bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modeling the need for hip and knee replacement surgery. Part 2. Incorporating census data to provide small‐area predictions for need with uncertainty bounds
Authors: Judge Andy , Welton Nicky J. , Sandhu Jat , Ben‐Shlomo Yoav 
Published: November 2009

AbstractObjectiveTo develop methods to produce small‐area estimates of need for hip and knee replacement surgery to inform local health service planning.MethodsMultilevel Poisson regression modeling was used to estimate rates of need for hip/knee replacement by age, sex, deprivation, rurality, and ethnic mix using a nationally representative population‐based survey (the English Longitudinal Study of Ageing, n = 11,392 people age ≥50 years). Estimates of need from the regression model were then combined with stratified census population counts to produce small‐area predictions of need. Uncertainty in the predictions was obtained by taking a Bayesian simulation‐based approach using WinBUGS software. This allows correlations in parameter estimates to be appropriately incorporated in the credible intervals for the small‐area predictions.ResultsSmall‐area estimates of need for hip/knee replacement have been produced for wards and districts in England. Rates of need are adjusted for the sociodemographic characteristics of an area and include 95% credible intervals. Need for hip/knee replacement varies geographically, dependant on the sociodemographic characteristics of an area.ConclusionFor the first time, small‐area estimates of need for hip/knee replacement surgery have been produced together with estimates of uncertainty to inform local health planning. The methodologic approach described here could be reproduced in other countries and for other disease indicators. Further research is required to combine small‐area estimates of need with provision to determine whether there is equitable access to care.
The New York City Rheumatology Objective Structured Clinical Examination: Five‐year data demonstrates its validity, usefulness as a unique rating tool, objectivity, and sensitivity to change
Authors: Berman Jessica R. , Lazaro Deana , Fields Theodore , Bass Anne R. , Weinstein Elena , Putterman Chaim , Dwyer Edward , Krasnokutsky Svetlana , Paget Stephen A. , Pillinger Michael H. 
Published: November 2009

AbstractObjectiveTraditional means of testing rheumatology fellows do not adequately assess some skills that are required to practice medicine well, such as humanistic qualities, communication skills, or professionalism. Institution of the New York City Rheumatology Objective Structured Clinical Examination (ROSCE) and our sequential 5 years of experience have provided us with a unique opportunity to assess its usefulness and objectivity as a rheumatology assessment tool.MethodsPrior to taking the examination, all of the fellows were rated by their program directors. Fellows from the participating institutions then underwent a multistation patient‐interactive examination observed and rated by patient actors and faculty raters. Assessments were recorded by all of the participants using separate but overlapping sets of instruments testing the Accreditation Council of Graduate Medical Education (ACGME) core competencies of patient care, interpersonal and communication skills, professionalism, and overall medical knowledge.ResultsAlthough the program directors tended to rate their fellows more highly than the ROSCE raters, typically there was agreement between the program directors and the ROSCE faculty in distinguishing between the highest‐ and lowest‐ performing fellows. The ROSCE faculty and patient actor assessments of individual trainees were notable for a high degree of concordance, both quantitatively and qualitatively.ConclusionThe ROSCE provides a unique opportunity to obtain a patient‐centered assessment of fellows' ACGME‐mandated competencies that traditional knowledge‐based examinations, such as the rheumatology in‐service examination, cannot measure. The ability of the ROSCE to provide a well‐rounded and objective assessment suggests that it should be considered an important component of the rheumatology training director's toolbox.
A patient's perspective on multidisciplinary treatment gain for fibromyalgia: An indicator for pre‐post treatment effects?
Authors: van Koulil Saskia , Kraaimaat Floris W. , van Lankveld Wim , van Riel Piet L. C. M. , Evers Andrea W. M. 
Published: November 2009

