bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation between serum calcium levels and dual‐phase 99mTc‐sestamibi parathyroid scintigraphy in primary hyperparathyroidism
Authors: Mshelia D. S. , Hatutale A. N. , Mokgoro N. P. , Nchabaleng M. E. , Buscombe J. R. , Sathekge M. M. 
Published: September 2011

SummaryAim:  The goal of the study is to correlate serum calcium levels with the results of dual‐phase 99mTc‐sestamibi parathyroid scintigraphy to find the best cut‐off level of the serum calcium that correlates with a positive presurgery.Methods:  In 111 patients, serum calcium and plasma parathormone (PTH) levels were compared with the results of the 99mTc‐MIBI scintigraphy and with this data determined the level of calcium above which the 99mTc‐MIBI scintigraphy was likely to be positive and below which the study was likely to be negative.Results:  In total, 11 men (18%) and 50 women (82%) had a positive 99mTc‐MIBI study. Overall 67% of those patients with a positive 99mTc‐MIBI study had a PTH >200 ng l−1 compared to only 9% of those with a negative 99mTc‐MIBI scintigraphy; however, for those with a positive study on an early 99mTc‐MIBI scintigraphy, this rose to 85%. Overall a serum calcium of >2·70 mmol l−1 was found in 82% of patients with a positive 99mTc‐MIBI study but only 14% of those with a negative 99mTc‐MIBI study, this is rose to 97% of patients with a parathyroid adenoma identified on early images. It is also shown that patients whose serum total calcium <2·51 mmol l−1 rarely have positive 99mTc‐MIBI scintigraphy.Conclusion:  99mTc‐MIBI parathyroid scintigraphy is most likely to yield identification and localization of a parathyroid adenoma when both PTH and calcium are elevated; however, although there is no lower limit of PTH which can predict a negative study, we cannot recommend 99mTc‐MIBI parathyroid scintigraphy if the serum calcium is <2·51 mmol l−1.
Nursing Home Price and Quality Responses to Publicly Reported Quality Information
Authors: Clement Jan P. , Bazzoli Gloria J. , Zhao Mei 
Published: September 2011

ObjectiveTo assess whether the release of Nursing Home Compare (NHC) data affected self‐pay per diem prices and quality of care.Data SourcesPrimary data sources are the Annual Survey of Wisconsin Nursing Homes for 2001–2003, Online Survey and Certification Reporting System, NHC, and Area Resource File.Study DesignWe estimated fixed effects models with robust standard errors of per diem self‐pay charge and quality before and after NHC.Principal FindingsAfter NHC, low‐quality nursing homes raised their prices by a small but significant amount and decreased their use of restraints but did not reduce pressure sores. Mid‐level and high‐quality nursing homes did not significantly increase self‐pay prices after NHC nor consistently change quality.ConclusionsOur findings suggest that the release of quality information affected nursing home behavior, especially pricing and quality decisions among low‐quality facilities. Policy makers should continue to monitor quality and prices for self‐pay residents and scrutinize low‐quality homes over time to see whether they are on a pathway to improve quality. In addition, policy makers should not expect public reporting to result in quick fixes to nursing home quality problems.
Primary Care and Health Outcomes among Older Patients with Diabetes
Authors: Prentice Julia C. , Graeme Fincke B. , Miller Donald R. , Pizer Steven D. 
Published: September 2011

ObjectiveThe aim of this study was to measure the relationship between days spent waiting for primary care and health outcomes among patients diagnosed with diabetes, especially among the elderly population.Data SourceSecondary data from VA administrative databases and Medicare claims.Study DesignThis is a retrospective observational study. Outcome variables include primary care utilization, mortality, heart attack, stroke, and ambulatory‐care sensitive condition (ACSC) hospitalization. The main explanatory variable of interest is VA primary care wait time. Negative binomial models predict utilization and stacked logistic regression models predict the probability of experiencing each health outcome. Models are stratified by the presence of a selected health condition and age.Principal FindingsLonger wait times were predicted to decrease utilization between 2 and 4 percent. There was no significant relationship between wait times and health outcomes for the overall sample. In stratified analyses, longer waits were associated with undesirable outcomes for those over age 70 with one of the selected health conditions or in certain narrower 5‐year age groups, but the overall pattern of results does not indicate a systematic and significant effect.ConclusionsThere was a modest effect of long wait times on primary care utilization but no robust effect of longer wait times on health outcomes. Waiting for care did not significantly compromise long‐term health outcomes for veterans with diabetes.
Behind‐the‐Counter Statins: A Silver Bullet for Reducing Costs and Increasing Access?
Authors: Sood Neeraj , Sun Eric , Zhuo Xiaohui 
Published: September 2011

