bluuebunny/crossref_metadata_2025_split huggingface dataset:
Consumer Experiences in a Consumer‐Driven Health Plan
Authors: Christianson Jon B. , Parente Stephen T. , Feldman Roger 
Published: July 2004

Objective. To assess the experience of enrollees in a consumer‐driven health plan (CDHP).Data Sources/Study Setting. Survey of University of Minnesota employees regarding their 2002 health benefits.Study Design. Comparison of regression‐adjusted mean values for CDHP and other plan enrollees: customer service, plan paperwork, overall satisfaction, and plan switching. For CDHP enrollees only, use of plan features, willingness to recommend the plan to others, and reports of particularly negative or positive experiences.Principal Findings. There were significant differences in experiences of CDHP enrollees versus enrollees in other plans with customer service and paperwork, but similar levels of satisfaction (on a 10‐point scale) with health plans. Eight percent of CDHP enrollees left their plan after one year, compared to 5 percent of enrollees leaving other plans. A minority of CDHP enrollees used online plan features, but enrollees generally were satisfied with the amount and quality of the information provided by the CDHP. Almost half reported a particularly positive experience, compared to a quarter reporting a particularly negative experience. Thirty percent said they would recommend the plan to others, while an additional 57 percent said they would recommend it depending on the situation.Conclusions. Much more work is needed to determine how consumer experience varies with the number and type of plan options available, the design of the CDHP, and the length of time in the CDHP. Research also is needed on the factors that affect consumer decisions to leave CDHPs.
Early Experience with Employee Choice of Consumer‐Directed Health Plans and Satisfaction with Enrollment
Authors: Fowles Jinnet Briggs , Kind Elizabeth A. , Braun Barbara L. , Bertko John 
Published: July 2004

Objective. To assess the initial impact of offering consumer‐defined health plan (CDHP) options on employees.Data Sources/Study Setting. A mail survey of 4,680 employees in the corporate offices of Humana Inc. in June 2001.Study Design. The study was a cross‐sectional mail survey of employees aged 18 and older who were eligible for health care benefits. The survey was conducted following open enrollment. The primary outcome is the choice of consumer‐directed health plan or not; the secondary outcome is satisfaction with the enrollment process. Important covariates include sociodemographic characteristics (age, gender, race, educational level, exempt or nonexempt status, type of coverage), health status, health care utilization, and plan design preferences.Data Collection Methods. A six‐page questionnaire was mailed to the home of each employee, followed by a reminder postcard and two subsequent mailings to nonrespondents.Principal Findings. The response rate was 66.2 percent. Seven percent selected one of the two new plan options. Because there were no meaningful differences between employees choosing either of the two new options, these groups were combined in multivariate analysis. A logistic regression modeled the likelihood of choosing the novel plan options. Those selecting the new plans were less likely to be black (odds ratio [OR] 0.46), less likely to have only Humana coverage (OR 0.30), and more likely to have single coverage (OR 1.77). They were less likely to have a chronic health problem (OR 0.56) and more likely to have had no recent medical visits (OR 3.21). They were more likely to believe that lowest premiums were the most important plan attribute (OR 2.89) and to think there were big differences in the premiums of available plans (OR 5.19). Employees in fair or poor health were more likely to have a difficult time during the online enrollment process. They were more likely to find the communications very helpful (OR 0.42) and the benefits information very understandable (OR 0.38). They were less likely to feel that they had enough time to make their enrollment decision (OR 0.47).Conclusions. Employees who were attracted to the new CDHP plan options valued the attributes that distinguished these plans from other choices. The shift to consumer‐defined plans and to the electronic provision of information, however, requires a significant increase in the communication support for all employees, but particularly for those in fair or poor health whose information needs are the most complex and individualized.
Iron storage indices and risk of bacterial infections in hemodialysis patients
Authors: Teehan Geoffrey S , Ruthazer Robin , Balakrishnan Vaidyanathapuram S , Snydman David , Jaber Bertrand L 
Published: July 2004

