bluuebunny/crossref_metadata_2025_split huggingface dataset:
Jimmo and the Improvement Standard: Implementing Medicare Coverage Through Regulations, Policy Manuals and other Guidance
Authors: Gladieux Jennifer E. , Basile Michael 
Published: January 2017

In Jimmo v. Sebelius, the plaintiffs alleged that the Centers for Medicare and Medicaid Services (CMS) regularly and improperly denied Medicare reimbursement for outpatient therapy treatment when the beneficiary did not show a likelihood of improvement. These denials, based on policy manuals and other guidance, appear to contradict the government's own regulations, which specifically prohibit coverage denials based solely on the so-called “Improvement Standard.” In Jimmo, the United States District Court for the District of Vermont found that CMS' use of the Improvement Standard may have violated the rulemaking provisions of the Administrative Procedure Act (APA) and denied CMS' motion for summary judgment. Subsequently, the parties settled out of court.In the settlement, CMS agreed to revise its policy manuals to clarify that the Improvement Standard was not an acceptable basis on which to deny Medicare coverage. CMS declined to defend its policies even though courts often grant deference to agency interpretations. The settlement implies that the agency feared that it would not have received such deference. It also implies that future Supreme Court decisions may give less deference to agency interpretations.
Obamacare's Impact on Labor Markets: Limits on the Predictive Value of Romneycare
Authors: Archambault Josh 
Published: January 2017

There has been great debate about the potential labor market impact of the Affordable Care Act (“ACA” or “Obamacare”). Some have pointed to Massachusetts as the harbinger of what is to come nationally, while others have predicted massive dumping of employer-based insurance. An extension of this labor market debate was on full display during the summer of 2012. Critics seized on a McKinsey & Co. survey that found that Obamacare could result in thirty percent of companies dropping employer-sponsored insurance (ESI). Meanwhile, proponents of the ACA quickly and continually referred to the experience of companies in Massachusetts as a way to push back on this narrative.Surprisingly, there is bipartisan agreement that Massachusetts’s own health reform efforts (“Romneycare”) does in fact serve as an accurate model for what to expect under the federal law: this has complicated a lucid discussion of the ACA’s potential labor market impact.
Assessing the True Impact of the ACA: Revisiting the CBO's Initial Predictions
Authors: Auerbach David 
Published: January 2017

In Obamacare’s Impact on Labor Markets: Limits on the Predictive Value of Romneycare, Josh Archambault makes a number of arguments about the ultimate impact of the Affordable Care Act (ACA). A central point is that the overall impact on the US labor market and economy will be worse than the Congressional Budget Office (CBO) projected—to some extent, because the CBO used the experience in Massachusetts as one piece of evidence in guiding its estimates. A recent report by the CBO on potential effects of the ACA on employment has added additional fuel to the debate. In particular, Archambault argues that more people will leave employer-sponsored insurance (ESI), and that the ACA will cost more than the CBO projected.Archambault makes many good points. The ACA does add new taxes, such as an additional 1% Medicare tax on families earning over $250,000, a 2.3% tax on medical devices, and additional taxes on some health insurers and tanning salons. Altogether, these taxes were expected to raise roughly $400 billion between 2010 and 2019.
Standard Stripping versus Long Saphenous Vein-Saving Surgery for Primary Varicose Veins: A Prospective, Randomized Study with the Patients as Their Own Controls
Authors: Campanello M. , Hammarsten J. , Forsberg C. , Bernland P. , Henrikson O. , Jensen J. 
Published: January 2017

Objective: To compare the postoperative discomfort and long-term outcome following standard stripping and atter long saphenous vein-saving surgery. Design: Prospective, randomized case-control study with patients serving as their own controls. Setting: Department of Surgery, County Hospital, Varberg, Sweden. Patients: Eighteen patients with bilateral primary varicose veins. Interventions: The patients were randomized prospectively to stripping or long saphenous vein-saving surgery. The leg causing most discomfort was operated on first. The other leg was operated on using the alternative method. Main outcome measures: Postoperative discomfort was assessed after an interview with the patient. Long-term outcome was determined by clinical assessment and Plethysmographic venous return time. Results: After 4 years the legs subjected to long saphenous vein-saving surgery yielded equal clinical results and had as great a prolongation of the plethysmographic venous return time as legs operated on using standard stripping. More patients reported greater discomfort following stripping than after vein-saving surgery. The saved long saphenous vein in all legs operated on was patent, compressible, non-sclerotic and free of intraluminal echoes. Conclusion: The long-term results of long saphenous vein-saving surgery are as good as standard stripping, provided that incompetent perforators are throughly mapped preoperatively and ligated at surgery. Long saphenous vein-saving surgery causes less subjective postoperative discomfort than standard stripping. The saved long saphenous vein can probably be used for future arterial reconstruction.
Depression, Osteoporosis and Osteoarthritis
Authors: Varga Ervin , Kline Nathan S 
Published: January 2017

