bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient and Provider Assessments of Adherence and the Sources of Disparities: Evidence from Diabetes Care
Authors: Lutfey Karen E. , Ketcham Jonathan D. 
Published: November 2005

Objective. To (1) compare diabetes patients' self‐assessments of adherence with their providers' assessments; (2) determine whether there are systematic differences between the two for certain types of patients; and (3) consider how the cognitive processing that providers use to assess adherence might explain these differences.Data Sources/Study Setting. Primary survey data were collected in 1998 from 156 patient provider pairs in two subspecialty endocrinology clinics in a large Midwestern city.Study Design. Data were collected in a cross‐sectional survey study design. Providers were surveyed immediately after seeing each diabetes patient, and patients were surveyed via telephone within 1 week of clinic visits.Data Collection/Extraction Methods. Bivariate descriptive results and multivariate regression analyses are used to examine how patient characteristics relate to four measures of overall adherence assessments: (1) patients' self‐assessments; (2) providers' assessments of patient adherence; (3) differences between those assessments; and (4) absolute values of those differences.Principal Findings. Patient self‐assessments are almost entirely independent of observable characteristics such as sex, race, and age. Provider assessments vary with observable characteristics such as patient race and age but not with less readily observable factors such as education and income. For black patients, we observe that relative to white patients, providers' assessments are significantly farther away from—although not systematically farther above or below—patients' self‐assessments.Conclusions. Providers appear to rely on observable cues, particularly age and race, to make inferences about an individual patient's adherence. These findings point to a need for further research of various types of provider cognitive processing, particularly in terms of distinguishing between prejudice and uncertainty. If disparities in assessment stem more from information and communication problems than from provider prejudice, policy interventions should facilitate providers' systematic acquisition and processing of information, particularly for some types of patients.
What Happens When Hospital‐Based Skilled Nursing Facilities Close? A Propensity Score Analysis
Authors: White Chapin , Seagrave Susanne 
Published: November 2005

Objective. To assess the effects of hospital‐based skilled nursing facility (HBSNF) closures on health care utilization, spending, and outcomes among Medicare fee‐for‐service beneficiaries.Data Sources. One hundred percent Medicare fee‐for‐service claims files for 1997–2002 were merged with Medicare Provider of Services files and beneficiary‐level enrollment records.Study Design. Medicare spending, the use of postacute care, and health outcomes, were compared among hospitals that did and did not close their HBSNFs between 1997 and 2001. Hospitals were stratified according to propensity scores (i.e., predicted probability of closure from a logistic regression) and analyses were conducted within these strata.Principal Findings. HBSNF closures were associated with increased utilization of alternative postacute care settings, and longer acute care hospital stays. Because of increased use of alternative settings, HBSNF closures were associated with a slight increase in total Medicare spending. There are no statistically robust associations between HBSNF closures and changes in either mortality or rehospitalization.Conclusions. HBSNF closures altered utilization patterns, but there is no indication that closures adversely affect beneficiaries' health outcomes.
Practice‐Level Effects of Interventions to Improve Asthma Care in Primary Care Settings: The Pediatric Asthma Care Patient Outcomes Research Team
Authors: Finkelstein Jonathan A. , Lozano Paula , Fuhlbrigge Anne L. , Carey Vincent J. , Inui Thomas S. , Soumerai Stephen B. , Sullivan Sean D. , Wagner Edward H. , Weiss Scott T. , Weiss Kevin B. 
Published: November 2005

Objective. To assess the practice‐level effects of (1) a physician peer leader intervention and (2) peer leaders in combination with the introduction of asthma education nurses to facilitate care improvement. And, to compare findings with previously reported patient‐level outcomes of trial enrollees.Study Setting. Data were included on children 5–17 years old with asthma in 40 primary care practices, affiliated with managed health care plans enrolled in the Pediatric Asthma Care Patient Outcomes Research Team (PORT) randomized trial.Study Design. Primary care practices were randomly assigned to one of two care improvement arms or to usual care. Automated claims data were analyzed for 12‐month periods using a repeated cross‐sectional design. The primary outcome was evidence of at least one controller medication dispensed among patients with persistent asthma. Secondary outcomes included controller dispensing among all identified asthmatics, evidence of chronic controller use, and the dispensing of oral steroids. Health service utilization outcomes included numbers of ambulatory visits and hospital‐based events.Principal Findings. The proportion of children with persistent asthma prescribed controllers increased in all study arms. No effect of the interventions on the proportion receiving controllers was detected (peer leader intervention effect 0.01, 95 percent confidence interval [CI]: −0.07, 0.08; planned care intervention effect −0.03, 95 percent CI: −0.09, 0.02). A statistical trend was seen toward an increased number of oral corticosteroid bursts dispensed in intervention practices. Significant adjusted increases in ambulatory visits of 0.08–0.10 visits per child per year were seen in the first intervention year, but only a statistical trend in these outcomes persisted into the second year of follow‐up. No differences in hospital‐based events were detected.Conclusions. This analysis showed a slight increase in ambulatory asthma visits as a result of asthma care improvement interventions, using automated data. The absence of detectable impact on medication use at the practice level differs from the positive intervention effect observed in patient self‐reported data from trial enrollees. Analysis of automated data on nonenrollees adds information about practice‐level impact of care improvement strategies. Benefits of practice‐level interventions may accrue disproportionately to the subgroup of trial enrollees. The effect of such interventions may be less apparent at the level of practices or health plans.
An Episode‐Based Framework for Analyzing Health Care Expenditures: An Application of Reward Renewal Models
Authors: Foster E. Michael , Xuan Fengjuan 
Published: November 2005

