bluuebunny/crossref_metadata_2025 huggingface dataset:
The Psoriasis Area and Severity Index Is the Adequate Criterion to Define Severity in Chronic Plaque-Type Psoriasis
Authors: Schmitt Jochen , Wozel Gottfried
Published: March 2005

Background: Chronic plaque-type psoriasis is a major dermatosis, but a significant question is still unanswered: What defines severity in chronic plaque-type psoriasis? While objective assessments like the Psoriasis Area and Severity Index (PASI) have frequently been used in clinical trials, quality of life (QOL) questionnaires are currently becoming more and more popular. Objective: This article summarizes the most important objective and subjective measurements of severity in psoriasis. For every dermatologist it is critically important to distinguish between severe psoriasis and psoriasis that severely affects QOL. Even if the PASI also has disadvantages, it is the most adequate instrument available to evaluate severity in plaque-type psoriasis. Result: We provide reasons why PASI >12 defines severe, PASI 7–12 moderate and PASI <7 mild chronic plaque-type psoriasis.
Targetoid Hemosiderotic Nevus
Authors: Tomasini Carlo , Broganelli Paolo , Pippione Mario
Published: March 2005

Background: Simulators of malignant melanoma comprise a heterogenous group of melanocytic and nonmelanocytic lesions of the skin. Among frequent clinical mimickers of melanoma are injured melanocytic nevi. Any change in the clinical appearance of a pre-existing nevus should alert the clinician to exclude the possibility of malignant transformation in order to early identify a lesion at a stage when complete cure can still be achieved. Objective: The purpose of this study was to present the clinical, dermoscopic and histopathologic findings of a series of acquired melanocytic nevi which abruptly developed a pigmented peripheral halo, presumably following minor trauma. Methods: A series of 6 cases of acquired melanocytic nevi which suddenly developed a targetoid halo were included in the study. All lesions were evaluated by dermoscopy. Three cases were surgically removed at different stages of evolution and submitted to histopathologic examination. In all cases, follow-up was obtained. Results: All the lesions arose on trauma-prone skin sites of young women. The sudden development of an asymptomatic, targetoid halo on a long-lasting, acquired exophytic nevus was the main presentation. Whereas the central nevus persisted, the ecchymotic halo ultimately disappeared. Histopathologic examination disclosed changes of the traumatized nevus in the central part, whereas the ring showed hemorrhage and hemosiderin deposits. Increased numbers of small vessels with hobnail characteristics were associated features. Conclusions: Targetoid hemosiderotic nevus is a distinctive clinicopathologic variant of traumatized acquired melanocytic nevus which should be included in the list of clinical simulators of melanoma.
Changing Trends in the Number of Deaths from Nonmelanoma Skin Cancer in Japan, 1955–2000
Authors: Ohtsuka Hisashi , Nagamatsu Shogo
Published: March 2005

Background: The incidence and number of deaths from nonmelanoma skin cancer (NMSC) have been reported to increase in many countries. However, those in Japan over a long time span have not been analyzed yet. Objective: To analyze the changing trends in the numbers of deaths from NMSC in Japan. Methods: We analyzed the annual trends in numbers of deaths from NMSC from 1955 to 2000 in Japan on the basis of the data from the Vital Statistics of Japan, Statistics and Information Department, Minister’s Secretariat, Ministry of Health, Labor and Welfare. Results: The general trends in numbers of deaths from NMSC were downward between 1979 and 1994, but upward after 1995. The recent annual increased proportion of deaths from NMSC was 3.8% (95% confidence interval: 1.3–6.3%). The general trends in age-standardized death rates were roughly downward, although the death rates plateaued after 1995. The number and proportion of deaths among the elderly were increasing. In recent years, more than 50% of the deaths among females occurred at or after 85 years of age, and the corresponding age for males was 75 years or after. Conclusion: Elderly individuals should be a focus of health promotion activities.
The Outcome after Cryosurgery and Intralesional Steroid Injection in Vulvar Lichen sclerosus Corresponds to Preoperative Histopathological Findings
Authors: Stücker Markus , Grape Jonas , Bechara Falk Georges , Hoffmann Klaus , Altmeyer Peter
Published: March 2005

Background: Vulvar lichen sclerosus (LS) still presents a therapeutic challenge. Questions: The aim of the present study was to investigate whether there is a correlation between preoperative histopathological findings in female LS and long-term results after cryosurgery and intralesional steroid injections. Material and Methods: 22 females with LS, mean age 65.3 ± 10.5 years, were treated with cryosurgery (–186°C) using the contact method with 1 freeze-thaw cycle per lesion and intralesional triamcinolone acetonide injection. The time between surgery and follow-up examination was 27.8 ± 14.6 months. We compared the clinical outcome and the thickness of the epidermis, the zone of sclerosis and the inflammatory infiltrate in biopsy specimens taken before treatment. Results: In 14 of 22 patients, a relapse after cryosurgery occurred (median after 7.5 months). Patients would ‘moderately’ recommend cryosurgery for LS (2.2 ± 0.9; minimum: 0, optimum: 4). Pruritus was significantly reduced (visual analog scale: preoperative 7.1 ± 2.6 vs. postoperative 2.0 ± 2.4; p = 0.001) even in patients with relapse (preoperative 7.6 ± 2.4 vs. postoperative 3.1 ± 2.28; p = 0.001). Women with relapse showed a significantly higher composed thickness of epidermis, sclerosis and inflammatory infiltrate (430 ± 139.0 µm) than those without relapse (314 ± 41.2 µm; p = 0.046). Conclusion: In our patients, cryosurgery and intralesional steroid injections were efficient in the treatment of LS. Patients showing relapse had a thicker epidermis and a stronger inflammatory infiltrate. Therefore a treatment of LS should be performed at an early stage of the disease.
Disseminated Granuloma Annulare – Treatment with Fumaric Acid Esters
Authors: Eberlein-König B. , Mempel M. , Stahlecker J. , Forer I. , Ring J. , Abeck D.
Published: March 2005