AbstractObjectiveIncreasing attention is devoted to the patient's perspective in clinical research and practice. However, the relationship between the patient's view on treatment progress and standardized pre‐post changes in health outcomes is not well understood. The objective of this study was to investigate whether the patient's perception of treatment gain converges with pre‐post treatment effects of a multidisciplinary treatment as assessed by standardized self‐report measures.MethodsDuring a tailored multidisciplinary treatment for fibromyalgia, validated self‐report questionnaires were assessed at baseline and posttreatment on the outcome measures of pain, functional disability, fatigue, anxiety, and negative mood. In addition, the participants were asked to fill in a questionnaire at the end of the treatment assessing the patient's perception of improvement on core outcomes, as well as satisfaction and usefulness of the treatment.ResultsModerate to relatively high correlations were found between the patient's perception of improvement and pre‐post changes on the physical outcomes, in contrast to small or nonsignificant correlations for psychological outcomes. In addition, satisfaction and usefulness were significantly related to pre‐post changes on physical outcomes, but no relationship was found with respect to psychological outcomes.ConclusionResults suggest that the patient's perception of treatment gain and pre‐post changes in outcomes during treatment assess different aspects of the patient's treatment progress, particularly with regard to psychological functioning. Future research on clinical improvements should consider the patient's perception of treatment gain as an independent and clinically relevant outcome, in addition to standardized trial data of pre‐post assessments of health outcomes.
A prospective approach to investigating the natural history of preclinical rheumatoid arthritis (RA) using first‐degree relatives of probands with RA
Authors: Kolfenbach Jason R. , Deane Kevin D. , Derber Lezlie A. , O'Donnell Colin , Weisman Michael H. , Buckner Jane H. , Gersuk Vivian H. , Wei Shan , Mikuls Ted R. , O'Dell James , Gregersen Peter K. , Keating Richard M. , Norris Jill M. , Holers V. Michael 
Published: November 2009

AbstractObjectiveTo describe a large, multicenter prospective cohort study of first‐degree relatives (FDRs) of probands with rheumatoid arthritis (RA), and outline the use of such a study in investigating the natural history of RA development.MethodsA total of 1,058 FDRs, none of whom met the American College of Rheumatology criteria for RA, were enrolled in a prospective study investigating genetic and environmental influences on the development of RA‐related autoimmunity. Demographic, epidemiologic, genetic, autoantibody, and physical examination data from the initial study enrollment visit were described for these FDRs, and the relationship was examined between genetic factors, autoantibodies, inflammation, and joint disease.ResultsFifty‐five percent of the FDRs had ≥1 copy of the shared epitope, 20% had ≥1 copy of the PTPN22 polymorphism, and ∼16% were positive for rheumatoid factor (RF; including isotypes) and/or anti–cyclic citrullinated peptide antibody. IgM‐RF positivity is associated with ≥1 tender joint on examination (odds ratio [OR] 2.50, 95% confidence interval [95% CI] 1.27–4.89; P < 0.01) and elevated C‐reactive protein (CRP) levels (OR 5.31, 95% CI 1.45–19.52; P = 0.01).ConclusionFDRs without RA demonstrate high prevalences of genetic risk factors and RA‐related autoantibodies. Additionally, an RF association with tender joints and elevated CRP levels suggests that autoantibodies are a valid intermediate marker of RA‐related autoimmunity in this cohort. This prospective FDR cohort will be a valuable resource for evaluating the relationship between genetic and epidemiologic factors and the development of RA‐related autoimmunity.
Identification of undiagnosed inflammatory arthritis in a community health fair screen
Authors: Deane Kevin D. , Striebich Christopher C. , Goldstein Barbara L. , Derber Lezlie A. , Parish Mark C. , Feser Marie L. , Hamburger Elaine M. , Brake Stacey , Belz Cindy , Goddard James , Norris Jill M. , Karlson Elizabeth W. , Holers V. Michael 
Published: November 2009

AbstractObjectiveTo identify individuals with undiagnosed inflammatory arthritis (IA) and rheumatoid arthritis (RA) in a community health fair screen, and to establish in a health fair setting the diagnostic accuracy of combinations of the Connective Tissue Disease Screening Questionnaire (CSQ) and autoantibody testing for IA.MethodsScreening for IA/RA was performed at health fair sites using a combination of the CSQ, joint examination, rheumatoid factor, and anti–cyclic citrullinated peptide (anti‐CCP) antibody testing. IA was defined as ≥1 swollen joint suggestive of synovitis on joint examination by a trained clinician.ResultsSix hundred one subjects were screened; 51.0% participated because of joint symptoms (pain, stiffness, or swelling). Eighty‐four subjects (14.0%) had ≥1 swollen joint, designated as IA on joint examination. Of the 601 subjects screened, 9 (1.5%) had IA and met ≥4 of 7 American College of Rheumatology criteria for RA but had no prior diagnosis of RA, and 15 (2.5%) had IA and RF and/or anti‐CCP positivity, suggesting early RA. The diagnostic accuracy of combinations of the CSQ and autoantibody testing for the identification of IA yielded maximal sensitivity, specificity, and positive and negative predictive values of 95.3%, 99.2%, 71.4%, and 97.7%, respectively.ConclusionHealth fair screening may be an effective approach for the identification of individuals with undiagnosed IA/RA. A combination of the CSQ and autoantibody testing alone has clinically useful diagnostic accuracy for the detection of IA. Decisions regarding which methodology to use for future health fair IA/RA screening will depend on goals of screening and funding.
The importance of allocation concealment and patient blinding in osteoarthritis trials: A meta‐epidemiologic study
Authors: Nüesch Eveline , Reichenbach Stephan , Trelle Sven , Rutjes Anne W. S. , Liewald Katharina , Sterchi Rebekka , Altman Douglas G. , Jüni Peter 
Published: November 2009

