bluuebunny/crossref_metadata_2025_split huggingface dataset:
Obesity Management
Authors: Davis Nichola J. , Emerenini Ada , Wylie-Rosett Judith 
Published: July 2006

Purpose The purpose of this study was to assess inner-city clinic patient attitudes about weight loss counseling and to assess practice behaviors of primary care physicians in residency training. Methods This is a cross-sectional survey of consecutive patients attending an outpatient internal medicine resident continuity clinic in the Bronx, New York. Participants completed a 30-item questionnaire; a 17-item Quick Weight, Activity & Excess Screener (WAVE); and 13 items to assess patients' attitudes about the physician's role in weight management. A chart review was conducted to ascertain resident practice patterns. Relationships of categorical data were evaluated using χ2 analyses and odds ratios. Results Chart reviews (n = 84) indicated that 80% of patients were either obese or overweight; 21% of obese patients and 11% of overweight patients had the diagnosis documented. Of the obese patients (n = 42), 17% had dietitian referrals and 36% had an indication of physician weight loss recommendation. A patient survey indicated that 86% of obese patients wanted to lose weight, 64% wanted a dietitian referral, and 62% felt that their physician could help with weight loss. Obese patients were significantly more likely to receive weight loss recommendations than were overweight patients, but frequency of visits and the diagnosis of diabetes did not increase the likelihood that weight would be addressed. Conclusions Physicians need to address how to manage obesity including assessing patient attitudes about making lifestyle changes and using dietitian and other referrals for weight reduction counseling.
Use of a Glucose Algorithm to Direct Diabetes Therapy Improves A1C Outcomes and Defines an Approach to Assess Provider Behavior
Authors: Miller Christopher D. , Ziemer David C. , Kolm Paul , El-Kebbi Imad M. , Cook Curtiss B. , Gallina Daniel L. , Doyle Joyce P. , Barnes Catherine S. , Phillips Lawrence S. 
Published: July 2006

Purpose The purpose of this study was to determine whether an algorithm that recommended individualized changes in therapy would help providers to change therapy appropriately and improve glycemic control in their patients. Methods The algorithm recommended specific doses of oral agents and insulin based on a patient's medications and glucose or A1C levels at the time of the visit. The prospective observational study analyzed the effect of the algorithm on treatment decisions and A1C levels in patients with type 2 diabetes. Results The study included 1250 patients seen in pairs of initial and follow-up visits during a 7-month baseline and/or a subsequent 7-month algorithm period. The patients had a mean age of 62 years, body mass index of 33 kg/m2, duration of diabetes of 10 years, were 94% African American and 71% female, and had average initial A1C level of 7.7%. When the algorithm was available, providers were 45% more likely to intensify therapy when indicated (P = .005) and increased therapy by a 20% greater amount (P < .001). A1C level at follow-up was 90% more likely to be <7% in the algorithm group, even after adjusting for differences in age, sex, body mass index, race, duration of diabetes and therapy, glucose, and A1C level at the initial visit (P < .001). Conclusions Use of an algorithm that recommends patient-specific changes in diabetes medications improves both provider behavior and patient A1C levels and should allow quantitative evaluation of provider actions for that provider's patients.
Responsiveness of the International Knee Documentation Committee Subjective Knee Form
Authors: Irrgang James J. , Anderson Allen F. , Boland Arthur L. , Harner Christopher D. , Neyret Philippe , Richmond John C. , Shelbourne K. Donald ,   International Knee Documentation Committee
Published: July 2006

