bluuebunny/crossref_metadata_2025_split huggingface dataset:
Application of hepatitis serology testing algorithms to assess inappropriate laboratory utilization
Authors: Ozbek Ozgen A. , Oktem Mehmet A. , Dogan Guliz , Abacioglu Yusuf H. 
Published: October 2004

AbstractRationale, aims and objectives  Many studies pointed out inappropriate utilization of laboratory caused by excessive amounts of tests ordered by doctors. To prevent and to eliminate the ordering of unhelpful tests, introducing diagnostic algorithms, which are also a suitable practice for application to hepatitis serology, have been suggested. This study aimed to determine inappropriate test ordering rates with respect to the commonly approved  algorithms  for  serological  diagnosis  of  viral  hepatitis.Methods  To assess the number of inappropriate test orders, laboratory records of samples sent for hepatitis A, B, and D serology were reviewed and evaluated retrospectively with respect to algorithms for serological diagnosis of viral hepatitis. Orders including serological marker groups with inadequate clinical information to determine whether or not the order was inappropriate were excluded from the analysis.Results  Application of diagnostic algorithms showed that 50% of anti‐HAV IgM and anti‐HAV total; 12.7% of anti‐HBs, 12.7% of anti‐HBc total, 78.5% of anti‐HBc IgM, 87.3% of HBe Ag, 78.8% of anti‐HBe, 58.7% of anti‐HD total orders were made inappropriately.Conclusions  Our study provides information for inappropriate laboratory utilization for hepatitis serology testing and we suggest to use diagnostic algorithms applied by the serology laboratory to decrease the rate of unhelpful test orders.
An evaluation of the adequacy of outpatient monitoring of thyroid replacement therapy
Authors: Stelfox Henry Thomas , Ahmed Sofia B. , Fiskio Julie , Bates David W. 
Published: October 2004

AbstractObjectives  Hypothyroid patients managed with excessive or insufficient thyroid replacement therapy are often difficult to clinically recognize. Monitoring may prevent or minimize the consequences of adverse drug events (ADEs). We sought to develop an explicit model of medication monitoring and to evaluate monitoring processes and ADEs in patients taking levothyroxine.Methods  A retrospective chart review of 400 outpatients receiving levothyroxine therapy between 1 January 2000 and 1 January 2001 at a large North American tertiary care hospital. We measured the proportion of patients satisfying minimum monitoring criteria, experiencing specific monitoring errors and having levothyroxine‐related ADEs. Explicit monitoring criteria were derived from the literature and through expert opinion. Adverse drug events were identified using structured implicit reviews.Results  Overall, only 56% (95% confidence interval [95% CI] 51–62%) of the patients prescribed levothyroxine received the minimal recommended monitoring. Errors were identified at all stages of the monitoring model. Patients who received the recommended monitoring had fewer levothyroxine‐related ADEs (1% vs. 6%, P = 0.013) than those who did not. Minority status (white people 2% vs. black people 4% vs. Hispanics 14%, P = 0.023) and primary language (English 3% vs. Non‐English 20%, P = 0.002) were the patient characteristics associated with levothyroxine‐related ADEs.Conclusion  Only half of outpatients taking levothyroxine at one tertiary care hospital received the recommended monitoring during one year of follow‐up. Levothyroxine‐related ADEs were more frequent in patients with lower‐quality monitoring and in minorities and non‐English speakers.
First episode psychosis: a novel methodology reveals higher than expected incidence; a reality‐based population profile in Northumberland, UK
Authors: Proctor S. E. , Mitford E. , Paxton R. 
Published: October 2004

