bluuebunny/crossref_metadata_2025_split huggingface dataset:
Delay in Treatment of Colorectal Cancer: Multifactorial Problem
Authors: Langenbach Mike Ralf , Schmidt Johannes , Neumann Jürgen , Zirngibl Hubert 
Published: February 2003

AbstractThe stage of a colorectal carcinoma represents the most important prognostic factor regarding the probability of survival. The primary objective of this study was to document the management of patients with colorectal carcinoma after onset of symptoms. Factors influencing the delay in definitive therapy should thus be determined. Anthropometric, social, and operative data were obtained by standardized questionnaires from 40 patients with colonic cancer and 30 patients with rectal cancer. The influence of delayed treatment on outcome was analyzed. A significant correlation was found for the time between onset of first symptoms and definitive surgical therapy with tumor stage (colon cancer: r = 0.52, p < 0.05; colorectal cancer: r = 0.62, p < 0.05). The time delay in rectal carcinoma patients averaged 224 days and in patients with colonic carcinoma 149 days. Social influences such as profession, type of education, marital status, and quality of health insurance had a significant influence on treatment delay, as did the clinical experience of the physician first contacted. The leading symptom in patients with rectal cancer was peranal hemorrhage, and in patients with colonic cancer it was abdominal pain. The main causes of iatrogenic delay were insufficient clinical investigation and a lack of awareness when typical first symptoms were present. Delayed treatment of colorectal cancer seems to be a multifactorial problem. Causes for such delay are found not only in the patients and their social environments but also in the type and quality of their medical care systems. Intensified education and earlier prevention are the major aims for patients and their physicians.
Hepatoduodenal Ligament Invasion by Gallbladder Carcinoma: Histologic Patterns and Surgical Recommendation
Authors: Kaneoka Yuji , Yamaguchi Akihiro , Isogai Masatoshi , Harada Tohru , Suzuki Masahiko 
Published: February 2003

AbstractA consensus for the optimal management of hepatoduodenal ligament (HDL) invasion by gallbladder carcinoma has yet to be reached. We retrospectively correlated the patterns of HDL invasion with the surgical outcome. From 1985 to 2000, 59 patients underwent combined resection of the extrahepatic bile duct and gallbladder and contiguous organs if required. Pathologic staging (UICC) was stage II, 4; stage III, 14; stage IVa, 10; and stage IVb, 31. Hepatoduodenal ligament invasion was subdivided into lymph node involvement (LNI) and bile duct infiltration (BDI). Patterns of HDL invasion were compared with bile duct morphology, resectability, and outcome. Bile duct infiltration (n = 32) caused stenosis of the bile duct in all cases, whereas LNI (n = 40) caused stenosis in only 4 cases. Resection was complete after extended cholecystectomy (n = 22) in 36%; 4b/5 segmentectomy (n = 10) in 90%; major hepatectomy (n = 2) in 50%; and hepatopancreatoduodenectomy (n = 17) in 53% of cases. Surgery was curative in 75% of patients without BDI, and was < 30% with BDI. The most common factor preventing curative resection in BDI was perineural invasion around the HDL. Perineural invasion occurred in over 70% of cases at either the cut end of the bile duct or in the margin of dissection. The 3‐year survival rates, excluding patients with R2 resection (residual cancer) and death in hospital, were LNI(−)BDI(−) (n = 8), 65.6%; LNI(+)BDI(−) (n = 17), 35.3%; LNI(−)BDI(+) (n = 7), 14.3%; and LNI(+)BDI(+) (n = 17), 5.9%. There were no 5‐year survivors with BDI. In conclusion, perineural invasion in BDI is an important obstacle to complete resection. Hepatopancreatoduodenectomy is a feasible strategy only for LNI(+)BDI(−) disease.
Nitric Oxide‐mediated Liver Injury in the Presence of Experimental Bile Duct Obstruction
Authors: Engin Atilla , Bozkurt B. Şükrü , Altan Nilgün , Memiş Leyla , Bukan Neslihan 
Published: February 2003

