bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reference ranges for natriuretic peptides for diagnostic use are dependent on age, gender and heart rate
Authors: Loke Ian , Squire Iain B. , Davies Joan E. , Ng Leong L. 
Published: November 2003

AbstractBackground:Plasma natriuretic peptide levels may be useful in the diagnosis of heart failure. The available natriuretic peptide assays differ markedly in their performance characteristics. In addition, plasma levels are influenced by a number of factors including age and gender.Aims:The aim of this study was to describe, in a healthy population, the influence of clinical and echocardiographic parameters on three natriuretic peptide moieties.Methods:1360 individuals were screened for the presence of left ventricular systolic dysfunction. We identified a cohort (n=720) of men aged 45–80 years (n=417) and women aged 55–80 years (n=303). None had history of cardiovascular disease or were taking any cardiovascular medication. All had normal echocardiographic and ECG findings. B‐type (BNP), N‐terminal pro‐B‐type (N‐BNP) and N‐terminal pro‐Atrial (N‐ANP) natriuretic peptides were assayed using in‐house immunoluminometric assays.Results:Of the considered clinical variables, only gender and heart rate (each P<0.005) were independently associated with levels of all three natriuretic peptides. Plasma levels of N‐ANP (15%), BNP (25%) and N‐BNP (75%) were higher in women compared to men. An increase in heart rate of 10 bpm corresponded to a reduction of 9% in N‐ANP or BNP and a 15% reduction in N‐BNP. Each 10 years of age was associated with 16% and 74% increase in ANP and N‐BNP levels, respectively, but no increase in plasma BNP. Left ventricular ejection fraction could be assessed in 582 (81%) subjects and correlated positively with N‐ANP (rs=6.48×10−3, P<0.001) and BNP (rs=2.4×10−2, P<0.001) but not N‐BNP (P=0.405). No parameter of diastolic function was associated with any peptide level.Conclusions:In this healthy population, plasma levels of N‐ANP, BNP and N‐BNP were variably influenced by clinical covariates. While all three peptides were higher in women, only N‐ANP and N‐BNP were influenced by age. Levels of all peptides were inversely correlated with heart rate. Using this immunoluminometric assay, plasma BNP is not influenced by age, in contrast to N‐ANP and N‐BNP. In constructing normal ranges for diagnostic use, covariates such as age and gender must be considered, in addition to the format of assay being used.
Adverse mortality effect of central sympathetic inhibition with sustained‐release moxonidine in patients with heart failure (MOXCON)
Authors: Cohn Jay N. , Pfeffer Marc A. , Rouleau Jean , Sharpe Norman , Swedberg Karl , Straub Matthias , Wiltse Curtis , Wright Theressa J. ,   for the MOXCON Investigators
Published: November 2003

AbstractBackground:The association between sympathetic activation and mortality in chronic heart failure and the favorable effect of beta blocking drugs has raised the possibility of therapeutic efficacy for central sympathetic inhibition with sustained‐release (SR) moxonidine, an imidazoline receptor agonist.Methods:A randomized double‐blind, placebo‐controlled trial was initiated in 425 centers in 17 countries with a plan to enter 4533 patients with New York Heart Association class II–IV heart failure and a reduced ejection fraction. Moxonidine SR or matching placebo was titrated to a target dose of 1.5 mg BID. The trial was powered to detect a 20% reduction in mortality, which required a total of 724 deaths.Findings:An early increase in death rate and adverse events in the moxonidine SR group led to premature termination of the trial because of safety concerns after 1934 patients were entered. Final analysis revealed 54 deaths (5.5%) in the moxonidine SR group and 32 deaths (3.4%) in the placebo group during the active treatment phase. Survival curves revealed a significantly (P=0.012) worse outcome in the moxonidine SR group. Hospitalization for heart failure, acute myocardial infarction and adverse events were also more frequent in the moxonidine SR group. Plasma norepinephrine was significantly decreased by moxonidine SR (−18.8% from baseline) vs. placebo (+6.9%).Interpretation:Early termination of the trial limited conclusions regarding the long‐term effects of central sympathetic inhibition. Nonetheless, the excess early mortality and morbidity suggest the likelihood of an adverse effect of moxonidine SR and raise concerns regarding the efficacy of generalized sympathetic inhibition in heart failure.
HEALTH CARE RESOURCE USE AND STROKE OUTCOME
Authors: Asplund Kjell , Ashburner Sharron , Cargill Kathy , Hux Margaret , Lees Ken , Drummond for the GAIN International Investigators Michael 
Published: November 2003

