bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nursing Home Assessment of Cognitive Impairment: Development and Testing of a Brief Instrument of Mental Status
Authors: Chodosh Joshua , Edelen Maria Orlando , Buchanan Joan L. , Yosef Julia Ann , Ouslander Joseph G. , Berlowitz Dan R. , Streim Joel E. , Saliba Debra 
Published: November 2008

OBJECTIVES: To test the accuracy of a brief cognitive assessment of nursing home (NH) residents and to determine whether facility nurses can reliably perform this assessment.DESIGN: Cross‐sectional, independent cognitive screening tests with NH residents.SETTING: Six Department of Veteran Affairs nursing facilities.PARTICIPANTS: Three hundred seventy‐four residents from six regionally distributed Veteran Affairs NHs.MEASUREMENTS: Three cognitive assessment instruments: the Brief Interview of Mental Status (BIMS), created for this study; the Minimum Data Set (MDS) 2.0 Cognitive Performance Scale (CPS), and the Modified Mini‐Mental State Examination (3MS) as the criterion standard. The 15‐point BIMS tests memory and orientation and includes free and cued recall items. Research assistants administered the 3MS and BIMS to all subjects. Facility nurses administered the same BIMS to a subsample.RESULTS: Three hundred seventy‐four of 417 (89.7%) residents approached completed the 3MS and research assistant–administered BIMS (BIMS‐R); 212 residents also received a facility nurse–administered BIMS (BIMS‐N). The BIMS‐R was more highly correlated with the 3MS than was the CPS (Pearson correlation coefficient (r)=0.79 vs 0.62; P<.01 for difference). For the subset who received facility assessments, the BIMS‐N was also more highly correlated with the 3MS (Pearson r=0.74 vs 0.65; P<.01 for difference). For any impairment (3MS<78), the area under the receiver operator characteristic curve (AUC) was 0.86 for the BIMS, versus 0.77 for the CPS. For severe impairment (3MS<48) the AUC was 0.94, versus 0.85 for the CPS.CONCLUSION: In this population, a brief cognitive test is a more accurate approach to cognitive assessment than the current observational methods employed using the MDS 2.0.
Future Research: A Prospective Longitudinal Study of Elder Self‐Neglect
Authors: Dyer Carmel Bitondo , Franzini Luisa , Watson Mary , Sanchez Luis , Prati Laura , Mitchell Stacy , Wallace Robert , Pickens Sabrina 
Published: November 2008

In almost every U.S. jurisdiction, elder self‐neglect is the most common allegation addressed by Adult Protective Service (APS) agencies. Not only is self‐neglect common, but this form of mistreatment is an independent risk factor for death. A lack of understanding of the precipitating factors and root causes and of the effect on social and medical systems persists in this field. Research in this area has been limited, because the needs of these vulnerable elderly people are complex and diverse. Moreover, these factors encompass interrelated medical, psychiatric, economic, social, and functional problems.In 2004, the National Institutes of Health Interdisciplinary Roadmap Initiative provided the means for preliminary exploration of elder self‐neglect through the formation of the Consortium for Research in Elder Self‐neglect of Texas (CREST). The goals of CREST include to conduct pilot studies, form interdisciplinary working groups, convene a national research conference, and appoint a national external advisory board. CREST orchestrated the work of 35 interdisciplinary investigators to achieve these goals.CREST researchers have begun to characterize the population of vulnerable elderly people who were reported to APS for neglecting themselves. The pilot studies provided a snapshot of 100 elderly people who had neglected themselves. A proposed next phase could involve a prospective longitudinal study of elderly people with severe self‐neglect. This study of the clinical course, the death rate, the causes of death, the occurrence of acute and chronic medical or mental illness, and the costs to the healthcare and social systems would greatly inform the field of elder mistreatment.
Ethnic Differences in Singapore's Dementia Prevalence: The Stroke, Parkinson's Disease, Epilepsy, and Dementia in Singapore Study
Authors: Sahadevan Suresh , Saw Seang Mei , Gao Wei , Tan Louis C.S. , Chin Jing Jih , Hong Ching ye , Venketasubramanian Narayanaswamy 
Published: November 2008

