bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of psychological factors on placebo responses in a randomized controlled trial comparing sham device to dummy pill
Authors: Bertisch Suzanne M. , Legedza Anna R. T. , Phillips Russell S. , Davis Roger B. , Stason William B. , Goldman Rose H. , Kaptchuk Ted J. 
Published: February 2009

AbstractObjectives  To explore to what extent psychological factors such as expectation, depression, anxiety and belief in alternative medicine impact placebo response and differential responses to separate placebo interventions.Methods  We analysed data from a randomized controlled trial designed to compare the clinical response of two distinct placebo treatments (sham acupuncture device and placebo pill) in 119 participants with persistent distal upper arm pain due to repetitive stress injury. We used a multivariable linear regression model to identify potential correlates of self‐reported upper extremity pain at the end of treatment in both placebo arms of the study combined. We also performed stratified analyses by placebo treatment.Results  We did not find any of the psychological factors of interest to be associated with pain at the end of treatment in our combined analysis. We found higher baseline pain score and pain for longer than 1 year's duration to be significantly associated with higher pain scores at the end of treatment for the placebo treatments combined. In stratified analyses, for the sham acupuncture group, we found higher baseline depression score, higher baseline pain score and younger age to be independently correlated with higher pain score at the end of treatment. For the placebo pill group, only baseline pain was significantly correlated to pain score at the end of treatment.Conclusion  In this trial, neither expectancy nor psychological states were associated with response to placebo, with the exception of baseline depression score for the sham acupuncture arm.
Towards quantifying the aesthetic outcomes of breast cancer treatment: comparison of clinical photography and colorimetry
Authors: Kim Min Soon , Rodney William N. , Cooper Tara , Kite Chris , Reece Gregory P. , Markey Mia K. 
Published: February 2009

AbstractRationale, aims and objectives  Scarring is a significant cause of dissatisfaction for women who undergo breast surgery. Scar tissue may be clinically distinguished from normal skin by aberrant colour, rough surface texture, increased thickness (hypertrophy) and firmness. Colorimeters or spectrophotometers can be used to quantitatively assess scar colour, but they require direct patient interaction and can cost thousands of dollars. By comparison, digital photography is already in widespread use to document clinical outcomes and requires less patient interaction. Thus, assessment of scar coloration by digital photography is an attractive alternative. The goal of this study was to compare colour measurements obtained by digital photography and colorimetry.Methods  Agreements between photographic and colorimetric measurements of colour were evaluated. Experimental conditions were controlled by performing measurements on artificial scars created by a make‐up artist. The colorimetric measurements of the artificial scars were compared with those reported in the literature for real scars in order to confirm the validity of this approach. We assessed the agreement between the colorimetric and photographic measurements of colour using a hypothesis test for equivalence, the intraclass correlation coefficient and the Bland–Altman method.Results  Overall, good agreement was obtained for three parameters (L*a*b*) measured by colorimetry and photography from the results of three statistical analyses.Conclusion  Colour measurements obtained by digital photography were equivalent to those obtained using colorimetry. Thus, digital photography is a reliable, cost‐effective measurement method of skin colour and should be further investigated for quantitative analysis of surgical outcomes.
Predictive model for progression of hearing loss: meta‐analysis of multi‐state outcome
Authors: Chao Ting‐Kuang , Chen Tony Hsiu‐Hsi 
Published: February 2009

AbstractRationale, aims and objectives  To develop a multi‐state Markov model to predict multi‐state progression of age‐related hearing loss (ARHL).Method  A systematic searching of literature from Medline (1966–2005) was performed. The disease process for hearing loss was modelled as a four‐state continuous‐time Markov process. We estimated the progression rates for each study separately, then calculated weighted averages over all studies across age groups, weighting for each study by the inverse of variance. The pooled estimates were obtained and transition probabilities between states were illustrated.Results  The progression of hearing loss increased with the ascending frequencies across all age groups. Men had significantly faster progression rates in all frequencies and age groups except for the age group of 90 years or older. In comparison between ears, the progression of hearing would be slightly faster in left ears initially in early elder life and did not show any difference in further ageing and later hearing declines. With the pooled estimates of progression rates, the probabilities of hearing deterioration could be obtained.Conclusions  The multi‐state model can quantify the nature course of hearing progression in ARHL. Predictions of hearing status can be simulated either at population or individual level with this model.
Appropriateness of colonoscopy in a digestive endoscopy unit: a prospective study using ASGE guidelines
Authors: Suriani Renzo , Rizzetto Mario , Mazzucco Dario , Grosso Silvia , Gastaldi Paola , Marino Maria , Sanseverinati Sabina , Venturini Ivo , Borghi Athos , Zeneroli Maria Luisa 
Published: February 2009