AbstractBackground:  Infection is the second leading cause of death among hemodialysis (HD) patients. Because iron overload may be a risk factor for bacterial infection, concerns about excessive use of intravenous (IV) iron have arisen. In this retrospective analysis, we explored the relationship between target iron storage indices, as outlined in the Dialysis Outcomes Quality Initiative (DOQI) guidelines, and the incidence of bacterial infections.Methods:  We reviewed the charts of 87 HD patients who received their first course of IV iron at our dialysis unit between 1997 and 2001. Transferrin saturation (TSAT) rate, ferritin level, and other clinical/laboratory measures were recorded at baseline. Patients were followed for up to 2 years for the outcomes of bacteremia and bacterial pneumonia and censored at death, end‐of‐study observation, or kidney transplantation. Cox proportional hazards regression was used to evaluate the relationship of bacterial infections to iron storage indices.Results:  Thirty‐two patients had at least one episode of bacterial infections. In multivariate analyses, after adjusting for sex and venous catheter use, iron‐replete state (ferritin > 100 ng/mL and TSAT > 20%) was associated with a threefold higher risk of bacterial infections (95% CI 1.3–6.6; p = 0.01). Although diabetes mellitus and lower serum albumin had a nonsignificant trend toward an increased risk of bacterial infections, no such relationship was seen with the first 3‐month cumulative IV iron dose.Conclusions:  This study suggests an increased risk for bacterial infections at modest levels of iron stores (ferritin > 100 ng/mL and TSAT > 20%) among HD patients initiating IV iron. Large prospective studies are needed to confirm these relationships.
Heparin‐induced thrombocytopenia during renal replacement therapy
Authors: Davenport Andrew 
Published: July 2004

AbstractThere is increasing awareness that antibodies to heparin/platelet factor 4 complex can develop in both those with acute renal failure treated with continuous forms of renal replacement therapy and, to a lesser extent, regular hemodialysis patients. Clinical manifestations include premature clotting of the extracorporeal circuit and increased central venous thrombosis with indwelling venous dialysis catheters, associated with thrombocytopenia and increased platelet activation. Nevertheless, a minority of patients who develop heparin/platelet factor 4 antibodies do not have thrombocytopenia or thrombosis. When systemic anticoagulation is also required to treat venous thrombosis, then synthetic heparinoids or the direct thrombin inhibitors argatroban or recombinant hirudins are the agents of choice. Neither the synthetic heparinoids nor hirudin, however, are without their own problems, in that a minority of patients may have cross‐reacting antibodies against the currently available heparinoids, and antibodies may similarly develop against recombinant hirudin, in this case leading to a potentiation of anticoagulant activity and increased risk of hemorrhage.
Recognition of cytomegalovirus clinical isolate antigens by sera from cytomegalovirus‐negative blood donors
Authors: Rahbar A.R. , Sundqvist V.‐A.S. , Wirgart B. Zweygberg , Grillner L. , Söderberg‐Naucler C. 
Published: July 2004

BACKGROUND:  The most common way to prevent transmission of CMV by blood transfusion is to use blood products from seronegative donors. Screening of blood donors for CMV infection is usually based on detection of antigens obtained from the CMV laboratory strain AD 169. Recent evidence suggests that approximately up to 20 percent of CMV‐negative blood donors may in fact be CMV‐DNA positive by PCR analyses.STUDY DESIGN AND METHODS:  In this study, sera from CMV‐seronegative, CMV‐seropositive, and CMV‐DNA‐positive/seronegative individuals, and from patients with acute and convalescent CMV infection for detection of CMV antibodies were analyzed. CMV antigens pre‐pared from cells infected with CMV clinical isolates or the CMV laboratory strain AD 169 in ELISA and Western blot assays were used.RESULTS:  All CMV‐positive sera from blood donors were seropositive for the CMV antigens prepared from AD 169 (A2) or from a CMV clinical isolate (C6). Interestingly, whereas all CMV‐negative blood donors were negative in tests for the CMV antigen A2, 36 percent were CMV seropositive using the CMV antigen C6 in ELISA.CONCLUSION:  The data suggest that a substantial number of CMV‐seronegative/CMV‐DNA‐positive serum samples contain antibodies that recognize CMV clinical isolate antigens.
Fully automated processing of buffy‐coat–derived pooled platelet concentrates
Authors: Janetzko Karin , Klüter Harald , Waeg Geert van , Eichler Hermann 
Published: July 2004

