bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using Vignettes to Compare the Quality of Clinical Care Variation in Economically Divergent Countries
Authors: Peabody John W. , Tozija Fimka , Muñoz Jorge A. , Nordyke Robert J. , Luck Jeff 
Published: November 2004

Objective. To determine whether clinical vignettes can measure variations in the quality of clinical care in two economically divergent countries.Data Source/Study Setting. Primary data collected between February 1997 and February 1998 at two Veterans Affairs facilities in the United States and four government‐run outpatient facilities in Macedonia.Study Design. Randomly selected, eligible Macedonian and U.S. physicians (>97 percent participation rate) completed vignettes for four common outpatient conditions. Responses were judged against a master list of explicit quality criteria and scored as percent correct.Data Collection/ Extraction. An ANOVA model and two‐tailed t‐tests were used to compare overall scores by case, study site, and country.Principal Findings. The mean score for U.S. physicians was 67 percent (+/−11 percent) compared to 48 percent (+/−11 percent) for Macedonian physicians. The quality of clinical practice, which emphasizes basic skills, varied greatly in both sites, but more so in Macedonia. However, the top Macedonian physicians in all sites approached or—in one case—exceeded the median score in the U.S. sites.Conclusions. Vignettes are a useful method for making cross‐national comparisons of the quality of care provided in very different settings. The vignette measurements revealed that some physicians in Macedonia performed at a standard comparable to that of their counterparts in the United States, despite the disparity of the two health systems. We infer that in poorer countries, policy that promotes improvements in the quality of clinical practice—not just structural inputs—could lead to rapid improvements in health.
Assessing the Efficiency of HIV Prevention around the World: Methods of the PANCEA Project
Authors: Marseille Elliot , Dandona Lalit , Saba Joseph , McConnel Coline , Rollins Brandi , Gaist Paul , Lundberg Mattias , Over Mead , Bertozzi Stefano , Kahn James G. 
Published: November 2004

Objective. To develop data collection methods suitable to obtain data to assess the costs, cost‐efficiency, and cost‐effectiveness of eight types of HIV prevention programs in five countries.Data Sources/Study Setting. Primary data collection from prevention programs for 2002–2003 and prior years, in Uganda, South Africa, India, Mexico, and Russia.Study Design. This study consisted of a retrospective review of HIV prevention programs covering one to several years of data. Key variables include services delivered (outputs), quality indicators, and costs.Data Collection/Extraction Methods. Data were collected by trained in‐country teams during week‐long site visits, by reviewing service and financial records and interviewing program managers and clients.Principal Findings. Preliminary data suggest that the unit cost of HIV prevention programs may be both higher and more variable than previous studies suggest.Conclusions. A mix of standard data collection methods can be successfully implemented across different HIV prevention program types and countries. These methods can provide comprehensive services and cost data, which may carry valuable information for the allocation of HIV prevention resources.
Private Care and Public Health: Do Vaccination and Prenatal Care Rates Differ between Users of Private versus Public Sector Care in India?
Authors: Howard David H. , Roy Kakoli 
Published: November 2004

Objective. To determine whether patients who use private sector providers for curative services have lower vaccination rates and are less likely to receive prenatal care.Data Sources/Study Setting. This study uses data from the 52d round of the National Sample Survey, a nationally representative socioeconomic and health survey of 120,942 rural and urban Indian households conducted in 1995–1996.Study Design. Using logistic regression, we estimate the relationship between receipt of preventive care at any time (vaccinations for children, prenatal care for pregnant women) and use of public or private care for outpatient curative services, controlling for demographics, household socioeconomic status, and state of residence.Data Collection/Extraction Methods. We analyzed samples of children ages 0 to 4 and pregnant women who used medical care within a 15‐day window prior to the survey.Principal Findings. With the exception of measles vaccination, predicted probabilities of the receipt of vaccinations and prenatal care do not differ based on the type of provider at which children and women sought curative care. Children and pregnant women in households who use private care are almost twice as likely to receive preventive care from private sources, but the majority still obtains preventive care from public providers.Conclusions. We do not find support for the hypothesis that children and pregnant women who use private care are less likely to receive public health services. Results are consistent with the notion that Indian households are able to successfully navigate the coexisting public and private systems, and obtain services selectively from each. However, because the study employed an observational, cross‐sectional study design, findings should be interpreted cautiously.
Franchising Reproductive Health Services
Authors: Stephenson Rob , Tsui Amy Ong , Sulzbach Sara , Bardsley Phil , Bekele Getachew , Giday Tilahun , Ahmed Rehana , Gopalkrishnan Gopi , Feyesitan Bamikale 
Published: November 2004

