hypothesis the results from the OMNIUM and ASTRONAUT studies would not be generalizible as ulcer healing and ulcer recurrence would differ in relation to Helicobacter pylori status.Methods. The data regarding H. pylori status were made available by AstraZenca allowing separate analysis of the outcome of those with NASID ulcers (i.e. without H. pylori infection) and those NSAID use was complicated with the presence of an active H. pylori infection.Results. Reanalysis confirmed that omeprazole was superior to placebo for the prevention of ulcer recurrence in chronic NSAID users. However, overall omeprazole was not significantly better than the subtherapeutic dose (400 µg/day) of misoprostol (14.5% vs. 19.6%, respectively, p = .93); 400 µg of misoprostol was actually superior to omeprazole for the prevention of gastric ulcers among those NSAID ulcers (8.2% vs. 16.6% for misoprostol and omeprazole, respectively; p < .05). Omeprazole was also not statistically different from misoprostol for gastric ulcer prevention in those whose NSAID use was complicated by an active H. pylori infection. Omeprazole was not significantly different from 300 mg of ranitidine for the prevention of NSAID gastric ulcers (14.6% vs. 11.6%, respectively, p = .56). Duodenal ulcers were over represented among H. pylori infected NSAID users and duodenal ulcer prevention was more sensitive to acid suppression than gastric ulcer.Conclusion. The OMNIUM and ASTRONAUT trials may have provided an unrealistic sense of security regarding the effectiveness of omeprazole for protection against ulcer recurrence in chronic NSAID users.
What To Do About Helicobacter pylori? A Decision Analysis of its Implication on Public Health
Authors: Sonnenberg Amnon 
Published: March 2003

ABSTRACTObjectives. Public health measures to eradicate Helicobacter pylori in the general population may prevent the occurrence of nonulcer dyspepsia (NUD), peptic ulcer (PUD) and gastric cancer, but may at the same time increase the prevalence of gastroesophageal reflux disease (GERD). A decision analysis is carried out to quantify the counteracting influences of H. pylori and resolve the controversy about a public policy to eliminate H. pylori from the general population.Methods. A compartment model is structured to analyze the jointly beneficial and adverse effects of H. pylori. Gastric acid, H. pylori infection, and other pathophysiological mechanisms influence the occurrence of reflux disease, peptic ulcer and dyspepsia, which all contribute to the occurrence of upper abdominal symptoms. Each influence is modeled as a separate compartment with various connections to other compartments. The simulation is carried out on an electronic spreadsheet.Results. A decision in favor or against eradication of all H. pylori depends primarily on the relative contribution of reflux disease vs. peptic ulcer and dyspepsia to upper abdominal symptoms in the general population. If reflux‐related symptoms contribute twice more than peptic ulcer plus dyspepsia to the overall occurrence of abdominal symptoms, a strategy to eradicate H. pylori would actually lower rather than raise public health. Below this threshold such strategy may improve general well‐being. In the individual patient infected with H. pylori, it remains beneficial to eradicate H. pylori, irrespective of the symptoms’ nature.Conclusions. Although it is advisable to treat H. pylori infection in the individual patient who comes to medical attention, a general policy directed towards complete elimination of H. pylori from the population would not be beneficial. A compartment model provides a simple yet powerful method to assess complex disease behavior.
Helicobacter pylori Infection in Children and Adults: A Single Pathogen But a Different Pathology
Authors: Gallo Nicoletta , Zambon Carlo‐Federico , Navaglia Filippo , Basso Daniela , Guariso Graziella , Grazia Piva Maria , Greco Eliana , Mazza Saverio , Fogar Paola , Rugge Massimo , Di Mario Francesco , Plebani Mario 
Published: March 2003