OBJECTIVES: To study the prevalence of dementia in Singapore among Chinese, Malays, and Indians.DESIGN: A two‐phase, cross‐sectional study of randomly selected population from central Singapore with disproportionate race stratification.SETTING: Community‐based study. Subjects screened to have cognitive impairment at phase 1 in their homes were evaluated clinically for dementia at phase 2 in nearby community centers.PARTICIPANTS: Fourteen thousand eight hundred seventeen subjects aged 50 and older (67% participation rate).MEASUREMENTS: The locally validated Abbreviated Mental Test was used to screen for cognitive impairment at phase 1. Dementia was diagnosed at phase 2 as per Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Possible Alzheimer's disease (AD) and possible vascular dementia (VD) were diagnosed along the National Institute of Neurological and Communicative Disorders—Alzheimer's Disease and Related Disorders Association and National Institute of Neurological Disorders and Stroke—Association Internationale pour la Recherche et l'Enseignement en Neuroscienes criteria, respectively.RESULTS: The overall age‐ and race‐standardized dementia prevalence was 1.26% (95% confidence interval (CI)=1.10–1.45). Prevalence (in 5‐year age bands) was 0.08% (50–54), 0.08% (55–59), 0.44% (60–64), 1.16% (65–69), 1.84% (70–74), 3.26% (75–79), 8.35% (80–84), and 16.42% (≥85). From age 50 to 69, 65% of dementia cases were VD; at older ages, 60% were AD. Logistic regression (adjusted for age, sex, education) showed that Malays had twice the risk for AD as Chinese, and Indians had more than twice the risk for AD and VD than Chinese.CONCLUSION: Singapore's dementia prevalence, primarily influenced by its Chinese majority, is lower than seen in the West. The striking interethnic differences suggest a need for a dementia incidence study and further investigation of underlying genetic and cultural differences between the three ethnic groups in relation to dementia risk.
Sensitivity of two hepatitis B virus, hepatitis C virus (HCV), and human immunodeficiency virus (HIV) nucleic acid test systems relative to hepatitis B surface antigen, anti‐HCV, anti‐HIV, and p24/anti‐HIV combination assays in seroconversion panels
Authors: Assal Azzedine , Barlet Valérie , Deschaseaux Marie , Dupont Isabelle , Gallian Pierre , Guitton Cathy , Morel P. , Van Drimmelen Harry , David Bernard , Lelie Nico , De Micco Philippe 
Published: November 2008

BACKGROUND: Accurate determination of the infectious window period (IWP) that remains with individual‐donation (ID) or minipool (MP) NAT compared to those with serology assays is essential for residual risk estimations.STUDY DESIGN AND METHODS: The relative sensitivity of the Procleix Tigris system (Gen‐Probe/Chiron) used in ID‐NAT format and cobas s 201 (Roche Molecular Systems) applied in 1:6 diluted samples to mimic six‐minipool (MP6) nucleic acid test (NAT) was assessed by quadruplicate testing of five seroconversion panels per marker. A mathematical analysis based on the log‐linear increase of viremia in the ramp‐up phase, as established with bDNA 3.0 assays enabled estimation of the IWP for human immunodeficiency virus (HIV) and hepatitis B virus (HBV) assays.RESULTS: The mean IWPs were Tigris HIV RNA 5.5 days, s 201 (1:6) HIV RNA 7.4 days, GenScreen Plus p24/anti‐HIV 17.8 days, PRISM anti‐HIV 19.0 days, Tigris HBV DNA 20.6 days, s 201 (1:6) HBV DNA 22.6 days, Bio‐Rad hepatitis B surface antigen (HBsAg) 37.8 days, and PRISM HBsAg 35.5 days. At estimated 50 percent NAT seroconversion rates, s 201 (1:6) and Tigris showed mean window‐period reduction times (WPRTs) of 30.5 to 35.5 days to hepatitis C virus antibody (anti‐HCV) assays, 10.4 to 13.5 days to anti‐HIV, or combination p24/anti‐HIV assays and 12.8 to 17.2 days to HBsAg assays.CONCLUSIONS: Tigris ID‐NAT detected HIV RNA 2 days earlier than s 201 MP6‐NAT, but the difference in sensitivity between the two NAT systems was not significant in HBV seroconversion panels. Insufficient seroconversion samples were available for reliable modeling of WPRT in early HCV infection, but 1.4 to 2.0 days could be predicted by translating analytical sensitivity data. Both multiplex NAT systems demonstrate significant WPRTs compared to (combined) antigen and antibody assays.
The effects of liberal versus restrictive transfusion thresholds on ambulation after hip fracture surgery
Authors: Foss Nicolai B. , Kristensen Morten Tange , Jensen Pia Søe , Palm Henrik , Krasheninnikoff Michael , Kehlet Henrik 
Published: November 2008