AbstractObjectiveTo evaluate the association of adequate allocation concealment and patient blinding with estimates of treatment benefits in osteoarthritis trials.MethodsWe performed a meta‐epidemiologic study of 16 meta‐analyses with 175 trials that compared therapeutic interventions with placebo or nonintervention control in patients with hip or knee osteoarthritis. We calculated effect sizes from the differences in means of pain intensity between groups at the end of followup divided by the pooled SD and compared effect sizes between trials with and trials without adequate methodology.ResultsEffect sizes tended to be less beneficial in 46 trials with adequate allocation concealment compared with 112 trials with inadequate or unclear concealment of allocation (difference −0.15; 95% confidence interval [95% CI] −0.31, 0.02). Selection bias associated with inadequate or unclear concealment of allocation was most pronounced in meta‐analyses with large estimated treatment benefits (P for interaction < 0.001), meta‐analyses with high between‐trial heterogeneity (P = 0.009), and meta‐analyses of complementary medicine (P = 0.019). Effect sizes tended to be less beneficial in 64 trials with adequate blinding of patients compared with 58 trials without (difference −0.15; 95% CI −0.39, 0.09), but differences were less consistent and disappeared after accounting for allocation concealment. Detection bias associated with a lack of adequate patient blinding was most pronounced for nonpharmacologic interventions (P for interaction < 0.001).ConclusionResults of osteoarthritis trials may be affected by selection and detection bias. Adequate concealment of allocation and attempts to blind patients will minimize these biases.
Ambulatory visit utilization in a national, population‐based sample of adults with osteoarthritis
Authors: Cisternas Miriam G. , Yelin Edward , Katz Jeffrey N. , Solomon Daniel H. , Wright Elizabeth A. , Losina Elena 
Published: November 2009

AbstractObjectiveTo estimate the proportion of adults with osteoarthritis (OA) seeing various medical providers and ascertain factors affecting the likelihood of a patient seeing an OA specialist.MethodsWe used data from the Medical Expenditures Panel Survey, a stratified random sample of the noninstitutionalized civilian population. We classified adults as having symptomatic OA if their medical conditions included at least 1 occurrence of the International Classification of Diseases, Ninth Revision Clinical Modification, codes 715, 716, or 719, and if they reported joint pain, swelling, or stiffness during the previous 12 months. For the purpose of our analysis, we defined rheumatologists, orthopedists, and physical therapists as OA specialists. We first estimated the proportion of OA individuals seen by OA specialists and other health care providers in a 1‐year period. We then used logistic regression to estimate the impact of demographic and clinical factors on the likelihood of an individual seeing an OA specialist.ResultsA total of 9,933 persons met the definition of OA, representing 22.5 million adults in the US. Of these persons, 92% see physicians during the year, 34% see at least 1 OA specialist, 25% see an orthopedist, 11% see a physical therapist, and 6% see a rheumatologist. Higher educational attainment, having more comorbidities, and residing in the northeastern US are significant positive predictors for a patient seeing an OA specialist. Significant negative predictors for seeing an OA specialist are being unmarried but previously married and having no health insurance.ConclusionMost adults with OA do not visit OA specialists. Those without insurance and with lower levels of education are less likely to see these specialists.
Understanding the lack of understanding: Invalidation from the perspective of the patient with fibromyalgia
Authors: Kool Marianne B. , van Middendorp Henriët , Boeije Hennie R. , Geenen Rinie 
Published: November 2009