Background and Purpose: Outcome in patients hospitalized for acute stroke varies considerably between populations. Within the framework of the GAIN International trial, a large multicenter trial of a neuroprotective agent (gavestinel, glycine antagonist), stroke outcome in relation to health care resource use has been compared in a large number of countries, allowing for differences in case mix.Methods: This substudy includes 1,422 patients in 19 countries grouped into 10 regions. Data on prognostic variables on admission to hospital, resource use, and outcome were analyzed by regression models.Results: All results were adjusted for differences in prognostic factors on admission (NIH Stroke Scale, age, comorbidity). There were threefold variations in the average number of days in hospital/institutional care (from 20 to 60 days). The proportion of patients who met with professional rehabilitation staff also varied greatly. Three-month case fatality ranged from 11% to 28%, and mean Barthel ADL score at three months varied between 64 and 73. There was no relationship between health care resource use and outcome in terms of survival and ADL function at three months. The proportion of patients living at home at three months did not show any relationship to ADL function across countries.Conclusions: There are wide variations in health care resource use between countries, unexplained by differences in case mix. Across countries, there is no obvious relationship between resource use and clinical outcome after stroke. Differences in health care traditions (treatment pathways) and social context seem to be major determinants of resource use. In making comparisons between countries, great care should be exercised in using outcome variables as indicators of quality of stroke care.
IMPACT OF GENE PATENTS ON THE COST-EFFECTIVE DELIVERY OF CARE: THE CASE OF BRCA1 GENETIC TESTING
Authors: Sevilla Christine , Julian-Reynier Claire , Eisinger François , Stoppa-Lyonnet Dominique , Bressac-de Paillerets Brigitte , Sobol Hagay , Moatti Jean-Paul 
Published: November 2003

Background: In 1994/95, two genes, BRCA1/2, associated with a predisposition to breast or ovarian cancer were identified. Genetic testing of deleterious BRCA1/2 mutations consequently can be proposed to individuals with a family history of breast or ovarian cancer to identify who is at risk. The granting of U.S. patents on BRCA1/2 to a privately owned company has led to the monopoly use of a unique technique (Direct Sequencing of the gene, DS) for BRCA1/2 testing in this country. Alternative strategies using prescreening techniques, however, have been experienced worldwide.Methods: On the basis of data collected at three laboratories of French public hospitals, we carried out a cost-effectiveness study comparing DS to 19 alternative strategies with the number of deleterious BRCA1 mutations detected as the outcome.Results: Results show that the DS strategy presents the highest average cost per mutation detected (9,882.5 °) and that there exist strategies using prescreening techniques that can reach similar effectiveness while reducing total costs. Moreover, other strategies can obtain a four- to sevenfold reduction in the average cost per mutation detected as soon as some rates of false negatives (2% to 13%) are deemed to be acceptable.Conclusions: Results suggest that gene patents with a very broad scope, covering all potential medical applications, may prevent health care systems from identifying and adopting the most efficient genetic testing strategies due to the monopoly granted for the exploitation of the gene. Policy implications for regulatory authorities, in the current context of the extension of BRCA1/2 patents in other countries, are discussed.
COMPARING COMMUNITY-PREFERENCE–BASED AND DIRECT STANDARD GAMBLE UTILITY SCORES: EVIDENCE FROM ELECTIVE TOTAL HIP ARTHROPLASTY
Authors: Feeny David , Blanchard Christopher , Mahon Jeffrey L. , Bourne Robert , Rorabeck Cecil , Stitt Larry , Webster-Bogaert Susan 
Published: November 2003