BACKGROUND: Perioperative anemia leads to increased morbidity and mortality and potentially inhibits rehabilitation after hip fracture surgery. As such, the optimum transfusion threshold after hip fracture surgery is unknown.PATIENTS AND METHODS: A total of 120 elderly, cognitively intact hip fracture patients admitted from their own home were randomly assigned to receive transfusion at a hemoglobin threshold of 10.0 g per dL (liberal) versus 8.0 g per dL (restrictive) in the entire perioperative period. Patients were treated according to a well‐defined multimodal rehabilitation program. Primary outcome was postoperative functional mobility measured with the cumulated ambulation score (CAS).RESULTS: Patients in the liberal group received transfusions more frequently than those in the restrictive group (44 patients vs. 22 patients; p < 0.01) and received more transfusions during hospitalization (median, 2 units [interquartile range, 1‐2] vs. 1 [1‐2]; p < 0.0001). There were no significant differences in postoperative rehabilitation scores (CAS: median, 9 [9‐15] vs. 9 [9‐13.5]; p = 0.46) or in length of stay (median, 18 days vs. 16 days, respectively; p = 0.46). There were fewer patients in the liberal transfusion group with cardiovascular complications (2% vs. 10%; p = 0.05) and a lower mortality (0% vs. 8%; p = 0.02).CONCLUSION: Although a liberal transfusion trigger did not result in increased ambulation scores, restrictive transfusion thresholds should be treated with caution in elderly high‐risk hip fracture patients, until their safety has been proved in larger randomized studies.
Cost‐effectiveness of additional hepatitis B virus nucleic acid testing of individual donations or minipools of six donations in the Netherlands
Authors: Borkent‐Raven B.A. , Janssen M.P. , Van Der Poel C.L. , De Wit G.A. , Bonsel G.J. , Van Hout B.A. 
Published: November 2008

BACKGROUND: To further reduce the risk of hepatitis B virus (HBV) transmission by blood transfusion, nucleic acid testing (NAT) can be employed. The aim of this study is to estimate the incremental cost‐effectiveness ratio (ICER) in the Netherlands of employing a triplex NAT assay aimed at HBV nucleic acid detection in individual donations (ID‐NAT) or in minipools of 6 donations (MP‐6‐NAT), compared to a triplex NAT assay in minipools of 24 donations (MP‐24‐NAT).STUDY DESIGN AND METHODS: A mathematical model was made of the whole transfusion chain from donors to recipients of blood in the Netherlands. The annual number of avoided HBV transmissions was estimated with the window‐period incidence model. The natural history of a HBV infection in recipients is described by a Markov model.RESULTS: The ICER of adding HBV MP‐6‐NAT or HBV ID‐NAT in the Netherlands is €303,218 (95% confidence interval [CI], €233,001‐€408,388) and €518,995 (95% CI, €399,359‐€699,120) per quality‐adjusted life‐year, respectively. The ICER strongly correlates with the age of transfusion recipients.CONCLUSION: The cost‐effectiveness of additional HBV NAT is limited by the limited loss of life caused by HBV transmission. Despite a higher effectiveness, HBV ID‐NAT is less cost‐effective than MP‐6‐NAT due to higher costs. A future equivalent participation of immigrants from HBV‐endemic countries in the donor base renders HBV NAT only slightly more cost‐effective.
Clinical‐grade purification of natural killer cells in haploidentical hematopoietic stem cell transplantation
Authors: Meyer‐Monard Sandrine , Passweg Jakob , Siegler Uwe , Kalberer Christian , Koehl Ulrike , Rovó Alicia , Halter Jörg , Stern Martin , Heim Dominik , Alois Gratwohl Johannes Rischewski , Tichelli André 
Published: November 2008

