bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are Racial Disparities in Alcohol Treatment Completion Associated With Racial Differences in Treatment Modality Entry? Comparison of Outpatient Treatment and Residential Treatment in Los Angeles County, 1998 to 2000
Authors: Bluthenthal Ricky N. , Jacobson Jerry O. , Robinson Paul L. 
Published: October 2007

Objective:  To determine whether racial and ethnic disparities in publicly funded alcohol treatment completion are due to racial differences in attending outpatient and residential treatment.Methods:  Statistical analysis of alcohol treatment completion rates using alcohol treatment patients’ discharge records from all publicly funded treatment facilities in Los Angeles County from 1998 to 2000 (n = 10,591).Results:  Among these patients, African American (OR = 0.52; 95% CI 0.47, 0.57) and Hispanic (OR = 0.89; 95% CI 0.81, 0.99) patients were significantly less likely to complete treatment as compared with White patients. We found that the odds of being in outpatient versus residential care were 1.42 (95% CI 1.29, 1.55) and 2.05 (95% CI 1.85, 2.26) for African American and Hispanic alcohol treatment patients, respectively, compared with White patients. Adjusting for addiction characteristics, employment, other patient‐level factors that might influence treatment enrollment, and unobserved facility‐level differences through a random effects regression model, these odds increased to 1.89 (95% CI 1.22, 2.94) for African American and to 2.12 (95% CI 1.40, 3.21) for Hispanics. We developed a conditional probability model to assess the contribution of racial differences in treatment modality to racial disparities in treatment completion. Estimates from this model indicate that were African American and Hispanic patients observed in outpatient care in this population to have the same probability of receiving residential care as White patients with otherwise similar characteristics, the White–African American difference in completion rates would be reduced from 13.64% (95% CI 11.58%, 15.71%) to 11.09% (95% CI 8.77%, 13.23%) and the White–Hispanic difference would disappear, changing from 2.63% (95% CI 0.29%, 4.95%) to −0.45% (−3.52%, 2.43%).Conclusion:  It appears that reductions in racial disparities in treatment completion could be gained by increasing enrollment in residential alcohol treatment for African American and Hispanic alcohol abusers in Los Angeles County. Further research addressing why minority alcohol abusers are less likely to receive residential alcohol treatment should be conducted, as well as research that examines why African American alcohol treatment patients have lower completion rates as compared with White patients regardless of treatment modality.
Two‐Year Outcome of an Intervention Program for University Students Who Have Parents With Alcohol Problems: A Randomized Controlled Trial
Authors: Hansson Helena , Rundberg Jenny , Zetterlind Ulla , Johnsson Kent Ove , Berglund Mats 
Published: October 2007

Background:  Only a few intervention studies aiming to change high‐risk drinking behavior have involved university students with heredity for alcohol problems. This study evaluated the effects after 2 years on drinking patterns and coping behavior of intervention programs for students with parents with alcohol problems.Method:  In total, 82 university students (57 women and 25 men, average age 25 years) with at least 1 parent with alcohol problems were included in the study. The students were randomly assigned to 1 of the 3 programs: (i) alcohol intervention program, (ii) coping intervention program, or (iii) combination program. All the 3 intervention programs were manual based and individually implemented during 2 2‐hour sessions, 4 weeks apart. Before the participants were randomly assigned, all were subjected to an individual baseline assessment. This assessment contained both a face‐to‐face interview and 6 self‐completion questionnaires: the Alcohol Use Disorders Identification Test, estimated Blood Alcohol Concentration, Short Index of Problems, the Symptom Checklist‐90, Coping with Parents’ Abuse Questionnaire, and The Interview Schedule for Social Interaction (ISSI). Follow‐up interviews were conducted after 1 and 2 years, respectively. The results after 1 year have previously been reported.Results:  All participants finished the baseline assessment, accepted and completed the intervention. Ninety‐five percent of the students completed the 24‐month follow‐up assessment. Only the group receiving the combination program continued to improve their drinking pattern significantly (p < 0.05) from the 12‐month follow‐up to the 24‐month follow‐up. The improvements in this group were significantly better than in the other 2 groups. The group receiving only alcohol intervention remained at the level of improvement achieved at the 12‐month follow‐up. The improvements in coping behavior achieved at the 12‐month follow‐up remained at the 24‐month follow‐up for all the 3 groups, i.e., regardless of intervention program.Conclusion:  Positive effects of alcohol intervention between 1 and 2 years were found only in the combined intervention group, contrary to the 1‐year results with effects of alcohol intervention with or without a combination with coping intervention.
Application of Assessing Care of Vulnerable Elders‐3 Quality Indicators to Patients with Advanced Dementia and Poor Prognosis
Authors: Wenger Neil S. , Solomon David H. ,   the members of the ACOVE‐3 Clinical Committee, Amin Alpesh , Besdine Richard K. , Blazer Dan G. , Cohen Harvey , Fulmer Terry , Ganz Patricia A. , Grunwald Mark , Hall William J. , Katz Paul R. , Kitzman Dalane W. , Leipzig Rosanne M. , Rosenthal Ronnie A. 
Published: October 2007