AbstractRationale, Aims and Objectives   To document the natural history/clinical course of an unselected population presenting with first episode psychosis across a Mental Health Trust.Method  An observational database was set up covering all patients over 15 years of age. Data were collected at pre‐sentation  and annual follow‐up  intervals.Results   A  total of 227 patients presented during the 3 years initial study period with a first episode psychosis. The commonest diagnoses were psychotic depression 19%, paranoid schizophrenia 11%, persistent delusional disorder 7% and bipolar affective disorder 7.5% giving an annual incidence of 30.36 per 100 000 population. At presentation, half had been admitted to hospital, nearly half of whom were detained under the Mental Health Act, and only a quarter were currently employed. Twenty‐six per cent had an episode of deliberate self‐harm and 14% had harmed others. A recurring pattern emerged of over half the patients being no  longer  in  contact  with  mental  health  services  1  year after presentation.  Data c ollection  is  ongoing.Conclusions    Clinical and managerial cooperation achieved a practical framework for data collection. This approach in an unselected population of patients yielded new insights into the course of first episode psychosis. The higher incidence than expected from the literature has implications for local strategic planning and provides a framework for detailed evaluation of a complex patient group.
An audit of clinical outcomes and client and referrer satisfaction with a Mood and Anxiety Disorders Unit
Authors: Lewis Raylene , Musella Emma , Berk Michael , Dodd Seetal , McKenzie Helen , Hyland Mary 
Published: October 2004

AbstractObjective  To evaluate outcome and client and referrer satisfaction with the service provided by a Mood and Anxiety Disorders Unit (MADU).Method  MADU was a specialized clinical service for the assessment and management of individuals suffering with affective and anxiety disorders. Clients were referred to MADU from a variety of health service providers. A telephone survey of 30 clients and 20 referrers who have used the services of MADU was conducted, investigating outcome satisfaction with the service provided by MADU.Results  Clients and referrers reported a high level of satisfaction with the service provided by MADU. There was a high degree of adherence to treatment recommendations. The mean Patient Global Impression of Improvement (PGI) rating by the clients before the MADU assessment was 2.74 (SD = 1.27). In comparison the mean PGI rat‐ing at the  time  of  follow‐up  was  6.64  (SD = 1.91).Conclusions  Specialist mood disorders units are a useful and potentially cost‐effective additional service included as a part of a mental health service.
Patient satisfaction profiling of individual physicians: impact of panel status
Authors: Murff Harvey J. , Orav E. John , Lee Thomas H. , Bates David W. , Fairchild David G. 
Published: October 2004

AbstractRationale, aims and objectives  Evaluation of physician performance is increasingly based on patient satisfaction. However, few data are available regarding the extent to which individual physician profiles might be influenced by factors such as whether a physician's practice is open or closed. We evaluated whether panel status (whether or not a physician is accepting new patients) is associated with patient satisfaction with their primary care physician (PCP).Methods  Cross‐sectional analysis of patient satisfaction surveys. Surveys were available for 1750 patients cared for by 69 PCPs. Patient satisfaction with their PCP was determined based on a composite of six questions derived from the Medical Outcomes Study. We used Generalized Estimating  Equations  to  adjust for physician level variation.Results  Patients of closed‐panel physicians were more likely to rate their satisfaction with the provider as ‘Excellent’ or ‘Very Good’ compared to patients of open‐panel physicians (78% vs. 69%, P < 0.0001). After adjusting for satisfaction with the practice site, provider years in practice, managed care coverage, provider productivity, and patient race, the association between a closed panel and satisfaction remained significant (odds ratio 1.60, 95% confidence  interval  1.10–2.31). Conclusions  Individual physicians’ patient satisfaction data are confounded by factors not likely to be adjusted for in available profiles. After adjusting for other variables, physicians with closed panels still had better patient satisfaction compared to physicians with open panels. Further research is necessary to determine if panel status might also confound patient satisfaction.
Gender bias in cardiovascular advertisements
Authors: Ahmed Sofia B. , Grace Sherry L. , Stelfox Henry Thomas , Tomlinson George , Cheung Angela M. 
Published: October 2004