Background:The therapy of disseminated granuloma annulare has often limited success. Treatment of granuloma annulare with fumaric acid esters (FAE) has recently been reported to be effective in 2 patients. Objectives: To assess the efficacy of a systemic therapy with FAE in consecutive patients with disseminated granuloma annulare. Methods:Eight patients with disseminated granuloma annulare were treated with FAE in tablet form according to the standard therapy regimen used in psoriasis. The colour and the elevation of the skin lesions were assessed by a visual analogue scale before and after therapy. Results:Systemic therapy with FAE induced a significant clinical improvement in elevation and colour of skin lesions, with remission in 3 and partial remission in 4 patients. One patient remained unchanged. Side-effects associated with the therapy were seen in 6 patients. Conclusions: Systemic therapy with FAE can be effective in patients suffering from disseminated forms of granuloma annulare, but side-effects of FAE have to be taken into consideration.
Alopecia areata universalis Sparing Nevus flammeus
Authors: Chen WenChieh
Published: March 2005

Alopecia areata is a common form of nonscarring hair disorder of unclear etiology. Cases with alopecia areata sparing congenital melanocytic nevi have been described. It is explained by the Renbök phenomenon or inverse Köbner phenomenon, which refers to normal hair growth in the psoriatic lesions observed in patients with psoriasis and alopecia areata. We report a 30-year-old man presenting with rapidly progressing alopecia areata universalis, which spared a large nevus flammeus on the left parietal scalp. Our case gives further evidence to the notion that nevus as genetic mosaic may show genetically determined resistance to alopecia areata.
Mucosal Pigmentation after Oral Lichen planus Treatment with Topical Tacrolimus
Authors: Fricain J.C. , Sibaud V. , Campana F. , Lepreux S. , Taïeb A.
Published: March 2005

Erosive oral lichen planus (OLP) is a painful chronic inflammatory disease that is sometimes resistant to systemic or topical therapies. Topical steroids remain the mainstay of therapy, but topical tacrolimus has recently been used to treat OLP resistant to topical corticosteroids. Topical tacrolimus appears as an effective and safe treatment of symptomatic OLP. We report the first histopathologically documented case of oral mucosa pigmentation after OLP treatment with topical tacrolimus. The relation between tacrolimus treatment and staining was suggested by the appearance of pigmentation during topical tacrolimus treatment and its clinical disappearance when treatment was stopped. Histopathology showed an increase in melanocyte numbers and melanogenesis.
Malignant Melanoma in a Candidate for Heart Transplantation
Authors: Tessari Gianpaolo , Forni Alberto , Naldi Luigi , Faggian Giuseppe , Mazzucco Alessandro , Barba Annalisa
Published: March 2005

A superficial spreading melanoma (Breslow thickness 0.4 mm) was diagnosed in a 65-year-old candidate for heart transplantation due to refractory end stage heart failure. After extensive review of the literature (USA and Europe), no clear guidelines about the management of candidates for transplantation with a previous diagnosis of melanoma were found. As this patient had a 5-year probability of survival higher than 95% and heart transplantation was necessary for saving his life, the final decision was to perform the transplantation. Unfortunately, the patient died of heart failure before a suitable heart became available. This case stresses the need for early and continuous dermatological evaluation of all candidates for solid organ transplantation. Clear guidelines for screening of skin cancer before transplantation are needed.
Complement Component C5a Is Integral to the Febrile Response of Mice to Lipopolysaccharide
Authors: Li S. , Boackle S.A. , Holers V.M. , Lambris J.D. , Blatteis C.M.
Published: March 2005