ABSTRACTBackground. The aims of this retrospective study were to ascertain in large series of children and adults: the relationship of the infecting strain to gastric mucosal lesions; and the relationship of the infecting strain to its duodenal localization.Materials and Methods. We studied 307 and 604 consecutive children and adults. In gastric mucosal samples H. pylori was cultured, genotyped and histologically assessed, while inflammation, activity and intestinal metaplasia were graded. In a subset of 171 patients H. pylori ureaseA (ureA) and cagA genes were amplified (PCR) using mucosal biopsies from the duodenum.Results. H. pylori infection was diagnosed in 40 children and 308 adults. cagA was identified in 50% and 65.5% of infected children and adults. Antral activity was associated with the density of infecting bacteria (p < .001) and with cagA (p < .01). Intestinal metaplasia was correlated with cagA (p < .001). The ureA gene was found in 56 duodenal samples from 82 H. pylori positive patients. Duodenal H. pylori ureA was significantly more frequent in patients with duodenal diseases than in those without (p < .01), cagA positive strains being mainly involved in the infection of this anatomical area (p < .01).Conclusions. A severe H. pylori‐associated gastritis is more prevalent when the density of infecting bacteria is high and when cagA positive strains cause the infection. The most virulent cagA positive H. pylori colonizes not only the gastric, but also the duodenal mucosa, which can be directly damaged by the bacteria itself or by its products.
Occupational Exposure to Human Immunodeficiency Virus: What Healthcare Providers Should Know
Authors: Aboulafia David M. 
Published: March 2003

PURPOSE
: The author reviews the risks of occupational exposure to HIV and provides a rationale for new postexposure guidelines for healthcare workers.
OVERVIEW
: Approximately 50,000 percutaneous exposures occur yearly among healthcare workers in the United States. Of these, approximately 5000 involve exposures to blood that is known to be infected with HIV. The risk of transmission after percutaneous exposure to HIV‐tainted blood has been estimated to be 0.3%, but the risk may be considerably higher to the healthcare worker if any of the following is present: a deep injury; visible blood on the sharp device; a procedure that involves a needle placed in the patient's artery or vein; and a patient with advanced AIDS. The increasing resistance of HIV strains to antiretroviral therapy continues to make treatment more difficult.
CLINICAL IMPLICATIONS
: Postexposure prophylaxis with zidovudine may reduce the risk of occupational infection by 80%. Advances in the ability to ameliorate HIV transmission rates and to treat individuals with resistant disease through innovations in drug therapy, engineering of controls for injury prevention, and more focused postexposure evaluation offer the hope of reducing this infrequent, but dangerous, occupational threat.
Cancer Self‐Help Groups and Family Physicians
Authors: Gray Ross E. , Carroll June C. , Fitch Margaret , Greenberg Marlene , Chart Pamela , Orr Vanessa 
Published: March 2003

PURPOSE
: Despite the phenomenal growth during the past decade of cancer self‐help groups for adult patients with cancer, little research has been conducted to document the interface between these groups and healthcare professionals, especially physicians. This study was initiated to provide information about family physician practices, awareness, and attitudes about self‐help groups.
DESCRIPTION
: A survey questionnaire was mailed to a random sample of Ontario family physicians drawn from the College of Family Physicians of Canada's membership database.
RESULTS
: A total of 911 completed questionnaires were returned, for a response rate of 64%. A majority (56.8%) of respondents were aware of at least one cancer self‐help group in their region; 26.8% of these spoke frequently with their cancer patients about such groups. Most family physicians indicated that they were positively inclined toward cancer self‐help groups, giving especially high ratings of helpfulness to sharing common experiences, overcoming isolation, feeling understood, and sharing information. Ratings of potential harm were low, with the most concern expressed about the possible provision of misinformation and the promotion of unconventional therapies. Responses to an open‐ended question showed that many family physicians qualify their support for cancer self‐help groups, depending on patient need, group composition, and leadership.
CLINICAL IMPLICATIONS
: Family physicians and other members of the cancer care team should give increased attention to informing cancer patients about the potential benefits of self‐help groups. Efforts need to be made to assist cancer self‐help groups in developing informational brochures and to ensure that groups are listed in cancer resource directories. Educational initiatives about self‐help groups would be useful for family physicians and other health professionals engaged in the care of cancer patients.
Limited Literacy Revisited Implications for Patient Education
Authors: Foltz Ann T. , Sullivan Joan M. 
Published: March 2003