AbstractRationale, aims and objectives  Appropriate indications for colonoscopy (C) are essential for a rational use of resources. The aim of this study is to evaluate the appropriateness of indication for C according to the American Society for Gastrointestinal Endoscopy (ASGE) guidelines and to evaluate whether appropriate use was correlated with the diagnostic yield of C.Methods  We analysed 677 consecutive C performed over an 11‐month period in a digestive endoscopy unit with an open access system.Results  The rate of ‘generally indicated’ C was 77% and ‘generally not indicated’ C was 18%. The rate of indication not listed in the ASGE guidelines was 5%. The percentage of generally not indicated C requested by gastroenterologists for outpatients was lower than that requested by primary care surgeons or doctors (9.5%, 29%, 25.3%, respectively). In 38 (7.3%) and in 111 (21.3%) of 520 patients with appropriate C, cancer and polyps larger than 5 mm were found, respectively. Twenty polyps greater than 5 mm were detected in 15 cases (12%) of 122 inappropriate C, with only one case of intramucosal carcinoma; four (12%) polyps measuring over 5 mm were found in C not listed in ASGE guidelines. No advanced stage cancer was detected in the inappropriate group and in C not listed in ASGE guidelines.Conclusions  Our results showed the high rate of inappropriate procedures, according to ASGE guidelines, requested by surgeons, internists and primary care doctors for both outpatients and inpatients. The proportion of not indicated endoscopic procedures requested by gastroenterologists must be reduced through more carefully application of ASGE guidelines. Endoscopic findings were more stringent in appropriate C.
Diagnostic accuracy of clinical criteria for identifying systolic and diastolic heart failure: cross‐sectional study
Authors: Maestre Ana , Gil Vicente , Gallego Javier , Aznar José , Mora Antonia , Martín‐Hidalgo Alberto 
Published: February 2009

AbstractObjective  To determine the validity and clinical usefulness of clinical criteria in the diagnosis of systolic and diastolic heart failure.Design  Cross‐sectional diagnostic study.Methods  216 patients admitted consecutively to the cardiology section of an academic hospital with a suspected diagnosis of heart failure in a period of 12 months. A definite diagnosis of heart failure (echocardiographic diagnostic criteria of left ventricular dysfunction) was cross‐matched with the results obtained using the test under investigation (Framingham clinical diagnostic criteria for heart failure). Sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio for positive test result (LR+) and likelihood ratio for negative test result (LR−) were calculated and used to construct clinical decision‐making diagrams.Results  The Framingham clinical criteria are very sensitive (92%) and moderately specific (79%). The diagnosis of heart failure was ruled out with a good LR− (0.1) but the diagnosis was confirmed with only a low level of evidence as the LR+ was 4.3. The main difference found between systolic and diastolic heart failure is that in the case of systolic failure the disease is ruled out conclusively (0.04), whereas in the case of diastolic failure the change in probability generated is at the borderline between conclusive and moderate (0.1).Conclusion  The absence of the Framingham clinical criteria rules out the diagnosis of heart failure, particularly in the case of systolic heart failure. However, the presence of these criteria do not necessarily confirm the diagnosis, which may be based in echocardiography.
Knowledge, practice and faith on Total Quality Management principles among workers in the Health Care System: Evidence from an Italian investigation
Authors: Gregori Dario , Napolitano Giampaolo , Scarinzi Cecilia , Semeraro Arianna , Rosato Rosalba , Pagano Eva , Zigon Giulia , Gabassi Piergiorgio 
Published: February 2009