Objectives: The complement system is critical to the febrile response of mice to intraperitoneally administered lipopolysaccharide (LPS). We previously identified C3 and C5 as two components potentially involved in this response. This study was designed to examine whether the complement system is also pivotal in the response of mice to intravenously or intracerebroventricularly injected LPS, to distinguish between C3 and C5 and their cognate derivatives as the essential mediator(s), and to determine whether the failure of complement-deficient mice to develop a fever could be due to their possible inability to secrete pyrogenic cytokines. Methods: Wild-type (WT; C57BL/6J) mice, hypocomplemented or not by intravenously injected cobra venom factor (10 U/mouse), and C3-, CR3- and C5-sufficient and -deficient mice were intravenously challenged with LPS (0.25 µg/mouse); WT and C3–/– mice pretreated with a C5a receptor antagonist (C5aRa) were similarly challenged. In addition, the serum levels of interleukin (IL)-1β, tumor necrosis factor (TNF)-α and IL-6 were compared in LPS-treated C5+/+ and C5–/– mice. Results: LPS induced a 1°C rise in core temperature in all the mice, except C5–/– mice and those pretreated with C5aRa. C5+/+ and C5–/– mice challenged intracerebroventricularly with LPS exhibited identical febrile responses. LPS induced similar increases in the serum levels of IL-1β, TNFα and IL-6 in C5+/+ and C5–/– mice. Conclusions: C5a is crucial for the development of febrile responses to LPS in mice; its site of action is peripheral, not central. The possibility that an inability to produce cytokines could account for the failure of C5–/– mice to develop a fever is not supported.
Increased Dopamine Content in Lymphocytes from High-Dose L-Dopa-Treated Parkinson’s Disease Patients
Authors: Rajda Cecilia , Dibó György , Vécsei László , Bergquist Jonas
Published: March 2005

Objectives: The intracellular (i.c.) content of dopamine and its metabolites was measured in the peripheral blood lymphocytes (PBLs) of Parkinson’s disease (PD) patients and healthy controls. Methods: Catecholamine levels of PBLs were measured using capillary electrophoresis in healthy controls and PD patients receiving different doses of L-dihydroxyphenylalanine (L-Dopa). Results: Higher i.c. dopamine content was found in lymphocytes from PD patients receiving a high dose of L-Dopa (700 ± 30 mg/day) as compared to lymphocytes from the healthy controls (p = 0.002) and from PD patients treated with a low dose of L-Dopa (400 ± 30 mg/day) (p = 0.022). The dihydroxyphenylacetic acid to dopamine ratio was significantly lower in the high-dose L-Dopa-treated PD patients than in the controls (p = 0.013). Conclusions: These findings suggest that the dopamine content and metabolism in the peripheral lymphocytes of PD patients are influenced by L-Dopa administration. This is the first study in which a dose-related effect of L-Dopa treatment was found in lymphocytes from PD patients.
Abnormal Thymic Microenvironment in Insulin-Like Growth Factor-II Transgenic Mice
Authors: Savino Wilson , Cotta-de-Almeida Vinícius , van Buul-Offers Sylvia C. , Koster Johanna G. , Dardenne Mireille
Published: March 2005

Objectives: Intrathymic T cell differentiation is driven by the thymic microenvironment, a tridimensional network of cells and extracellular matrix (ECM). Previous data showed that lymphoid and microenvironmental compartments are under the control of hormones and growth factors. We then attempted to define if insulin-like growth factor-II (IGF-II) was also involved in such a control. Methods: We used IGF-II transgenic (Tg) mice and studied their thymic microenvironment by immunohistochemistry. Moreover, we evaluated thymocytes in terms of their ability to adhere to thymic epithelial cells and to migrate through epithelial cells and ECM. Results: Transgenic IGF-II expression results in abnormalities of the thymic epithelium. Terminal differentiation of thymic epithelial cells (TEC) is modified, with the appearance of large clusters of cells immunoreactive to the monoclonal antibody KL1, which specifically recognizes highly differentiated TEC. Accordingly, treatment of cultured TEC with exogenous IGF-II induces the appearance of KL1+ cells and increases TEC proliferation. IGF-II Tg animals exhibit increased serum levels of the TEC-derived hormone thymulin. These effects were seen even when the IGF-II transgene was inserted in dwarf mice. Moreover, deposition of fibronectin and laminin is also enhanced in IGF-II Tg mouse thymus and in IGF-II-treated TEC cultures. Furthermore, ECM-mediated interactions between thymocytes and TEC are affected by exogenous IGF-II, as exemplified by the enhancement of thymocyte adhesion to TEC monolayers and thymocyte migration in thymic nurse cell complexes. Conclusions: Our data indicate that IGF-II pleiotropically affects the thymic epithelium, both in vivo and in vitro, and that some of these changes may have consequences on thymocyte/TEC interactions.
Neonatal Androgenization Affects the Intrathymic T-Cell Maturation in Rats
Authors: Leposavić Gordana , Pejčić-Karapetrović Branka , Kosec Duško
Published: March 2005