BACKGROUND: Because of a high risk of graft‐versus‐host disease (GVHD), donor lymphocyte infusions with unmodified lymphapheresis products are not used after haploidentical hematopoietic stem cell transplantation. Natural killer (NK) cells have antitumor activity and may consolidate engraftment without inducing GVHD. Production of NK cells under good manufacturing practice (GMP) conditions in a sufficient number is difficult.STUDY DESIGN AND METHODS: Twenty‐four apheresis procedures and subsequent NK‐cell enrichment from 14 haploidentical donors were performed. NK‐cell enrichment was performed using a GMP suitable immunomagnetic procedure. Factors influencing the NK‐cell recovery, purity, and NK‐cell dose were analyzed.RESULTS: A median number of 4.9 × 108 NK cells were obtained and median NK‐cell recovery was 58 percent. Median T‐cell depletion was 4.32 log. The absolute NK‐cell number in the final product after processing significantly correlated with the preharvest NK‐cell content of the peripheral blood (p = 0.002, r = 0.867). The NK‐cell recovery was inversely correlated to the absolute NK‐cell number in the apheresis product (p = 0.01, r = −0.51). The NK‐cell dose per kg of body weight of the patient was inversely correlated to the weight of the patient (p = 0.007, r = −0.533).CONCLUSION: Donors with a high NK‐cell count in peripheral blood are likely to provide NK‐cell products with the highest cell number. However, maximal NK‐cell dose is limited and high NK‐cell doses may only be obtained for patients with a low body weight, making children and young adults the best candidates for NK‐cell therapy.
Factors affecting the frequency of red blood cell outdates: an approach to establish benchmarking targets
Authors: Heddle Nancy M. , Liu Yang , Barty Rebecca , Webert Kathryn E. , Whittaker Susan , Gagliardi Kate , Lauzon Deborah , Owens Wendy 
Published: November 2008

BACKGROUND: Benchmarking is a useful tool to identify best practices and to compare an organization's performance with that of similar peers, allowing for continuous quality improvement. In this study, a provincial database of red blood cell (RBC) product inventory/disposition in hospitals was analyzed to identify factors that affected RBC outdates and to systematically establish optimal target levels for RBC outdates.STUDY DESIGN AND METHODS: RBC inventory/disposition data for a 21‐month period from 156 hospitals were analyzed using logistic regression techniques to identify factors that affected RBC outdating (month of the year, distance from the blood supplier, monthly transfusion activity, hospital type, and provincial region). The results were used to categorize hospitals into groupings that accounted for the factors affecting wastage. Within each grouping, the lower quartile was selected as the optimal target threshold.RESULTS: Three factors were identified as significantly affecting RBC outdating: distance from the blood supplier, mean monthly transfusion activity, and month of the year. Accounting for these variables, three hospital groupings were identified and benchmarking targets were established for mean monthly RBC outdating: There were 73 hospitals in Group 1 and their target level was 0.4 percent, 59 hospitals in Group 2 with a target of 1.1 percent, and 24 hospitals in Group 3 with a target of 20.3 percent.CONCLUSION: A method is described for establishing evidence‐based benchmarking targets for RBC outdating that allows for hospitals to be grouped with similar peers taking into account logistic factors that impact on product outdating.
Impact of a policy to permit the return of donors repeat‐reactive to the Abbott PRISM antibody to hepatitis B core antigen assay
Authors: O'Brien Sheila F. , Yi Qi‐Long , Fan Wenli , Fearon Margaret A. , Scalia Vito , Goldman Mindy 
Published: November 2008