AbstractBackground  The implementation of Total Quality Management (TQM) principles in the sanitary field, in order to be effective, requires a radical change in management practice as well as the organizational culture and its philosophy. The need to monitor such a transformation emerges too.Objectives  This study surveys how well TQM principles are known and understood by health care professionals from the employees' point of view and the factors affecting it.Research design and subjects  The Health Care System in Trieste was surveyed.Measures  The Total Quality Test was used, a novel and quick instrument aimed at routine assessment of the penetration and interiorization of TQM principles within the health care structure.Results  Direct exposure to public, job role and time spent working within the same structure have been proved related to the penetration of TQM principles, whereas previous formative intervention did not prove to be associated with the penetration of TQM principles.Conclusions  The implementation of a quick and simple instrument to monitor the TQM implementation highlighted several critical areas for intervention.
Can individuals with a significant risk for cardiovascular disease be adequately identified by combination of several risk factors? Modelling study based on the Norwegian HUNT 2 population
Authors: Petursson Halfdan , Getz Linn , Sigurdsson Johann A. , Hetlevik Irene 
Published: February 2009

AbstractRationale, aims and objectives  Clinicians are generally advised to consider several risk factors when evaluating patients' cardiovascular disease (CVD) risk. Our aim was to study whether combined assessment of five traditional risk factors might help doctors demarcate a relatively distinct and manageable group of high‐risk individuals. We selected five modifiable risk factors and estimated the proportion of a well‐defined population with ‘unfavourable’ levels of at least two of them, as defined by four internationally renowned guidelines. The impact of including so‐called ‘prehypertension’ among the risk factors was specifically addressed, and the results are discussed in a wider perspective.Material and methods  Guideline implementation was modelled on data from a cross‐sectional Norwegian population study comprising 62 104 adults aged 20–79 years (The Nord‐Tröndelag Health Study 1995–7). Total, age‐ and gender‐specific point prevalences of individuals with zero, one, two, three or more factors, in addition to established disease, were calculated.Results  One single CVD risk factor was exhibited by 12.4% of the population; two factors by 21.5%; and three or more by 49.7%. Established CVD or diabetes mellitus was reported by 12.5%. In total, 83.7% of the population exhibited a risk or disease profile with at least two factors, if prehypertension was included.Conclusions  If guideline recommendations are literally applied, as many as 84% of adults in Norway could exhibit two or more CVD or risk factors and thus be considered in need of individual, clinical attention. This challenges the widely held presumption that ‘the net will close’ around a manageable group of individuals‐at‐risk if several risk factors are jointly considered. As the finding of this study arises in one of the world's most long‐ and healthy‐living populations, it raises several practical as well as ethical questions.
Paediatric experiences with work‐hour limitations
Authors: Fortuna Robert J. , Palfrey Judith S. , Shelov Steven P. , Samuels Ronald C. 
Published: February 2009

AbstractObjectives  To evaluate the perceived impact of work‐hour limitations on paediatric residency training programmes and to determine the various strategies used to accommodate these restrictions.Methods  A three‐page pre‐tested survey was administered to programme directors at the 2004 Association of Paediatric Programme Directors meeting. The impact of work‐hours was evaluated with Likert‐type questions and the methods used to meet work‐hour requirements were compared between large programmes (≥30 residents) and small programmes.Results  Surveys were received from 53 programme directors. The majority responded that work‐hour limitations negatively impacted inpatient continuity, time for education, schedule flexibility and attending staff satisfaction. Supervision by attending staff was the only aspect to significantly improve. Perceived resident satisfaction was neutral. To accommodate work‐hour limitations, 64% of programmes increased clinical responsibility to existing non‐resident staff, 36% hired more non‐resident staff and 17% increased the number of residents. Only one programme hired additional non‐clinical staff. Large programmes were more likely to use more total methods on the inpatient wards (P < 0.01) and in the intensive care units (P < 0.05) to accommodate work‐hour limitations.Conclusions  Programme directors perceived a negative impact of work‐hours on most aspects of training without a perceived difference in resident satisfaction. While a variety of methods are used to accommodate work‐hour limitations, programmes are not widely utilizing non‐clinical staff to alleviate clerical burdens.
Comparison of QuantiFERON TB‐G‐test to TST for detecting latent tuberculosis infection in a high‐incidence area containing BCG‐vaccinated population
Authors: Kariminia Amina , Sharifnia Zarin , Aghakhani Arezoo , Banifazl Mohammad , Eslamifar Ali , Hazrati Mahboob , Ramezani Amitis 
Published: February 2009

