bluuebunny/crossref_metadata_2025_split huggingface dataset:
Origins of Early Intervention in First-Episode Psychosis
Authors: Sanbrook Mark , Harris Anthony 
Published: May 2003

Objective: To outline reasons contributing to the delayed introduction of early intervention strategies for first-episode psychosis, followed by a discussion of recent factors that have supported the increased use of these strategies. Conclusions: The reasons for this delay include pessimistic beliefs carried over from early in the 20th century about the prognosis of schizophrenia, the central role of the institution in psychiatric history, and the need for a working neurobiological model for psychosis. The discovery of the antipsychotic drugs, the process of deinstitutionalization, and new conceptualizations of schizophrenia have been necessary precursors to current best practice treatments. In recent years these factors have been complemented by the increasing influence of consumer and family advocacy groups, and government policy initiatives.
The selection of triple therapy for Helicobacter pylori eradication in chronic renal insufficiency
Authors: Sheu B.‐S. , Huang J.‐J. , Yang H.‐B. , Huang A.‐H. , Wu J.‐J. 
Published: May 2003

SummaryAim: To establish a triple therapy regimen for Helicobacter pylori eradication in patients with chronic renal insufficiency.Methods: Eighty‐eight patients with chronic renal insufficiency and H. pylori infection were evenly randomized into two groups receiving 1‐week lansoprazole, 30 mg, clarithromycin, 500 mg, and either amoxicillin, 750 mg, or metronidazole, 500 mg, twice daily. The adverse events and compliance with triple therapy were reviewed at the week 1 visit. Patients provided stool samples at week 6 to assess the success of H. pylori eradication by H. pylori‐specific stool antigen. The serum creatinine levels were monitored at enrolment, at weeks 1, 2 and 6 and on any unscheduled visit after triple therapy.Results: The success of H. pylori eradication was higher in the lansoprazole–clarithromycin–metronidazole group than in the lansoprazole–clarithromycin–amoxicillin group (intention‐to‐treat analysis: 84% vs. 66%, P < 0.05: per protocol analysis: 93% vs. 76%, P < 0.05). Complete drug compliance was also better in the lansoprazole–clarithromycin–metronidazole group than in the lansoprazole–clarithromycin–amoxicillin group (77% vs. 52%, P < 0.05). Patients in the lansoprazole–clarithromycin–metronidazole group had a lower risk of acute renal failure than those in the lansoprazole–clarithromycin–amoxicillin group (2% vs. 18%, P < 0.05; relative risk, 0.128, 95% confidence interval, 0.016–0.979).Conclusions: Triple therapy with metronidazole and clarithromycin, but not amoxicillin, can be used for H. pylori eradication in patients with chronic renal insufficiency, because it is more effective, well tolerated and less likely to cause deterioration of renal function.
Rescue therapy with tacrolimus is effective in patients with severe and refractory inflammatory bowel disease
Authors: Baumgart D. C. , Wiedenmann B. , Dignass A. U. 
Published: May 2003

SummaryBackground : Oral tacrolimus, approved for the prophylaxis of organ rejection in liver or kidney transplants, has been reported to be effective in anecdotal cases of refractory inflammatory bowel disease.Aim : To evaluate the usefulness of low‐dose oral tacrolimus in refractory inflammatory bowel disease.Methods:  Thirty‐one adult Caucasian patients with steroid‐dependent (n = 15) or steroid‐refractory (n = 16) inflammatory bowel disease (Crohn's disease, n = 6; ulcerative colitis, n = 23; pouchitis, n = 2) were enrolled. Tacrolimus (0.1 mg/kg body weight per day) was administered orally in 30 patients and initially intravenously in one patient (0.01 mg/kg body weight per day), aiming for serum trough levels of 4–6 ng/mL. The median treatment duration was 12 months (range, 1–137 months).Results : Twenty‐eight patients (90.3%) experienced a clinical and laboratory response and 20 (64.5%) went into remission. One ulcerative colitis patient and two Crohn's disease patients did not improve. Three ulcerative colitis patients (9.7%) were colectomized at 1, 12 and 24 months after tacrolimus initiation. In 19 of 23 patients (82.6%) taking steroids, steroids were reduced or discontinued. Side‐effects included a temporary rise of creatinine (n = 3, 9.7%), tremor or paraesthesias (n = 3, 9.7%), hyperkalaemia (n = 1, 3.2%), hypertension (n = 1, 3.2%) and an opportunistic infection (n = 1, 3.2%).Conclusion : Oral tacrolimus is safe and effective in refractory inflammatory bowel disease.
Infliximab in refractory pouchitis complicated by fistulae following ileo‐anal pouch for ulcerative colitis
Authors: Viscido A. , Habib F. I. , Kohn A. , Papi C. , Marcheggiano A. , Pimpo M. T. , Vernia P. , Cadau G. , Caprilli R. 
Published: May 2003

