bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sources of Variation in the Costs of Health Care for Asthma Patients in Australia
Authors: Kenny Patricia , Hall Jane , King Madeleine , Lancsar Emily 
Published: June 2009

Objectives Individuals with chronic conditions, such as asthma, on average incur high health care costs, though good control can reduce costs and improve health outcomes. However, there may be substantial variation between patients in their use of services and therefore costs. Our objective was to investigate the sources of such variation in health system and out-of-pocket costs for people with asthma. Methods A longitudinal observational study of 252 people with asthma in New South Wales, Australia, followed for three years, using six-monthly postal surveys and individual administrative data. Factors associated with costs were investigated using generalized linear mixed models. Results There was substantial variability in costs between individuals but relatively little within-person change over time for the majority. Costs to the health system and out-of-pocket costs were higher with increasing asthma-related health problems and increasing age. Health system costs were less for patients living outside the state capital (Sydney) and for those in the middle income group relative to high and low income groups. Conclusions Those with poorly-controlled asthma and the elderly require more carefully targeted strategies to improve their health and ensure appropriate use of resources. Access to appropriate services for those living outside of major cities should be improved. Co-payments for the middle-income groups and those living outside major cities should be reduced to improve equity in the use of services.
Patient and Hospital Characteristics Associated with Claims and Compensations for Patient Injuries in Coronary Artery Bypass Grafting in Finland
Authors: Järvelin Jutta , Rosenqvist Gunnar , Häkkinen Unto , Sintonen Harri 
Published: June 2009

Objectives To analyse the association between individual patients’ risk factors and rates of claims and compensations for patient injuries in an insurance scheme in which proof of negligence is not required. And to explore whether either hospital productivity or volume of procedures is related to claims and compensation rates. Methods A two-step sequential logistic regression was applied on data collected from administrative registers. It included 17,834 patients who had undergone coronary artery bypass grafting at public hospitals in Finland between 1998 and 2002. The main outcome measure was the odds of claiming and receiving compensation. Results Men were less likely to claim compensation (odds ratio [OR] 0.66; 95% confidence interval 0.54-0.81), but among those having claimed were more likely to receive compensation (OR 2.08; 1.15-3.75) than women. Patients with a co-morbidity were more likely to claim (OR 1.29; 1.06-1.57), but among those having claimed were less likely to receive compensation (OR 0.52; 0.31-0.86) than those without a co-morbidity. Advanced age reduced the probability of claiming (OR 0.71; 0.52-0.96). Conclusions Although high-risk patients file a claim more frequently than low-risk patients, the latter have a higher probability of getting their claims accepted and receiving compensation. This risk pattern is probably a reflection of compensation practices related to patient injuries involving an infection.
Delivering Health Care Through Community Pharmacies: Are Working Conditions Deterring Female Pharmacists’ Participation?
Authors: Gidman Wendy , Day Jennie , Hassell Karen , Payne Katherine 
Published: June 2009

Objective Recent UK government policy has placed community pharmacists at the frontline of health care delivery in order to improve patient access. Community pharmacy has been beset by recruitment and retention problems which potentially threaten health service delivery. This is largely a consequence of an increased demand for pharmacists. Additionally, the proportion of female pharmacists in the profession has risen. Consequently, interrupted career patterns and part-time working practices have increased, shrinking the pool of available workers. This study aimed to examine the importance of factors influencing female community pharmacists’ work patterns. Method Q methodology was used in a sample of 40 female UK-based community pharmacists. Results Nine distinct factors emerged from a factor analysis of Q sorts: fulfilled pharmacists; family first or pharmacy shelved; low stress altruist; permanent part-time employees; focused on free time and finances; pressurized modernizers; wandering wage slaves; overloaded and under resourced for the new contract; and pin money part-timers. Female community pharmacists often worked below their potential and part-time at a practitioner level in response to a combination of domestic commitments and intensifying work place pressures. Conclusions Family-friendly flexible work environments, adequate staffing levels and improved management support, might be more effective in increasing workforce participation than enhanced salary levels in this group of workers.
Developing a Framework for Transferring Knowledge Into Action: A Thematic Analysis of the Literature
Authors: Ward Vicky , House Allan , Hamer Susan 
Published: June 2009