BACKGROUND: The expected donor loss from recent implementation of antibody to hepatitis B core antigen (anti‐HBc) testing in Canada was uncertain but potentially significant based on US experience. To reduce donor loss from false‐reactive tests, repeat‐reactive donors without other evidence of infection were eligible to return. The aim was to evaluate the impact of anti‐HBc testing on donor loss and to evaluate the effectiveness of this policy.STUDY DESIGN AND METHODS: For each donor in the first year of implementation (April 9, 2005‐April 8, 2006) repeat‐reactive for the presence of anti‐HBc only but eligible to return (screening test for hepatitis B surface antigen–negative, plus not reactive to antibody to hepatitis B surface antigen [anti‐HBs] and hepatitis B virus [HBV] DNA supplemental tests), 10 matched donors not reactive to the anti‐HBc assay were selected. Return rates over 2 years were compared using conditional logistic regression. Testing outcomes were tabulated.RESULTS: Over the first year of testing, 412,236 donors (951,423 donations) were tested for anti‐HBc, and 4,489 donors were repeat‐reactive (1.3% of first‐time donors, 1.0% of repeat donors). Of these 85.6 percent were also reactive for the presence of anti‐HBs and/or HBV DNA supplemental tests leaving less than 15 percent eligible to return, of whom 73 percent returned (vs. 90% of controls, p < 0.001). Of the 300 anti‐HBc repeat‐reactive returning donors, 74 percent were anti‐HBc repeat‐reactive again (thus permanently deferred), 19 percent were deferred for other reasons versus 14 percent of controls (p < 0.05), and 7 percent (21 donors) did not react and were eligible to continue donating.CONCLUSION: Most donors repeat‐reactive for the presence of anti‐HBc likely have past exposure to HBV. If eligible, most are willing to return, but likely to test anti‐HBc repeat‐reactive again.
Novel ICE‐Guided Registration Strategy for Integration of Electroanatomical Mapping with Three‐Dimensional CT/MR Images to Guide Catheter Ablation of Atrial Fibrillation
Authors: ROSSILLO ANTONIO , INDIANI STEFANO , BONSO ALDO , THEMISTOCLAKIS SAKIS , CORRADO ANDREA , RAVIELE ANTONIO 
Published: November 2008

Introduction:
Image integration is used in AF ablation procedures. To maximize the efficacy of image integration, it is essential to obtain good alignment between the electroanatomical map and the 3D image of the heart. In the present study, we compared an ICE‐guided landmark registration with an ICE‐guided focused endocardial surface registration.
Methods and Results:
In 20 patients, registration was based on posterior landmarks acquired under ICE guidance (group A); in another 20 matched patients, a new ICE‐guided focused endocardial surface registration technique was used (group B). In these latter patients, a single landmark was acquired in the inferior part of the LIPV, and several surface points were recorded in the posterior area of the left PV antrum and around the antra of the right PVs. The mean ablation point‐to‐CT image distance was calculated in both groups. In group A, the mean landmark point‐to‐CT image distance was also calculated after adding the surface registration. The mean landmark point‐to‐CT image distance was 4.62 ± 1.65 mm and increased to 7.66 ± 2.44 mm when surface registration was added. The ablation point‐to‐CT image distance was significantly shorter in group B (1.73 ± 0.29 mm vs 3 ± 0.99 mm; P < 0.001).
Conclusions:
This ICE‐guided focused endocardial surface registration seems to be superior to landmark registration in achieving a better alignment between the CT/MR image and the electroanatomical map. The concurrent use of standard surface registration may result in rotation of the atrial chamber.
Efficacy of Medical Therapy for the Reduction of Heart Failure Events in Patients with Implanted Cardioverter Defibrillators
Authors: PIETRASIK GRZEGORZ , GOLDENBERG ILAN , McNITT SCOTT , POLONSKY BRONISLAVA , MOSS ARTHUR J. , ZAREBA WOJCIECH 
Published: November 2008