OBJECTIVES: To use a formal decision‐making strategy to reach clinically appropriate, internally consistent decisions on the application of quality indicators (QIs) to vulnerable elders (VEs) with advanced dementia (AD) or poor prognosis (PP).DESIGN: Using a conceptual model that classifies QIs principally by aim and burden of the care process, 12 clinical experts rated whether each Assessing Care of Vulnerable Elders‐3 (ACOVE‐3) QI should be applied in evaluating quality of care for older persons with AD or PP. QI exclusions were assessed for each of the 26 conditions and by whether these conditions were mainly medical (e.g., diabetes mellitus), geriatric (e.g., falls), or crosscutting processes of care (e.g., pain management). QI exclusions were also identified for older persons who decided against hospitalization or surgery.RESULTS: Of 392 ACOVE‐3 QIs, 140 (36%) were excluded for patients with AD and 135 (34%) for patients with PP; 57% of QIs focusing on medical conditions were excluded from patients with AD and 53% from patients with PP, whereas only 20% of QIs for geriatric conditions were excluded from AD and 15% from PP. All QIs with care processes judged to carry a heavy burden were excluded; 86% of moderate‐burden QIs were excluded from AD and 92% from PP. All QIs aimed at long‐term goals were excluded; 83% of intermediate‐term goal QIs were excluded from AD and 98% from PP. Individuals holding a preference to forgo hospitalization or surgery would be excluded from 7% of potentially applicable QIs.CONCLUSION: Measurement of quality of care for VEs with AD, PP, and less‐aggressive care preferences should include only a subset of the ACOVE‐3 QIs, largely those whose burden is light and whose goal is continuity or short‐term improvement or prevention.
Dementia Undiagnosed in Poor Older Adults with Functional Impairment
Authors: Wilkins Consuelo H. , Wilkins Kenneth L. , Meisel Marie , Depke Marilyn , Williams James , Edwards Dorothy F. 
Published: October 2007

OBJECTIVES: To identify variables associated with diagnosing dementia in poor older adults by comparing older people with dementia who were diagnosed by their primary care physicians (PCPs) with those not diagnosed by their PCP.DESIGN: Observational study.SETTING: Community‐based, in‐home cognitive assessment program.PARTICIPANTS: Four hundred eleven adults aged 55 and older with cognitive impairment.MEASUREMENTS: Instrumental activities of daily living (IADLs), activities of daily living (ADLs), Mini‐Mental State Examination, Short Blessed Memory Orientation and Concentration Test, and Clinical Dementia Rating.RESULTS: Alzheimer's disease was the most common diagnosis in this group of primarily African‐American (73%) older people. Of the 411 participants, 232 (56%) were not diagnosed by their PCP. Participants without a previous diagnosis were older (mean age 81.7 vs 78.7, P=.01), more independent in IADLs (P<.001), and more likely to live alone (P=.001) than persons diagnosed by their PCP. Of the 201 who lived alone, 66% were not diagnosed with dementia by their PCP. Variables associated with PCP diagnosis were more severe cognitive impairment (P<.001), spouse caregiver (P=.009), younger age (P=.02) and care from a university‐based PCP (P=.04).CONCLUSION: Persons with dementia who were older and lived alone were less likely to be diagnosed by their PCP. Although persons not diagnosed by their PCP had less cognitive impairment, they had substantial impairment in activities, including handling finances, cooking, and managing medications.
A Randomized Trial of Depression Assessment Intervention in Home Health Care
Authors: Bruce Martha L. , Brown Ellen L. , Raue Patrick J. , Mlodzianowski Amy E. , Meyers Barnett S. , Leon Andrew C. , Heo Moonseong , Byers Amy L. , Greenberg Rebecca L. , Rinder Susan , Katt Wendy , Nassisi Pamela 
Published: October 2007