purpose
: It is important to determine whether teaching materials are understood and deemed accurate by the cancer patients being served. The authors used a series of patient participatory interviews to evaluate two brochures: Chemotherapy: What It Is and How It Helps by the American Cancer Society; and Helping Yourself During Chemotherapy: 4 Steps for Patients by the National Cancer Institute. The authors sought to determine whether 1) the brochures were clear; 2) differences in presentation were perceived by patients; and 3) differences influenced respondents' understanding and opinions of the brochures.
description of study
: A qualitative, focus‐group methodology was used. Twelve cancer patients, eight of whom were women and six of whom were African American, were recruited from three outpatient clinics. Participants ranged in age from 31 to 62 years of age, and in education from completion of ninth grade to graduate school. Patients participated in a series of five groups, with a series of semistructured questions about content and format being asked of each group. All sessions were audiotaped. The investigators reviewed data both independently and together to identify content and format evaluations.
results
: Findings showed that most participants were drawn first by the National Cancer Institute format; the American Cancer Society brochure was seen as having more information; the two brochures were seen as complementary; some confusion arose from the content of both brochures; and the discussions of emotional and sexual aspects were important.
clinical implications
: These findings support the need for simple, clearly written brochures rather than brochures of varying literacy levels. The confusion caused by differences in advice given by the two organizations indicates the need to address specific areas in which dissimilarities exist. Finally, the project demonstrates the utility of patient focus groups for evaluation of patient education material.
Complementary Therapy Use Among Older Cancer Patients
Authors: Wyatt Gwen K. , Friedman Laurie L. , Given Charles W. , Given Barbara A. , Beckrow Kathryn Christensen 
Published: March 2003

purpose
: The purpose of this study was to assess the use of complementary therapies among older cancer patients, to report patterns of use, and to understand who is more likely to use complementary therapies.
description of study
: A survey was conducted of 699 older cancer patients at 4 weeks and 6 weeks into cancer treatment. All participants were 64 years of age or older, had received a diagnosis of breast, colorectal, prostate, or lung cancer, and were recruited from community cancer treatment centers throughout Michigan. Measures of interest included self‐reported physical symptoms, depressive symptomatology, optimism, spirituality, and use of conventional and complementary health services.
results
: Approximately 33% of older cancer patients reported using complementary therapies. These individuals were more likely to be women, to be breast cancer patients, and to have a higher level of education. The three most frequently used therapies were exercise, herbal therapy, and spiritual healing. Complementary therapy users were significantly more optimistic than nonusers. Also, there were significant differences between users and nonusers on types of physical symptoms experienced, but no differences on reported depressive symptomatology or spirituality.
clinical implications
: Oncology providers need to be aware that one third of their older patients are likely to supplement conventional care with complementary therapies. Therefore, providers should be knowledgeable about the safety and efficacy, in particular, of various exercise programs, herbal and vitamin therapies, and spiritual healing. It would be beneficial to develop a system within cancer centers by which patients could easily report on their use of complementary therapies, allowing providers to work in partnership with their patients.
Feasibility of Assessing Quality in Medical Oncology Practices
Authors: Cornfeld Mark J. , Jadwin Anne , O'Grady Peg , Babb Jim , Engstrom Paul F. 
Published: March 2003