Objectives: Do utility scores based on patient preferences and scores based on community preferences agree? The purpose is to assess agreement between directly measured standard gamble (SG) utility scores and utility scores from the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) systems.Methods: Patients were assessed repeatedly throughout the process of waiting to see a surgeon, waiting for surgery, and recovery after total hip arthroplasty (THA). Group mean scores are compared using paired t-tests. Agreement is assessed using the intraclass correlation coefficient (ICC).Results: The mean SG, HUI2, and HUI3 (SD) scores at assessment 1 are 0.62 (0.31), 0.62 (0.19), and 0.52 (0.21); n=103. At assessment 2, the means are 0.67 (0.30), 0.68 (0.30), and 0.58 (0.22); n=84. There are no statistically significant differences between group mean SG and HUI2 scores. Mean SG and HUI3 scores are significantly different. ICCs are low.Conclusions: At the mean level for the group, SG and HUI2 scores match closely. At the individual level, agreement is poor. HUI2 scores were greater than HUI3 scores. HUI2 and HUI3 are appropriate for group level analyses relying on community preferences but are not a good substitute for directly measured utility scores at the individual leve.
ASSESSMENT OF DIAGNOSTIC TESTS TO INFORM POLICY DECISIONS-VISUAL ELECTRODIAGNOSIS
Authors: Johnston Renea V. , Burrows Elizabeth , Raulli Alexandra 
Published: November 2003

Objectives: To conduct a systematic review of the evidence for the effectiveness of five visual electrodiagnostic tests to inform the Medical Services Advisory Committee (MSAC) of the Department of Health and Ageing (Australia) in its decision in allocating public funding for new technologies.Methods: We searched the biomedical literature to identify English-language articles published from 1966 to September 2000. We assessed validity of methodology of included studies against the following criteria: investigators (i) compared test with an appropriate reference test; (ii) tested an appropriate spectrum of patients; (iii) masked assessment of study and reference tests; (iv) measured the study test independently of clinical information; and (v) measured the reference test before any interventions.Results: Sixty-one articles met inclusion criteria for critical appraisal: nineteen were cross-sectional studies that compared a study test with another test, thirty-four were case-control studies that compared a test in a group of patients with an eye disease to a group of subjects without eye disease, and eight studies were case series. None of the included studies met all of the validity criteria. Only four studies provided enough information to calculate diagnostic characteristics but were flawed due to inclusion of patients already diagnosed with disease or lack of an appropriate reference test and, thus, overestimated test accuracy.Conclusions: Identified studies did not provide sufficient valid evidence of the clinical value of the five visual tests in diagnosing diseases of the retina or optic nerve. Thus, MSAC recommended that the tests not be supported by public funding.
Cognitive functioning and psychiatric symptomatology in patients with chronic hepatitis C
Authors: Hilsabeck Robin C. , Hassanein Tarek I. , Carlson Meghan D. , Ziegler Elizabeth A. , Perry William 
Published: November 2003

AbstractHepatitis C virus (HCV) infection is a major public-health-care problem, with over 170 million infected worldwide. Patients with chronic HCV infection often complain of various cognitive problems as well as symptoms of depression, anxiety, and fatigue. Relatively little is known, however, about the specific cognitive deficits that are common among HCV patients, and the influence of psychiatric symptomatology on cognitive functioning. In the current study of 21 chronically infected HCV patients, we assessed subjective cognitive dysfunction, depression, anxiety, and fatigue and compared these symptom areas to cognitive tests assessing visuoconstruction, learning, memory, visual attention, psychomotor speed, and mental flexibility. Results revealed that cognitive impairment ranged from 9% of patients on a visuoconstruction task to 38% of patients on a measure of complex attention, visual scanning and tracking, and psychomotor speed, and greater HCV disease severity as indicated by liver fibrosis was associated with greater cognitive dysfunction. Objective cognitive impairment was not related to subjective cognitive complaints or psychiatric symptomatology. These findings suggest that a significant portion of patients with chronic HCV experience cognitive difficulties that may interfere with activities of daily living and quality of life. Future research using cognitive measures with HCV-infected patients may assist researchers in identifying if there is a direct effect of HCV infection on the brain and which patients may be more likely to progress to cirrhosis and hepatic encephalopathy. (JINS, 2003, 9, 847–854.)
Everyday numerical abilities in Alzheimer's disease
Authors: Martini Laura , Domahs Frank , Benke Thomas , Delazer Margarete 
Published: November 2003