Objectives. Networks of franchised health establishments, providing a standardized set of services, are being implemented in developing countries. This article examines associations between franchise membership and family planning and reproductive health outcomes for both the member provider and the client.Methods. Regression models are fitted examining associations between franchise membership and family planning and reproductive health outcomes at the service provider and client levels in three settings.Results. Franchising has a positive association with both general and family planning client volumes, and the number of family planning brands available. Similar associations with franchise membership are not found for reproductive health service outcomes. In some settings, client satisfaction is higher at franchised than other types of health establishments, although the association between franchise membership and client outcomes varies across the settings.Conclusions. Franchise membership has apparent benefits for both the provider and the client, providing an opportunity to expand access to reproductive health services, although greater attention is needed to shift the focus from family planning to a broader reproductive health context.
Social Resources and Occupational Status Attainment: Comparison of Japanese and American Employees’ Personal Networks
Authors: Nakao Keiko 
Published: November 2004

Abstract:  The present study compares Japan and the USA in the ways in which individuals’ personal relationships affect the social standing they achieve. The conceptual framework applied here is similar to that used in established research in Western countries, which examines the effects of both human capital and social capital. The analyses are based on the data collected from a random sample of adult residents in Tokyo, which contains information about their personal networks. This data set is compared with the social network module of the 1985 General Social Survey in the United States.The analyses supported both human capital and social capital theories in the process of status attainment in both countries. Human capital, however, seems to have a stronger influence especially in the USA sample, because certain structural characteristics are associated with one's own educational achievement, which in turn are instrumental in attaining social capital. Unlike the USA, however, the access to social capital in Japan was found primarily through homophily, showing little effect based upon the type of networks they have. The results suggest the difference between the two countries in terms of the function of social resources and the strength of ties that are instrumental in the process of status attainment.
Somatic Symptoms in Headache Patients: The Influence of Headache Diagnosis, Frequency, and Comorbidity
Authors: Maizels Morris , Burchette Raoul 
Published: November 2004

Background.—Mood disorders of anxiety and depression are well known to be comorbid with primary headache disorders. Less is known of the comorbidity of other somatic symptoms with headache.Methods.—Headache Clinic patients were screened with the Primary Care Evaluation of Mental Disorders (PRIME‐MD), a multidimensional psychiatric screening tool. The prevalence of somatic symptoms was compared by headache diagnosis, frequency of severe headache, and psychiatric diagnosis. Follow‐up data were obtained 6 months after consultation.Results.—Clinical diagnoses and PRIME‐MD data were available for 289 patients. Associated somatic symptoms were more frequent in patients with chronic migraine (mean 5.5, P < .001) and chronic daily headache (CDH) (6.3, P= .008) compared to episodic migraine (4.0); in patients with severe headache >2 days per week compared to ≤2 days per week (6.15 vs. 4.15, P < .001); and in patients with a clinical diagnosis of anxiety or depression, or both, compared to no anxiety or depression, (5.7, P= .05, 5.2, P <. 05, and 6.8, P < .001, respectively, vs. 4.5). The most common specific symptoms were fatigue (73%), sleep difficulty (60%), and nausea/indigestion (55%). Compared to a primary care sample, patients with severe headache >2 days per week had significantly higher somatic counts (P= .01).Six‐month follow‐up data were available for 140 patients. Associated symptoms decreased both for patients with and without decrease in severe headache frequency (mean reduction of 1.0, P= .01 and 0.8, P= .003, respectively).Conclusion.—Associated somatic symptoms are more common in patients with chronic migraine and CDH, with more frequent severe headaches, and with associated anxiety or depression. Patients with episodic migraine have similar somatic prevalence as a previously studied primary care population. The spectrum of headache disorders may be characterized as showing increasing somatic prevalence as headaches, particularly severe headaches, become more frequent.
Dynamic Mechanical (Brush) Allodynia in Cluster Headache
Authors: Ashkenazi Avi , Young William B. 
Published: November 2004