SummaryAim:  To determine the efficacy of infliximab in the treatment of chronic refractory pouchitis complicated by fistulae following ileal pouch‐anal anastomosis for ulcerative colitis.Methods:  This open study included seven patients (four females, three males) with chronic refractory pouchitis complicated by fistulae. Pouchitis was diagnosed by clinical, endoscopic and histological criteria. The sites of the fistulae were as follows: pouch‐bladder in one, vaginal in three, perianal in two, and both vaginal and perianal in one. Extra‐intestinal manifestations (erythema nodosum, arthralgia) were present in four patients. Crohn's disease was carefully excluded in all patients after re‐evaluation of the history, re‐examination of the original proctocolectomy specimen and examination of the proximal small bowel. All patients had been treated with antibiotics and three with steroids. Patients received infliximab, 5 mg/kg, at 0, 2 and 6 weeks. Azathioprine (2.5 mg/kg) was also started for all patients as bridge therapy. Clinical response was classified as complete, partial or no response. Fistulae closure was classified as complete (cessation of fistulae drainage and total closure of all fistulae), partial (a reduction in the number, size, drainage or discomfort associated with fistulae) or no closure. The pouchitis disease activity index and quality of life were also used as outcome measures.Results:  Clinically, all patients improved. At the 10‐week follow‐up, six of the seven patients had a complete clinical response, and five had complete fistulae closure. At the 10‐week follow‐up, the median pouchitis disease activity index decreased from 12 (baseline) (range, 10–15) to 5 (range, 3–8); the median quality of life decreased from 37 points (range, 33–40) to 14 (range, 9–18). Erythema nodosum and arthralgia showed complete remission soon after the first infusion of infliximab.Conclusions:  These preliminary results indicate that infliximab may be recommended for the treatment of refractory pouchitis complicated by fistulae following ileal pouch‐anal anastomosis for ulcerative colitis.
Meta‐analysis: comparing the efficacy of proton pump inhibitors in short‐term use
Authors: Klok R. M. , Postma M. J. , Van Hout B. A. , Brouwers J. R. B. J. 
Published: May 2003

SummaryBackground:  Proton pump inhibitors have a prominent role in the management of acid‐related diseases. Controlling expenses on proton pump inhibitors would yield great economic benefits for Dutch health care.Aim:  To investigate whether clinical differences in proton pump inhibitors exist.Methods:  We searched Medline, EMBASE and the Cochrane Library. We identified papers in English, German, French or Dutch in which two or more proton pump inhibitors were compared under the same clinical conditions in gastro‐oesophageal reflux disease, peptic ulcer disease or Helicobacter pylori eradication. The pooled relative risks were calculated using the Mantel–Haenszel method.Results:  Two significant differences were found in the proton pump inhibitors compared. In gastro‐oesophageal reflux disease, esomeprazole 40 mg was superior to omeprazole 20 mg (relative risk, 1.18; 95% confidence interval, 1.14–1.23). In peptic ulcer disease, pantoprazole 40 mg was superior to omeprazole 20 mg (relative risk, 1.07; 95% confidence interval, 1.02–1.13). In Helicobacter pylori eradication, no significant differences were found.Conclusions:  Both significant differences found were in favour of the highest dose of proton pump inhibitor on a milligram basis. This indicates that the difference may be dose dependent and not proton pump inhibitor specific. Therefore, when prescribing proton pump inhibitors, arguments other than clinical efficacy, such as those related to pharmaco‐economics, may be considered.
Refeeding syndrome: effective and safe treatment with Phosphates Polyfusor
Authors: Terlevich A. , Hearing S. D. , Woltersdorf W. W. , Smyth C. , Reid D. , Mccullagh E. , Day A. , Probert C. S. J. 
Published: May 2003