Objectives Although there is widespread agreement about the importance of transferring knowledge into action, we still lack high quality information about what works, in which settings and with whom. While there are a large number of models and theories for knowledge transfer interventions, the majority are untested, meaning that their applicability and relevance is largely unknown. This paper describes the development of a conceptual framework of translating knowledge into action and discusses how it can be used for developing a useful model of the knowledge transfer process. Methods A narrative review of the knowledge transfer literature identified 28 different models which explained all or part of the knowledge transfer process. The models were subjected to a thematic analysis to identify individual components and the types of processes used when transferring knowledge into action. The results were used to build a conceptual framework of the process. Results Five common components of the knowledge transfer process were identified: problem identification and communication; knowledge/research development and selection; analysis of context; knowledge transfer activities or interventions; and knowledge/research utilization. We also identified three types of knowledge transfer processes: a linear process; a cyclical process; and a dynamic multidirectional process. From these results a conceptual framework of knowledge transfer was developed. The framework illustrates the five common components of the knowledge transfer process and shows that they are connected via a complex, multidirectional set of interactions. As such the framework allows for the individual components to occur simultaneously or in any given order and to occur more than once during the knowledge transfer process. Conclusion Our framework provides a foundation for gathering evidence from case studies of knowledge transfer interventions. We propose that future empirical work is designed to test and refine the relevance, importance and applicability of each of the components in order to build a more useful model of knowledge transfer which can serve as a practical checklist for planning or evaluating knowledge transfer activities.
Tackling Climate Change Close to Home: Mobile Breast Screening as a Model
Authors: Bond Alan , Jones Andrew , Haynes Robin , Tam Matthew , Denton Erika , Ballantyne Mandy , Curtin John 
Published: June 2009

Objective Health services contribute significantly to carbon dioxide (CO2) emissions and, while services in the UK are beginning to address this, the focus has been on reducing energy consumption rather than road transport, a major component of emissions. We aimed to compare the distances travelled by patients attending mobile breast screening clinics compared to the distance they would need to travel if screening services were centralized. Methods Anonymized postcode records were analysed to determine driving distances potentially saved through attendance at 20 mobile breast screening clinics rather than at two centralized locations. Based on assumptions for the typical car used, the CO2 emissions were calculated for the current case of decentralized service through mobile clinics compared to a hypothetical case where only centralized services are available over one complete three-year cycle of breast screening invitations. Results The availability of mobile breast screening clinics for the 60,675 women who underwent screening over a three-year cycle led to a return journey distance savings of 1,429,908 km. Taking into account the CO2 emissions of the tractor unit used for moving the mobile clinics around, this equates to approximately 75 tonnes of CO2 saved in any one year. Conclusions Decentralizing health care delivery can potentially provide substantial reductions in emissions at the same time as improving the patient experience. Thus, the ‘care close to home’ agenda can simultaneously improve health outcomes and the environment.
National Clinical Guidance
Authors: Light Kate , Harden Melissa , Misso Kate 
Published: June 2009

Anyone who participates in the provision of health care, whether a practitioner, manager or policy-maker, needs to ensure they are familiar with the most up-to-date guidance and rulings from their country's advisory organizations. This edition of What's on the Web looks at websites produced by national health care advisory organizations, especially those involved in advising on medicines and other interventions. If you would like to alert readers to useful web pages or suggest topics for this column, please send details to:
Impact of Reporting Gram Stain Results From Blood Culture Bottles on the Selection of Antimicrobial Agents
Authors: Uehara Yuki , Yagoshi Michiko , Tanimichi Yumiko , Yamada Hiroko , Shimoguchi Kazuo , Yamamoto Sachiyo , Yanai Mitsuru , Kumasaka Kazunari 
Published: June 2009