Purpose: This study was designed to test the feasibility of conducting routine quality assessment within community medical oncology practices.Description of study: Eleven medical oncologists practicing within the Fox Chase Network were surveyed over an 8‐month period, using a standardized 10‐item checklist. Eight of the items (ie, board certification, continuing education, office procedure manual for chemotherapy, chemotherapy flow sheets, body surface area calculations, adherence to guidelines for follow‐up of breast cancer, adjuvant hormones in women with estrogen receptor‐positive breast cancer, and patient satisfaction survey) were chosen because they measure structural and process variables particularly relevant to the high‐volume clinical services seen in private practice oncology. The authors also calculated two rates (protocol accrual and neutropenic complications of chemotherapy) to test as putative indicators of quality.Results: The authors found a high level of both physician interest in developing the audit measures and compliance with the survey process. Overall quality of care, as measured by structure and process variables, was excellent with negligible internal variability. Derived rates of protocol accrual (0.003–0.373; mean 0.11, SD 0.11) and neutropenic sepsis (0.004–0.014; mean 0.007, SD 0.004) show considerable variability, however, and are only minimally correlated (r = −.36). These are both potential indicators of quality that should be further evaluated.Clinical implications: The authors have demonstrated the feasibility of conducting quality assessment within private medical oncology practices and have identified two easily calculated rates that merit further study as potential indicators of quality.
Community Implementation of Home Care Palliative Care Education
Authors: Ferrell Betty R. , Borneman Tami 
Published: March 2003

purpose: The purpose of this National Cancer Institute‐funded training project was to improve end‐of‐life care agencies through implementation of a palliative care curriculum. The Home Care Outreach for Palliative Care Education (HOPE) program was designed to improve the knowledge and skills of home healthcare professionals who provide care to the terminally ill and their families at home.description of program: A five‐module palliative care education curriculum was designed and implemented in five home care agencies in the Los Angeles area. One hundred twenty‐five nurses and 28 home health aides participated. The methods of data collection included two written surveys conducted before and after intervention, chart audit tool and a case study analysis form.results: The precourse data revealed deficiencies in home‐care agency staff knowledge in and clinical aspects of end‐of‐life care. Regarding agency nurses' knowledge on end‐of‐life issues, the overall percentage scores from preeducation to posteducation rose from 84.6% to 89.0% (P = .0001). Participants rated the education program as extremely valuable for the home care agency staff.clinical implications: As home care will likely continue to be a primary setting for end‐of‐life healthcare, improvement of palliative care education in home health agencies is needed. The HOPE project provided insight and experience in the education of nonhospice home care staff in end‐of‐life care. Participant responses and evaluations indicated that end‐of‐life care education can improve the quality of care provided by home health agencies. Finally, this education program may result in a heightened awareness of hospice care and, although not objectively quantified, perhaps an increase in referrals to hospice.
Online Cancer Patient Education
Authors: Cumbo Angelique , Agre Patricia , Dougherty James , Callery Matt , Tetzlaff Linda , Pirone Jane , Tallia Rob 
Published: March 2003

purpose: Two patient education CD‐ROMs were converted to a web‐based environment. This article reports on users' evaluations of the programs' usability and content.description of evaluation: Subscribers to a center's web newsletter were asked to view one of two web programs and to complete a survey. The first 150 respondents were offered a free patient education CD‐ROM of their choice, but users continued to respond to the survey even after a notice stated that 150 responses were received. A total of 301 surveys were completed (Colorectal Cancer Program 168; Chemotherapy Program 133).results: Sixty‐eight percent of Colorectal Cancer Program respondents and 50% of Chemotherapy Program respondents considered the program to be more useful or much more useful than any other source of information on the topic. A majority of users for both programs preferred to view the information on the Internet rather than on CD‐ROM. Many users reported trouble accessing certain segments of the media. Common complaints included the inability to open video or audio clips and the length of time needed for each page to load, despite a high‐speed Internet connection.clinical implications: Internet use is high, with 60% of US households reporting having used the Internet to search for health information. However, little is known about user satisfaction with specific sites and what about them users like or do not like. It is hoped that these and other user evaluations will help web site authors and developers improve their sites.
Promoting Fecal Occult Blood Testing in Rural African American Women
Authors: Powe Barbara D. 
Published: March 2003