AbstractRationale Women with cardiovascular disease are treated less aggressively than men. The reasons for this disparity are unclear. Pharmaceutical advertisements  may  influence  physician  practices  and  patient  care. Aims and objective To determine if female and male patients are equally likely to be featured  in  cardiovascular  advertisements. Methods We examined all cardiovascular advertisements from US editions of general medical and cardiovascular journals published between 1 January 1996 and 30 June 1998. For each unique advertisement, we recorded the total number of journal appearances and the number of appearances in journals’ premium positions. We noted the gender, age, race and role of both the primary figure and the  majority  of  people  featured  in  the  advertisement. Results Nine  hundred and nineteen unique cardiovascular advertisements were identified of which 254 depicted a patient as the primary figure. A total of 20%[95% confidence interval (CI) 15.3–25.5%] of these advertisements portrayed a female patient, while 80% (95% CI 74.5–84.7%) depicted a male patient,P < 0.0001. Female patient advertisements appeared 249 times (13.3%; 95% CI 8.6–18.9%) while male patient advertisements appeared 1618 times (86.7%; 95% CI 81.1–91.4%),P < 0.0001. Female patient advertisements also had significantly fewer mean appearances than male patient advertisements in journals’ premium positions (0.82 vs. 1.99,P = 0.02). Similar results were seen when the advertisements were analysed according to predominant gender.Conclusions Despite increasing emphasis on cardiovascular disease in women, significant under‐representation of female patients exists in cardiovascular advertisements. Physicians should be cognizant of this gender bias.
An evaluation of risk factors for adverse drug events associated with angiotensin‐converting enzyme inhibitors
Authors: Morimoto Takeshi , Gandhi Tejal K. , Fiskio Julie M. , Seger Andrew C. , So Joseph W. , Cook E. Francis , Fukui Tsuguya , Bates David W. 
Published: October 2004

AbstractRationale, aims and objectives  To identify potential factors leading to discontinuation of angiotensin‐converting enzyme (ACE) inhibitors because of adverse drug events.Methods  Retrospective cohort study was conducted at outpatient clinics affiliated with an urban tertiary care hospital. ACE inhibitors were administered to 2225 consecutive outpatients.Results  In 19% of the total cohort, ACE inhibitors were discontinued because of adverse drug events. Cox proportional hazard model identified the following independent risk factors for discontinuation because of adverse drug events: age, female gender, ethnicity other than African American or Latino, no history of previous ACE inhibitor use, history of cough caused by another ACE inhibitor, hypertension, anxiety or depression, no hemodialysis, and elevated creatinine. History of smoking was shown to be a risk factor for cough [hazard ratio (HR): 2.5; 95% confidence interval (CI): 1.1–5.7], angioedema (HR: 2.7; 95% CI: 1.1–7.0), and hyperkalaemia (HR: 5.4; 95% CI: 1.3–23.2). History of ACE inhibitor‐induced cough was not only a risk factor for cough (HR: 12.9; 95% CI: 7.5–22.3) but also for angioedema (HR: 9.1; 95% CI: 2.1–39.9). Patients with creatinine ≥ 1.6 mg dL−1 were likely to discontinue ACE inhibitors because of renal dysfunction (HR: 4.7; 95% CI: 1.5–12.7) and hyperkalaemia (HR: 10.9; 95% CI: 3.1–39.0). East Asians were more likely to develop cough (HR: 2.5; 95% CI: 1.1–5.7) and hyperkalaemia (HR: 80.3; 95% CI: 5.4–1190) and African Americans to develop angioedema (HR: 3.5;  95%  CI:  1.3–8.9). Conclusions  Although further validation is necessary, these risk factors should help doctors identify patients with elevated risk for adverse drug events because of ACE inhibitors.
Use of porcine tumor necrosis factor receptor 1‐Ig fusion protein to prolong xenograft survival
Authors: Costa C. , Bell N. K. , Stabel T. J. , Fodor W. L. 
Published: October 2004