Background and Purpose The International Knee Documentation Committee Subjective Knee Form was developed to measure change in symptoms, function, and sports activity in patients treated for a variety of knee conditions. Although previous research has demonstrated reliability and validity of the form, its responsiveness has not been evaluated. The purpose of this study was to determine responsiveness of the International Knee Documentation Committee Subjective Knee Form. Study Design Cohort study (diagnosis); Level of evidence, 1. Methods Patients who participated in the original validation study for the International Knee Documentation Committee Subjective Knee Form completed the form and a 7-level global rating of change scale that ranged from greatly worse to greatly better after a mean of 1.6 years (range, 0.5-2.3 years). Analyses included calculation of the standardized response mean and mean change in International Knee Documentation Committee Subjective Knee Form score compared to the patient's perception of change on the global rating of change scale. In addition, a receiver operating characteristic curve was plotted to determine the change in score that best distinguished patients who improved from those who did not. Results The overall standardized response mean was 0.94, which is considered large. With the exception of those who were slightly worse or unchanged, the mean change in the International Knee Documentation Committee Subjective Knee Form score compared to the patients’ perceived global ratings of change was as expected (greatly worse,–15.1; somewhat worse,–8.4; slightly worse, 20.6; no change, 10.7; slightly better, 5.9; somewhat better, 18.1; greatly better, 38.7). The receiver operating characteristic curve analysis revealed that a change score of 11.5 points had the highest sensitivity, and a change score of 20.5 points had the highest specificity to distinguish between those who were or were not improved. Conclusion The International Knee Documentation Committee Subjective Knee Form is a responsive measure of symptoms, function, and sports activity for patients with a variety of knee conditions.
Outcome and Structural Integrity after Arthroscopic Rotator Cuff Repair Using 2 Rows of Fixation
Authors: Anderson Kyle , Boothby Michael , Aschenbrener Daniel , Van Holsbeeck Marnix 
Published: July 2006

Background Although arthroscopic repairs of the rotator cuff are becoming increasingly popular, security of fixation remains a concern. Two-row repairs have been described, but clinical outcome reports have primarily involved open techniques. Hypothesis An arthroscopic repair technique that uses 2 rows of fixation produces satisfactory outcome and structural integrity by ultrasonography. Study Design Case series; Level of evidence, 4. Methods Forty-eight patients (52 shoulders) with a full-thickness, but fully reducible, rotator cuff tear who met the inclusion criteria were treated with an arthroscopic rotator cuff repair using 2 rows of suture anchors. The mean tear size was 2.47 cm (range, 1-4 cm). Patients were evaluated by subjective functional assessment (L'Insalata Shoulder Rating Questionnaire), clinical examination, including measured strength testing, and ultrasonography. Results At a mean follow-up of 30 months (minimum of 2 years), functional scores improved from a mean of 42 preoperatively to 93 postoperatively (P <. 001). Active range of motion was increased in all measured planes (P <. 001). Strength was also increased in elevation (P <. 001), external rotation (P <. 001), and internal rotation (P =. 033). Nine of the 52 shoulders (17%) had evidence of retear or persistent defect on postoperative ultrasonography. There were no differences detected in functional scores between those with an intact repair and those with a defect, but those with an intact repair were stronger in elevation (P =. 006) and external rotation (P =. 001). Conclusion An arthroscopic 2-row rotator cuff repair produces excellent functional outcome and repair integrity comparable with previously reported open repairs. Presence of a defect after repair did not appear to affect patient-reported function and return to preinjury activity but did affect measured strength.
An Allogenic Cell–Based Implant for Meniscal Lesions
Authors: Weinand Christian , Peretti Giuseppe M. , Adams Samuel B. , Bonassar Lawrence J. , Randolph Mark A. , Gill Thomas J. 
Published: July 2006

Background Meniscal tears in the avascular zones do not heal. Although tissue-engineering approaches using cells seeded onto scaffolds could expand the indication for meniscal repair, harvesting autologous cells could cause additional trauma to the patient. Allogenic cells, however, could provide an unlimited amount of cells. Hypothesis Allogenic cells from 2 anatomical sources can repair lesions in the avascular region of the meniscus. Study Design Controlled laboratory study. Methods Both autologous and allogenic chondrocytes were seeded onto a Vicryl mesh scaffold and sutured into a bucket-handle lesion created in the medial menisci of 17 swine. Controls consisted of 3 swine knees treated with unseeded implants and controls from a previous experiment in which 4 swine were treated with suture only and 4 with no treatment. Menisci were harvested after 12 weeks and evaluated histologically for new tissue and percentage of interface healing surface; they were also evaluated statistically. Results The lesions were closed in 15 of 17 menisci. None of the control samples demonstrated healing. Histologic analysis of sequential cuts through the lesion showed formation of new scar-like tissue in all experimental samples. One of 8 menisci was completely healed in the allogenic group and 2 of 9 in the autologous group; the remaining samples were partially healed in both groups. No statistically significant differences in the percentage of healing were observed between the autologous and allogenic cell-based implants. Conclusion Use of autologous and allogenic chondrocytes delivered via a biodegradable mesh enhanced healing of avascular meniscal lesions. Clinical Relevance This study demonstrates the potential of a tissue-engineered cellular repair of the meniscus using autologous and allogenic chondrocytes.
Parental understanding of wheeze and its impact on asthma prevalence estimates
Authors: Michel G. , Silverman M. , Strippoli M-P. F. , Zwahlen M. , Brooke A. M. , Grigg J. , Kuehni C. E. 
Published: July 2006