OBJECTIVES:To determine whether an educational intervention would improve depression assessment and appropriate referral. Secondary analyses tested whether referral led to depression improvement.DESIGN:Training in the Assessment of Depression (TRIAD) was a three‐group, nurse‐randomized trial. Researchers interviewed randomly selected patients at baseline and 8 weeks.SETTING:Three certified home healthcare agencies in Westchester County, New York.PARTICIPANTS:Fifty‐three medical/surgical nurses were randomized within agency to three intervention groups: full, minimal, or control. Research contact with nurses' patients (aged >65; N=477) yielded 256 (53.7%) enrolled subjects, 84 (17.6%) ineligibles, and 120 (25.2%) refusals; 233 of the 256 (87.1%) enrolled patients completed follow‐up interviews.INTERVENTION:Nurse training in clinically meaningful use of depression sections of Medicare's mandatory Outcome and Assessment Information Set (OASIS).MEASUREMENTS:Nurse‐assessed mood or anhedonia (OASIS) versus research assessments using the Structured Clinical Interview for Axis IDiagnostic and Statistical Manual of Mental Disorders, Fourth EditionDisorders (SCID); referrals for mental health evaluation (agency records), and depression severity (24‐item Hamilton Depression Rating Scale; HDRS).RESULTS:Referral rates for patients with (SCID) depressed mood or anhedonia (n=75) varied according to nurse group: 50.0% full intervention, 18.5% minimal, 21.4% control (P=.047). Rates for nondepressed patients (n=180) did not differ (4.9%, 2.0%, 5.8%, respectively;P=.60). In patients with major or minor depression (n=37), referral was associated with symptom improvement. Change in HDRS was 5 points greater in referred patients than others (P=.04). Concordance between OASIS and SCID did not differ between intervention groups.CONCLUSION:TRIAD showed that training nurses to assess for depression using an approach developed in partnership with home healthcare agencies led to appropriate referral and care for depressed patients.
Bath Aids and the Subsequent Development of Bathing Disability in Community‐Living Older Persons
Authors: Gill Thomas M. , Han Ling , Allore Heather G. 
Published: October 2007

OBJECTIVES: To determine whether the availability of bath aids may forestall the subsequent development of bathing disability.DESIGN: Prospective cohort study.SETTING: Greater New Haven, Connecticut.PARTICIPANTS: Five hundred one nondisabled (required no personal assistance in bathing) community‐living residents aged 73 and older.MEASUREMENTS: The availability of five bath aids (grab bars, bath seat, nonskid mat or abrasive strips, handheld shower spray, and long‐handled brush or sponge) was ascertained during a comprehensive home‐based assessment. Subsequently, participants were followed with monthly telephone interviews to determine the onset of persistent (i.e., present for at least 2 consecutive months) disability in bathing and were evaluated for disability in three bathing subtasks (bathing transfers, washing whole body, and drying whole body) during the next home‐based assessment, which was completed 18 months after the initial assessment.RESULTS: The presence of a bath seat was associated with a greater likelihood of developing persistent disability in bathing and disability in each of the three bathing subtasks, although these associations were not statistically significant after adjustment for potential confounders. Nonsignificantly greater risk was also observed for grab bars, handheld shower spray, and long‐handled brush or sponge. In the adjusted analysis, the presence of nonskid mats or abrasive strips was associated with a 23% lower risk (nonsignificant) of persistent bathing disability and a lower likelihood of developing disability in washing and drying one's whole body, with corresponding odds ratios of 0.28 (P=.003) and 0.38 (P=.030), respectively.CONCLUSION: In this longitudinal study, the presence of bath aids, with the exception of nonskid mats or abrasive strips, did not forestall the subsequent development of bathing disability. Because it may not be possible to fully account for the effects of self‐selection, clinical trials may be necessary to demonstrate the potential value of bath aids in community‐living older persons.
Do the Left Atrial Substrate Properties Correlate with the Left Atrial Mechanical Function? A Novel Insight from the Electromechanical Study in Patients with Atrial Fibrillation
Authors: SUNG SHIH‐HSIEN , CHANG SHIH‐LIN , HSU TSUI‐LIEH , YU WEN‐CHUNG , TAI CHING‐TAI , LIN YENN‐JIANG , LO LI‐WEI , WONGCHAROEN WANWARANG , TUAN TA‐CHUAN , HU YU‐FENG , UDYAVAR AMEYA , CHEN SHIH‐ANN 
Published: October 2007