Objective. To illustrate an episode‐based framework for analyzing health care expenditures based on reward renewal models, a stochastic process used in engineering for describing processes that cycle on and off with “rewards” (or costs) occurring at the end of each cycle.Data Sources/Study Setting. Data used in the illustration were collected as part of an evaluation of a national initiative to improve mental health services for children and youth. Participants were enrolled in a longitudinal study at a demonstration site and in a comparison community between 1997 and 1999. The illustration involves analyses of mental health expenditures at the two sites and of the dynamics of service use behind those expenditures.Data Collection/Extraction Methods. Services data were derived from management information systems as well as patient records at inpatient facilities in the two communities. These data cover services received between 1997 and 2003. The analysis focuses on the year following study entry.Principal Findings. Between‐site differences in expenditures reflect complex between‐site differences in the timing of service use. In particular, children at the demonstration stayed in treatment longer but were less likely to return for treatment later. In contrast, children at the comparison site experienced substantially less continuity of care. Costs per day of treatment within an episode were comparable at the two sites.Conclusions. Reward renewal models offer a promising means for integrating research on service episodes and the dynamics of service use with that on health care expenditures.
Assessment of the Equivalence of the Spanish and English Versions of the CAHPS® Hospital Survey on the Quality of Inpatient Care
Authors: Hurtado Margarita P. , Angeles January , Blahut Steven A. , Hays Ron D. 
Published: November 2005

Objective. To describe translation and cultural adaptation procedures, and examine the degree of equivalence between the Spanish and English versions of the Agency for Healthcare Research and Quality's (AHRQ) Consumer Assessments of Healthcare Providers and Systems (CAHPS®) Hospital Survey (H‐CAHPS®) of patient experiences with care.Data Sources. Cognitive interviews on survey comprehension with 12 Spanish‐speaking and 31 English‐speaking subjects. Psychometric analyses of 586 responses to the Spanish version and 19,134 responses to the English version of the H‐CAHPS survey tested in Arizona, Maryland, and New York in 2003.Study Design. A forward/backward translation procedure followed by committee review and cognitive testing was used to ensure a translation that was both culturally and linguistically appropriate. Responses to the two language versions were compared to evaluate equivalence and assess the reliability and validity of both versions.Data Collection/Extraction Methods. Comparative analyses were carried out on the 32 items of the shortened survey version, focusing on 16 items that comprise seven composites representing different aspects of hospital care quality (communication with nurses, communication with doctors, communication about medicines, nursing services, discharge information, pain control, and physical environment); three items that rate the quality of the nursing staff, physician staff, and the hospital overall; one item on intention to recommend the hospital. The other 12 items used in the analyses addressed mainly respondent characteristics. Analyses included item descriptives, correlations, internal consistency reliability of composites, factor analysis, and regression analysis to examine construct validity.Principal Findings. Responses to both language versions exhibit similar patterns with respect to item–scale correlations, factor structure, content validity, and the association between each of the seven qualities of care composites with both the hospital rating and intention to recommend the hospital. Internal consistency reliability was slightly, yet significantly lower for the Spanish‐language respondents for five of the seven composites, but overall the composites were generally equivalent across language versions.Conclusions. The results provide preliminary evidence of the equivalence between the Spanish and English versions of H‐CAHPS. The translated Spanish version can be used to assess hospital quality of care for Spanish speakers, and compare results across these two language groups.
Role of Cognitive Testing in the Development of the CAHPS® Hospital Survey
Authors: Levine Roger E. , Fowler Floyd J. , Brown Julie A. 
Published: November 2005