The thymus structure, expression of CD4/CD8/TCRαβ on thymocytes and thymocyte proliferative and apoptotic indexes were analyzed in sexually immature 30-day-old and in sexually mature 60-day-old female rats neonatally androgenized (NA) by subcutaneous injection of 500 µg testosterone propionate/day on days 1–3 and in their vehicle-administered counterparts. The treatment affected normal thymus development. Thus, at 30 days of age, there was a reduction in the thymus weight, reflecting a decrease in the main thymic compartments. However, at 60 days of age, thymus weight did not significantly differ from that in age-matched controls, since the cortical volume enlargement was followed by a proportional decrease in the medullary volume. In rats of both ages, the changes in thymic compartments most likely reflected alterations in the size of both lymphoid and nonlymphoid components. Furthermore, in NA rats, substantial changes in thymocyte phenotypic characteristics were registered, in spite of their age. In both groups of NA rats, a decrease in the relative proportion of the least mature CD4–8–TCRαβ– cells and in that of CD4+8– TCRαβ–/TCRαβlow cells followed by an increase in the percentage of their successor CD4+8+TCRαβ–/TCRαβlow cells was detected. In addition, in 30-day-old NA rats, the relative proportions of CD4+8+TCRαβhigh cells (just positively selected) and that of mature single positive (CD4+8– and CD4–8+) and CD4–8– double negative TCRαβhigh cells, were reduced, while in 60-day-old NA rats only the percentage of CD4+8+TCRαβhigh thymocytes was decreased. Thus, the study showed that the changes in the development of the hypothalamo-pituitary-gonadal axis induced by neonatal androgenization may affect the thymus development and intrathymic T-cell maturation.
Age- and Sex-Related Variation in Song-Control Regions in Cassin’s Finches, Carpodacus cassinii
Authors: MacDougall-Shackleton Scott A. , Ball Gregory F. , Edmonds Eric , Sul Raeme , Hahn Thomas P.
Published: March 2005

Male Cassin’s finches (Carpodacus cassinii) sing long, complex songs that incorporate many elements mimicked from other species. Although one-year-old males (males in their first breeding season) are sexually competent and do breed, they sing a simpler song (fewer syllable types) than do males two or more years old (called after-second-year males). Females do occasionally sing, but with much less stereotypy and complexity than breeding males of any age. We collected brains from free-living breeding after-second-year males (identified by their red plumage), one-year-old males (identified by their female-like brown plumage), and adult females to examine sex- and age-related differences in three song-control nuclei: HVC, Area X and RA. Nuclei volumes were reconstructed by measuring the Nissl-defined area in every second section. There was a large sex difference in all three nuclei, with female volumes 40–50% that of males. There was no difference in HVC volume between age classes of males. However, one-year-old (brown) males had significantly larger Area X volume than did the older (red) males, with red males’ Area X about 75% the volume of brown males’. These data raise questions regarding the functional significance of Area X and related nuclei in relation to song development in vocal mimics.
A Subjective Distance Between Stimuli: Quantifying the Metric Structure of Representations
Authors: Oliva Damián , Samengo Inés , Leutgeb Stefan , Mizumori Sheri
Published: March 2005

As subjects perceive the sensory world, different stimuli elicit a number of neural representations. Here, a subjective distance between stimuli is defined, measuring the degree of similarity between the underlying representations. As an example, the subjective distance between different locations in space is calculated from the activity of rodent's hippocampal place cells and lateral septal cells. Such a distance is compared to the real distance between locations. As the number of sampled neurons increases, the subjective distance shows a tendency to resemble the metrics of real space.
Nonlinear Complex-Valued Extensions of Hebbian Learning: An Essay
Authors: Fiori Simone
Published: March 2005

The Hebbian paradigm is perhaps the best-known unsupervised learning theory in connectionism. It has inspired wide research activity in the artificial neural network field because it embodies some interesting properties such as locality and the capability of being applicable to the basic weight-and-sum structure of neuron models. The plain Hebbian principle, however, also presents some inherent theoretical limitations that make it impractical in most cases. Therefore, modifications of the basic Hebbian learning paradigm have been proposed over the past 20 years in order to design profitable signal and data processing algorithms. Such modifications led to the principal component analysis type class of learning rules along with their nonlinear extensions. The aim of this review is primarily to present part of the existing fragmented material in the field of principal component learning within a unified view and contextually to motivate and present extensions of previous works on Hebbian learning to complex-weighted linear neural networks. This work benefits from previous studies on linear signal decomposition by artificial neural networks, nonquadratic component optimization and reconstruction error definition, neural parameters adaptation by constrained optimization of learning criteria of complex-valued arguments, and orthonormality expression via the insertion of topological elements in the networks or by modifying the network learning criterion. In particular, the learning principles considered here and their analysis concern complex-valued principal/minor component/subspace linear/nonlinear rules for complex-weighted neural structures, both feedforward and laterally connected.
Rate and Synchrony in Feedforward Networks of Coincidence Detectors: Analytical Solution
Authors: Mikula Shawn , Niebur Ernst
Published: March 2005

We provide an analytical recurrent solution for the firing rates and cross-correlations of feedforward networks with arbitrary connectivity, excitatory or inhibitory, in response to steady-state spiking input to all neurons in the first network layer. Connections can go between any two layers as long as no loops are produced. Mean firing rates and pairwise cross-correlations of all input neurons can be chosen individually. We apply this method to study the propagation of rate and synchrony information through sample networks to address the current debate regarding the efficacy of rate codes versus temporal codes.