AbstractObjectivePatients with fibromyalgia have difficulty with the invisibility and medically unexplained character of the syndrome. Disbelief, lack of acceptance, and stigmatization by their spouse, family, colleagues, the health care system, and society are key issues in their lives. Nevertheless, the components of this phenomenon that we term “invalidation” are not clear. The aim of our study was to identify the definition and structure of invalidation as perceived by patients with fibromyalgia.MethodsA hierarchical cluster analysis was applied to examine everyday invalidation experiences of patients with fibromyalgia. Ninety‐four statements about invalidation that were derived from interviews and a card‐sorting (Q‐sort) technique provided the input for this cluster analysis.ResultsThe hierarchical structure of invalidation showed a higher‐order distinction between statements reflecting “discounting” and “understanding.” Discounting was subdivided into the components “denying” and “patronizing” (consisting of “lecturing” and “overprotecting”). Understanding was subdivided into “supporting” and “acknowledging.” These higher‐order constructs were further subdivided into 15 lower‐order clusters that reflected cognitive, affective, and behavioral aspects of invalidation.ConclusionInvalidation as perceived by patients with fibromyalgia includes active negative social responses (denying, lecturing, and overprotecting) as well as a lack of positive social responses (supporting and acknowledging) with respect to the patient and the condition of the patient. This definition of invalidation provides a basis to quantify invalidation and to study its impact on symptom severity, quality of life, therapy adherence, therapy outcome, and other important aspects of fibromyalgia.
Patient responsibility for medical decision making and risky treatment options
Authors: Fraenkel Liana , Peters Ellen 
Published: November 2009

AbstractObjectiveStudies have shown that increasing patient participation in decision making decreases utilization of risky procedures. It has been demonstrated that risk perception is increased under conditions that emphasize volition, or the act of choosing. The objective of this study was to examine whether emphasizing volition increases patients' risk perception and decreases their willingness to accept risk.MethodsConsecutive patients attending outpatient clinic appointments viewed a video in which a physician described the availability of a new medication associated with a rare risk of a serious side effect. Patients' willingness to accept treatment and worry about the risk of the serious side effect were measured under 2 different conditions: one that minimized patient involvement and the one that maximized patient involvement in the decision‐making process.ResultsThe willingness of the subject to take the proposed medication was lower (mean ± SD 4.2 ± 3.7 versus 5.3 ± 3.7; P < 0.001) and their worry about the risk of the adverse event was greater in the high compared with the low involvement condition (mean ± SD 6.1 ± 3.7 versus 5.5 ± 3.8; P < 0.001).ConclusionIncreasing patient responsibility in medical decision making may decrease the patient's willingness to accept risky treatment options.
Caspase 1–independent activation of interleukin‐1β in neutrophil‐predominant inflammation
Authors: Guma Monica , Ronacher Lisa , Liu‐Bryan Ru , Takai Shinji , Karin Michael , Corr Maripat 
Published: November 2009

AbstractObjectiveInterleukin‐1β (IL‐1β) is a key cytokine linked to the pathogenesis of acute arthritis. Caspase 1, neutrophil elastase, and chymase all process proIL‐1β to its biologically active form. This study was undertaken to examine the potential contributions of each of these proteases in experimental models of inflammatory arthritis.MethodsCaspase 1–deficient (Casp1−/−) and wild‐type (WT) mice were tested for their response to arthritogenic K/BxN serum transfer for induction of arthritis or injection of monosodium urate monohydrate (MSU) crystals for induction of peritonitis. All mice were prophylactically treated with inhibitors of neutrophil elastase or chymase. Arthritic paws were tested for the presence of IL‐1β protein by enzyme‐linked immunosorbent assay and Western blotting. Neutrophils and mast cells from WT and mutant mice were tested for their ability to secrete IL‐1β after in vitro stimulation, in the presence of protease inhibitors.ResultsCasp1−/− and WT mice developed paw swelling to the same extent in the K/BxN serum transfer–induced arthritis model. MSU crystal injection into Casp1−/− mice also resulted in neutrophil influx and production of measurable peritoneal IL‐1β protein. Both of these responses were attenuated with neutrophil elastase inhibitors. K/BxN serum transfer–induced arthritis was also reduced by treatment with a chymase inhibitor. Casp1−/− neutrophils and mast cells, when exposed to MSU crystals, secreted similar amounts of IL‐1β protein upon in vitro stimulation with lipopolysaccharide, albeit at lower levels than that secreted by WT cells. Elastase and chymase inhibitors reduced the amount of IL‐1β released by these cells.ConclusionThe production of IL‐1β by neutrophils and mast cells is not exclusively dependent on caspase 1, and other proteases can compensate for the loss of caspase 1 in vivo. These pathways might therefore compromise the caspase 1–targeted therapies in neutrophil‐predominant arthritis.
The FAS −670A>G polymorphism influences susceptibility to systemic sclerosis phenotypes
Authors: Broen J. , Gourh P. , Rueda B. , Coenen M. , Mayes M. , Martin J. , Arnett F. C. , Radstake T. R. D. J. 
Published: November 2009