A correlation was found between clinical depression and the presence of either osteoporosis or osteoarthritis. Sex, age and race influenced which disease pattern was expressed. Other research has indicated a relationship between parathyroid disease and depression. The effectiveness of lithium therapy in affective disorders is also of possible relevance. The nature of the relationship between mineral metabolism and affective disease may well lead to an explanation of the pathogenesis of affective disorders.
Preliminary Results of a Clinical Trial Relative to the Use of Rifamycin SV in the Treatment of Herpes Zoster
Authors: Bruni L , Califano A , Angelis De G , Montagnani A , Pisani M , Pezzarossa G , Pozzo G , Reali D , Rebora A , Zanca A 
Published: January 2017

In a controlled clinical trial undertaken in ten Italian centres, rifamycin SV was compared to associations of various drugs such as erythromycin, aureomycin, multivitamin preparations, etc, in the treatment of herpes zoster. Up to now 144 patients, suffering from herpes zoster at different localizations, were divided into three groups and randomly given either rifamycin SV by intramuscular injection and topically, or rifamycin SV by injection only, or the routine treatment used at the particular centre in question. To evaluate the effectiveness of the treatments, the presence of subjective and objective symptoms was determined before treatment started and daily thereafter. The duration, in days, of the most important symptoms, such as erythema, vesicles, scabs and pain, was considered for this partial evaluation. All the above-mentioned symptoms constantly showed a shorter duration in the two groups treated with rifamycin SV compared to the group treated with other therapies, with differences as significant on statistical calculation as they were important on the level of a clinical evaluation of the disease's course.
Comparative Efficacy of Lormetazepam (Noctamid®) and Diazepam (Valium®) in 100 Out-Patients with Insomnia
Authors: Hernández M Sastre y , Hentschel H-D , Fichte K 
Published: January 2017

Lormetazepam (Noctamid®) at a dosage of 1 mg was compared with diazepam (Valium®) at a dosage of 5 mg in a 7-day double-blind study. The study involved fifty patients in the lormetazepam group and fifty patients in the diazepam group. All the patients were suffering from sleep disorders as a concomitant symptom of general diseases. Lormetazepam was significantly better than diazepam in the: Reduction of the time taken to fall asleep (p < 0.05) Prolongation of the duration of uninterrupted sleep (p < 0.05) Reduction of the frequency of awakening (p < 0.05) Lormetazepam displayed no hang-over effects or other side-effects and, in this respect too, was significantly superior to diazepam (p < 0.05).
Expression of Proliferating Cell Nuclear Antigen (PCNA) in Multiple Myeloma: Its Relationship to Bone Marrow Microvessel Density and other Factors of Disease Activity
Authors: Alexandrakis M.G. , Passam F.H. , Pappa C.A. , Dambaki C. , Sfakiotaki G. , Alegakis A.K. , Kyriakou D.S. , Stathopoulos E. 
Published: January 2017