Objective.—To examine the occurrence of dynamic mechanical (brush) allodynia (BA) in patients with cluster headache (CH).Background.—Cutaneous allodynia was described in migraine. It was related to sensitization of neurons in the trigeminal nucleus caudalis (TNC). This phenomenon has not been previously described in cluster headache.Methods.—We examined adult patients with episodic or chronic CH for the presence of BA. Demographic data and the characteristics of CH were obtained through a questionnaire. Allodynia testing was performed by repetitively applying a 4 × 4‐inch gauze pad to skin areas in the trigeminal and cervical dermatomes. Degree of allodynia was measured on a 100‐mm visual analog scale (VAS). The relations between the location and severity of headache and allodynia were assessed.Results.—Ten patients (all male, mean age 39.3) were included in the study. Seven had episodic CH (ECH) and 3 had chronic CH (CCH). Two patients were in acute attack when tested for BA. In total, 4 (40%) of the 10 patients had BA (2 [28.6%] of the 7 with ECH and 2 [66.7%] of the 3 with CCH). Median disease duration was 22 years for patients with BA and 12 years for patients without BA. Of the two patients in acute attack, one had BA, ipsilateral to the headache, which was reduced 20 minutes after treatment, along with reduced headache severity.Conclusions.—This is the first report on the occurrence of cutaneous allodynia in CH. The presence of BA in CH may be related to CH type (episodic vs. chronic) and to the duration of disease. These results support the concept that allodynia in CH may result from a time‐dependent process of neuronal sensitization.
Osmophobia and Taste Abnormality in Migraineurs: A Tertiary Care Study
Authors: Kelman Leslie 
Published: November 2004

Objectives.—This study assesses osmophobia and taste abnormality for the first time in a large sample of migraine patients.Methods.—Seven hundred and twenty seven migraineurs were evaluated. Osmophobia, taste abnormality, and perfume or odor trigger were graded from 0 to 3.Results.—In patients with data, 24.7% of 673 patients complained of osmophobia (12.5% occasional, 7% frequent, and 5.2% very frequent) and 24.6% of 505 of taste abnormality (13.5% occasional, 6.1% frequent, and 5.0% very frequent). Perfume or odor trigger of acute migraine occurred in 45.5% of 724 patients (22.7% occasional, 10.2% frequent, and 12.6% very frequent). Perfume or odor trigger was associated with osmophobia in 61.5% and taste abnormality 62.1%. Osmophobia without taste abnormality occurred in 28.3% and taste abnormality without osmophobia in 40.3%. A greater percentage of females than males had osmophobia (25.7 vs. 17.5), taste abnormality (25.4 vs. 17.9), and perfume or odor trigger (49.3 vs. 22.1), all P < .0001.Conclusions.—Osmophobia and taste abnormality occur in about one quarter of migraineurs during an acute migraine attack while perfume or odor trigger migraine in almost 50% of patients. Osmophobia and taste abnormality in the acute migraine attack, as well as perfumes or odor as a migraine trigger, are more common in females than in males.
Dextroamphetamine Pilot Crossover Trials and n of 1 Trials in Patients With Chronic Tension‐Type and Migraine Headache
Authors: Haas David C. , Sheehe Paul R. 
Published: November 2004