BACKGROUND:  The OrbiSac device, which was develo‐ped to automate the manufacture of buffy‐coat PLT con‐centrates (BC‐PCs), was evaluated.STUDY DESIGN AND METHODS:  In‐vitro characteristics of BC‐PC preparations using the OrbiSac device were compared with manually prepared BC‐PCs. For standard processing (Std‐PC, n = 20), four BC‐PCs were pooled using 300 mL of PLT AS (PAS) followed by soft‐spin centrifugation and WBC filtration. The OrbiSac pre‐paration (OS‐PC, n = 20) was performed by automated pooling of four BC‐PCs with 300 mL PAS followed by centrifugation and inline WBC filtration. All PCs were stored at 22°C. Samples were withdrawn on Day 1, 5, and 7 evaluating PTL count, blood gas analysis, glucose, lactate, LDH, β‐thromboglobulin, hypotonic shock response, and CD62p expression.RESULTS:  A PLT content of 3.1 ± 0.4 × 1011 (OS‐PCs) versus 2.7 ± 0.5 × 1011 (Std‐PCs, p < 0.05) was found. A CV of 19 percent (Std‐PC) versus 14 percent (OS‐PC) suggests more standardization in the OS group. At Day 7, the Std‐PCs versus OS‐PCs showed a glucose consumption of 1.03 ± 0.32 µmol per 109 PLT versus 0.75 ± 0.25 µmol per 109 PLT (p < 0.001), and a lactate production of 1.50 ± 0.86 µmol per 109 versus 1.11 ± 0.61 µmol per 109 (p < 0.001). The pH (7.00 ± 0.19 vs. 7.23 ± 0.06; p < 0.001), pO2 (45.3 ± 18 vs. 31.3 ± 10.4 mmHg; p < 0.01), and HCO3 levels (4.91 ± 1.49 vs. 7.14 ± 0.95 mmol/L; p < 0.001) suggest a slightly better aerobic metabolism within the OS group. Only small differences in CD62p expression was observed (37.3 ± 12.9% Std‐PC vs. 44.8 ± 6.6% OS‐PC; p < 0.05).CONCLUSION:  The OrbiSac device allows an improved PLT yield without affecting PLT in‐vitro characteristics and may enable an improved consistency in product volume and yield.
Hepatitis C core antigen in Polish blood donors
Authors: Letowska Magdalena , Brojer Ewa , Mikulska Maria , Gronowska Agnieszka , Rosiek Aleksandra 
Published: July 2004