Objective. To describe how cognitive testing results were used to inform the modification and selection of items for the Consumer Assessment of Health Providers and Systems (CAHPS®) Hospital Survey pilot test instrument.Data Sources. Cognitive interviews were conducted on 31 subjects in two rounds of testing: in December 2002–January 2003 and in February 2003. In both rounds, interviews were conducted in northern California, southern California, Massachusetts, and North Carolina.Study Design. A common protocol served as the basis for cognitive testing activities in each round. This protocol was modified to enable testing of the items as interviewer‐administered and self‐administered items and to allow members of each of three research teams to use their preferred cognitive research tools.Data Collection/Extraction Methods. Each research team independently summarized, documented, and reported their findings. Item‐specific and general issues were noted. The results were reviewed and discussed by senior staff from each research team after each round of testing, to inform the acceptance, modification, or elimination of candidate items.Principal Findings. Many candidate items required modification because respondents lacked the information required to answer them, respondents failed to understand them consistently, the items were not measuring the constructs they were intended to measure, the items were based on erroneous assumptions about what respondents wanted or experienced during their hospitalization, or the items were asking respondents to make distinctions that were too fine for them to make. Cognitive interviewing enabled the detection of these problems; an understanding of the etiology of the problem informed item revisions. However, for some constructs, the revisions proved to be inadequate. Accordingly, items could not be developed to provide acceptable measures of certain constructs such as shared decision making, coordination of care, and delays in the admissions process.Conclusions. Cognitive testing is the most direct way of finding out whether respondents understand questions consistently, have the information needed to answer the questions, and can use the response alternatives provided to describe their experiences or their opinions accurately. Many of the candidate questions failed to meet these standards. Cognitive testing only evaluates the way in which respondents understand and answer questions. Although it does not directly assess the validity of the answers, it is a reasonable premise that cognitive problems will seriously compromise validity and reliability.
Alterations in carbohydrate metabolism in critically ill cats
Authors: Chan Daniel L. , Freeman Lisa M. , Rozanski Elizabeth A. , Rush John E. 
Published: November 2005

AbstractObjective:To characterize the alterations in carbohydrate metabolism as they relate to the development of hyperglycemia in critically ill cats.Design:Prospective, observational, controlled study.Setting:Intensive care unit at a university veterinary teaching hospital.Animals:Twenty‐six non‐diabetic cats admitted into the intensive care unit for a variety of diseases and 21 healthy control cats.Interventions:Blood samples were obtained from critically ill cats upon admission to the intensive care unit. Blood was similarly obtained from control cats.Measurements and main results:For all cats, venous blood glucose, lactate, cortisol, insulin, glucagon, epinephrine, norepinephrine, and non‐esterified fatty acid concentrations were determined and compared between the 2 groups of cats. Compared with controls, critically ill cats had significantly higher median concentrations of glucose [183 (range 51–321) mg/dLversus110 (91–165) mg/dL;P<0.001], lactate [2.5 (0.6–11.1) mmol/Lversus1.8 (0.4–4.1) mmol/L;P=0.01], cortisol [7.8 (0.3–53.7) μg/dLversus4.4 (1.5–8.3) μg/dL;P=0.005], glucagon [186 (46–3128) pg/mLversus97 (30–252) pg/mL;P=0.001], and norepinephrine [1.5 (0.2–16.4) pg/mLversus0.63 (0.21–3.61) pg/mL;P=0.003]. Compared with controls, critically ill cats also had a significantly lower median plasma insulin concentration [9 (2–52) μU/mLversus17 (3–35) μU/mL;P=0.04]. The presence or degree of hyperglycemia in critically ill cats was not related to any single measured variable.Conclusions:Similar to critically ill human patients, alterations in carbohydrate metabolism are present in critically ill cats and likely contribute to the hyperglycemia commonly observed in this population.
Development of a Preliminary Framework for Informing the Risk Analysis and Risk Management of Nanoparticles
Authors: Morgan Kara 
Published: November 2005

Erratum Risk Analysis 25: 3, 711‐718Decisions are often made even when there is uncertainty about the possible outcomes. However, methods for making decisions with uncertainty in the problem framework are scarce. Presently, safety assessment for a product containing engineered nano‐scale particles is a very poorly structured problem. Many fields of study may inform the safety assessment of such particles (e.g., ultrafines, aerosols, debris from medical devices), but engineered nano‐scale particles may present such unique properties that extrapolating from other types of studies may introduce, and not resolve, uncertainty. Some screening‐level health effects studies conducted specifically on engineered nano‐scale materials have been published and many more are underway. However, it is clear that the extent of research needed to fully and confidently understand the potential for health or environmental risk from engineered nano‐scale particles may take years or even decades to complete. In spite of the great uncertainty, there is existing research and experience among researchers that can help to provide a taxonomy of particle properties, perhaps indicating a relative likelihood of risk, in order to prioritize nanoparticle risk research. To help structure this problem, a framework was developed from expert interviews of nanotechnology researchers. The analysis organizes the information as a system based on the risk assessment framework, in order to support the decision about safety. In the long term, this framework is designed to incorporate research results as they are generated, and therefore serve as a tool for estimating the potential for human health and environmental risk.
Relationship between general health status and the change in chewing ability: a longitudinal study of the frail elderly in Japan over a 3‐year period
Authors: Miura Hiroko , Kariyasu Makoto , Yamasaki Kiyoko , Arai Yumiko , Sumi Yasunori 
Published: November 2005