Abstract:  Background:  Delayed rejection of xenografts is a major hurdle that needs to be addressed to achieve long‐term engraftment in the pig‐to‐primate transplant setting. Both vascular and avascular xenografts are susceptible to a delayed rejection process that comprises humoral and cellular responses. Tumor necrosis factor (TNF) is believed to play a role in this process by promoting cell activation, apoptosis and the recruitment of inflammatory cells. To address this problem, we engineered the donor cell in such a way that it could block both human and porcine TNF.Methods:  We produced a recombinant fusion protein containing the extracellular domain of the porcine TNF‐Receptor 1 and an IgG Fc moiety (pTNFR1Ig). We first evaluated by flow cytometry the pTNFR1Ig capacity to prevent TNFα‐induced expression of SLAI, SLAII, VCAM‐1, ICAM‐1 and E‐selectin on the cell surface of porcine aortic endothelial cells (PAEC). The effect on TNFα‐mediated cell death was also assessed by propidium iodide staining after incubating PAEC with TNFα plus cycloheximide for 24 h. PAEC and porcine fibroblasts were subsequently engineered by retroviral infection to express and secrete pTNFR1Ig and their resistance to the TNFα effects was tested in vitro. Finally, we transplanted mock‐control and pTNFR1Ig‐expressing PAEC under the kidney capsule of BALB/c mice in the absence of immunosuppression and examined the degree of rejection at 2 and 3 weeks post‐transplantation.Results:  Treatment with pTNFR1Ig resulted in a very potent blockade of human, porcine and murine TNFα activity on porcine cells. It inhibited the upregulation of all cell surface markers of activation tested as well as the TNFα‐mediated cell death. Moreover, pTNFR1Ig‐expressing PAEC showed prolonged engraftment in a pig‐to‐mouse xenotransplant model.Conclusions:  Incorporation of strategies that block TNF may prove useful in the development of xenografts resistant to delayed rejection.
Hyperacute rejection of hDAF‐transgenic pig organ xenografts in cynomolgus monkeys: influence of pre‐existing anti‐pig antibodies and prevention by the αGAL glycoconjugate GAS914
Authors: Lam Tuan T. , Hausen Bernard , Boeke‐Purkis Katrin , Paniagua Ricardo , Lau Macy , Hook Laurie , Berry Gerry , Higgins John , Duthaler Rudolf O. , Katopodis Andreas G. , Robbins Robert , Reitz Bruce , Borie Dominique , Schuurman Henk‐Jan , Morris Randall E. 
Published: October 2004

Abstract:  Background:  Our introductory pig‐to‐cynomolgus monkey heart or kidney transplantation using organs from pigs transgenic for human decay‐accelerating factor (hDAF), showed a high incidence of hyperacute rejection (HAR), which was ascribed to extraordinary high levels of anti‐pig antibodies. We evaluated the efficacy of GAS914, a Galα1–3Gal trisaccharide linked to a poly‐l‐lysine backbone, in inhibition of HAR.Methods:  hDAF transgenic heterotopic heart (n = 15) or life‐supporting kidney (n = 8) transplantation included induction with cyclophosphamide or anti‐thymocyte globulin, and maintenance with cyclosporine or tacrolimus, steroids and mycophenolate sodium/mofetil. Four doses of GAS914 were given before transplantation. Rejection was confirmed by graft histology, and anti‐pig antibody levels were determined in various assays.Results:  Four of six heart transplants without GAS914 treatment showed HAR. Nine subsequent transplants with GAS914 pre‐treatment, did not show HAR (chi‐square, P < 0.05). Two of four kidney transplants without GAS914 treatment ended with HAR. Four subsequent transplants with GAS914 did not show HAR. Animals with HAR showed extremely high antibody levels. Samples just before transplantation showed significantly higher antibody levels in recipients presenting with HAR. In all assays antibody levels were significantly lowered by GAS914 pre‐treatment.Conclusions:  HAR of hDAF solid organs could be ascribed to high levels of anti‐pig antibodies. It is hypothesized that the hDAF transgene shows a threshold in efficacy, above which an overwhelming attack by antibodies and complement activation cannot be modulated to prevent HAR. HAR does not occur when animals with lower levels are used, or when antibodies are effectively depleted from the circulation by GAS914 treatment.
Prolonged survival of fetal pig islet xenografts in mice lacking the capacity for an indirect response
Authors: Koulmanda Maria , Laufer Terri M , Auchincloss Hugh , Neal Smith R 
Published: October 2004