The expression of the proliferating cell nuclear antigen (PCNA) was studied in plasma cells in bone marrow biopsies from patients with multiple myeloma (MM) using a double immunostaining method. In the same samples, microvessel density (MVD), after staining with anti-CD34 antibodies, was determined before and after chemotherapy. The correlation of PCNA expression and MVD with other myeloma parameters (clinical stage, bone marrow plasma cell infiltration and serum interleukin –6 (IL-6)) was also investigated. The study population included 51 newly diagnosed MM patients, 12 patients in plateau phase after treatment and 15 normal controls. Pretreatment mean ± SE values of PCNA, MVD, plasma cell infiltration and serum IL-6 were significantly higher than post treatment values and controls. Pretreatment PCNA expression correlated significantly with bone marrow MVD (p<0.05) plasma cell infiltration (p<0.01) and IL-6 (p<0.01). These findings show that the proliferative activity of plasma cells is related to the angiogenic activity in the bone marrow of multiple myeloma patients. Both PCNA and MVD correlate with markers of disease activity thus may provide additional information when included in the initial evaluation of myeloma bone marrow biopsies.
Tridimensional Personality of Adolescents with Internet Addiction and Substance Use Experience
Authors: Ko Chih-Hung , Yen Ju-Yu , Chen Cheng-Chung , Chen Sue-Huei , Wu Kuanyi , Yen Cheng-Fang 
Published: January 2017

Objective: This study aimed to examine the differences in personality characteristics between adolescents with and without Internet addiction and substance use experience as defined by the Tridimensional Personality Questionnaire (TPQ), and to compare personality characteristics among groups of adolescents with both Internet addiction and substance use experience (comorbid group), those with only Internet addition (Internet addiction group), those with only substance use experience (substance experience group), and those without Internet addiction or substance use experience (control group). Method: In the cross-sectional investigation, we recruited 3662 students (2328 boys and 1334 girls) from high schools in southern Taiwan. Our investigation was conducted using the TPQ, the Chen Internet Addiction Scale, and Questionnaires for Experience in Substance Use. Results: Adolescents with Internet addiction were more likely to have substance use experience. High novelty seeking (NS), high harm avoidance (HA), and low reward dependence (RD) predicted a higher proportion of adolescents with Internet addiction. High NS, low HA, and low RD predicted a higher proportion of adolescents with substance use experience. Of the 4 groups, the Internet addiction group had the highest HA scores and the comorbid group had the lowest HA scores. Conclusion: Adolescents with high NS and low RD should be provided with effective strategies for preventing Internet addiction and substance use. In addition, the Internet addiction group and the comorbid group should be provided with different preventative strategies focused on HA.
Monitoring and Management of Metabolic Risk Factors in Outpatients Taking Antipsychotic Drugs: A Controlled Study
Authors: Jennex Amber , Gardner David M 
Published: January 2017

Objective: To evaluate the screening, monitoring, and management of metabolic risk factors and diseases in long-term antipsychotic users in relation to current practice guidelines and current standards of care as represented by a control group from an HIV clinic. Methods: We undertook a retrospective chart review of mental health clinic outpatients taking antipsychotic drugs long-term (cases) and HIV outpatients prescribed highly active antiretroviral therapy (control subjects). Results: We included 99 mental health clinic patients and 98 HIV patients in the analysis. According to information available in the outpatient clinic chart, the 10-year coronary artery disease risk was computable for 28% of the mental health clinic patients (mean risk 11.9%) and for 90% of the HIV patients (mean risk 9.5%) (χ2 = 77.0, P < 0.001). Metabolic risk factors were less frequently documented in mental health clinic charts. All HIV clinic patients were screened for hypertension and diabetes, and 90% were screened for dyslipidemia, whereas this information was missing for 30%, 39%, and 60% of mental health clinic patients, respectively ( P < 0.001 for all). Disease monitoring was also more comprehensive in HIV clinic charts (for example, 100% of HIV patients were monitored for lipids, compared with 71% of mental health clinic patients; P = 0.001). Conclusions: Improved efforts are needed in the somatic care of patients with bipolar disorder and schizophrenia who are taking antipsychotics, given that they typically have moderate-to-high risk for metabolic diseases.
Permissible Errors in Managing Property: An Approach to the Threshold of Capacity
Authors: Silberfeld Michel , Corber Wendy 
Published: January 2017

Objective: To demonstrate a practical approach to describing the threshold of mental capacity. Method: A retrospective analysis of 62 cases of assessments for capacity to manage property was carried out to record the type and frequency of errors. Results: For items on the Mini-Mental State Examination (MMSE), there was no clear demarcation of items associated with a judgement of capable. On the clinical criteria, several items almost completely distinguished capable from incapable subjects. Conclusions: The permissible error approach makes the threshold of capacity explicit. It is well suited to the emphasis put on functional performance in the evaluation of mental capacity.
The Adequacy of Measurement of Short and Long-Term Consequences of False-Positive Screening Mammography
Authors: Brodersen John , Thorsen Hanne , Cockburn Jill 
Published: January 2017