Abstract
We assessed the usefulness of reporting direct blood Gram stain results compared with the results of positive blood cultures in 482 episodes and monitored impact on selection of antimicrobial treatment. We found that the reporting groups “Staphylococcus spp,” “Pseudomonas spp and related organisms,” and “yeasts” identified in this way matched perfectly with later culture identification. When the report indicated Staphylococcus spp or Pseudomonas spp and related organisms, physicians started or changed antimicrobials suitable for these bacteria more frequently than when “other streptococci” and “family Enterobacteriaceae” were reported (P &lt; .05). Incorrect recognition of Acinetobacter spp as Enterobacteriaceae family is still the most challenging problem in this context. Gram stain results that definitively identify Staphylococcus spp, Pseudomonas spp and related organisms, and yeasts reliably can be rapidly provided by clinical laboratories; this information has a significant impact on early selection of effective antimicrobials. Further investigation is needed to assess the clinical impact of reporting Gram stain results in bacteremia.
FU-MK-1 Expression in Human Gallbladder Carcinoma
Authors: Ikeda Takeaki , Nakayama Yoshifuku , Hamada Yoshihiro , Takeshita Morishige , Iwasaki Hiroshi , Maeshiro Kensei , Yamashita Yuichi , Kuroki Masahide , Ikeda Seiyo 
Published: June 2009

Abstract
Gallbladder carcinoma is an aggressive type of neoplasm difficult to cure by conventional procedures. Because of the lack of reliable markers for assessing the prognosis, this retrospective study was designed to investigate the prognostic significance of MK-1 overexpression in human carcinoma of the gallbladder. Immunohistochemical staining using monoclonal antibody FU-MK-1 (MK-1 antigen) was performed on paraffin-embedded tissues from 63 patients who had undergone surgical resection for gallbladder carcinoma.
Expression of MK-1 was found in 50 (79%) of 63 tumor samples. All 21 papillary and 12 of 13 well-differentiated tubular adenocarcinomas but only 1 of 8 poorly differentiated adenocarcinomas were positive for FU-MK-1. Multivariate analysis showed that only MK-1 expression was an independent prognostic marker (P = .0473), and Kaplan-Meier curves showed that MK-1 expression was significantly related to increased overall survival (P &lt; .0001). These results suggest that MK-1 expression is a prognostic marker in gallbladder carcinoma.
A Histologically Defined Subset of High-Grade Dysplasia in Barrett Mucosa Is Predictive of Associated Carcinoma
Authors: Zhu Weijian , Appelman Henry D. , Greenson Joel K. , Ramsburgh Stephen R. , Orringer Mark B. , Chang Andrew C. , McKenna Barbara J. 
Published: June 2009

Abstract
To ascertain the prevalence of carcinoma in esophagi resected for high-grade dysplasia (HGD) using current criteria and to evaluate histologic features that may predict concurrent carcinoma, we studied specimens from 127 esophagectomies performed for HGD, or HGD “suspicious” for carcinoma (HGD/S) in Barrett mucosa. Corresponding biopsy specimens in 69 cases were reviewed and reclassified.
Based on original diagnoses, carcinoma was present in 15 (17%) of 89 HGD and 28 (74%) of 38 HGD/S cases. By reclassification, only 1 (5%) of 21 cases with HGD had carcinoma in the resection specimen. Of 25 cases reclassified as HGD/S, 18 (72%) had carcinoma in the resection specimen, as did 17 (74%) of 23 reclassified as adenocarcinoma. With 1 additional select histologic feature, the risk of carcinoma was 39%; with 2 or more features, the risk increased to 83% to 88%.
Based on current criteria, no more than 5% of esophagectomies performed for a biopsy diagnosis of Barrett HGD harbor carcinoma. When HGD/S is diagnosed based on certain additional features, carcinoma is found in nearly 40% of cases with 1 feature and more than 80% with 2 or more features. Our findings highlight the evolution of diagnostic criteria for Barrett dysplasia.
Aberrant Expression of Cyclin A Correlates With Morphogenesis of Reed-Sternberg Cells in Hodgkin Lymphoma
Authors: Chang Kung-Chao , Chang Yao , Jones Dan , Su Ih-Jen 
Published: June 2009