SummaryBackground:  Severe hypophosphataemia associated with refeeding syndrome requires treatment with intravenous phosphate to prevent potentially life‐threatening complications. However, evidence for replacement regimens is limited and current regimens are complex and replace phosphate inadequately.Aim:  To assess the effectiveness and safety of 50 mmol intravenous phosphate infusion, given as a ‘Phosphates Polyfusor’, for the treatment of severe hypophosphataemia in refeeding syndrome.Methods:  Patients with refeeding syndrome and normal renal function received a Phosphates Polyfusor infusion for the treatment of severe hypophosphataemia (< 0.50 mmol/L). The outcome measures were serial serum phosphate, creatinine and calcium concentrations for 4 days following phosphate infusion and adverse events.Results:  Over 2 years, 30 patients were treated. Following treatment, 37% of cases had a normal serum phosphate concentration and 73% had a serum phosphate concentration of > 0.5 mmol/L within 24 h. Ten patients required more than one Phosphates Polyfusor infusion. Within 72 h, 93% of cases had achieved a serum phosphate concentration of ≥ 0.50 mmol/L. No patient developed renal failure. Three episodes of transient mild hyperphosphataemia were recorded. Four patients developed mild hypocalcaemia.Conclusions:  This is the largest published series of the use of intravenous phosphate for the treatment of severe hypophosphataemia (< 0.50 mmol/L), and is the most effective regimen described. All patients had refeeding syndrome and were managed on general wards.
Systematic review: antacids, H2‐receptor antagonists, prokinetics, bismuth and sucralfate therapy for non‐ulcer dyspepsia
Authors: Moayyedi P. , Soo S. , Deeks J. , Forman D. , Harris A. , Innes M. , Delaney B. 
Published: May 2003

SummaryBackground: Evidence for the effectiveness of antacids, histamine‐2 receptor antagonists, bismuth salts, sucralfate and prokinetic therapy in non‐ulcer dyspepsia is conflicting.Aim: To conduct a systematic review evaluating these therapies in non‐ulcer dyspepsia.Methods: Electronic searches were performed using the Cochrane Controlled Trials Register, Medline, EMBASE, Cinahl and SIGLE until September 2002. Dyspepsia outcomes were dichotomized into cured/improved vs. same/worse.Results: Prokinetics [14 trials, 1053 patients; relative risk reduction (RRR), 48%; 95% confidence interval (95% CI), 27–63%] and histamine‐2 receptor antagonists (11 trials, 2164 patients; RRR, 22%; 95% CI, 7–35%) were significantly more effective than placebo. Bismuth salts (RRR, 40%; 95% CI, − 3% to 65%) were superior to placebo, but this was of marginal statistical significance. Antacids and sucralfate were not statistically significantly superior to placebo. A funnel plot suggested that the prokinetic and histamine‐2 receptor antagonist results could be due to publication bias.Conclusions: The meta‐analyses suggest that histamine‐2 receptor antagonists and prokinetics are superior to placebo. These data are difficult to interpret, however, as funnel plot asymmetry suggests that the magnitude of the effect could be due to publication bias or other heterogeneity‐related issues.
Review article: oral, modified‐release mesalazine formulations — proprietary versus generic
Authors: Forbes A. , Cartwright A. , Marchant S. , Mcintyre P. , Newton M. 
Published: May 2003

SummaryProducts containing mesalazine have been used in the treatment of inflammatory bowel disease for many years. Many of the oral, modified‐release products are reaching the point of patent expiration, and it is expected that several new ‘generic’ versions will be developed. As mesalazine acts topically, the drug needs to be available at the site of inflammation to be effective. For this reason, the currently available products have been developed with individual formulations so that physicians have a choice when matching the different release profiles to the site and extent of disease. As such, the current guidelines state that oral, delayed‐release mesalazine formulations are not interchangeable and should be prescribed by their proprietary (brand) name.The standard regulatory assessment process for generic or ‘copy’ products, using systemic bioequivalence data, does not appear to be sufficient when evaluating topically acting, oral, modified‐release products. We therefore recommend that the regulatory bodies should require that new, oral mesalazine products should be assessed by a combination of dissolution, bioequivalence and (a minimum of one) adequately powered, comparative trial to determine therapeutic equivalence. Of most importance here is that the assessment of new modified‐release products is sufficiently rigorous to allow patients and physicians to be confident in their use.
Clinical usefulness of KRAS mutational analysis in the diagnosis of pancreatic adenocarcinoma by means of endosonography‐guided fine‐needle aspiration biopsy
Authors: Pellisé M. , Castells A. , Ginès A. , Solé M. , Mora J. , CastellvÍ‐Bel S. , Rodríguez‐Moranta F. , Fernàndez‐Esparrach G. , Llach J. , Bordas J. M. , Navarro S. , Piqué J. M. 
Published: May 2003