BACKGROUND:  The goal of this study was to evaluate the feasibility of adopting the HCV core antigen ELISA (HCVcAg) for routine screening of Polish blood donors.STUDY DESIGN AND METHODS:  A total of 133,279 donor samples were tested by ORTHO HCVcAg. All repeatedly reactive (RR) samples were tested by neutrali‐zation test for confirmation, RIBA HCV for anti‐HCV, and by Cobas Amplicore for HCV RNA. All donations were tested for ALT level.RESULTS:  The HCVcAg test specificity was 99.94 percent. In total, 1499 donations (1.12%) were initially reactive and 124 (0.09%) were RR. Antibodies to HCV were found in 22 out of 124 donors and HCV RNA was detected in 19 out of 22. In 10 out of the 19 HCV‐RNA‐positive donors, the HCVcAg neutralization test was positive. Among the 102 HCVcAg RR/anti‐HCV‐negative donors, there were 6 neutralization‐test‐positive indivi‐duals, and all were HCV RNA positive. Elevated ALT level was observed in one of them. During the follow‐up studies of three HCVcAg RR/HCV‐RNA‐positive donors, sero‐convertion was observed 5 to 7 weeks after the initial HCVcAg‐positive result. In all, HCVcAg results became negative once antibodies to HCV were detected.CONCLUSION:  The HCVcAg test proved to be feasible for routine screening in the Polish Blood Transfusion Service. Six HCVcAg RR/anti‐HCV‐negative donors were identified. The calculated residual risk in this study of donors in the preseroconversion window was 45 per million. Mandatory testing of every blood and plasma donation for HCVcAg or HCV RNA was recommended as of January 2, 2002.
The use of autologous platelet gel to treat difficult‐to‐heal wounds: a pilot study
Authors: Mazzucco Laura , Medici Dante , Serra Massimo , Panizza Renzo , Rivara Giorgio , Orecchia Sara , Libener Roberta , Cattana Elena , Levis Alessandro , Betta Pier Giacomo , Borzini Piero 
Published: July 2004

BACKGROUND:  Chronic ulcers can benefit from topical treatment with growth factors (GFs). PLT gel provides tissue regeneration‐inducing GFs. The aim of this study was to verify the effectiveness of autologous PLT gel in the treatment of nonhealing skin lesions.STUDY DESIGN AND METHODS:  PLT gel was pro‐duced by treating PLTs with autologous thrombin. Two groups of patients were investigated: patients with dehis‐cent sternal wounds and patients with necrotic skin ulcers. Patients treated with PLT gel were retrospectively compared with patients having similar lesions but undergoing conventional treatment. The clinical endpoints of the study were the healing rate, the length of hospital stay, and/or the time required to bring about adequate tissue regeneration in order to undergo reconstructive plastic surgery.RESULTS:  In patients with treated dehiscent sternal wounds the healing rate (3.5 vs. 6.0 wks, p = 0.0002) and hospital stay (31.5 vs. 52.5 days, p < 0.0001) were signi‐ficantly reduced. Patients with treated necrotic skin ulcers required a notably shorter time to have surgery (median 15.0 vs. 35.5 wks, p < 0.0001). Neither adverse reactions nor in‐situ recurrences were observed.CONCLUSIONS:  Patients with chronic unhealing wounds showed substantial improvement when treated with PLT gel lesion dressings.
Posttransfusion recovery of stored red blood cells in very low birth weight infants using a hemoglobin balance model
Authors: Bechensteen Anne Grete , Chapel Sunny , Veng‐Pedersen Peter , Widness John A. 
Published: July 2004

BACKGROUND:  A Hb balance model was used in very low birth weight (VLBW) infants to predict posttransfusion Hb levels from which we inferred allogeneic RBC recovery after transfusion of RBCs stored for varying periods of time.STUDY DESIGN AND METHODS:  Premature VLBW infants receiving RBC transfusions during the 1st month of life were evaluated retrospectively for RBC survival of stored donor blood. Actual Hb levels measured in infant blood 1 and 2 days after RBC transfusions were com‐pared to those predicted using a Hb balance model based on factors affecting blood Hb loss and gain. Transfusions were subgrouped according to whether or not infants were clinically stable at the time of RBC transfusion. Model‐predicted RBC recovery was also evaluated relative to duration of RBC storage.RESULTS:  Model‐predicted mean (± SD) Hb levels 2 days after transfusion among the 30 VLBW infants receiv‐ing a total of 57 RBC transfusions were only 4 percent higher than actual values observed (15.2 ± 1.2 g/dL vs. 14.7 ± 1.4, respectively; p < 0.05). The infant's clinical status at the time of transfusion did not affect predicted 1‐ and 2‐day posttransfusion RBC recovery. Model‐predicted recovery of transfused RBCs was modestly, but significantly, decreased with increasing duration of donor RBC storage (i.e., 10% lower by 42 days—the maximal allowed storage period for donor blood [p < 0.01]).CONCLUSIONS:  Our model‐predicted RBC survival results are consistent with—but not direct evidence of—hemolysis of donor blood after RBC transfusion. Although observed post‐RBC Hb levels 2 days after transfusion averaged only 4 percent less than predicted, model‐predicted survival of donor RBCs at 42 days suggested a modest decrease (i.e., by 10%).
Long‐term survival after blood transfusion: a population based study in the North of England
Authors: Wallis Jonathan P. , Wells Angus W. , Matthews John N. , Chapman Catherine E. 
Published: July 2004