The epidemiology of wheeze in children, when assessed by questionnaires, is dependent on parents' understanding of the term “wheeze”.In a questionnaire survey of a random population sample of 4,236 children aged 6–10 yrs, parents' definition of wheeze was assessed. Predictors of a correct definition were determined and the potential impact of incorrect answers on prevalence estimates from the survey was assessed.Current wheeze was reported by 13.2% of children. Overall, 83.5% of parents correctly identified “whistling or squeaking” as the definition of wheeze; the proportion was higher for parents reporting wheezy children (90.4%). Frequent attacks of reported wheeze (adjusted odds ratio (OR) 3.0), maternal history of asthma (OR 1.5) and maternal education (OR 1.5) were significantly associated with a correct answer, while the converse was found for South Asian ethnicity (OR 0.6), first language not English (OR 0.6) and living in a deprived neighbourhood (OR 0.6).In summary, the present study showed that misunderstanding could lead to an important bias in assessing the prevalence of wheeze, resulting in an underestimation in children from South Asian and deprived family backgrounds. Prevalence estimates for the most severe categories of wheeze might be less affected by this bias and questionnaire surveys on wheeze should incorporate measures of parents' understanding of the term wheeze.
Airway dimensions measured from micro-computed tomography and high-resolution computed tomography
Authors: Dame Carroll J. R. , Chandra A. , Jones A. S. , Berend N. , Magnussen J. S. , King G. G. 
Published: July 2006

Volume averaging results in both over- and underestimation of airway dimensions when they are measured by high-resolution computed tomography (HRCT). The current authors calibrated computerised measurements of airway dimensions from HRCT against a novel three-dimensional micro-computed tomography (CT) standard, which has a 50-fold greater resolution, as well as against traditional morphometry.Inflation-fixed porcine lung cubes were scanned by HRCT and micro-CT. A total of 59 lumen area (Ai), 30 wall area (Aaw) and 11 lumen volume (Vi) measurements were made. Aiwas measured from the cut surface of 11 airways by morphometry. Airways in scanned images were matched using branching points. After calibration, the errors of Ai, Aawand ViHRCT measurements were determined.The current authors found a systematic, size-dependent underestimation of Aiand overestimation of Aawfrom HRCT measurements. This was used to calibrate an HRCT measurement algorithm. The 95% limits of agreement of subsequent measurements were ±3.2 mm2for Ai, ±4.3 mm2for Aaw, and ±11.2 mm3for Viwith no systematic error. Morphometric measurements agreed with micro-CT (±2.5 mm2) without systematic error.In conclusion, micro-computed tomography image data from inflation-fixed airways can be used as calibration standards for three-dimensional lumen volume measurements from high-resolution computed tomography, while morphometry is acceptable for two-dimensional measurements. The image dataset could be used to validate other developmental three-dimensional segmentation algorithms.
Effect of primary-care spirometry on the diagnosis and management of COPD
Authors: Walker P. P. , Mitchell P. , Diamantea F. , Warburton C. J. , Davies L. 
Published: July 2006