Abstract
Reed-Sternberg (RS) cells represent a histopathologic hallmark for Hodgkin lymphoma (HL). Viral proteins may induce aberrant expression of cyclin A and lead to multinucleation in virus-infected cells. We investigated whether Epstein-Barr virus (EBV) latent membrane protein-1 (LMP1) and cyclin A are involved in the morphogenesis of RS cells. We immunohistochemically analyzed “individual” tumor cells in 34 HLs for the subcellular expression of cyclin A and HL-related markers. In LMP1+ and LMP1– HLs, multinucleated RS cells aberrantly expressed cyclin A in cytoplasm, while the mononuclear Hodgkin cells expressed cyclin A predominantly in nuclei (P &lt; .001). No differential expression of CD15, CD30, or CD99 in HL cells was found. In vitro, EBV-LMP1 increased cytoplasmic cyclin A expression and multinucleation in an HL cell line. Therefore, the aberrant expression of cyclin A is commonly associated with RS cell morphologic features in HL, probably through LMP1 signaling or other similar mechanisms in EBV– cases.
Decorin Is Significantly Overexpressed in Nephrogenic Systemic Fibrosis
Authors: Gambichler Thilo , Kreuter Alexander , Skrygan Marina , Burkert Björn , Altmeyer Peter , Schieren Gisela 
Published: June 2009

Abstract
The role of the proteoglycans in the pathogenesis of nephrogenic systemic fibrosis (NSF) is unclear. We assessed expression of decorin, versican, and transforming growth factor β1 (TGF-β1) in skin specimens of 10 patients with biopsy-proven NSF and different control groups. Real-time reverse transcription–polymerase chain reaction studies and immunohistochemical analysis were performed on full-thickness skin specimens. The messenger RNA (mRNA) and protein levels of decorin were significantly higher in the skin lesions of patients with NSF than in skin lesions of patients with systemic sclerosis, patients undergoing hemodialysis, and healthy subjects. The versican mRNA levels in NSF lesions differed significantly only from the levels in healthy subjects. TGF-β1 mRNA expression was significantly overexpressed in NSF lesions compared with control skin specimens investigated. In NSF specimens, the mRNA expression of TGF-β1 and decorin were highly correlated (r = 0.92). Our results suggest that decorin and TGF-β1 may have a fundamental role in the pathogenesis of NSF. Conversely, versican seems less likely to be of pathogenetic significance in NSF.
Automated Cellular Imaging System III for Assessing HER2 Status in Breast Cancer Specimens
Authors: Minot Douglas M. , Kipp Benjamin R. , Root Renee M. , Meyer Reid G. , Reynolds Carol A. , Nassar Aziza , Henry Michael R. , Clayton Amy C. 
Published: June 2009

Abstract
The goal of this study was to assess the performance characteristics of the Automated Cellular Imaging System (ACIS III) for HER2 immunohistochemical analysis. The study was performed on 187 biopsy slides from patients who underwent HER2 testing between January and February 2008. Three scoring methods by the ACIS III were compared with the manual score and fluorescence in situ hybridization (FISH) results for HER2 amplification. The equal distribution score (EQD) method, in which 2 areas each of high-, moderate-, and low-intensity staining were measured, most closely matched the FISH HER2 amplification result. The numbers of immunohistochemically negative (0 or 1+)/FISH+ cases were equivalent for all methods. The EQD method had significantly fewer 2+ cases (n = 16) (P &lt; .001) vs the manual method (n = 35) and yielded a higher positive predictive value (38%) for HER2 amplification compared with the manual method (20%). The EQD method may more accurately identify FISH-amplified HER2 cases with fewer 2+ cases that would be “reflexed” to FISH compared with the manual method.
Utility of CD56 Immunohistochemical Studies in Follow-up of Plasma Cell Myeloma
Authors: Harrington Alexandra M. , Hari Parameswaran , Kroft Steven H. 
Published: June 2009