AbstractWe investigated the possible mechanism of common bile duct (CBD) obstruction‐related liver cell necrosis in a guinea pig model during a 24‐hour period of biliary occlusion. A total of 30 male albino guinea pigs were randomly and equally assigned to two groups. Group 1 underwent sham laparotomy (SL), and group 2 underwent common bile duct ligation (CBDL). All the animals were followed for the first 24‐hours after operation. The liver antioxidant defense was examined by measuring liver total superoxide dismutase (TSOD), copper/zinc‐containing superoxide dismutase (Cu‐ZnSOD), manganese superoxide dismutase (MnSOD), and glutathione peroxidase (GPx) activities as well as the reduced glutathione (GSH) concentration. Severity of necrosis was assessed by blind quantitation of liver specimens using a histologic scoring system. Histologic evidence of grade +2 hepatocellular necrosis was observed in the CBDL group, as was a more than fourfold increase in plasma nitrite plus nitrate [NOx] concentrations in these animals. Although no significant difference was found between the two groups for liver Cu‐ZnSOD activity, the CBDL group showed a marked decrease in MnSOD activity. Concomitant increases in liver GPx activity and the GSH level were measured in the CBDL group. These data supported the hypothesis that excessive production of [NOx] and its derivative peroxynitrite contribute to a coexisting MnSOD deficiency in the mitochondria and lead to liver cell necrosis in cholestatic animals.
Serial plasma fibronectin levels in pre‐eclamptic and normotensive women
Authors: Sud S.S. , Gupta I. , Dhaliwal L.K. , Kaur B. , Ganguly N.K. 
Published: February 2003

AbstractObjective: Endothelial cell damage has been put forward as an underlying factor for development of pre‐eclampsia. This study was carried out to see if fibronectin, which is a marker of endothelial damage, could be used as a marker of pre‐eclampsia. Methods: A longitudinal study was conducted on 100 normotensive primigravidae registered before 20 weeks of gestation. These subjects were followed until delivery and three blood samples were collected, first at registration, i.e. before 20 weeks, second around 28 weeks and third at 36 weeks or later till delivery. Fibronectin levels were assayed by ELISA and women observed for any signs of pre‐eclampsia. Results: Fourteen subjects developed pre‐eclampsia. Fibronectin levels were observed to rise as pregnancy advanced but the rise was significantly higher in subjects who developed pre‐eclampsia. The fibronectin levels were also significantly higher in these 14 subjects even in the first sample, i.e. before 20 weeks of gestation when compared with normotensive subjects (P<0.01). Conclusions: Fibronectin levels could be used as an early valuable biomarker for the development of pre‐eclampsia.
Low‐dose diclofenac potassium in the treatment of episodic tension‐type headache
Authors: Kubitzek Florian , Ziegler Gabrielle , Gold Morris S. , Liu Jiun‐Min H. , Ionescu Elisabeta 
Published: February 2003

AbstractBackground. Several clinical trials have demonstrated that low doses of non‐steroidal anti‐inflammatory drugs relieve episodic tension‐type headache (ETH).Aims. The aims of this placebo‐controlled study were to determine whether single doses of diclofenac‐K 12.5 and 25 mg effectively relieve ETH in adults and to compare it to ibuprofen 400 mg.Methods. A single‐dose multicentre, randomised, double‐blind, double‐dummy, clinical trial was conducted at 22 primary care centres in Germany. All subjects had a history of ETH according to the classification of the International Headache Society. Of 684 subjects randomised, 620 used the study drugs for an episode of tension headache occurring within one month after enrolment: diclofenac‐K 12.5 mg (n=160), diclofenac‐K 25 mg (n=156), ibuprofen 400 mg (n=151) and placebo (n=153). The primary efficacy variable was total pain relief, calculated as the time‐weighted sum of the pain relief assessments from baseline to the 3 h evaluation time (TOTPAR‐3).Results. For TOTPAR‐3, all active treatments were superior to placebo; no statistically significant difference between the three active treatments could be detected. A similar pattern was also observed with regard to TOTPAR‐6 (6 h evaluation time), ≥50%maxTOTPAR at 3 and 6 h, weighted pain intensity difference at 3 and 6 h (SPID‐3; SPID‐6), percentage of patients with complete headache relief at 2 h, end of study global evaluation and time to rescue medication. The number‐needed‐to‐treat (NNT) at 6 h was 4.5 (2.9–9.2) in the ibuprofen 400 mg group, 4.0 (2.8–7.3) in the diclofenac‐K 12.5 mg group and 3.9 (2.7–7.1) in the diclofenac‐K 25 mg group. These differences were not statistically significant.Conclusion. Diclofenac‐K, administered as single doses of 12.5 and 25 mg effectively relieves ETH and is comparable to ibuprofen 400 mg.
Therapeutic approaches to fibromyalgia syndrome in the United Kingdom: a survey of occupational therapists and physical therapists
Authors: Sim Julius , Adams Nicola 
Published: February 2003