Primary-care spirometry has been promoted as a method of facilitating accurate diagnosis of chronic obstructive pulmonary disease (COPD). The present study examined whether improving rates of diagnosis lead to improvements in pharmacological and nonpharmacological management.From 1999 to 2003, the current authors provided an open-access spirometry and reversibility service to a local primary-care area, to which 1,508 subjects were referred. A total of 797 (53%) had pre-bronchodilator airflow obstruction (AFO). Of the subjects who underwent reversibility testing, 19.3% were no longer obstructed post-bronchodilator. The results and records of a subgroup of 235 subjects with post-bronchodilator AFO were examined.Of the 235 subjects, 130 received a new diagnosis, most commonly COPD. The patients with COPD were significantly undertreated before spirometry and testing led to a significant increase in the use of anticholinergics (37versus18%), long-acting β-agonists (25versus8%) and inhaled steroids (71versus52%). More than three quarters of smokers received smoking cessation advice but very few were referred for pulmonary rehabilitation.In conclusion, primary-care spirometry not only increases rates of chronic obstructive pulmonary disease diagnosis, but it also leads to improvements in chronic obstructive pulmonary disease treatment. The use of bronchodilator reversibility testing in this setting may be important to avoid misdiagnosis.
Evidence that mesothelial cells regulate the acute inflammatory response in talc pleurodesis
Authors: Marchi E. , Vargas F. S. , Acencio M. M. , Antonangelo L. , Genofre E. H. , Teixeira L. R. 
Published: July 2006

Intrapleural instillation of talc is used to produce pleurodesis in cases of recurrent malignant pleural effusions. The mechanisms by which pleurodesis is produced remain unknown but may involve either injury or activation of the mesothelium. The aim of the current study was to assess the inflammatory response of pleural mesothelial cells to talc in an experimental model in rabbits.A group of 10 rabbits were injected intrapleurally with talc (200 mg·kg-1) and undiluted pleural fluid was collected after 6, 24 or 48 h for measurement of interleukin (IL)-8, vascular endothelial growth factor (VEGF) and transforming growth factor (TGF)-β1. Samples of pleura were studied to assess the inflammatory infiltrate and mesothelial cell viability.The pleural fluid IL-8 concentration peaked at 6 h, whereas VEGF and TGF-β1 concentrations increased steadily over 48 h. Immunohistochemistry for cytokeratin showed a preserved layer of mesothelial cells despite the intense inflammatory pleural reaction.In conclusion, it is proposed that the mesothelial cell, although injured by the talc, may actively mediate the primary inflammatory pleural response in talc-induced pleurodesis.
Inspiratory fraction and exercise impairment in COPD patients GOLD stages II–III
Authors: Albuquerque A. L. P. , Nery L. E. , Villaça D. S. , Machado T. Y. S. , Oliveira C. C. , Paes Â. T. , Neder J. A. 
Published: July 2006

The inspiratory-to-total lung capacity ratio or “inspiratory fraction” (inspiratory capacity(IC)/total lung capacity (TLC)) may be functionally more representative than traditional indices of resting airflow limitation and lung hyperinflation in patients with chronic obstructive pulmonary disease (COPD).In the present retrospective study, a comparison was made of the individual performance of post-bronchodilator IC, IC/TLC and forced expiratory volume in one second (FEV1) in predicting a severely reduced peak oxygen uptake (V′O2; <60% predicted) in 44 COPD patients Global Initiative for Chronic Obstructive Lung Disease stages II-III (post-bronchodilator FEV1ranging from 31–79% pred).Patients with lower IC/TLC values (≤0.28) showed increased lung volumes and reduced exercise capacity as compared with other subjects. Following a multiple linear regression analysis, only IC/TLC and FEV1remained as independent predictors ofV′O2(r2 = 0.33). A receiver operating characteristic (ROC) curve analysis revealed that an IC/TLC ≤0.28 had the highest specificity (89.6%), positive predictive value (80%) and overall accuracy (86.3%) in identifying patients withV′O2<60% pred. In addition, the area under the ROC curve tended to be higher for IC/TLC than IC.In conclusion, post-bronchodilator total lung capacity-corrected inspiratory fraction provides useful information in addition to forced expiratory volume in one second and inspiratory capacity, to estimate the likelihood of chronic obstructive pulmonary disease patients to present with severely reduced maximal exercise capacity.
Neurofibromatosis-associated lung disease: a case series and literature review
Authors: Zamora A. C. , Collard H. R. , Wolters P. J. , Webb W. R. , King T. E. 
Published: July 2006