AbstractObjectiveTo investigate the possible role of the FAS −670A>G functional polymorphism in the genetic predisposition to systemic sclerosis (SSc) susceptibility or clinical phenotype.MethodsA total of 2,900 SSc patients and 3,186 healthy controls were included in this study. We analyzed the genotype and allele frequencies of the FAS −670A>G polymorphism in 9 distinct ethnic cohorts, including 6 cohorts of European ancestry (a Spanish cohort of 228 SSc patients and 265 controls, a Dutch cohort of 203 SSc patients and 277 controls, a German cohort of 313 SSc patients and 247 controls, an Italian cohort of 323 SSc cases and 89 controls, a British cohort of 269 SSc patients, and a Swedish cohort of 182 patients) and 3 distinct ethnic cohorts from the US (a cohort of 1,047 white patients and 692 controls, a cohort of 159 Hispanic patients and 137 controls, and a cohort of 176 black SSc patients and 194 controls). Genotyping was performed using a TaqMan 5′ allelic discrimination assay.ResultsIn the British, Italian, and American white cohorts we observed an association of the FAS −670G allele with limited cutaneous SSc (lcSSc) (odds ratios [ORs] 1.25, 1.43, and 1.18, respectively). A meta‐analysis comprising all 9 cohorts revealed an association of both the FAS −670G allele (OR 1.10) and the FAS −670GG genotype (OR 1.13) with the lcSSc phenotype. In a meta‐analysis including only white subjects, both the FAS −670G allele and the FAS −670GG genotype remained associated with lcSSc (allele OR 1.12; genotype OR 1.16). In addition, a recessive model of the −670GG genotype exhibited a strong association with SSc, lcSSc, and anticentromere antibody–positive lcSSc (OR 1.23, OR 1.33, and OR 1.45, respectively).ConclusionOur data show that the FAS −670A>G polymorphism plays a role in lcSSc susceptibility. A similar trend has been observed in other autoimmune diseases.
Increased tibiofemoral cartilage contact deformation in patients with anterior cruciate ligament deficiency
Authors: Van de Velde Samuel K. , Bingham Jeffrey T. , Hosseini Ali , Kozanek Michal , DeFrate Louis E. , Gill Thomas J. , Li Guoan 
Published: November 2009

AbstractObjectiveTo investigate the in vivo cartilage contact biomechanics of the tibiofemoral joint following anterior cruciate ligament (ACL) injury.MethodsEight patients with an isolated ACL injury in 1 knee, with the contralateral side intact, participated in the study. Both knees were imaged using a specific magnetic resonance sequence to create 3‐dimensional models of knee bone and cartilage. Next, each patient performed a lunge motion from 0° to 90° of flexion as images were recorded with a dual fluoroscopic system. The three‐dimensional knee models and fluoroscopic images were used to reproduce the in vivo knee position at each flexion angle. With this series of knee models, the location of the tibiofemoral cartilage contact, size of the contact area, cartilage thickness at the contact area, and magnitude of the cartilage contact deformation were compared between intact and ACL‐deficient knees.ResultsRupture of the ACL changed the cartilage contact biomechanics between 0° and 60° of flexion in the medial compartment of the knee. Compared with the contralateral knee, the location of peak cartilage contact deformation on the tibial plateaus was more posterior and lateral, the contact area was smaller, the average cartilage thickness at the tibial cartilage contact area was thinner, and the resultant magnitude of cartilage contact deformation was increased. Similar changes were observed in the lateral compartment, with increased cartilage contact deformation from 0° to 30° of knee flexion in the presence of ACL deficiency.ConclusionACL deficiency alters the in vivo cartilage contact biomechanics by shifting the contact location to smaller regions of thinner cartilage and by increasing the magnitude of the cartilage contact deformation.