Our results from applying the network solution to several examples support the following conclusions: (1) differential propagation efficacy of rate and synchrony to higher layers of a feedforward network is dependent on both network and input parameters, and (2) previous modeling and simulation studies exclusively supporting either rate or temporal coding must be reconsidered within the limited range of network and input parameters used. Our exact, analytical solution for feedforward networks of coincidence detectors should prove useful for further elucidating the efficacy and differential roles of rate and temporal codes in terms of different network and input parameter ranges.
Dynamical Behaviors of a Large Class of General Delayed Neural Networks
Authors: Chen Tianping , Lu Wenlian , Chen Guanrong
Published: March 2005

Research of delayed neural networks with varying self-inhibitions, interconnection weights, and inputs is an important issue. In the real world, self-inhibitions, interconnection weights, and inputs should vary as time varies. In this letter, we discuss a large class of delayed neural networks with periodic inhibitions, interconnection weights, and inputs. We prove that if the activation functions are of Lipschitz type and some set of inequalities, for example, the set of inequalities 3.1 in theorem 1, is satisfied, the delayed system has a unique periodic solution, and any solution will converge to this periodic solution. We also prove that if either set of inequalities 3.20 in theorem 2 or 3.23 in theorem 3 is satisfied, then the system is exponentially stable globally. This class of delayed dynamical systems provides a general framework for many delayed dynamical systems. As special cases, it includes delayed Hopfield neural networks and cellular neural networks as well as distributed delayed neural networks with periodic self-inhibitions, interconnection weights, and inputs. Moreover, the entire discussion applies to delayed systems with constant self-inhibitions, interconnection weights, and inputs.
Difficulty of Singularity in Population Coding
Authors: Amari Shun-ichi , Nakahara Hiroyuki
Published: March 2005

Fisher information has been used to analyze the accuracy of neural population coding. This works well when the Fisher information does not degenerate, but when two stimuli are presented to a population of neurons, a singular structure emerges by their mutual interactions. In this case, the Fisher information matrix degenerates, and the regularity condition ensuring the Cramér-Rao paradigm of statistics is violated. An animal shows pathological behavior in such a situation. We present a novel method of statistical analysis to understand information in population coding in which algebraic singularity plays a major role. The method elucidates the nature of the pathological case by calculating the Fisher information. We then suggest that synchronous firing can resolve singularity and show a method of analyzing the binding problem in terms of the Fisher information. Our method integrates a variety of disciplines in population coding, such as nonregular statistics, Bayesian statistics, singularity in algebraic geometry, and synchronous firing, under the theme of Fisher information.
Quantifying Stimulus Discriminability: A Comparison of Information Theory and Ideal Observer Analysis
Authors: Thomson Eric E. , Kristan William B.
Published: March 2005

Performance in sensory discrimination tasks is commonly quantified using either information theory or ideal observer analysis. These two quantitative frameworks are often assumed to be equivalent. For example, higher mutual information is said to correspond to improved performance of an ideal observer in a stimulus estimation task. To the contrary, drawing on and extending previous results, we show that five information-theoretic quantities (entropy, response-conditional entropy, specific information, equivocation, and mutual information) violate this assumption. More positively, we show how these information measures can be used to calculate upper and lower bounds on ideal observer performance, and vice versa. The results show that the mathematical resources of ideal observer analysis are preferable to information theory for evaluating performance in a stimulus discrimination task. We also discuss the applicability of information theory to questions that ideal observer analysis cannot address.
Synaptic Shot Noise and Conductance Fluctuations Affect the Membrane Voltage with Equal Significance
Authors: Richardson Magnus J. E. , Gerstner Wulfram
Published: March 2005

The subthreshold membrane voltage of a neuron in active cortical tissue is a fluctuating quantity with a distribution that reflects the firing statistics of the presynaptic population. It was recently found that conductance-based synaptic drive can lead to distributions with a significant skew. Here it is demonstrated that the underlying shot noise caused by Poissonian spike arrival also skews the membrane distribution, but in the opposite sense. Using a perturbative method, we analyze the effects of shot noise on the distribution of synaptic conductances and calculate the consequent voltage distribution. To first order in the perturbation theory, the voltage distribution is a gaussian modulated by a prefactor that captures the skew. The gaussian component is identical to distributions derived using current-based models with an effective membrane time constant. The well-known effective-time-constant approximation can therefore be identified as the leading-order solution to the full conductance-based model. The higher-order modulatory prefactor containing the skew comprises terms due to both shot noise and conductance fluctuations. The diffusion approximation misses these shot-noise effects implying that analytical approaches such as the Fokker-Planck equation or simulation with filtered white noise cannot be used to improve on the gaussian approximation. It is further demonstrated that quantities used for fitting theory to experiment, such as the voltage mean and variance, are robust against these non-Gaussian effects. The effective-time-constant approximation is therefore relevant to experiment and provides a simple analytic base on which other pertinent biological details may be added.
Patient Adherence Improves Glycemic Control
Authors: Rhee Mary K. , Slocum Wrenn , Ziemer David C. , Culler Steven D. , Cook Curtiss B. , El-Kebbi Imad M. , Gallina Daniel L. , Barnes Catherine , Phillips Lawrence S.
Published: March 2005

Purpose

The purpose of this study was to assess the influence of appointment keeping and medication adherence on HbA1c.