SummaryAim : To establish the usefulness of KRAS mutational analysis in the diagnosis of pancreatic adenocarcinoma by comparing this technique with conventional cytology in aspirates obtained by endosonography‐guided fine‐needle aspiration.Methods : All consecutive patients with pancreatic focal lesions undergoing endosonography‐guided fine‐needle aspiration were included. Samples were obtained with the concourse of an attendant cytopathologist. Detection of codon‐12 KRAS mutations was performed by the restriction fragment length polymorphism‐polymerase chain reaction method. The effectiveness of conventional cytology, KRAS mutational analysis and their combination was established with respect to the definitive diagnosis. A cost‐effectiveness analysis was also performed.Results : Thirty‐three patients had pancreatic adenocarcinoma and 24 patients had other lesions. A total of 136 samples was obtained. In patients in whom specimens were adequate (93% for cytology; 100% for mutational analysis), the specificity of both techniques was 100%, whereas the sensitivity favoured cytology (97% vs. 73%). When inadequate samples were considered as misdiagnosed, a combination of both techniques reached the highest overall accuracy (cytology, 91%; mutational analysis, 84%; combination of both, 98%).Conclusions : Cytology from aspirates obtained by endosonography‐guided fine‐needle aspiration is the most precise single technique for the diagnosis of pancreatic adenocarcinoma. However, when adequate specimens are not available to reach a cytological diagnosis, the addition of KRAS mutational analysis represents the best strategy.
Meta‐analysis: evaluation of adjuvant therapy after curative liver resection for hepatocellular carcinoma
Authors: Mathurin P. , Raynard B. , Dharancy S. , Kirzin S. , Fallik D. , Pruvot F.‐R. , Roumilhac D. , Canva V. , Paris J.‐C. , Chaput J.‐C. , Naveau S. 
Published: May 2003

SummaryAim : To evaluate adjuvant modalities after curative resection for hepatocellular carcinoma using a meta‐analysis of randomized and non‐randomized controlled trials.Methods : In a first step, a meta‐analysis of randomized controlled trials was carried out. Sensitivity analyses after inclusion of non‐randomized controlled trials were performed. Four therapeutic modalities were evaluated: pre‐operative transarterial chemotherapy, post‐operative transarterial chemotherapy, systemic chemotherapy and a combination of systemic and transarterial chemotherapy.Results : Only post‐operative transarterial chemotherapy improved survival significantly at 2 years [difference, 22.8%; confidence interval (CI), 8.6–36.9%; P = 0.002] and 3 years (difference, 27.6%; CI, 8.2–47.1%; P = 0.005), and decreased the probability of no recurrence at 1 year (difference, 28.8%; CI, 16.7–40.8%; P < 0.001), 2 years (difference, 27.6%; CI, 8.2–47.1%; P = 0.005) and 3 years (difference, 28%; CI, 8.2–47.9%; P = 0.006). In a sensitivity analysis after inclusion of non‐randomized controlled trials, post‐operative transarterial chemotherapy still improved survival at 1 year (difference, 9.6%; CI, 0.8–18.3%; P = 0.03), 2 years (difference, 13.5%; CI, 0.9–26%, P = 0.04) and 3 years (difference, 18%; CI, 7–28.9%; P < 0.001), and decreased the probability of no recurrence at 1 year (difference, 20.3%; CI, 7.7–33%; P = 0.002), 2 years (difference, 35%; CI, 21.4–46.3%; P < 0.001) and 3 years (difference, 34.5%; CI, 18.7–50.3%; P < 0.001).Conclusion : Post‐operative transarterial chemotherapy improved survival and decreased the cumulative probability of no recurrence. New randomized controlled trials evaluating this modality are required.
Meta‐analysis: proton pump inhibitor or H2‐receptor antagonist for Helicobacter pylori eradication
Authors: Graham D. Y. , Hammoud F. , El‐Zimaity H. M. T. , Kim J. G. , Osato M. S. , El‐Serag H. B. 
Published: May 2003