ObjectiveTo examine how the 2004 introduction of behind‐the‐counter (BTC) simvastatin in the United Kingdom affected utilization, prices, and expenditures.Data Sources/Study SettingSecondary data on simvastatin utilization, prices, and expenditures between 1997 and 2007 in the United Kingdom and four other countries.Study DesignWe used a difference‐in‐differences approach to estimate how the introduction of BTC simvastatin affected utilization, prices, and expenditures. This approach compares outcomes in the United Kingdom before and after the introduction of BTC simvastatin, using outcomes in countries where the drug remained prescription only to control for possible confounders.Data Collection/Extraction MethodsData on simvastain utilization, prices, and expenditures between 1997 and 2007 in the United Kingdom and four other countries were obtained from an outside vendor.Principal FindingsThe introduction of BTC simvastatin in the United Kingdom led to a significant increase in utilization of simvastatin and a significant decline in expenditures for simvastatin purchases. Our results are robust to alternate model specifications.ConclusionsBehind‐the‐counter statins have the potential to simultaneously increase use of statins and lower expenditures.
Mojave toxin‐type ascending flaccid paralysis after an envenomation by a Southern Pacific Rattlesnake in a dog
Authors: Hoggan Sarah R. , Carr Amy , Sausman Karen A. 
Published: September 2011

AbstractObjectiveTo describe the clinical presentation and case management of a dog that developed ascending flaccid paralysis after being envenomated by a Southern Pacific rattlesnake.Case SummaryA dog was presented after it was bitten by a Southern Pacific rattlesnake. Only mild local edema and a minor coagulapathy developed, which is atypical for the Southern Pacific envenomation where hemotoxic effects are more commonly observed. Instead, a severe, rapidly progressing, ascending flaccid paralysis leading to acute respiratory failure, consistent with Mojave toxin, was seen. The patient was treated with repeated doses of antivenin and supported with mechanical ventilation. Despite clinical improvement of the paralysis over subsequent 3 days and successful weaning off the ventilator, the dog decompensated and succumbed to acute respiratory distress syndrome.New or Unique Information ProvidedThe geographic region where this envenomation occurred has a documented population of Southern Pacific rattlesnakes with Mojave toxin in their venom. To the knowledge of the authors, this is the first reported case in the veterinary literature of an ascending flaccid paralysis, consistent with Mojave toxin, developing after an envenomation by a Southern Pacific rattlesnake.
Outcome and medical management in dogs with lower motor neuron disease undergoing mechanical ventilation: 14 cases (2003–2009)
Authors: Rutter Christine R. , Rozanski Elizabeth A. , Sharp Claire R. , Powell Lisa L. , Kent Marc 
Published: September 2011