purpose: The purpose of this experimental study was to test the effectiveness of a multiphasic culturally relevant intervention, delivered over a 1‐year period to increase the rates of participation in fecal occult blood testing (FOBT) at the initial screening opportunity and at the 1‐year follow‐up screening opportunity among rural African American women.description of study: The study used a pretest/post‐test design among African American women who attended senior citizen centers in a rural southern state. The centers were randomly assigned to the cultural and self‐empowerment group, who received the five‐phased intervention, the modified cultural group, who received phase I of the intervention only, or the traditional group, who served as the control group. Data were collected at the initial and 1‐year follow‐up screenings. Hemoccult kits were distributed, collected, and analyzed at no cost to the participants. Data were analyzed using descriptive statistics, repeated measures, and longitudinal models for binary outcomes.results: Women in the cultural and self‐empowerment group had a significantly higher rate of participation in FOBT than did those in the modified cultural group and the traditional group. The modified cultural group had a significantly higher rate of participation in FOBT than the did the traditional group. Predictors of participation in FOBT were the women's family history of colorectal cancer and the average number of visits to their healthcare provider.clinical implications: Colorectal cancer screening and diagnostic testing opportunities should be offered consistently to women who visit their provider for routine, nonemergent office visits. As successful interventions to increase colorectal cancer screening are introduced into community settings, these interventions also should be tested within physicians' offices and other community agencies.
Mucosal Tissue Injury in Cancer Therapy
Authors: McGuire Deborah B. 
Published: March 2003

purpose: The purpose of this article is as follows: 1) to describe the characteristics and scope of mucosal tissue injury associated with cancer treatment; 2) to discuss recent advances in related basic and clinical science; and 3) to articulate research needs and opportunities to be addressed through collaborative interdisciplinary research.overview: Mucosal tissue injury is both a direct and indirect consequence of cancer therapy, with manifestations that include damage and a number of other potentially serious sequelae. Current research in mucosal tissue injury is focused on the biology, immunology, and genetics of mucosal injury; clinical problems; assessment and management; and processes and outcomes of care.clinical implications: Results from these various areas of research enhance the understanding of the mechanisms of mucosal tissue injury, provide direction for the development of policy and for clinical practice, and help to define research needs and opportunities. Future research on the complex process of mucosal tissue injury will be interdisciplinary and will cross the boundaries among basic, translational, and clinical science.
A Concept of Integrated Water Management Illustrated for Flanders (Belgium)
Authors: Schneiders Anik , Verheyen Rudi 
Published: March 2003

ABSTRACTIntegrated catchment management (ICM) is an application of the concept of sustainable development for aquatic ecosystems. It aims at developing, maintaining, and restoring the water system to reach the quality objectives of multifunctional use for this generation without compromising the uses for future generations. The quality objectives should be based on sufficient ecosystem knowledge. ICM demands a solid and workable framework built on the integration of knowledge and organizational integration which are supported by statutory rules and (international) regulations. In Flanders, future legal support will be based on both the framework for water action plans proposed by the European Commission, and a Flemish decree concerning integrated water management. The overview given for ecosystem knowledge is (on a Flemish scale) based on data networks. The interrelation and processing of large data sets deliver basic knowledge to build up policy visions for land‐use planning and environmental planning. Organizational integration will be worked out on two levels: an Integrated Water Consultation Committee on a Flemish level (13,806 km2) will work out the outlines and examine the sector‐oriented long‐term demand for water; and Catchment Committees on a subbasin level (scale: 700–2300 km2) will bring together the relevant parties and work out integrated catchment plans (ICP). Bringing together the administrations of Environmental Planning and Town and Country Planning around one vision, with a balanced multifunctional use, is one of the biggest challenges of ICP in Flanders.