BACKGROUND:  Blood transfusion may transmit infec‐tious diseases with long incubation periods. Estimation of the risks of transmission of such disease requires know‐ledge of long‐term survival of transfused patients. No such information is available in the UK, where there is particular concern about possible transmission by trans‐fusion of variant CJD.STUDY DESIGN AND METHODS:  Information on survival after transfusion and demographics was collected for all patients transfused during June 1994 in a popula‐tion of 2.9 million served by a single blood center.RESULTS:  A total of 2899 patients were transfused with 10,760 units of RBCs (99% of RBCs issued during the study period). Follow‐up to death or 5 years was com‐pleted for 98.2 percent, and 46.9 percent of all transfusion recipients were alive at 5 years; 41 percent of transfused RBC units and 36 percent of transfused FFP were given to patients who were alive at 5 years. Median age at transfusion was 67 years (mean, 60.9 years). Shorter patient survival was associated with increasing patient age, increasing numbers of RBC units transfused, trans‐fusion of plasma or PLTs, and nonsurgical indications for transfusion.CONCLUSIONS:  Posttransfusion survival is lower than estimated in previous decades in other countries. This is probably due to a relative increase in use of transfusion for older patients and for medical indications. Our figures may be used to predict and stratify the risk of infections, such as variant CJD, amongst different groups of transfusion recipients.
Neonatal neutropenia and bacterial sepsis associated with placental transfer of maternal neutrophil‐specific autoantibodies
Authors: Davoren Anne , Saving Kay , McFarland Janice G. , Aster Richard H. , Curtis Brian R. 
Published: July 2004

BACKGROUND:  Passively acquired neonatal neutro‐penia is an infrequently reported complication of maternal autoimmune neutropenia (AIN). Two affected siblings are described. The firstborn developed Citrobacter meningitis and was permanently disabled. The second was success‐fully managed with pre‐ and postnatal injections of recom‐binant human granulocyte colony‐stimulating factor (rHuG–CSF).STUDY DESIGN AND METHODS:  Neutrophil‐specific antibodies were evaluated by flow cytometry (FC), monoclonal antibody immobilization of granulocyte antigens, and granulocyte agglutination assays.RESULTS:  A neutrophil‐reactive antibody was detected by FC in samples of the mother's serum spanning a 4‐year time frame. This antibody reacted with neutrophils from the mother, father, and their first infant and with 18 of 20 target neutrophils tested. In serologic studies, it was shown that the antibody was not specific for the commonly recognized neutrophil‐specific alloantigens HNA‐1a (NA1), HNA‐1b (NA2), HNA‐1c (SH), HNA‐2a (NB1), or HNA‐3a (5b).CONCLUSION:  Severe neonatal neutropenia in the two siblings appears to have been caused by placental transfer of a maternal neutrophil‐reactive autoantibody of undetermined specificity. Neutrophil counts should be evaluated in infants born to mothers with chronic neutropenia of possible autoimmune origin so that neutropenic infants can be carefully monitored and antibiotics and/or rHuG–CSF administered if indicated.
The in vitro quality of red blood cells frozen with 40 percent (wt/vol) glycerol at −80°C for 14 years, deglycerolized with the Haemonetics ACP 215, and stored at 4°C in additive solution‐1 or additive solution‐3 for up to 3 weeks
Authors: Valeri C. Robert , Srey Rithy , Tilahun Daniel , Ragno Gina 
Published: July 2004