Abstract
Although 70% to 80% of plasma cell myelomas (PCMs) express CD56, few data are available on the usefulness of CD56 immunohistochemical analysis in assessing residual disease. We retrospectively reviewed 127 PCM posttreatment bone marrow (BM) specimens, classifying them as positive or negative for residual disease (independent of CD56 immunohistochemical studies) based on abnormal plasma cell (PC) morphologic features or flow cytometry (FC) and/or light chain restriction by immunohistochemical studies (conventional criteria). CD56 immunohistochemical analysis was performed on these and 20 negative lymphoma staging BM specimens. Of 127 BM specimens, 74 were positive and 53 were negative for residual PCM by conventional criteria. Of 74 BM specimens positive by conventional criteria, 59 (80%) demonstrated CD56 (strong+) PCs in clusters and/or with cytologic atypia. Of the 53 BM specimens negative by conventional criteria, 3 showed CD56 (strong+) morphologically atypical PCs in clusters or scattered. CD56 immunohistochemical analysis is useful for detecting residual PCM, particularly in morphologically equivocal cases in which light chain restriction cannot be demonstrated, and may serve as a potential response criterion.
Differences in Recognition of the 1st WHO International Reference Reagents for hCG-Related Isoforms by Diagnostic Immunoassays for Human Chorionic Gonadotropin
Authors: Sturgeon Catharine M , Berger Peter , Bidart Jean-Michel , Birken Steven , Burns Chris , Norman Robert J , Stenman Ulf-Håkan ,   the IFCC Working Group on hCG
Published: June 2009

Abstract
Background: The 1st WHO International Reference Reagents (IRRs) for 6 human chorionic gonadotropin (hCG)-related molecular variants, highly purified and calibrated in substance concentrations by the IFCC Working Group for hCG, permit experimental elucidation of what commercially available hCG methods measure in molar terms and enable assessment of their fitness for clinical purposes.
Methods: Pools containing known amounts of the IRRs spiked into normal human serum were issued to participants through the UK National External Quality Assessment Service for hCG for a period of 7 years. Among 16 assays used, 4 recognized only hCG, whereas 6 recognized hCG and its free β-subunit (hCGβ), and 6 recognized hCG, hCGβ, and the beta core fragment.
Results: Differences in calibration of current hCG assays are moderate. Mean recovery of the current International Standard (IS), hCG IS 75/589, was 107% (range 93% to 126%), whereas that of the IRR 99/688 for hCG was 139% (range 109%–164%). Between-method variation for the latter (CV 12.3%) was also greater than for IS 75/589 (CV 8.8%). Recognition of hCGβ varied markedly (CV 37%). Most assays overestimated it, but 2 RIAs produced results that were slight underestimations. Recognition of the beta core fragment was even more variable (CV 57%) and was closest to equimolarity for the RIAs.
Conclusions: Assays for hCG show considerable variation in their recognition of various forms of hCG, and this variablility is the most important cause of method-related differences in hCG results in serum and an even more important cause of method-related differences in urine measurements. Equimolar recognition of the major hCG isoforms is essential if between-method comparability for hCG is to be improved.
A New Standard Genetic Map for the Laboratory Mouse
Authors: Cox Allison , Ackert-Bicknell Cheryl L , Dumont Beth L , Ding Yueming , Bell Jordana Tzenova , Brockmann Gudrun A , Wergedal Jon E , Bult Carol , Paigen Beverly , Flint Jonathan , Tsaih Shirng-Wern , Churchill Gary A , Broman Karl W 
Published: June 2009

AbstractGenetic maps provide a means to estimate the probability of the co-inheritance of linked loci as they are transmitted across generations in both experimental and natural populations. However, in the age of whole-genome sequences, physical distances measured in base pairs of DNA provide the standard coordinates for navigating the myriad features of genomes. Although genetic and physical maps are colinear, there are well-characterized and sometimes dramatic heterogeneities in the average frequency of meiotic recombination events that occur along the physical extent of chromosomes. There also are documented differences in the recombination landscape between the two sexes. We have revisited high-resolution genetic map data from a large heterogeneous mouse population and have constructed a revised genetic map of the mouse genome, incorporating 10,195 single nucleotide polymorphisms using a set of 47 families comprising 3546 meioses. The revised map provides a different picture of recombination in the mouse from that reported previously. We have further integrated the genetic and physical maps of the genome and incorporated SSLP markers from other genetic maps into this new framework. We demonstrate that utilization of the revised genetic map improves QTL mapping, partially due to the resolution of previously undetected errors in marker ordering along the chromosome.