Background:Prophylactic therapy with the implantable cardioverter defibrillator (ICD) reduces the mortality among patients with left ventricular dysfunction; however, life‐prolonging device therapy has been shown to be associated with an increased risk for subsequent heart failure (HF) events. There are limited data on the effect of the primary types of HF medications, angiotensin converting enzyme inhibitors (ACE‐I), and beta‐blockers on HF progression in ICD‐treated patients.Methods:Multivariate Cox proportional hazards regression analysis was used to assess the effect of time‐dependent medical therapy with ACE‐I and beta‐blockers on the development of HF in patients with an ICD in the Multicenter Automatic Defibrillator Trail (MADIT) II.Results:In multivariate analysis, ICD therapy was associated with a significant 39% increase in the risk of HF as compared with conventional medical therapy. ACE‐I and beta‐blockers exhibited a graded efficacy for the reduction in the risk of HF events in ICD‐treated patients: the greatest risk reduction of HF was seen in patients taking combination therapy (HR = 0.36, P < 0.001), followed by patients using beta‐blockers only (HR = 0.51, P = 0.017) and ACE‐I only (HR = 0.64, P = 0.071). Beta‐blocker subtypes (metoprolol [HR = 0.49, P = 0.001] and carvedilol [HR = 0.58, P = 0.004]) exhibited similar efficacy. Consistent results were demonstrated when the combined endpoint of HF or death was assessed.Conclusions:ICD‐treated patients experience an increased risk for HF events that can be significantly attenuated by medical therapy with beta‐blockers and ACE‐inhibitors.
First Experiences for Pulmonary Vein Isolation with the High‐Density Mesh Ablator (HDMA): A Novel Mesh Electrode Catheter for Both Mapping and Radiofrequency Delivery in a Single Unit
Authors: MEISSNER AXEL , PLEHN GUNNAR , VAN BRACHT MARC , SCHRAGE MAX OLAV , CHRIST MARTIN , MAAGH PETRA , BUTZ THOMAS , BORCHARD ROLF , TRAPPE HANS‐JOACHIM 
Published: November 2008

Background: Interventional therapy of atrial fibrillation (AF) is often associated with long examination and fluoroscopy times. The use of mapping catheters in addition to the ablation catheter requires multiple transseptal sheaths for left atrial access. Objectives: The purpose of this prospective study was to evaluate feasibility and safety of pulmonary vein (PV) isolation using the high‐density mesh ablator (HDMA), a novel single, expandable electrode catheter for both mapping and radiofrequency (RF) delivery at the left atrium/PV junctions. Methods: Twenty‐six patients with highly symptomatic paroxysmal AF (14, 53.8%) and persistent AF (12, 46.2%) were studied. Segmental PV isolation via the HDMA was performed using a customized pulsed RF energy delivery program (target temperature 55–60°C, power 70–100 W, 600–900 seconds RF application time/PV). Results: All 104 PVs in 26 patients could be ablated by the HDMA. Segmental PV isolation was achieved with a mean of 3.25 ± 1.4 RF applications for a mean of 603 ± 185 seconds. Entrance conduction block was obtained in 94.2% of all PV. The mean total procedure and fluoroscopy time was 159.0 ± 32 minutes and 33.5 ± 8.6 minutes, respectively. None of the patients experienced severe acute complications. After 3 months no PV stenosis was observed, and 85.6% and 41.6% of the patients with PAF and persistent AF, respectively, did not report symptomatic AF. Conclusions: In this first study of PV isolation using the HDMA, our findings suggest that this method is safe and yields good primary success rates. The HDMA simplifies AF ablation, favorably impacting procedure and fluoroscopy times.