Methods

A retrospective evaluation was performed in 1560 patients with type 2 diabetes who presented for a new visit to the Grady Diabetes Clinic between 1991 and 2001 and returned for a follow-up visit and HbA1c after 1 year of care. Appointment keeping was assessed by the number of scheduled intervening visits that were kept, and medication adherence was assessed by the percentage of visits in which self-reported diabetes medication use was as recommended at the preceding visit.

Results

The patients had an average age of 55 years, body mass index (BMI) of 32 kg/m2, diabetes duration of 4.6 years, and baseline HbA1c of 9.1%. Ninety percent were African American, and 63% were female. Those who kept more intervening appointments had lower HbA1c levels after 12 months of care (7.6% with 6-7 intervening visits vs 9.7% with 0 intervening visits). Better medication adherence was also associated with lower HbA1c levels after 12 months of care (7.8% with 76%-100% adherence). After adjusting for age, gender, race, BMI, diabetes duration, and diabetes therapy in multivariate linear regression analysis, the benefits of appointment keeping and medication adherence remained significant and contributed independently; the HbA1c was 0.12% lower for every additional intervening appointment that was kept (P= .0001) and 0.34% lower for each quartile of better medication adherence (P= .0009).

Conclusion

Keeping more appointments and taking diabetes medications as directed were associated with substantial improvements in HbA1c. Efforts to enhance glycemic outcomes should include emphasis on these simple but critically important aspects of patient adherence.
Implementing the Chronic Care Model for Improvements in Diabetes Care and Education in a Rural Primary Care Practice
Authors: Siminerio Linda M. , Piatt Gretchen , Zgibor Janice C.
Published: March 2005

Purpose

The purpose of this pilot study was to determine the impact of implementing elements of the chronic care model (CCM; decision support, self-management, and delivery system redesign) on providers' diabetes care practices and patient outcomes in a rural practice setting.

Methods

In this pilot study, 104 patients with type 2 diabetes and 6 providers in a rural primary care practice were involved in an intervention that included a certified diabetes educator (CDE) who educated and supported providers on diabetes management and adherence to the American Diabetes Association (ADA) Standards of Care over the year of the project. The CDE also provided diabetes self-management education (DSME) at the office site for 29 of the 104 patients who received their care in the practice. The following variables were evaluated: provider perceived barriers to care and adherence to ADA standards of care and patient A1C, blood pressure, cholesterol, knowledge, and empowerment levels.

Results

Provider adherence to ADA Standards of Care increased significantly across all process measures. Patients who received DSME at point of service in the primary care practice setting gained improvements in knowledge, empowerment, A1C, and high-density lipoprotein cholesterol levels.

Conclusions

Implementing systems to support decision support, selfmanagement education, and delivery system redesign has a positive influence on practices and patient outcomes in outlying rural communities.
Barriers to A1C Testing Among a Managed Care Population
Authors: Delaronde Steven
Published: March 2005

Purpose

The purpose of this study is to explore reasons adults with diabetes do not receive at least 2 A1C tests per year as recommended by the American Diabetes Association (ADA).

Methods

ConnectiCare, a regional managed care company based in Farmington, Connecticut, identified adult members with diabetes who did not have a medical claim for an A1C laboratory test from their physician. A questionnaire was sent to 740 randomly selected members asking them to report the number of A1C tests they received in the past 12 months and reasons for not receiving the number of tests recommended by the ADA. After sending an automated telephone reminder to nonrespondents, a 26% (n = 192) response rate was achieved.

Results

Thirty-three percent of respondents (n = 63) reported having diabetes and receiving fewer than 2 A1C tests in the past year. Respondents were equally divided between men and women, with a mean age of 58 years. The primary reasons given for not obtaining at least 2 A1C tests as recommended by the ADA were that respondents were unaware that the test is recommended (49%), not informed of the need for the test by their physician (38%), never heard of the A1C test (33%), and not seen regularly by their physician (19%).

Conclusions

Diabetes self-management education remains an important means of encouraging adherence to important ADA recommendations such as regular A1C testing. Barriers to A1C testing can be addressed in multiple settings, including individual and group education, disease management programs, and physician education.
Initiating Treatment Success — My Individualized Nutrition and Exercise Plan
Authors: Kearns JoAnn W. , Kemmis Karen , Ploutz-Snyder Robert , Weinstock Ruth S.
Published: March 2005

The authors’ class structure incorporates individual meal and exercise planning in the group setting. This study was conducted to (1) determine if class participants can create their own meal and exercise plans, (2) determine if class participants feel they will be able to adhere to their meal and exercise plans, and (3) assess adherence to the plans over time. Subjects were recruited from the classes offered at the Joslin Diabetes Center. Following completion of class, patients completed the evaluation questionnaire. Two and 6 months later, study participants received follow-up questionnaires by phone or mail. Among respondents, 63% were able to determine their own carbohydrate goals, with 95.9% indicating they could adhere to the plan, and 82.8% felt the plan would be easier than previous ones. At 2 and 6 months, respectively, 89% and 92% of the participants felt they were following the meal plan either some or most of the time. One hundred percent of the respondents were able to determine their own exercise plan, with 98% indicating they could adhere to the plan, and 85.7% felt the new plan would be easier than previous ones. At 2 and 6 months, respectively, 70% and 73% felt they were following their exercise plan either some or most of the time. Individualized meal and exercise plans can be successfully created in a group setting.
Recruitment and Retention of Rural African Americans in Diabetes Research
Authors: Loftin Wanda Anderson , Barnett Steven K. , Bunn Peggy Summers , Sullivan Patra
Published: March 2005

Purpose

The purpose of this article was to describe lessons learned about recruitment and retention of rural African Americans from published literature, the authors’ research, and research experience. Two rural, communitybased research studies with African Americans with diabetes are used to illustrate different issues and strategies in recruitment and retention.