Objectives: The aim of this study is to review quantitative studies on women's experiences of consequences of false-positive screening mammography to assess the adequacy of the most frequently used instruments for measuring short-term and long-term psychological consequences. Methods: Relevant papers reporting quantitative studies on consequences of false-positive screening mammography were identified using MEDLlNE, CINAHL, EMBASE and PsycInfo databases. Articles citing development and psychometric properties of the most frequently used measures were also retrieved. Finally, the review focused on studies that had used at least one of the most frequently used measures. Results: Twenty-three relevant studies were identified. The most commonly used measures were the General Health Questionnaire (GHQ), the Hospital Anxiety and Depression Scale (HADS), the Psychological Consequences Questionnaire (PCQ) and the State-Trait Anxiety Inventory (STAI). One or more of these was used in 17 of the 23 studies. Conclusions: The GHQ, the HADS and the STAI have problems with language, content relevance, and content coverage in studies of false-positive screening mammography. These instruments should not be used to measure psychological consequences of any kind of cancer screening. The PCQ is an adequate questionnaire for measuring short-term consequences, and the PCQ is preferable to other measures because of its higher sensitivity. However, there is little evidence that the PCQ is able to adequately detect all long-term consequences of screening mammography. Given the inadequacy of the measurement instruments used, any current conclusions about the long-term consequences of false-positive results of screening mammography must remain tentative.
Clinical and Ethical Perspectives on Rationing of High-Cost Drugs
Authors: Poirier Therese I. , Giannetti Vincent J. 
Published: January 2017

Objective: To analyze the use of high-cost drugs from a clinical decision-making approach and ethical perspectives on rationing. Case: The case of a 26-year-old intravenous drug user with AIDS raises issues of how to ration high-cost drugs such as foscarnet, monoclonal antibodies (MAbs) for septic shock, and granuclocyte colony-stimulating factor. Assessment: Should a patient with a terminal illness receive high-cost drugs given limited healthcare resources? Necessary clinical information including treatment algorithms, risk to benefit ratios, and cost-effectiveness data are evaluated. Rationing, especially bedside rationing, by the clinician is rejected because it is contrary to the clinician's ethical obligation of beneficence and nonmaleficence. Patient autonomy and desires may also conflict with society's interest in equitably distributing resources. Treatment could be denied if costs exceed benefits for the outcomes and thus deny resources to others who have more basic healthcare needs. There is no obligation to offer medically futile care or for the patient to accept extraordinary medical care. Conclusions: An ethical argument for rationing cannot be made because of the lack of a clear clinical and societal consensus on specific criteria for rationing of healthcare dollars. The decision to use high-cost drugs in the case presented is made using a clinical decision-making approach based on available treatment guidelines. This assumes that the patient continues to consent to therapy and that there is continued benefit.
Failure of Hallux MP Preservation Surgery for Rheumatoid Arthritis
Authors: Thordarson David B. , Aval Soheil , Krieger Lauren 
Published: January 2017

Eight patients underwent surgery on 15 feet for rheumatoid forefoot problems. Thirteen of the 15 feet that were operated upon had an attempt to preserve the hallux metatarsophalangeal joint while resectional arthroplasty was performed on the lesser MP joints. All of the 13 feet that had the MP joint preserved had a well-preserved joint space preoperatively and no active signs of inflammation at the time of this procedure. Eight feet underwent a distal Chevron osteotomy to realign the great toe, two feet underwent an IP fusion as only the IP joint had evidence of erosive changes, and one foot underwent a combination of a Chevron osteotomy and a proximal phalangeal osteotomy (Akin procedure). Two patients had no surgery on their first ray as it was well aligned with no evidence of erosive changes. Of the 13 feet that did not have a fusion performed, 11 had development of a valgus deformity or inflammatory erosions. The average time to failure was 24 months (range, six to 36 months). The Chevron/Akin procedure remained successful at 18 months and one of the IP fusions was successful at six years after surgery. Although patients with rheumatoid forefoot disease may on occasion have a well-preserved hallux MP joint with minimal or no deformity and no active inflammation, with severe lesser toe involvement, most of these patients will fail a surgical procedure which does not involve fusion of the hallux MP joint.
Mitchell and Wilson Metatarsal Osteotomies for the Treatment of Hallux Valgus: Comparison of Outcomes Two Decades after the Surgery
Authors: Madjarevic Mladen , Kolundzic Robert , Matek Danijel , Smigovec Igor , Crnkovic Tomislav , Trkujla Vladimir 
Published: January 2017