AbstractThe present study investigated everyday numerical abilities in a group of 21 patients affected by mild to moderate dementia of Alzheimer's type (DAT). Though patients did not differ from a control group in standard laboratory tests tapping transcoding, number comparison, simple calculation, and estimation, they showed significant difficulties in numerical tasks embedded in an everyday context, such as handling money, a bus schedule, or a television program. Patients' difficulties were attributed to those multiple cognitive demands which are inherent to real situations as compared to well-structured abstract paper-and-pencil tasks. Overall, the study suggests that the examination of numerical abilities in DAT patients should go beyond abstract paper-and-pencil tasks which can only partially reflect the actual numerical skills in DAT and should therefore include also tasks simulating everyday life situations. Assessment of everyday numerical skills may be crucial in planning adequate support for patients, for example in handling money, but also in designing targeted training programs. (JINS, 2003, 9, 871–878.)
Reexamining the effects of epilepsy surgery on IQ in children: Use of regression-based change scores
Authors: Sherman Elisabeth M.S. , Slick Daniel J. , Connolly Mary B. , Steinbok Paul , Martin Roy , Strauss Esther , Chelune Gordon J. , Farrell Kevin 
Published: November 2003

AbstractPrior studies have found no adverse effects of pediatric epilepsy surgery on IQ. However, empirical techniques such as regression models, designed to account for confounding factors such as practice effects and test–retest reliability and able to provide a standardized method for evaluating outcome, have not been used in studying change after pediatric epilepsy. The goal of this study was to demonstrate the regression technique while empirically measuring the effect of epilepsy surgery on IQ in a group of pediatric patients. Predictors of retest IQ (e.g., baseline IQ, retest interval, demographics, epilepsy severity) were evaluated in a control group with intractable seizures (N = 23) assessed twice with the WISC–III. The resulting equation was used to evaluate IQ changes in a second group of children who underwent epilepsy surgery (N = 22). In controls, baseline IQ was a strong predictor of retest IQ. Number of AEDs was inversely related to retest IQ. Based on the control regression, four children (18%) in the surgical sample obtained significantly higher than expected postsurgical IQ scores and one child (5%) obtained a lower than expected IQ score. This study demonstrates that regression-based techniques yield informative estimates on outcome and may be an improvement over prior methods of measuring change after pediatric epilepsy surgery. (JINS, 2003, 9, 879–886.)
Psychosocial status after pediatric traumatic brain injury: A subtype analysis using the Child Behavior Checklist
Authors: Hayman-Abello Susan E. , Rourke Byron P. , Fuerst Darren R. 
Published: November 2003

AbstractThis study identified subtypes of psychosocial functioning in children who had sustained traumatic brain injury (TBI). Child Behavior Checklist (CBCL) profiles for 92 participants, aged 12 to 18 years, who had sustained a mild, moderate, or severe TBI were subjected to Q-Factor analysis. Sixty-four of the participants (75%) were classified into a four-category psychosocial typology labelled Normal (n = 32), Attention (n = 14), Delinquent (n = 10), and Withdrawn–Somatic (n = 8). This typology was found to overlap in part with previous TBI psychosocial typology (Butler et al., 1997), and with three of the clinical profile types derived by Achenbach (1993) for the CBCL. The majority of participants, including those who sustained severe TBI, were assigned to the Normal subtype and the overall level of psychosocial deviance was relatively mild in the other three subtypes. The results of this study support previous typology efforts and confirm the heterogeneous presentation of social and emotional functioning following TBI. (JINS, 2003, 9, 887–898.)
Who makes good use of memory aids? Results of a survey of people with acquired brain injury
Authors: Evans Jonathan J. , Wilson Barbara A. , Needham Paul , Brentnall Sue 
Published: November 2003