Methods

Relevant MEDLINE articles and clinical studies were reviewed, and the design, implementation, and results of the 2 community-based studies were evaluated. Information from the literature, research results, and sample selection, participation, and attrition experiences were synthesized to determine effective approaches for recruitment and retention.

Results

Research funding, design, and implementation; recruitment methods; culturally competent approaches; caring, trusting provider-patient relationships; incentives; follow-up; and factors in the rural environment emerged as important issues influencing recruitment and retention.

Conclusion

Recruitment and retention of African Americans in rural diabetes research is a significant challenge, and adequate funding should be sought early in the research process. Culturally competent approaches; caring, trusting relationships; incentives; and follow-up are important concepts in successful recruitment, participation, and retention of African Americans. The lessons learned may be applicable to the more widespread issue of recruitment and retention of rural African Americans in diabetes education programs.
Strategies for Maintaining Integrity of a Behavioral Intervention
Authors: Whitmer Kyra , Sweeney Carole , Slivjak Anne , Sumner Connie , Barsevick Andrea
Published: March 2005

The purpose of this article is to address issues in maintaining the integrity of a behavioral intervention. Examples are provided from a recently completed study on how to train research staff and monitor the integrity of the intervention. In this exemplar, the integrity of the behavioral intervention was addressed by the design of the study and research staff training. Throughout the study, the integrity of the behavioral intervention was monitored by delineating a checklist of topics that must be addressed, critiquing audiotapes of the intervention, and discussing incomplete or missing elements with the research staff.
Improving Resident Outcomes With GAPN Organization Level Interventions
Authors: Krichbaum Kathleen , Pearson Valinda , Savik Kay , Mueller Christine
Published: March 2005

This research tested the effectiveness of the second tier of interventions in a two-tiered nursing intervention model designed to improve quality of care for residents in long-term care facilities (LTCFs). The first tier of the model called for gerontological advanced practice nurses (GAPNs) to provide direct care and to teach staff to implement care protocols for residents with incontinence, pressure ulcers, depression, and aggression. Results of the first-tier study indicated significant improvement in resident outcomes in incontinence, pressure ulcers, and aggression. In the second tier, GAPNs added a set of organization-level (OL) interventions including membership on the LTCF quality assurance committee and collaborating with staff on problem-solving teams. Analysis following the addition of OL interventions revealed significant improvement in both depression scores and in the trajectory of depression in residents of the LTCF where OL interventions were used.
Retention of Minority Participants in Clinical Research Studies
Authors: Keller Colleen S. , Gonzales Adelita , Fleuriet K. Jill
Published: March 2005

Recruitment of minority participants for clinical research studies has been the topic of several analytical works. Yet retention of participants, most notably minority and underserved populations, is less reported and understood, even though these populations have elevated health risks. This article describes two related, intervention-based formative research projects in which researchers used treatment theory to address issues of recruitment and retention of minority women participants in an exercise program to reduce obesity. Treatment theory incorporates a model of health promotion that allows investigators to identify and control sources of extraneous variables. The authors’ research demonstrates that treatment theory can improve retention of minority women participants by considering critical inputs, mediating processes, and substantive participant characteristics in intervention design.
Benefits and Challenges in Developing a Program of Research
Authors: Daly Barbara J. , Douglas Sara L. , Kelley Carol G.
Published: March 2005

The ultimate goals of nursing research are knowledge generation and improvement in nursing practice. Designing studies that provide the evidence needed for practice change and that have clear implications for immediate application to current practice environments is particularly challenging. Research programs that consist of sequential studies, each building on and expanding on the results of the previous work, offer the greatest promise for generating understanding of the human phenomenon relevant to nursing practice. The authors review their experience with a series of studies of inpatient and postdischarge needs and interventions associated with chronic critical illness to illustrate the benefits of developing a longitudinal research program as well as the importance of strategies that will foster application of results. Recommendations for developing such a program are discussed.
Exercise and Functional Tasks Among Adults Who Are Functionally Limited
Authors: Topp Robert , Boardley Debra , Morgan Amy L. , Fahlman Mariane , McNevin Nancy
Published: March 2005