Background: At short-term followup, the Mitchell osteotomy appears to provide more symptomatic improvement than the Wilson osteotomy. We compared the outcomes of the two procedures two decades after the surgeries. Methods: In a two-center retrospective study, 30 patients (35 feet) who had Mitchell osteotomies and 28 patients (35 feet) who had Wilson osteotomies were evaluated 20 to 22 years after surgery for correction of the hallux valgus angle (HVA) and intermetatarsal (IMA) angle, changes in the shortening of the first metatarsal and improvement in the overall status (a composite radiographic and clinical outcome according to Bonney and McNab). Results: With adjustment for the preoperative values and surgical center (analysis of covariance), the HVA (degrees) had a higher correction in the Mitchell group ( p = 0.075), while IMA was comparably corrected by the two methods. Shortening of the first metatarsal was greater in the Wilson group ( Mitchell- Wilson = −1.93, 95% CI −2.69 to −1.17, p < 0.001). Before the surgery, overall status was graded “poor” or “good” in all feet (28/7 Mitchell, 29/6 Wilson). After the surgery, the status was graded “excellent,” or “good” (29/6) in the Mitchell group, and “excellent,” “good” or “poor” (25/7/3) in the Wilson group. The status was improved by at least one grade-level in all 35 feet in the Mitchell group and in 31 of 35 feet in the Wilson group. With stratification for the preoperative status, the proportion of “improvements” was higher in the Mitchell group ( Mitchell-Wilson = 11.1%, 95% CI 0.7 to 21.5%, p = 0.036). In an alternative analysis (logistic regression), with adjustment for the preoperative status, center, and IMA values, the Mitchell method also appeared superior in this outcome (likelihood ratio test p = 0.021). Conclusions: As assessed 20 to 22 years after the surgery, the Mitchell osteotomy resulted in less shortening of the first metatarsal in a somewhat greater proportion of feet with an improved overall status than the Wilson method.
Stenting Procedure for Sinus Stenosis with Transverse-Sigmoid Dural Arteriovenous Fistulas
Authors: Fukumoto S. , Ueda T. , Igase K. , Ohue S. , Kumon Y. , Ohnishi T. 
Published: January 2017

We reported the dural AVF case with sinus stenosis, that was entirely treated through the stenting procedure. 61-year-old male had been realizing the attack which causes bilateral visual problem. He would have suffered from the intracranial hypertension caused by dural AVF in the right transverse sinus and left transverse sinus stenosis. We performed TVE and sinus stenting, then used the antiplatelet and the anticoagulant. However, six months later, he suffered from SAH due to recurrence of dural AVF. We performed TVE again, denser packing than usual. Two years later, he have no symptom, angiographically, there was no recurrence of dural AVF and patency of stented sinus. We think denser embolizations should have performed in case of dural AVF with sinus stenting.
Endovascular Coil Embolisation of Metachronous Mycotic Aneurysms
Authors: Roth T.C. , Chaloupka J.C. , Bowers P.N. , Berger S.B. , Wecht D.A. , Awad I.A. 
Published: January 2017

While receiving optimal antibiotic therapy for subacute bacterial endocarditis (SBE), a teenage girl with mild congenital mitral insufficiency presented with two separate episodes of subarachnoid haemorrhage from two rapidly evolving metachronous mycotic aneurysms within the vertebrobasilar circulation. Both aneurysms were successfully treated by endovascular coil embolisation with the GDC system. This permitted at the minimum, successful amelioration of the short term risk of rerupture of the aneurysms, and facilitated operative management of the patient's infected mitral valve. The case further illustrates the utility and effectiveness of endovascular therapy for managing not only the neurovascular sequelae of SBE, but also perhaps the enhanced ability to optimally manage the source of mycotic aneurysms. In addition, the potential limitations and risks of this therapeutic strategy are assessed.