AbstractWilson and Watson (1996) identified several factors that were associated with use of memory aids and strategies in a group of people with acquired brain injury. The present study tested these findings, with the aim of identifying the variables that best predict effective use of memory aids after brain injury. One-hundred and one people with memory problems arising from brain injury and their carers were interviewed to identify the aids/strategies used to compensate for memory impairment, and the efficacy of their use. Information relating to variables previously found, or hypothesized to predict use of memory aids, was collected. Use of memory aids correlated with level of independence. External aids such as calendars, wall charts, and notebooks were the most commonly used memory aids. Electronic organizers were not used by many participants. The variables that best predicted use of memory aids were (1) current age, (2) time since injury, (3) number of aids used premorbidly, and (4) a measure of attentional functioning. The implications for rehabilitation services are discussed. (JINS, 2003, 9, 925–935.)
Lessons on measuring construct validity: A commentary on Delis, Jacobson, Bondi, Hamilton, and Salmon
Authors: Larrabee Glenn J. 
Published: November 2003

AbstractThis commentary expands on issues raised by Delis, Jacobson, Bondi, Hamilton, and Salmon, in their paper on the use of shared variance techniques to establish construct validity. Significant discussion is focused on method variance, and how this can distort the results of factor analysis. Solutions are offered for the appropriate use of factor analysis in construct validation. Examples are also provided of construct validation procedures that do not rely on correlational or shared variance techniques. (JINS, 2003, 9, 947–953.)
Selective impairment in effortful information processing in major depression
Authors: Hammar Åsa , Lund Anders , Hugdahl Kenneth 
Published: November 2003

AbstractAutomatic and effortful information processing in depressed patients was investigated by a visual search paradigm, in order to examine dysfunctional effortful processing in depressed patients. Twenty-one patients with major depression, according to the DSM–IV, and with a moderate depression measured by the Hamilton Rating Scale score at >18 participated in the study. The healthy control group was matched for age, gender, and level of education. Half of the trials involved only one type of distractor, and the other half of the trials involved two types of distractors being presented. The results show that the performance of the depressed patients was equal to the control group when the target was easily recognized with only one type of distractor present. However, when target detection required a more difficult and complex attentive search strategy, effortful information processing, the depressed patients needed longer visual search time compared to the controls. Depressed patients seem to have impaired performance on effortful but not automatic information processing. (JINS, 2003, 9, 954–959.)
An open label pilot study of citalopram for depression and boredom in ambulatory cancer patients
Authors: THEOBALD DALE E. , KIRSH KENNETH L. , HOLTSCLAW ELIZABETH , DONAGHY KATHLEEN , PASSIK STEVEN D. 
Published: November 2003

Objective:Significant levels of depressive symptoms are an impediment to adjustment and affect greater than one-third of people with cancer. The clinical diagnosis of major depression is estimated to occur in 25%. Depression is dramatically underrecognized by oncologists and oncology nurses, and as a result, often undertreated. Clinical experience suggests that antidepressants of virtually all types are well tolerated and potentially efficacious. There is, however, a lack of an evidence base for the use of antidepressants in cancer patients.Methods:We undertook an open-label pilot study using citalopram in 30 cancer patients who reported a high level of depressive symptoms on the Zung Self-Rating Depression Scale (ZSDS). In addition to the ZSDS, eligible patients completed a series of visual analog scales for pain, depression, and sleep disturbance; the Functional Assessment of Cancer Therapy-General Module; and the Purposelessness, Understimulation, and Boredom Scale developed by the research team. Patients began a 2-month course of therapy with citalopram 20 mg, increasing to 40 mg at the end of the fourth week if the patient was in the same range of depressive symptoms as measured by the ZSDS.Results:Twenty-one of 30 patients completed the protocol. The average age of the sample was 57.32 years (SD= 12.6) and was comprised of 11 women (52.4%) and 10 men (47.6%). Depressive symptoms decreased and quality of life improved during the 8-week treatment period. Of special interest was the rate of improvement in boredom, and using the total boredom score of the PUB, significant improvement compared to baseline was seen in weeks 6 (F= 5.266,p< .05) and 8 (F= 9.248,p< .01).Significance of results:Overall, the positive findings suggest the need for a randomized, double-blind, placebo-controlled trial of citalopram in cancer patients. Regarding the interplay of boredom and depression, the relationship between improvements in depressive symptoms and boredom is complex. This is illustrated by the way in which the different elements respond to antidepressant treatment. Depression began to improve almost immediately upon initiation of treatment whereas improvement in boredom does not become evident until week 6.