Abstract: Background: Xenografts of islets from organ‐cultured fetal pig pancreases transplanted into non‐immunosuppressed mice are rejected within 10 days. Immunosuppression with anti‐T cell (anti‐CD4) monoclonal antibody alone delays rejection of these xenografts for about 28 days, but rejection eventually occurs despite marked depletion of T cells. To determine if the critical CD4+ T cells responsible for xenograft islet rejection function through the direct or indirect pathway, selective class II‐deficient mice that express class II antigens only on their thymic epithelium (not on peripheral cells) with normal numbers of CD4+ T cells, (class II‐, CD4+), were used as recipients of xenograft islets to test if rejection occurs in the absence of an indirect response.Methods: Control (C57BL/6) or class II‐, CD4+ mice were transplanted under the kidney capsule with cultured fetal pig islets. Class II‐, CD4+ mice have normal numbers of B cells, CD4+,γδT cells, and slightly increased numbers of CD8+ T cells. Additional mice were thymectomized before receiving anti‐CD4 or anti‐CD8 monoclonal antibodies. Islet graft survival was determined histologically as fetal pig islets were too immature to secrete insulin.Results: Xenograft survival in control animals was 7 to 14 days. In contrast, graft survival in class II‐, CD4+ mice was significantly prolonged to greater than 35 days. Depletion of CD8+ T cells in class II‐, CD4+ mice prolonged graft survival to about 70 days. Depletion of CD4+ T cells from these mice further prolonged xenograft survival to about 100 days.Conclusions: These results suggest that the rejection of pig islets by mice initially depends on a CD4 dependent indirect response. The CD4 direct response also contributes to graft destruction. CD8+ T cells also participate in graft destruction, albeit weakly.
Anti‐non‐Gal porcine endothelial cell antibodies in acute humoral xenograft rejection of hDAF‐transgenic porcine hearts in cynomolgus monkeys
Authors: Lam Tuan T. , Paniagua Ricardo , Shivaram Giridhar , Schuurman Henk‐Jan , Borie Dominique C. , Morris Randall E. 
Published: October 2004

Abstract:  Background:  Anti‐Galα1–3Gal (Gal) antibodies play a major role in hyperacute rejection and acute humoral xenograft rejection (AHXR) in porcine‐to‐nonhuman primate transplantation. The role of anti‐non‐Gal antibodies in AHXR is less well defined.Methods:  Eleven cynomolgus monkeys received a heterotopic heart transplant from a human decay‐accelerating factor transgenic pig, and maintenance immunosuppression with cyclosporin A or tacrolimus, steroids, mycophenolate sodium or mycophenolate mofetil, and in 10 animals the Gal‐containing soluble glycoconjugate GAS914. Six ended with AHXR (6 to 78 day survival) and five did not show AHXR (9 to 36 day survival). Anti‐Gal antibodies were depleted in vivo with GAS914, or in vitro with Gal‐coated Sepharose beads. IgM‐ and IgG‐class anti‐non‐Gal antibodies in serum depleted of anti‐Gal antibodies were measured by flow cytometry using porcine endothelial target cells.Results:  Compared with pre‐transplant values, all six recipients with AHXR showed a substantially higher level of anti‐non‐Gal IgM antibodies at rejection; in five animals there was also an increase in IgG‐class antibodies. There was no relevant change in recipients without AHXR. AHXR at time of cessation of heart contraction could be preceeded by a steady increase in antibody level starting 2 to 3 weeks earlier.Conclusions:  AHXR is invariably associated with increased circulating anti‐non‐Gal antibodies. These antibodies are not observed in recipients without AHXR, and five of six recipients with AHXR were adequately depleted of anti‐Gal antibodies by maintenance GAS914. This indicates that anti‐non‐Gal antibodies play a significant role in the pathogenesis of AHXR. Also, the assessment of these antibodies could be used as an early monitor of AHXR.
Assessing the risk potential of porcine circoviruses for xenotransplantation: consensus primer‐PCR‐based search for a human circovirus
Authors: Hattermann Kim , Maerz Alexander , Slanina Heiko , Schmitt Cornelia , Mankertz Annette 
Published: October 2004

Abstract:  Background:  An important issue with respect to virus safety in xenotransplantation is the search for human analogues of porcine viruses, because transmission of a porcine virus followed by recombination with a related human virus may lead to a new emerging virus of unknown pathogenicity, host range and virulence. In case of circoviruses, two types of porcine circovirus (PCV1 and PCV2) are described, but the existence of an analogous human circovirus has not yet been investigated.Methods:  This study describes the analysis of human samples with a consensus primer‐PCR approach designed to amplify conserved regions from the rep gene of circoviruses from the genus Circovirus. DNA from human sera, lymph nodes, blood and urine was extracted and investigated with this method that has led previously to the identification of a new avian circovirus.Results:  By screening 1101 samples (there of 168 from immunocompromised patients), no evidence for the existence of a human circovirus related to the genus Circovirus was obtained.Conclusions:  This result renders the existence of a human circovirus related to the porcine circoviruses more unlikely, nevertheless the presence of such a virus cannot be ruled out.