AbstractBackground and purpose. This study sought information from occupational therapists (OTs) and physical therapists (PTs) working in rheumatology in the UK on their usual methods of treatment and management of patients with fibromyalgia syndrome (FMS).Methods. Data were gathered by self‐completion questionnaire on: work setting; referrals of FMS patients; usual treatment objectives; assessment and treatment approaches; perceived responsiveness of patients; and other perceptions of the management of FMS. Most data were in the form of frequency counts, with some ordinal scales and open responses.Results. Responses were obtained from 142 therapists (71% response rate), of whom 47 OTs and 39 PTs managed patients with FMS. The foremost therapeutic objective was increased functional ability for OTs, and increased exercise tolerance and general fitness for PTs. Pain reduction or management was rated as the second objective for both groups. An endurance‐based exercise program and energy conservation techniques were the most frequently utilized interventions. Patients with FMS were thought to be ‘moderately responsive’ to physical management. Predictors of outcome were considered to be largely psychosocial, rather than physical, in nature.Conclusion. These data provide a preliminary profile of current practice in the management of FMS among UK therapists and indicate certain differences in approach between OTs and PTs.
Transcutaneous electrical nerve stimulation (TENS) can reduce postoperative analgesic consumption. A meta‐analysis with assessment of optimal treatment parameters for postoperative pain
Authors: Bjordal Jan Magnus , Johnson Mark I. , Ljunggreen Anne Elisabeth 
Published: February 2003

AbstractAim. We investigated the literature of randomised placebo‐controlled trials to find out if transcutaneous electrical nerve stimulation (TENS) or acupuncture‐like transcutaneous electrical nerve stimulation (ALTENS) can reduce analgesic consumption after surgery.Results. Subgroup analysis for adequate treatment (pulse frequency: 1–8 Hz [ALTENS] or 25–150 Hz [TENS], current intensity: “strong, definite, subnoxious, maximal tolerable” or above 15 mA, and electrode placement in the incision area) were performed. Twenty‐one randomised, placebo‐controlled trials with a total of 1350 patients were identified. For all trials, the mean reduction in analgesic consumption after TENS/ALTENS was 26.5% (range −6 to +51%) better than placebo. Eleven of the trials compromising 964 patients, had reports which stated that a strong, subnoxious electrical stimulation with adequate frequency was administered. They reported a mean weighted reduction in analgesic consumption of 35.5% (range 14–51%) better than placebo. In nine trials without explicit confirmation of sufficient current intensity and adequate frequency, the mean weighted analgesic consumption was 4.1% (range −10 to +29%) in favour of active treatment. The difference in analgesic consumption was significantly (p=0.0002) in favour of adequate stimulation. The median frequencies used in trials with optimal treatment was 85 Hz for TENS and 2 Hz in the only trial that investigated ALTENS.Conclusion. TENS, administered with a strong, subnoxious intensity at an adequate frequency in the wound area, can significantly reduce analgesic consumption for postoperative pain.
High-energy-density matter research at GSI Darmstadt using
intense heavy ion beams
Authors: TAHIR N.A. , SHUTOV A. , VARENTSOV D. , HOFFMANN D.H.H. , SPILLER P. , LOMONOSOV I. , WIESER J. , JACOBY J. , FORTOV V.E. 
Published: February 2003

This paper presents two-dimensional numerical simulations of
heating of matter with intense heavy ion beams. It has been
shown that it is very advantageous to irradiate the target with
two different beams simultaneously, a main high intensity bunched
beam of a heavy element like uranium and an unbunched low intensity
beam of a lighter element like argon. The main beam is used
to heat the target while the second beam is used as a diagnostic
tool.Influence of the shape of the focal spot on compression and
heating of matter has also been studied using an elliptic focal
spot with an ellipticity of 1.5 (semimajor axis is along
y-axis and is 1.5 times the semiminor axis which is
along x-axis). It has been found that the temporal
behavior of the development of density, pressure, and temperature
profiles along different directions is quite different, which
is not the case with a circular focal spot.
TOWARD TRANSPARENCY IN HEALTH TECHNOLOGY ASSESSMENT
Authors: Hailey David 
Published: February 2003