AbstractObjective  Until recently, the only tool for detection of latent tuberculosis infection (LTBI) was the tuberculin skin test (TST). QuantiFERON‐TB Gold In‐Tube test (QFT) is a promising in vitro diagnostic test for LTBI that has potential advantages over the TST. In this study we aimed to compare QFT with TST for diagnosis of LTBI.Patients and methods  A total of 186 BCG‐vaccinated subjects enrolled in study. They underwent TST and QFT assay. They divided in two groups. Group 1 includes individuals who were at low risk for exposure to M. tuberculosis (LRG) and Group 2 includes individuals who were likely to have been exposed to M. tuberculosis infections (HRG).Results  Overall agreement between QFT and TST was 89.3% (kappa = 0.052). In LRG, agreement between the two tests was 52.6% (95% confidence interval, 44–60%) with κ‐values of 0.019. In HRG agreement between the two tests was 63.2% (95% confidence interval, 42–84%) with κ‐values of 0.28.Conclusion  In conclusion, the QFT assay showed acceptable results for determining latent M. tuberculosis infection in vaccinated population. The decision to select QFT over TST will depend on the population, purpose of testing and resource availability.
Prehospital pain treatment: an economic productivity factor in emergency medicine?
Authors: Hubert Hervé , Guinhouya Comlavi , Ricard‐Hibon Agnès , Wiel Eric , Durocher Alain , Goldstein Patrick 
Published: February 2009

AbstractRationale and objectives  Analgesia is a recommended practice for pain treatment in prehospital emergency medicine, but all experts note suboptimal pain relief or oligoanalgesia. The increase in the Care Workload (CW) and the Medical Treatment Duration (MTD) linked to analgesia are two explanatory factors, and they are representative of the unavailability of a prehospital team. The unavailability of a team is an opportunity cost which is probably the most important cost within the framework of prehospital emergency. The aim of this study was to analyse the influence of analgesia use on the availability of prehospital emergency teams.Methods  This study was a prospective, multicentre cohort study conducted in 10 French Mobile Emergency and Resuscitation Services (MERS) between September 2001 and June 2003. A case–control study was performed including 568 case patients who received analgesia matched with controls based on diagnosis and severity. The pairs were compared for MTD and CW.Results  No significant difference between cases and controls was found concerning MTD (P = 0.134). Conversely, a difference was found for CW (P < 10−4), with a mean value of 53.7 Project Recherche Nursing (PRN) points for the cases and 45.8 PRN points for the controls.Conclusions  This study shows that analgesia generates an additional CW without increasing the MTD, and does not hinder the MERS teams' availability. This economic result should improve adherence to these clinical practice guidelines. Thus, analgesia appears to be a factor of productivity in the current context of economic pressures in terms of the funding of the healthcare system.
MRI algorithm for medical necessity for auto accident injured patients
Authors: Chen Shande , Laughlin James E 
Published: February 2009