This study compared the efficacy of 16 weeks of either resistance training, aerobic walking, or combined resistance training and aerobic walking on the performance of functional tasks among adults age 65 years and older with limited functional ability. One hundred thirty-one older adult individuals were randomized into four groups: resistance training, aerobic walking, combined resistance and aerobic walking groups, or a nonexercise control group. Each of the exercise groups documented 70% compliance with their respective exercise intervention, which included three weekly exercise sessions. At baseline, and 8 and 16 weeks following baseline, all participants completed six assessments of their functional ability. Analysis of covariance indicated that all three exercise intervention groups significantly improved measures of functional ability, with the resistance group demonstrating the most consistent gains over the six measures. These findings indicate that older adults who are functionally limited can improve their functional ability through a variety of types of exercise.
Mediator Analysis of Moms on the Move
Authors: Fahrenwald Nancy L. , Atwood Jan R. , Johnson David R.
Published: March 2005

This study examined whether improvements in physical activity discovered in a test of Moms on the Move were mediated by the behavioral constructs from which the intervention was derived. Identifying mediator variables is vital for intervention planning. The intervention was derived from the Transtheoretical Model (TTM) of behavior change and promoted moderately intense activities like walking. Sedentary mothers with children enrolled in the Women, Infants, and Children program (N = 44) were randomly assigned to the experimental intervention or attention control. Large effect sizes were reported for improvements in physical activity and changes in TTM constructs. This study examined whether the physical activity improvements were mediated by the behavioral constructs. Statistical analyses used bivariate correlation coefficients and two-stage multiple linear regression. These exploratory findings did not support the hypothesis that increased physical activity, which was associated with the experimental intervention, was mediated by the TTM constructs.
Claustrophobia and Adherence to CPAP Treatment
Authors: Chasens Eileen R. , Pack Allan I. , Maislin Greg , Dinges David F. , Weaver Terri E.
Published: March 2005

This study evaluated the effect of claustrophobia, an abnormal dread or fear of closed spaces, on adherence to continuous positive airway pressure (CPAP) therapy. The design was a secondary analysis of data from a prospective study of participants (N = 153) that completed 3 months of CPAP therapy from seven sleep disorders centers in the United States and Canada. A 15-item subscale adapted from the Fear and Avoidance Scale measured claustrophobic tendencies pre-CPAP treatment and again after 3 months. An overt monitor attached to the CPAP machines recorded mask-on CPAP adherence. There was a statistically significant difference in claustrophobia scores by adherence group (< 2 hours, 2 to < 5 hours, ≥ 5 hours) and time period (pre-CPAP and after 3 months CPAP). Poor CPAP adherence (< 2 hours per night)was more than two times higher in participants with a claustrophobia score ≥ 25. Identification of persons with increased claustrophobia tendencies and targeted interventions may increase adherence.
Care Management and Wound Care: The Expanding Role of the Care Manager in the New Millennium and Opportunities for Collaboration and Innovation
Authors: Gerrity Ellen P.
Published: March 2005

The care manager (CM) has the unique ability to engage the force that will promote a collaborative health care team approach to the home care patient customer (PC). Broader collaboration between various business partners and health care providers is needed. This collaboration ensures that real or imagined care barriers are resolved timely and safely. By uniting a model of collaboration with innovation, an optimal level of health may be achieved for PCs. The primary diagnosis dictates only a portion of PC care. Unaddressed or inadequately addressed comorbidities and environmental or psychosocial factors negatively affect home care outcomes—for example, chronic wounds that do not heal or worsen under care when wound healing is the goal. By assuming the global-holistic view of the PC and/or family’s needs, the CM will be the link to other health team members to identify any resource or service to operate at a best practice level.
Wound Pain Management in the Home Care Patient
Authors: Bradley Marianne , Villalona Yurcania
Published: March 2005

Pain is now identified as the fifth vital sign, yet this component is not always addressed as part of a wound assessment. With more patients being cared for at home with chronic wounds, adequate pain management options are essential to improve quality of life and patient outcomes. The focus of this article is to identify the importance of appropriate pain assessment and offer specific management options for our wound patients at home.
Implementing Clinical Practice Changes: A Practical Approach
Authors: Wysocki Annette B. , Bookbinder Marilyn
Published: March 2005

Implementing changes in clinical practice is critical for insuring the highest quality patient care. Ideally, changes in clinical practice should be based upon high-quality research findings or so-called evidence-based medicine. The increase in health care expenditures and data on the variance in clinical practices are exerting external pressures on professionals to justify practice patterns and are now tightly linked to reimbursement. As these factors fuel tensions between quality practice and care on one hand and cost on the other, clinicians must increasingly be prepared to justify the processes and resources used to deliver the required care to produce optimal patient outcomes. Continuously monitoring the clinical literature and implementing clinical practice changes, when a sufficient body of evidence exists, will contribute to improved patient outcomes. This involves three practical steps: (a) examining and evaluating the research, (b) gauging the likelihood of success, and (c) recommending and implementing a clinical practice change.
Screening for Depression in 21st-Century Home Care
Authors: Sherlock Meg
Published: March 2005

The presence of untreated depression as a comorbidity in a home care patient is costly and clinically challenging. Depression is treatable and routinely seen in home care patients. Screening for depression in home care and referring positive screens for a full diagnostic interview can provide necessary treatment and improve outcomes. This approach suggests standardizing the questions for two Outcome and Assessment Information Set (OASIS) items as a screen for depression in home care.