BACKGROUND:  Red blood cells (RBCs) frozen with 40 percent (wt/vol) glycerol, stored at −80°C (mean temperature; range, −65 to −90°C) for 14 years, deglycerolized in the Haemonetics automated cell processor (ACP) 215 with the 325‐mL disposable bowl, and stored at 4°C in additive solution (AS)‐1 or AS‐3 for 21 days were evaluated.STUDY DESIGN AND METHODS:  A total of 106 units of citrate phosphate dextrose adenine‐1 RBCs were frozen with 40 percent (wt/vol) glycerol in the original 800‐mL polyvinylchloride plastic bag and stored in corrugated cardboard boxes at −80°C for 14 years. The thawed units were deglycerolized with the ACP 215 with a 325‐mL disposable bowl and stored in AS‐1 or AS‐3 at 4°C for 21 days.RESULTS:  The freeze‐thaw recovery value was 94 ± 4 percent (mean ± SD), the freeze‐thaw‐wash recovery value was 80 ± 7 percent, and there was no breakage. Thirty‐eight units were processed as 19 pairs. Two units of ABO‐matched units were thawed, pooled, divided equally into two units, and deglycerolized. One unit was stored in AS‐1 and the other in AS‐3 at 4°C for 21 days. Units stored in AS‐1 exhibited significantly greater hemolysis than those stored in AS‐3.CONCLUSIONS:  Acceptable results were achieved when RBCs frozen at −80°C for 14 years were deglycerolized in the ACP 215. Deglycerolized RBCs in AS‐1 exhibited significantly higher hemolysis than those in AS‐3 after storage at 4°C for 7 to 21 days.
Investigation of red blood cells from α1,3‐galactosyltransferase‐knockout pigs for human blood transfusion
Authors: Rouhani Foad J. , Dor Frank J.M.F. , Cooper David K.C. 
Published: July 2004

BACKGROUND:  Pigs are a potential source of red blood cells (RBCs) for transfusion into humans, but the pre‐sence of galactose‐α1,3‐galactose (Gal) epitopes on their surface, against which humans have anti‐Gal, has been perceived as a major barrier. α1,3‐Galactosyltransferase gene‐knockout pigs, which do not express Gal epitopes on RBCs (Gal–/–), have recently become available.STUDY DESIGN AND METHODS:  In vitro, RBCs from Gal–/– pigs were exposed to sera from naïve humans or baboons or from baboons previously sensitized to pig antigens; immunoglobulin binding was measured by flow cytometry, and cytotoxicity, by a hemolytic assay. In vivo, relatively small numbers of Gal–/– RBCs were transfused into two nonsensitized untreated baboons. The survival of pig RBCs was detected by flow cytometry.RESULTS:  In vitro, binding of immunoglobulin (Ig) M from naïve human or baboon sera was detected to Gal–/– RBCs but was significantly less than to Gal+/+ RBCs; IgG binding to Gal–/– RBCs was absent or minimal. Sera had minimal cytotoxicity to Gal–/– RBCs compared to Gal+/+ RBCs. Sensitized baboon sera demonstrated much higher IgG binding to Gal–/– RBCs and increased cytotoxicity, but again these were less than to Gal+/+ RBCs. In vivo, the transfusion of relatively small volumes of Gal–/– RBCs was followed by detection of the cells in the baboon's blood for only 5 minutes.CONCLUSION:  Pig RBCs are rapidly phagocytosed from the primate circulation by a mechanism not involving anti‐Gal.