AbstractObjectiveTo describe the application of intermittent positive pressure ventilation (IIPV) in dogs with lower motor neuron disease (LMND).DesignMulti‐institutional, retrospective study (2003–2009).SettingIntensive care units at multiple university teaching hospitals.AnimalsFourteen dogs withLMNDthat underwentIIPV.InterventionsNone.Measurements and Main ResultsThe ventilatory logs of 4 teaching hospitals were searched for dogs undergoingIIPVin association with a diagnosis of acuteLMND. The medical records were evaluated for signalment, specificLMND, ventilatory management and duration, complications associated with ventilation, duration of hospitalization, and outcome. Descriptive statistics were used as indicated. Fifteen records were evaluated, 1 dog was excluded since it experienced cardiopulmonary arrest (CPA) before commencement ofIIPV. The median age was 7.0 years (range 10 mo to 12 y). There were 5 Labrador retrievers, 4 mixed breeds, and 5 other breeds were each represented once. Five dogs were diagnosed with myasthenia gravis, 4 dogs with polyradiculoneuritis, and 5 dogs had an undeterminedLMND. Clinical signs of weakness before ventilation were present for a median of 36 hours (range 6 h to 14 d). Dogs were ventilated for a median of 109 hours (range 5–261 h). Nine dogs had temporary tracheostomies performed, and 8 dogs received nutritional support. Five dogs developed ventilator associated pneumonia. Six dogs were successfully weaned from the ventilator with a median ventilatory time of 49 hours (range 25–192 h). Three dogs survived to discharge. No singleLMNDwas associated with a better outcome.ConclusionsHigh euthanasia rates and iatrogenic complications limit the ability to accurately prognosticate for affected dogs in this retrospective study, but in dogs withLMNDthat is severe enough to requireIIPV, support may be required days to weeks.
Autoimmune hepatitis from the paediatric perspective
Authors: Roberts Eve A. 
Published: September 2011

AbstractAutoimmune hepatitis (AIH) is an important entity within the broad spectrum of autoimmune hepatobiliary disease comprised of AIH, primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC). Since the 1960s, AIH has been investigated with extensive clinical research aimed at effective therapeutic intervention. It was one of the first liver diseases where treatment was demonstrated to prolong survival. AIH occurs in children, as well as in adults. Its clinical manifestations in children may differ from classic adult AIH. These differences have elucidated certain aspects of AIH and hepatobiliary disease in general. There are two major patterns of AIH: type 1, with anti‐smooth muscle antibodies and type 2, with anti‐liver/kidney microsomal antibodies. The second type of AIH was first identified in children and is more common in younger patients. AIH often presents as acute disease in children and also in adults: the nomenclature has dropped the allusion to chronicity. Some children who have sclerosing cholangitis present with clinical disease closely resembling AIH; this AIH‐like PSC, termed autoimmune sclerosing cholangitis (ASC), is also found in adults. Children with AIH may have identifiable monogenic disorders of immune regulation such as autoimmune polyendocrinopathy‐candidiasis‐ectodermal dystrophy (APECED). Like adults with AIH, children with AIH usually respond very favourably to immunosuppressive treatment with corticosteroids ± azathioprine. True cures seem to be rare, although many children achieve a stable remission. Nonetheless children with AIH may develop cirrhosis and some require liver transplantation. Early diagnosis and improved treatment strategies may further improve the outlook for children with AIH.
Use of antiviral therapy in surveillance: impact on outcome of hepatitis B‐related hepatocellular carcinoma
Authors: Chan Stephen L. , Mo Frankie K. F. , Wong Vincent W. S. , Liem Giok S. , Wong Grace L. H. , Chan Vicky T. C. , Poon Darren M. C. , Loong Herbert H. F. , Yeo Winnie , Chan Anthony T. C. , Mok Tony S. K. , Chan Henry L. Y. 
Published: September 2011

AbstractBackgroundAntiviral therapy for hepatitis B virus (HBV) infection is frequently prescribed for patients with chronic HBV infection during surveillance for hepatocellular carcinoma (HCC). In patients who subsequently develop HCC, the impact of antiviral therapy on the outcome of HCC remains unclear.AimsWe aimed to study the impact of antiviral therapy on the survival of patients who developed HCC.MethodsFrom two prospective surveillance cohorts, the use of antiviral therapy for patients with HCC was retrospectively reviewed. We compared the overall survival, liver function and tumour characteristics between patients with and without antiviral therapy during surveillance. Multivariate analysis was conducted to determine the independent prognostication of antiviral therapy.ResultsDuring a median follow‐up of 10.1 years of 1429 patients, 148 cases of HCC were diagnosed and followed up for a median of 5.7 years. Twenty‐nine patients were given antiviral therapy during surveillance and continued treatment after diagnosis of HCC. The median survival of this group of patients was better than the rest of cohorts (hazard ratio: 0.472; 95% CI: 0.25–0.89; P = 0.0191). Use of antiviral therapy remained an independent prognostic factor after adjustment for demographic factors and tumour staging on multivariate analysis. Exploratory analysis revealed that patients who commenced antiviral therapy during surveillance had lower HBV DNA, lower serum alanine transaminase, better hepatic reserves and higher rate of local treatment at diagnosis of HCC.ConclusionThis study provides evidence that commencement of antiviral therapy during the surveillance period is associated with improvement in overall survival in HBV‐related HCC.
A 2‐Year Follow‐Up of a Lifestyle Physical Activity Versus a Structured Exercise Intervention in Older Adults
Authors: Opdenacker Joke , Delecluse Christophe , Boen Filip 
Published: September 2011