Objective.—To examine the preventive effects of dextroamphetamine in select small groups of patients with chronic tension‐type and migraine headache.Background.—Neither amphetamine nor methylphenidate is used as a headache preventive. This study was undertaken after a chance observation led one of us to prescribe dextroamphetamine with apparent successes in specific patients with chronic tension‐type or migraine headaches.Methods.—Two pilot trials were done. Trial 1 tested patients who were taking dextroamphetamine, while Trial 2 tested patients who had never taken this drug. Each trial obtained full data on eight subjects with chronic tension‐type headache and eight subjects with migraine headache. A randomized, double‐blinded, controlled, multiple‐crossover design was used. Subjects took capsules containing dextroamphetamine or equi‐stimulatory caffeine (the control) during four alternating 20‐day periods. Trial 1 subjects took their pretrial dextroamphetamine dose at breakfast and lunch. Trial 2 subjects took 10 mg at these times. Subjects recorded the integer from 0 to 3 that represented their headache intensity during the previous 24 hours. The subject's data were the average daily headache grade for the two dextroamphetamine periods and for the two caffeine periods. The differential effect of amphetamine and caffeine on each group of eight subjects and on each individual was analyzed by t‐tests.Results.—In both trials, the tension‐type and migraine groups had lower mean daily headache grades in the amphetamine than in the caffeine periods. P values for these differences indicated that there were real drug effects, on the average, in the migraine groups (P < .05) and suggestive but inconclusive effects in the tension‐type groups (P < .10). The individual n of 1 analyses showed that five tension‐type and three migraine subjects in Trial 1 and three tension‐type and three migraine subjects in Trial 2 had considerably lower mean daily headache grades on amphetamine with P values indicating, at various levels of significance (from P < .05 to P < .001), real amphetamine effects. Twelve of the remaining 18 patients had lower, albeit not significant, mean daily grades with amphetamine. No subject in either trial had a significantly lower mean daily headache grade on caffeine.Conclusions.—Dextroamphetamine had real preventive effects on chronic tension‐type and migraine headaches in some subjects. These results should encourage other investigators to study its effects on these headaches.
Laser Lithotripsy for Treatment of Canine Uroliths
Authors: Davidson Ellen B. , Ritchey Jerry W. , Higbee Russell D. , Lucroy Michael D. , Bartels Kenneth E. 
Published: November 2004

Objective—To confirmin vivooptimal laser energy settings previously determinedin vitrofor lithotripsy, to develop a technique for Ho:YAG laser lithotripsy, and to evaluate acute and chronic tissue effects of laser lithotripsy.Study design—Prospective, randomized preclinical trial.Animals or Sample Population—Nineteen intact, adult male dogs.Methods—Via cystotomy, a single urolith was inserted into the urethra to the level of the base of the os penis to simulate obstruction. Uroliths (calcium oxalate, urate, or magnesium ammonium phosphate) were fragmented by Ho:YAG laser, in contact mode through a 320 μ optic fiber, passed through the operating channel of a 2.8 mm flexible endoscope. The time and total energy to fragmentation were recorded. Dogs were euthanatized immediately after lithotripsy (3 dogs) or at 3 days (7 dogs), and urethral lesions and any stone remnants were evaluated. Urethral integrity was also evaluated in 9 other dogs by endoscopy on day 10; these were also monitored clinically for 30 days.Results—The mean time for adequate fragmentation was 166.7 seconds (range, 47–494.5 seconds). The mean±SD energy used was 1418±851.2 J. In part 1, 2 dogs were obstructed with urolith fragments at necropsy. Eight dogs had minimal (<30 mg) or no urolith material evident within the urethra. Four dogs had gross focal or circumferential erosion, ulceration, or hemorrhage of the urethral mucosa. Lesions were not associated with the site of laser irradiation in 2 dogs. In dogs observed for 30 days, hematuria, pollakiuria, and stranguria that were observed after lithotripsy, resolved in all affected dogs by day 5. No mucosal lesions were observed by endoscopy and none of the dogs became obstructed.Conclusion—Laser lithotripsy with the Ho:YAG laser in contact mode successfully fragmented obstructive uroliths in male dogs.Clinical relevance—Laser lithotripsy may be a clinically relevant technique for treatment of urolithiasis in male dogs; clinical studies to evaluate long‐term effects on urethral mucosa and the role of repeat treatment for recurrence are indicated.
Prognostic Implications of the Degree of Shunt Narrowing and of the Portal Vein Diameter in Dogs with Congenital Portosystemic Shunts
Authors: Kummeling Anne , Van sluijs Frederik J. , Rothuizen Jan 
Published: November 2004