Background: The atrial substrate is the determinant of occurrence and maintenance of atrial fibrillation (AF), which can induce remodeling of atrial function and structure. This study investigated the relationship between the left atrial (LA) substrate properties and LA mechanical function. Methods: Forty‐four consecutive patients (50.3 ± 10.7 years old, 33 men) who presented with sinus rhythm during echocardiographic study before receiving catheter ablation for AF were enrolled. The LA diameter, LA volume, ratio of early and late transmitral filling flow velocities (E/A), LA appendage flow velocity, and transmitral velocity‐time integral (VTI) were measured by the echocardiography. The LA empty fraction (LAEF), which was obtained via dividing the difference between maximal and minimal LA volume by maximal LA volume, was calculated as a parameter of the global LA contractile function. The LA global contact voltage mapping (NavX system) was performed before pulmonary vein isolation. Results: Mean LA voltage and LA low voltage zone index (LVZ index, area with voltage < 0.5 mV, divided by total LA surface area) showed significant correlation with LA diameter and volume, but only the LA LVZ index showed significant correlation with A‐wave velocity, transmitral A‐wave VTI, and LAEF (r =–0.340, –0.411, –0.426; P = 0.024, 0.006, 0.005, respectively). We divided the LA LVZ index into three groups (< 10%, 10–20%, > 20%). The LAEF got worse and the transmitral A‐wave VTI percentage (divided by transmitral VTI) decreased as LA LVZ index increased. Conclusions: The LA substrate properties showed close correlation with LA size, but only the LA LVZ index correlated with the LA mechanical function.
Electrocardiographic Optimization of Interventricular Delay in Cardiac Resynchronization Therapy: A Simple Method to Optimize the Device
Authors: VIDAL BÀRBARA , TAMBORERO DAVID , MONT LLUIS , SITGES MARTA , DELGADO VICTORIA , BERRUEZO ANTONIO , DÍAZ‐INFANTE ERNESTO , TOLOSANA JOSE M. , PARÉ CARLES , BRUGADA JOSEP 
Published: October 2007

Introduction: Echocardiography is widely used to optimize CRT programming, but it is time‐consuming. This study aimed to correlate the optimal interventricular pacing (V‐V) interval obtained by echo with the optimal V‐V interval obtained by a simpler method based on the surface ECG. Methods and Results: Three V‐V intervals were tested: LV preactivation at –30 ms, simultaneous biventricular pacing (0 ms), and RV preactivation at +30 ms. The one that achieved the best LV synchrony was chosen as the optimal V‐V. This result was then compared with two different ECG measurements. The first ECG method considered the best V‐V to be that which achieved the narrowest QRS. The second V‐V method consisted in measuring the interval from the pacing spike to the beginning of the fast deflexion of the QRS complex in leads V1, V2, first pacing from the LV (T1), and after from the RV (T2). The T2‐T1 interval was considered as a surrogate measurement of interventricular delay and defined as the best V‐V. A cohort of 31 consecutive patients treated with CRT was studied. Optimal V‐V interval obtained by echo was –30 ms in 25 patients (80%), +30 ms in three patients (10%), and 0 ms in the remaining three patients (10%). Echo results had 32% coincidence with the first ECG method (r = 0.2, P = NS) and 83% coincidence with the second ECG method (r = 0.81 P< 0.001). Conclusions: The time difference in the fast ventricular depolarization observed between RV and LV stimulation in the surface ECG shows a good correlation with the V‐V optimization chosen according to echo.
High Diagnostic Yield and Accuracy of History, Physical Examination, and ECG in Patients with Transient Loss of Consciousness in FAST: The Fainting Assessment Study
Authors: VAN DIJK NYNKE , BOER KIMBERLY R. , COLMAN NANCY , BAKKER ANNEMIEKE , STAM JAN , VAN GRIEKEN JOHANNES J.M. , WILDE ARTHUR A.M. , LINZER MARK , REITSMA JOHANNES B. , WIELING WOUTER 
Published: October 2007

Background: Transient loss of consciousness (TLOC) is a common clinical problem. Objective: The aim of this study was to assess the yield and accuracy of the initial evaluation, consisting of standardized history, physical examination, and ECG performed by attending physicians in patients with TLOC. Methods and Results: Five hundred and three adult patients (mean age 53 ± 19; 56% male) presenting with TLOC to the Academic Medical Center Amsterdam between February 2000 and May 2002 were included in this study. After initial evaluation, the physician made a certain, a highly likely (>80% certain), or no initial diagnosis. Initially undiagnosed patients received additional cardiological testing, additional history taking, and autonomic function tests. After 2 years of follow‐up, an expert committee determined the final diagnoses.Two‐year follow‐up was obtained in 99% of the patients. The yield of certain diagnoses after the initial evaluation was 24%, increasing to 63% after including the highly likely diagnoses. The diagnostic accuracy of the initial certain diagnoses was 93% (95% CI 87–97%), decreasing to 88% (95% CI 84–91%) after inclusion of the initial highly likely diagnoses. Conclusion: Attending physicians can make a diagnosis based on initial evaluation in 63% of patients with TLOC, with an overall diagnostic accuracy of 88%. The use of additional testing, beyond history, physical examination, and ECG can be avoided in many patients with TLOC.
Interaction of anaesthetic drugs and UV‐B irradiation in the anterior segment of the rat eye
Authors: Zhang Fengju , Löfgren Stefan , Söderberg Per G. 
Published: October 2007