OBJECTIVES: To evaluate the long‐term effects of a lifestyle intervention and a structured exercise intervention on physical fitness and cardiovascular risk factors in older adults.
DESIGN: Controlled trial with randomization between the intervention groups.
SETTING: Belgium, Vlaams‐Brabant.
PARTICIPANTS: One hundred eighty‐six sedentary but healthy men and women aged 60 to 83.
INTERVENTIONS: Participants in the lifestyle intervention were stimulated to integrate physical activity into their daily routines and received an individualized home‐based program supported by telephone calls. The structured intervention consisted of three weekly supervised sessions in a fitness center. Both interventions lasted 11 months and focused on endurance, strength, flexibility, and postural and balance exercises.
MEASUREMENTS: Cardiorespiratory fitness, muscular strength, functional performance, blood pressure, and body composition were measured before (pretest), at the end (11 months, posttest), and 1 year after the end (23 months, follow‐up) of the interventions.
RESULTS: The results from pretest to posttest have already been published. The current study analyzed the results from posttest to follow‐up. There was a decrease in cardiorespiratory fitness, muscular fitness, and functional performance from posttest to follow‐up in the structured intervention group but not in the control group or the lifestyle intervention group. At 23 months, participants in both groups still showed improvements in cardiorespiratory fitness. In addition, the structured group showed long‐term improvements in muscular fitness, whereas the lifestyle group showed long‐term improvements in functional performance. No long‐term effects were found for blood pressure or body composition.
CONCLUSION: These results highlight the potential of a structured fitness center–based intervention and a home‐based lifestyle intervention in the battle against inactivity in older adults. Lifestyle programs are especially valuable because they require fewer resources and less time from health institutions and health practitioners.
Avoidability of Hospital Transfers of Nursing Home Residents: Perspectives of Frontline Staff
Authors: Lamb Gerri , Tappen Ruth , Diaz Sanya , Herndon Laurie , Ouslander Joseph G. 
Published: September 2011

OBJECTIVES: To describe nursing home (NH) staff perceptions of avoidability of hospital transfers of NH residents.
DESIGN: Mixed methods qualitative and quantitative analysis of 1,347 quality improvement (QI) review tools completed by staff at 26 NHs and transcripts of conference calls.
SETTING: Twenty‐six NHs in three states participating in the Interventions to Reduce Acute Care Transfers (INTERACT II) QI project.
PARTICIPANTS: Site coordinators and staff who participated in project orientation and conference calls and completed QI tools.
MEASUREMENTS: NH and hospitalization data collected for the INTERACT II project. An interprofessional team coded and quantified reasons for hospital transfer on 1,347 QI review tools.
RESULTS: Staff rated 76% of the transfers in the QI review tools as not avoidable. Common reasons for transfers rated as unavoidable were acute change in resident status, family insistence, and physician order for transfer. These same reasons were given for transfers rated as avoidable. Avoidable ratings were associated with a broader set of reasons and recommendations for improvement, including earlier identification and management of changes in clinical status, earlier discussion with family members about advance directives, and more‐comprehensive communication with physicians. NHs that were more actively engaged in the INTERACT II interventions rated more transfers as avoidable. Percentage of transfers rated avoidable was not correlated with change in hospitalization rates.
CONCLUSION: NH staff rated fewer hospital transfers as avoidable than published estimates. Greater attention to the complex array of reasons that staff provide for hospital transfer should be considered in strategies to reduce avoidable hospitalizations of NH residents.
Trends in Use of High‐Risk Medications for Older Veterans: 2004 to 2006
Authors: Pugh Mary Jo V. , Hanlon Joseph T. , Wang Chen‐Pin , Semla Todd , Burk Muriel , Amuan Megan E. , Lowery Ashlei , Good Chester B. , Berlowitz Dan R. 
Published: September 2011