AbstractRationale  Magnetic resonance imaging (MRI) is often used as a diagnostic test to evaluate personal injury. However, it increases the health care cost. Therefore, it is important to study the necessity for using MRI.Objective  To examine the percentages of MRI ordering between orthopaedic surgeon and non‐surgeon referring health care providers, and to propose an MRI an algorithm to reduce unnecessary MRI for patients with personal injuries.Methods  This is a retrospective study. A total of 2000 patients that received a soft tissue injury and did not require surgery between 1 January 2000 and 31 December 2004, were examined. Among them, 1000 patients came directly to one of the authors, an orthopaedic surgeon, and other 1000 were referred to the same surgeon. The percentages of MRI ordered by the author and the referring health care providers are examined. For referred patients, the orthopaedic author re‐examined each patient to determine whether he thought the MRI was necessary. The Chi‐square test and McNemar's test are used for comparisons for the percentages, and confidence intervals are reported. The study examines the overall MRI ordering, and MRI ordering separately for body regions.Conclusions  We found that there was a great disparity between the percentages of MRI ordering between the orthopaedic surgeon and the non‐surgeon referring doctors, the orthopaedic surgeon ordered significantly less MRI (P‐values < 0.001). Adopting the proposed algorithm of medical necessity for ordering MRI or considering early referral to an orthopaedic surgeon prior to ordering MRI can significantly reduce the medical cost for these patients.
Evaluating the effect of change on change: a different viewpoint
Authors: Shahar Eyal 
Published: February 2009

Rationale  When a causal variable and its presumed effect are measured at two time points in a cohort study, most researchers prefer to fit some type of a change model. Many of them believe that such an analysis is superior to a cross‐sectional analysis ‘because change models estimate the effect of change on change’, which sounds epistemologically stronger than ‘estimating a cross‐sectional association’.Methods  In this paper I trace two commonly used regression models of change to their cross‐sectional origin and describe these models from the perspectives of time‐stable confounders, effect modification, and causal diagrams. In addition, I cite three viewpoints from the statistical literature.Results  The so‐called change models do not estimate anything conceptually different from cross‐sectional models. A change model is superior to a cross‐sectional model mainly because it corresponds to a self‐matched design. Statistical viewpoints markedly differ about the appropriate parameterization and interpretation of such data.Conclusion  Contrary to prevailing thought, a model of changes between two time points does not estimate any special causal idea called ‘longitudinal effect’. The main advantage of regressing ‘change on change’ is complete control of time‐stable confounders, a key concern in observational studies. Many analysts fail to realize that that important advantage is usually lost when they fit a random effects model.
Goal attainment for multiple cardiovascular risk factors in community‐based clinical practice (a Canadian experience)
Authors: Farahani Pendar , Levine Mitchell 
Published: February 2009

AbstractBackground  The primary goal in the clinical management of atherosclerotic cardiovascular (CV) disease is to reduce major CV risk factors. A single risk factor approach has been traditionally used for demonstrating effectiveness of therapeutic interventions designed to reduce CV risk in clinical trials, but a global CV risk reduction approach should be adopted when assessing effectiveness in the clinical practice setting.Objectives  To explore combined goal achievement for low‐density lipoprotein cholesterol (LDL‐C), fasting plasma glucose and systolic‐diastolic blood pressure, in patients with dyslipidemia on pharmacotherapy in community‐based clinical practices across Canada.Methods  In a cross‐sectional study, patients filling a prescription for any antihyperlipidemia therapy in selected pharmacies in Ontario, Quebec, British Columbia and Nova Scotia were recruited. Family physicians of the participating patients were requested to provide information from the patient's medical record. Ten‐year CV risk was identified for each patient according to the Framingham criteria.Results  High‐risk patients comprised 52% of the patient population; 34% were moderate‐risk and 14% were low‐risk. Patients had a mean of 2.8 CV risk factors; high‐risk 3.7, moderate‐risk 2.3 and low‐risk 1.2. LDL‐C goal attainment was observed in 62%, 79% and 96% of patients in high‐risk, moderate‐risk and low‐risk strata respectively. BP goal was achieved in high‐risk patients 58%, moderate‐risk 83% and low‐risk 95%. Glucose levels were below the threshold in 91% of patients. Complete global CV risk reduction was achieved in only 21%, 66% and 92% of high‐risk, moderate‐risk and low‐risk strata respectively.Conclusion  This study illustrates that many patients with dyslipidemia in the Canadian population, and in particular the high‐risk patients, did not meet the therapeutic targets for specific CV risk factors according to the Canadian guidelines. Overall, 54% of patients failed to achieve a state of complete global CV risk reduction.