An association of neurofibromatosis with diffuse lung disease (NF-DLD) has been described, but its true prevalence and characteristics remain unclear. The objective of the present study was to define diffuse lung disease in patients with neurofibromatosis.A retrospective case series and literature review in a tertiary care academic medical centre is reported in which medical records, chest radiographs and high-resolution computed tomography (HRCT) scans were reviewed.A total of 55 adult patients with neurofibromatosis were identified, three of whom had NF-DLD. A literature review revealed 16 articles reporting 61 additional cases, yielding a total of 64 NF-DLD cases. The mean age of patients was 50 yrs. Males outnumbered females; most reported dyspnoea. Of the 16 subjects with documented smoking histories, 12 were ever-smokers. Eight patients had HRCT scan results demonstrating ground-glass opacities (37%), bibasilar reticular opacities (50%), bullae (50%), cysts (25%) and emphysema (25%); none had honeycombing. A group of 14 patients had surgical biopsy results that showed findings of interstitial fibrosis (100%) and interstitial inflammation (93%).In conclusion, neurofibromatosis with diffuse lung disease is a definable clinical entity, characterised by upper lobe cystic and bullous disease and lower lobe fibrosis. Its relationship to smoking remains unclear.
Maternal smoking is associated with impaired neonatal toll-like-receptor-mediated immune responses
Authors: Noakes P. S. , Hale J. , Thomas R. , Lane C. , Devadason S. G. , Prescott S. L. 
Published: July 2006

Infants of smokers have much higher rates of respiratory infection, asthma and airway disease. The current study assessed the effects of maternal smoking in pregnancy on neonatal toll-like-receptor (TLR)-mediated immune responses as a possible contributing factor to the elevated rates of respiratory illness.In a prospective birth cohort, the cord blood immune responses of neonates of smoking and nonsmoking mothers were compared. Maternal and cord serum cotinine were measured to confirm the level of cigarette smoke exposure. Neonatal cytokine responses were assessed to optimal doses of TLR2, TLR3, TLR4 and TLR9 ligands.Cotinine levels confirmed maternal reporting of cigarette smoking in pregnancy, with significantly higher cotinine levels in maternal and cord blood compared with the nonsmoking group. Infants of smoking mothers showed significantly attenuated innate TLR-mediated responses compared with infants of nonsmokers.The current findings indicate that in addition to effects on developing airways, maternal smoking also has significant immunological effects in pregnancy, which could contribute to the well recognised, subsequent increased risk of respiratory infections and asthma. These effects appear to be mediated through effects on toll-like receptor-mediated innate response pathways, which also promote regulatory pathways in the inhibition of allergic immune responses in the postnatal period, suggesting that other environmental interactions are highly relevant to the “hygiene hypothesis”.
Driving ability in sleep apnoea patients before and after CPAP treatment: evaluation on a road safety platform
Authors: Mazza S. , Pépin J-L. , Naëgelé B. , Rauch E. , Deschaux C. , Ficheux P. , Lévy P. 
Published: July 2006

Sleepiness is considered to be the major cause of increased traffic accidents in patients with obstructive sleep apnoea syndrome (OSAS). Until now, OSAS patients′ driving ability has been assessed using driving simulators, but no assessment in a more natural driving environment has been carried out to date.The aim of the present study was to evaluate driving parameters in OSAS and in controls on a road safety platform, and to compare them with attentional in-laboratory measures before and after continuous positive airway pressure treatment.The parameters measured were: reaction time; distance to stop and number of collisions on the platform; maintenance of wakefulness; and sustained, selective and divided attention in laboratory.Patients exhibited much longer reaction times than controls, leading to a lengthening of the vehicle′s stopping distance of 8.8 m at 40 km·h-1and to twice the number of collisions. Patients did not demonstrate objective sleepiness or selective and sustained attention deficits. Divided attention deficits were found. However, they did not allow the prediction of real driving impairment. After CPAP treatment, there was no longer any difference between patients and controls regarding driving and attention performances.Driving abilities are significantly impaired in obstructive sleep apnoea syndrome. After continuous positive airway pressure treatment, deficits were normalised. This stresses the importance of evaluating attentional parameters in apnoeic patients and of offering continuous positive airway pressure treatment even to non-sleepy subjects.