OBJECTIVES: To examine the change in use of high‐risk medications for the elderly (HRME), as defined by the National Committee on Quality Assurance's Healthcare Effectiveness Data and Information Set (HEDIS) quality measure (HEDIS HRME), by older outpatient veterans over a 3‐year period and to identify risk factors for HEDIS HRME exposure overall and for the most commonly used drug classes.
DESIGN: Longitudinal retrospective database analysis.
SETTING: Outpatient clinics within the Department of Veterans Affairs (VA).
PARTICIPANTS: Veterans aged 65 by October 1, 2003, and who received VA care at least once each year until September 30, 2006.
MEASUREMENTS: Rates of use of HEDIS HRME overall and according to specific drug classes each year from fiscal year 2004 (FY04) to FY06.
RESULTS: In a cohort of 1,567,467, high‐risk medication exposure fell from 13.1% to 12.3% between FY04 and FY06 (P<.001). High‐risk antihistamines (e.g., diphenhydramine), opioid analgesics (e.g., propoxyphene), skeletal muscle relaxants (e.g., cyclobenzaprine), psychotropics (e.g., long half‐life benzodiazepines), endocrine (e.g., estrogen), and cardiac medications (e.g., short‐acting nifedipine) had modest but statistically significant (P<.001) reductions (range −3.8% to −16.0%); nitrofurantoin demonstrated a statistically significant increase (+36.5%; P<.001). Overall HEDIS HRME exposure was more likely for men, Hispanics, those receiving more medications, those with psychiatric comorbidity, and those without prior geriatric care. Exposure was lower for individuals exempt from copayment. Similar associations were seen between ethnicity, polypharmacy, psychiatric comorbidity, access‐to‐care factors, and use of individual HEDIS HRME classes.
CONCLUSION: HEDIS HRME drug exposure decreased slightly in an integrated healthcare system. Risk factors for exposure were not consistent across drug groups. Future studies should examine whether interventions to further reduce HEDIS HRME use improve health outcomes.
Interleukin‐6, C‐Reactive Protein, and Tumor Necrosis Factor‐Alpha as Predictors of Mortality in Frail, Community‐Living Elderly Individuals
Authors: Giovannini Silvia , Onder Graziano , Liperoti Rosa , Russo Andrea , Carter Christy , Capoluongo Ettore , Pahor Marco , Bernabei Roberto , Landi Francesco 
Published: September 2011

OBJECTIVES:To investigate whether interleukin‐6 (IL‐6), C‐reactive protein (CRP) and tumor necrosis factor‐alpha (TNF‐α) protein levels predict all‐cause mortality in older persons living in the community.
DESIGN: Prospective cohort study.
SETTING: Data were from the Aging and Longevity Study in the Sirente Geographic Area, a prospective cohort study.
PARTICIPANTS: Individuals aged 80 and older living in an Italian mountain community (N=362).
MEASUREMENTS: Participants were classified according to the median value of the three inflammation markers (IL‐6, 2.08 pg/mL; TNF‐α, 1.43 pg/mL; CRP, 3.08 mg/L). A composite summary score of inflammation was also created. The main outcome was risk of death after 4 years of follow‐up.
RESULTS: One hundred fifty deaths occurred during 4 years of follow‐up. In the unadjusted model, high levels of each of the three markers were associated with greater mortality. After adjusting for potential confounders, high levels of IL‐6 (hazard ratio (HR)=2.18, 95% confidence interval (CI)=1.29–3.69) and CRP (HR=2.58, 95% CI=1.52–4.40) were associated with a significantly greater risk of death, whereas the association between TNF‐α protein levels and mortality was no longer significant (HR=1.26, 95% CI=0.74–2.15). The composite summary score of inflammation was strongly associated with mortality, with the highest risk estimated for individuals with all three inflammatory markers above the median.
CONCLUSION: Low levels of inflammatory markers are associated with better survival in older adults, independent of age and other clinical and functional variables.