Objectives: As an initiative of the International Network of Agencies for Health Technology Assessment (INAHTA), a checklist for assessment reports was developed as a means of improving transparency and consistency in HTA.Methods: Preparation of a summary of key elements in HTA reports, drawing on experience in preparation of such documents, information from guidelines for HTA, and individual assessments. Review by INAHTA agencies and modification of the summary to reflect the consensus.Results: The resulting checklist includes 17 questions, with supporting detail. General areas covered include preliminary information, why and how the assessment has been prepared, the results of the assessment, implications of the results, and conclusions.Conclusions: The checklist is intended to be considered by those preparing or using an HTA report. It reflects the views of INAHTA members and is seen as a mechanism to improve the standard of HTA reports, being complementary to the more detailed guidelines on how to conduct assessments.
DOES CLINICAL TRIAL SUBJECT SELECTION RESTRICT THE ABILITY TO GENERALIZE USE AND COST OF HEALTH SERVICES TO “REAL LIFE” SUBJECTS?
Authors: Kennedy Wendy A. , Laurier Claudine , Malo Jean-Luc , Ghezzo Heberto , L'archevêque Jocelyne , Contandriopoulos André-Pierre 
Published: February 2003

Objectives: To explore one aspect of the external validity of the randomized controlled trial (RCT), specifically how being selected for inclusion in a trial and having participated has influenced the use and cost of asthma-related health services.Methods: Services used by asthmatic users of inhaled corticosteroids (iCSTs) having previously participated in an RCT (TS, n = 46) were compared with individuals who had never participated (NS, n = 51).Results: TS were more likely to use higher (≥400 μg) daily doses of iCSTs than NS (OR, 3.3; 95% CI, 1.1–8.3) but less likely to visit emergency departments (OR, 0.3; 95% CI, 0.1–0.7). Total asthma-related costs did not differ significantly.Conclusions: Subject differences may impede generalizing from RCTs to real life.
PRE-ASSESSMENT TO ASSESS THE MATCH BETWEEN COST-EFFECTIVENESS RESULTS AND DECISION MAKERS' INFORMATION NEEDS
Authors: IJzerman Maarten J. , Reuzel Robert P. B. , Severens Hans L. 
Published: February 2003

Objective: To determine if a pre-assessment can be used to establish whether cost-effectiveness results would meet the actual information needs of Dutch healthcare decision makers.Methods: Two recent studies in rehabilitation medicine served as study material. Based on Wholey, a limited pre-assessment was performed in which the potential impact of cost-effectiveness analysis (CEA) results on intended users' decision making was assessed. Desk research and semi-structured interviews with several intended users of CEA results were performed. These included general practitioners, representatives of health insurance companies, the Health Care Insurance Board (CvZ), and medical guidelines committees.Results: In day-to-day decision making of the interviewed decision makers, a cost-effectiveness criterion seemed to be of limited importance. Instead, results from clinical effectiveness studies and budget impact studies appeared to be sufficient. CvZ, however, preferred relative cost-effectiveness to be a criterion for inclusion in future reimbursement guidelines. In both cases the limited pre-assessments changed the expectations of the investigators regarding decision-making impact of an economic evaluation.Conclusion: This study revealed that the use of CEA results for Dutch micro- and meso-level healthcare decision making is not self-evident. The main purpose of CEA results is to support health policy making and planning at a macroeconomic level. Pre-assessment can be a valuable tool in designing a CEA to support the actual information needs of the decision makers.
EFFICACY AND SAFETY OF VISCOSUPPLEMENTATION WITH HYLAN G-F 20 FOR THE TREATMENT OF KNEE OSTEOARTHRITIS
Authors: Espallargues Mireia , Pons Joan M. V. 
Published: February 2003