Objective—To determine prognostic evaluation and correlation of the degree of narrowing and the diameter of the portal vein in dogs with a congenital portosystemic shunt (CPS).Study Design—Longitudinal prospective study.Animals—Ninety‐seven dogs with CPS.Methods—Shunt diameter was recorded before and after silk ligation to calculate degree of closure. Portal vein diameter was measured in 74 dogs. Short‐term (30 days) and long‐term (>1 year) outcome were evaluated. Dogs with clinical signs after 1 year were re‐examined to assess the degree of portosystemic shunting and compared with matched operated dogs without clinical signs. Correlations between clinical outcome, degree of closure, and portal vein diameter were statistically analyzed.Results—Short‐term and long‐term mortality were 27% and 2.9% respectively. Clinical recurrence occurred in 10% of dogs. The degree of closure was significantly associated with mortality, but not with clinical recurrence. A significant correlation was found between degree of closure and the diameter of the cranial part of the portal vein. Portal vein diameter was only significantly associated with mortality in extrahepatic CPS. Subclinical portosystemic shunting was confirmed in 3 of 10 dogs.Conclusion—The degree of shunt closure depended on portal development. Long‐term outcome did not depend on the degree of closure or portal development at the time of surgery. This suggested that factors such as hepatic and portal regeneration after surgery may be important.Clinical Relevance—Determination of factors that predict the outcome after surgical treatment of CPS in dogs is important to gain insight in treatment selection or new therapeutic options.
Self‐Retaining Braces For Canine Arthroscopy
Authors: Schulz Kurt S. , Holsworth Ian G. , Hornof William J. 
Published: November 2004

Objective— To describe self‐retaining braces for canine shoulder, elbow, hip, and stifle arthroscopy.Study Design— Clinical design and application.Sample Population— Clinical patients admitted for elective arthroscopy.Methods— Self‐retaining braces were designed and constructed from commercially available products, steel tubing, and upholstery. The design efficacy was determined by clinical use.Results— A shoulder/hip retraction device was constructed from a heavy‐duty Mayo stand and a steel T frame. An elbow brace and a stifle brace were constructed from a commercially available positioning arm and steel tubing. These devices were used successfully in clinical canine arthroscopy and provided consistent stability for arthroscopic surgery without the need of a surgical assistant.Conclusions— Arthroscopic self‐retaining braces can be constructed from commercially available products and other simple materials to provide reliable patient positioning without the need for a surgical assistant.Clinical relevance— Self‐retaining braces may provide improved patient stabilization and eliminate the need for a surgical assistant in most cases of canine arthroscopy.
A New Dissection Technique for Approach to Right‐sided Intrahepatic Portosystemic Shunts: Anatomic Study and Use in Three Dogs
Authors: Tobias Karen M. , Byarlay Judy M. , Henry Robert W. 
Published: November 2004

Objective—To determine the feasibility of indirect suture passage around the right portal vein for attenuation of right‐sided intrahepatic portosystemic shunts (IHPSS).Study Design—Anatomic study of cadavers and prospective evaluation of clinical cases.Animals—Nine canine cadavers (median weight, 20.5 kg) and 6 client‐owned dogs suspected of having right‐sided IHPSS.Methods—Silicone casts of the caudal vena cava and pre‐ and intrahepatic portal veins were made in fresh canine cadavers. A suture was passed dorsal to the portal vein above and below its bifurcation and pulled laterally so that it surrounded the right portal vein. The number and size of portal and caudal vena cava branches that interfered with the suture passage were recorded. Intra‐ and postoperative complications were evaluated in 3 dogs with right‐sided IHPSS and 3 dogs suspected of having right‐sided IHPSS that had right portal vein dissection and occlusion using this technique.Results—Suture passage and placement around the right portal vein were easily accomplished in all 9 specimens. A 1 mm branch from the dorsal surface of the right portal vein was included in the encircling ligature in 4 specimens. The dissection technique was used successfully in 3 dogs with right‐sided IHPSS and 2 other clinical cases. The portal branch to the papillary process of the caudate lobe interfered with suture placement in 1 dog with a central IHPSS.Conclusions—Indirect suture passage for ligation of the right portal vein can be successfully performed in normal dogs and dogs with congenital portosystemic shunts.Clinical Relevance—Hemorrhage, vascular trauma, and surgery time may be reduced using this technique for attenuation of right‐sided IHPSS.