Abstract.Purpose:  To determine the impact of anaesthesia on acute transient cataractogenesis and ultraviolet radiation (UVR)‐induced cataractogenesis.Methods:  Sprague‐Dawley rats were anaesthetized with pentobarbital, which caused almost full eyelid closure, or xylazine/ketamine, which caused eyelid retraction and proptosis. The eyelids of one eye were kept open with either a suture or adhesive tape, or both. The other eye was kept closed with either a suture or tape. Cataract was graded clinically and quantified in vitro as intensity of forward light scattering. In two UVR experiments, anaesthetized rats were irradiated unilaterally with 5 kJ/m2 UVR‐B 300 nm for 15 mins. The difference between the two UVR experiments was the degree of proptosis in the pentobarbital group. Corneal drying was judged clinically with a grading scale.Results:  Within 60 mins of anaesthesia induction in the first experiment, almost all lenses in open eyes developed cataract, whereas all lenses in closed eyes remained clear. In the first UVR experiment the lens light scattering was significantly higher in the xylazine/ketamine group. In the second UVR experiment the pentobarbital group was treated to achieve proptosis similar to that in the xylazine/ketamine group, which led to a smaller difference in lens light scattering between the two anaesthesia groups. Lens light scattering in the pentobarbital groups was significantly higher with forced proptosis than without prominent proptosis.Conclusions:  Xylazine/ketamine anaesthesia facilitates the development of UVR‐induced cataract, whereas pentobarbital anaesthesia does not. Xylazine/ketamine anaesthesia induces more proptosis and therefore leads to increased exposure of the cornea and, secondarily, the lens.
Jamming of 25‐gauge instruments in the cannula during vitrectomy for vitreous haemorrhage
Authors: Shinoda Hajime , Nakajima Takeshi , Shinoda Kei , Suzuki Kotaro , Ishida Susumu , Inoue Makoto 
Published: October 2007

Abstract.Purpose:  To report the jamming of 25‐gauge instruments in the cannula during vitreous surgery for non‐clearing vitreous haemorrhage.Methods:  Forty‐five eyes underwent vitrectomy with 25‐gauge instruments for non‐clearing vitreous haemorrhage (VH group). The incidence of 25‐gauge instruments jamming in the cannula was determined retrospectively and compared with that in 112 eyes that underwent vitrectomy for epiretinal membrane (ERM group), also using 25‐gauge instruments.Results:  The 25‐gauge vitreous cutter or light pipe became jammed in the cannula in three eyes (7%) in the VH group and the instrument locked inside the cannula had to be removed with the cannula. None of the 25‐gauge instruments in the ERM group jammed (p = 0.022, Fisher's exact probability test). Two of three eyes developed giant retinal breaks near the sclerotomy but no retinal break related to the sclerotomy was detected in the ERM group. Examination of the cutter revealed blood trapped between the cutter and the cannula.Conclusions:  Twenty‐five gauge instruments may become jammed in the cannula in eyes with non‐clearing vitreous haemorrhage. Clinicians should be aware of this surgical complication when 25‐gauge instruments are used in vitreous haemorrhage.
Resolution of macular oedema in occult choroidal neovascularization under oral Sorafenib®treatment
Authors: Kernt Marcus , Staehler Michael , Stief Christian , Kampik Anselm , Neubauer Aljoscha S. 
Published: October 2007

Abstract.Purpose: To report on the effect of oral nexavar (Sorafenib®) treatment in one patient with neovascular age‐related macular degeneration (AMD) and advanced renal cell cancer (RCC).Methods: After two intravitreal injections of bevacizumab (1.25 mg) for occult choroidal neovascularization (CNV) in AMD, the patient was started on oral Sorafenib®(400 mg twice daily) treatment for RCC.Results: Visual acuity (VA) was 20/80 in the left eye and optical coherence tomography (OCT) demonstrated persistent central thickening to 251 µm after bevacizumab. After 6 weeks of oral Sorafenib®treatment, VA had increased to 20/70 and a significant decrease in retinal thickness to 208 µm was observed on OCT. The patient remained stable during a further 3 months of follow‐up.Conclusions: Resolution of macular oedema and stabilization of VA under oral treatment with the multikinase inhibitor Sorafenib®was observed. This observation warrants further investigation.