Objectives: To review the scientific evidence on the efficacy, effectiveness, and safety of intra-articular injections of Hylan G-F 20 for the treatment of knee osteoarthritis.Methods: Systematic review of experimental and observational studies performed in humans up to December 1999. Qualitative and quantitative (meta-analytic) techniques were used for data synthesis.Results: A single course of intra-articular Hylan G{-}F 20 provides a statistically significant and clinically relevant short-term decrease of the painful symptomatology of knee osteoarthritis and improves joint function. It also seems to delay the need for knee replacement, if results observed in noncontrolled studies are confirmed. Hylan G-F 20 has a comparable efficacy to that of oral NSAID, and a smaller risk of gastrointestinal adverse effects. It seems to be well tolerated and safe, but the short follow-up in most studies limits any extrapolation of the effectiveness and safety over the longer term. There is also scarce evidence on the effect of multiple courses of Hylan G-F 20, and the scientific rigor of both experimental and nonexperimental studies reviewed is somewhat limited.Conclusions: Whereas there is good quality scientific evidence showing that Hylan G-F 20 is a safe and well-tolerated therapy providing a short-term decrease of the pain symptoms while improving joint function, the delay of the need for knee replacement as well as the durability of the effect over the longer term have only been demonstrated in noncontrolled clinical series. The available evidence is not sufficient to reach firm conclusions on the effect of multiple courses of intra-articular injections of Hylan G-F 20 on health outcomes.
DEVELOPMENT OF EXPLICIT CRITERIA FOR TOTAL KNEE REPLACEMENT
Authors: Escobar Antonio , Quintana José Maria , Aróstegui Immaculada , Azkárate Jesús , Güenaga José Ignacio , Arenaza Juan Carlos , Garai Idoia 
Published: February 2003

Objectives: To develop and test an appropriateness of indications tool for total knee replacement (TKR) in patients with osteoarthritis.Methods: Criteria were developed using a modified Delphi panel judgment. Another panel rated the same indications, and the results were compared with the main panel. Test-retest of the main panel was performed. Regression models were used to assess the contribution of each algorithm variable. A classification tree was developed.Results: The procedure was considered appropriate in 167 (26.8%) scenarios, and there was agreement on 112 (67.1%) of them. When the rates of the main panel were compared with those of a second panel, the result was a kappa statistic of 0.75. The test-retest kappa for the main panel was 0.78. Neither in the first case nor in the second was there an instance in which a scenario classified as appropriate shifted to inappropriate or vice versa. The regression models showed that symptomatology and radiology were the variables that explained most of the variability of appropriateness as determined by panelists. In the classification tree performed, the probability of misclassification was 3.8% with 150 scenarios, of the 156 analyzed and classified correctly.Conclusions: The previous parameters tested showed acceptable results for an evaluation tool. These results support the use of this algorithm as an aid in formulating clinical practice guidelines and to promote the appropriateness of TKR.
A COST-EFFECTIVENESS ANALYSIS OF rhDNase IN CHILDREN WITH CYSTIC FIBROSIS
Authors: Grieve Richard , Thompson Simon , Normand Charles , Suri Ranjan , Bush Andrew , Wallis Colin 
Published: February 2003

Objectives: This study compared the relative cost-effectiveness of daily recombinant human deoxyribonuclease (rhDNase), with alternate day rhDNase and hypertonic saline (HS) for treating children with cystic fibrosis (CF).Methods: A randomized controlled trial with a crossover design allocated 40 CF children consecutively to 12 weeks of daily rhDNase, alternate day rhDNase, or HS. The primary outcome measure was forced expiratory volume in 1 second (FEV1), a measure of lung function. All health resource use was prospectively documented for each patient and multiplied by unit costs to give a total health service cost for each 12-week treatment period. The nonparametric bootstrap method was used to present cost-effectiveness acceptability curves and net benefit statistics for each treatment comparison, for various hypothetical levels of the decision maker's ceiling ratio.Results: Compared with HS, there was a 14% improvement in FEV1 for daily rhDNase (95% CI, 5% to 23%), and a 12% improvement (95% CI, 2% to 22%) for alternate day rhDNase. For a ceiling ratio of £200 per 1% gain in FEV1, the mean net benefits of daily and alternate day rhDNase compared with HS were £1,158 (95% CI, −£621 to 2,842) and £1,188 (95% CI, −847 to 3,343), respectively; the mean net benefit of daily compared with alternate day rhDNase was *minus;£30 (95% CI, −£2,091 to 1,576).Conclusions: If decision makers are prepared to pay £200 for a 1% gain in FEV1 over a 12-week period, then on average either rhDNase strategy is cost-effective.