Objectives:  The aim of the present study was to identify the onset predictors of a change in chewing ability over a 3‐year period in the frail elderly.Methods:  The subjects were frail elderly people living in southern Japan. Data were collected at baseline (n = 92) and 3 years later (n = 60). The dependent variable was a change in self‐rated chewing ability. The independent variables were age, gender, number of present teeth, dentition, maximum bite force (evaluated using a pressure‐sensitive foil), basic activities of daily living, self‐rated general health status, higher level of competence (evaluated using Tokyo Metropolitan Institute of Gerontology index), cognitive status (evaluated by revised Hasegawa Dementia Rating scale), and quality of life (evaluated using Philadelphia Geriatric Center morale scale) at baseline. To identify the most reliable predictors, bivariate analysis and multiple logistic regression analysis were performed, with the change of chewing ability as the dependent variable.Results:  Bivariate analysis showed the change in chewing ability was significantly associated with general health status (p < 0.01), number of present teeth (p < 0.05) and maximum bite force (p < 0.01). Backward logistic regression analysis revealed that the most reliable predictor of a change in chewing ability at 3 years was general health status (odds ratio = 6.35, 95% CI = 1.69–23.88).Conclusion:  The present findings suggest that general health status at baseline produces a change in chewing ability.
Oral health among institutionalised elderly in Zagreb, Croatia
Authors: KraljevićŠimunković S. , Vučićević Boras V. , Pandurić J. , Alajbeg Žilić I. 
Published: November 2005

Objective:  A survey of dental health status was conducted in the institutionalised elderly in Zagreb, Croatia in order to assess the dental and oral health of the elderly population.Participants:  In 139 institutionalised elderly from a single nursing home in Zagreb, dental and oral status was registered according to World Health Organization criteria. There were 108 (77.7%) female and 31 (22.3%) male subjects aged 58–99 years.Results:  The results showed that 45.3% of the interviewed persons were totally edentulous in both jaws. A significant increase in prevalence of edentulousness with the increasing age was recorded. The mean decayed, missing and filled teeth number was 27. The average number of teeth with caries was 1.03 per person, the number of the teeth extracted was 6.9 per person and teeth with fillings 0.74 per person. The average number of teeth with root caries was 0.17. Approximately 9 teeth per person were in need of treatment. Filled teeth were found 25.9% of subjects and decayed teeth in 30.9%. The mean number of remaining sound teeth, decayed teeth and residual roots in the elderly decreased with increasing age. Complete periodontal treatment was required in 5.8% of the participants and no significant differences between genders in periodontal status could be noticed.Conclusion:  The results of this study suggest poor dental health in this group of the institutionalised elderly and the necessity of improving and implementing some special features in the dental health services programs for the institutionalised elderly.
Documentation standards for beginning students
Authors: Brewer Richard K. 
Published: November 2005

The importance of writing programs that are readable has finally gained preeminence in the struggle with such competing and contradictory goals as “cuteness” and “optimization” of code. As a result, a much greater stress on documentation standards is found in computer science education these days. Industry and government standards for documentation are being more widely adhered to and certain points of agreement have emerged. Some excellent books have been written that cover the subject (Van Tassel, 1974; Ledgard, 1975; Kernighan & Plauger, 1974); however it is safe to say that both the exhaustive treatment of the subject in such publications and the extremely high standards proposed probably preclude wholesale adoption by instructors of beginning level programming courses. What is proposed here is a set of common sense, scaled down documentation standards for the student in a first programming course in, say, FORTRAN, PL/I, ALGOL, or Basic.
The following represents an amalgam of documentation requirements achieved as a result of teaching introductory programming to college students for nine years. The actual sources have been the literature, colleagues, and last but not least, experience. They are not intended to represent an “only” or “best” approach; the author has recently encountered other efforts in this direction that must surely be as reasonable and effective. It does represent one educator's approach; it is sufficiently scaled down so that one might reasonably expect to use it as a standard for beginning students; and it may be most useful as a contributor of components to be integrated into a more effective set of standards.
The basics of documentation and readable programming include comments, meaningful variable names, labelled output, flowcharts, and clear program flow. The major components of and basic rules for each of these categories will be presented in the context of the needs and limitations of the beginning student.