SummaryAim : To compare H2‐receptor antagonists and proton pump inhibitors as adjuvants to triple therapy for Helicobacter pylori eradication.Methods : H. pylori‐infected patients with peptic ulcer were randomized to receive either 300 mg nizatidine or 30 mg lansoprazole plus 1 g amoxicillin and 500 mg clarithromycin taken b.d. for 7 days. H. pylori eradication was assessed 4 weeks after therapy. Using meta‐analytical techniques, we combined the results of this study with other randomized controlled comparisons of H2‐receptor antagonists and proton pump inhibitors as adjuvants to triple therapy.Results : One hundred and one patients were randomized. H. pylori eradication was 94% (47/50) [95% confidence interval (CI), 83–99%] (intention‐to‐treat) in the H2‐receptor antagonist group vs. 86% (44/51) (95% CI, 74–94%) in the proton pump inhibitor group (P = 0.3). There has been a total of 12 similar studies (1415 patients). The overall efficacy was similar in intention‐to‐treat analysis: 78% (549/701) with H2‐receptor antagonists vs. 81% (575/714) with proton pump inhibitors (odds ratio, 0.86; 95% CI, 0.66–1.12). A non‐significant trend favouring H2‐receptor antagonist (79% vs. 69%; odds ratio, 1.14; 95% CI, 0.76–1.71; P = 0.5) was seen in the comparison of clarithromycin‐containing regimens. In contrast, in non‐clarithromycin‐containing trials, there was a slight, but significant, advantage with proton pump inhibitors (85% vs. 78%; odds ratio, 0.64; 95% CI, 0.45–0.92; P = 0.02).Conclusion : Overall, proton pump inhibitor andH2‐receptor antagonist antisecretory agents appear to be similarly effective as adjuvants for H. pylori triple therapy. It is unlikely that the direct anti‐H. pylori effect of proton pump inhibitors is responsible for their ability to enhance anti‐H. pylori therapy.
An inter‐ and intra‐laboratory comparison of breath 13CO2 analysis
Authors: Perri F. , Zagari R. M. , Uebersax J. S. , Quitadamo M. , Bazzoli F. ,   The Helicobacter Pylori Sige Study Group on CO Measurement Standardization
Published: May 2003

SummaryBackground:  13C breath test analysis requires accurate 13CO2 measurements.Aim:  To perform a multicentre study to evaluate the repeatability and reproducibility of breath 13CO2 analysis.Methods:  Two series of 25 paired randomly coded tubes (each consisting of 23 13CO2‐enriched breath samples and two samples of standard reference pure CO2 with certified δ13CPDB) were sent to participating centres for 13CO2 measurement. Each series of tubes was analysed 10 days apart. The repeatability and reproducibility of 13C measurements was assessed by Mandel's k and h statistics.Results:  Twenty‐two centres participated in the study: 18 showed good inter‐ and intra‐laboratory variability, whilst four showed abnormally high inter‐ or intra‐laboratory variability. Breath test results were also significantly affected by the accuracy of the 13C analytical procedures.Conclusions:  A low accuracy of 13C measurements may significantly affect the results of breath tests, leading to inappropriate clinical decisions. Standardization of 13C analysis is required to guarantee optimal 13C measurements and accurate 13C breath test results.
Current practice in surveillance strategy for patients with Barrett's oesophagus in the UK
Authors: Mandal A. , Playford R. J. , Wicks A. C. 
Published: May 2003

SUMMARYBackground:  Many guidelines exist regarding the surveillance of patients with Barrett's oesophagus. There are limited data, however, with regard to whether practitioners follow these guidelines.Methods:  We assessed current surveillance practice amongst members of the British Society of Gastroenterology using a simple 11‐question anonymized survey, mailed to 300 randomly selected members from the British Society of Gastroenterology Handbook.Results : Two hundred and three of the 300 (68%) responded, 76% considering that surveillance was worthwhile. In those who considered surveillance to be worthwhile, 83% used sub‐selection based on age, the length of Barrett's oesophagus or the presence of ulcer or stricture. Patients with Barrett's oesophagus of < 3 cm (short‐segment) were considered to be inappropriate for surveillance by 62%. Forty‐one per cent reported following the ‘advised’ recommendations of four‐quadrant biopsies every 2 cm, whereas 44% followed a ‘random and suspicious areas only’ protocol. Marked variation was reported in the re‐endoscope interval for both low‐ and high‐grade dysplasia. Only 55% reported that two experienced pathologists reviewed all biopsies showing high‐grade dysplasia.Conclusions:  Despite the existence of multiple guidelines for Barrett's surveillance, clinical practice varies widely in the UK. This may be due to a lack of knowledge or because gastroenterologists remain unconvinced by the quality of the current evidence of its value. These results have implications for studies attempting to collate data from multiple centres.