bluuebunny/crossref_metadata_2025_split huggingface dataset:
Application of a Propensity Score Approach for Risk Adjustment in Profiling Multiple Physician Groups on Asthma Care
Authors: Huang I‐Chan , Frangakis Constantine , Dominici Francesca , Diette Gregory B. , Wu Albert W. 
Published: January 2005

Objectives. To develop a propensity score‐based risk adjustment method to estimate the performance of 20 physician groups and to compare performance rankings using our method to a standard hierarchical regression‐based risk adjustment method.Data Sources/Study Setting. Mailed survey of patients from 20 California physician groups between July 1998 and February 1999.Study Design. A cross‐sectional analysis of physician group performance using patient satisfaction with asthma care. We compared the performance of the 20 physician groups using a novel propensity score‐based risk adjustment method. More specifically, by using a multinomial logistic regression model we estimated for each patient the propensity scores, or probabilities, of having been treated by each of the 20 physician groups. To adjust for different distributions of characteristics across groups, patients cared for by a given group were first stratified into five strata based on their propensity of being in that group. Then, strata‐specific performance was combined across the five strata. We compared our propensity score method to hierarchical model‐based risk adjustment without using propensity scores. The impact of different risk‐adjustment methods on performance was measured in terms of percentage changes in absolute and quintile ranking (AR, QR), and weighted κ of agreement on QR.Results. The propensity score‐based risk adjustment method balanced the distributions of all covariates among the 20 physician groups, providing evidence for validity. The propensity score‐based method and the hierarchical model‐based method without propensity scores provided substantially different rankings (75 percent of groups differed in AR, 50 percent differed in QR, weighted κ=0.69).Conclusions. We developed and tested a propensity score method for profiling multiple physician groups. We found that our method could balance the distributions of covariates across groups and yielded substantially different profiles compared with conventional methods. Propensity score‐based risk adjustment should be considered in studies examining quality comparisons.
Variations among Institutional Review Board Reviews in a Multisite Health Services Research Study
Authors: Dziak Kathleen , Anderson Roger , Sevick Mary Ann , Weisman Carol S. , Levine Douglas W. , Scholle Sarah Hudson 
Published: January 2005

Objective. To document the Institutional Review Board (IRB) review process and to explore the impact of different patient notification procedures.Data Sources/Study Setting. Review of IRB application and correspondence records prospectively collected during a multisite study of health care quality involving telephone interviews of 3,000 participants across 15 primary care sites.Study Design. Records were reviewed to ascertain: (1) the type of IRB review conducted, (2) the number of days from submission to approval of the IRB application, (3) whether the IRB required patient notification and/or consent prior to the release of names, and (4) patient participation rates.Data Collection/Extraction Methods. The study coordinating center prepared a common study protocol for IRB submission and assisted sites with submission. The application, correspondence with the IRB, consent script, and patient letters were collected, reviewed, coded, and analyzed.Principal Findings. IRBs at the 15 sites and survey center varied in the type of IRB required and the number of days from submission to approval (range of 5–172 days). Four sites required patient notification in advance of the study; 2–11 percent of patients refused in opt‐out sites and 37 percent in the single opt‐in site. Participation among contacted patients did not appear to be related to patient notification procedures.Conclusions. Variations in IRB requirements can affect response rates and sample generalizability.
Institutional Review Boards and Multisite Studies in Health Services Research: Is There a Better Way?
Authors: Gold Jennifer L. , Dewa Carolyn S. 
Published: January 2005

Objective. The following paper examines the issue of whether the current system for ethics review of multisite health services research protocols is adequate, or whether there exist alternative methods that should be considered.Principal Findings. (1) Investigators at different sites in a multisite project often have very different experiences with respect to the requirements and requests of the review board. Other problems include the waste of time and resources spent on document preparation for review boards, and delays in the commencement of research activities. (2) There are several possible reasons why there is variability in ethics review. These include the absence of standardized forms, differences in the background and experiences of board members, the influence of institutional or professional culture, and regional thinking. (3) Given the limited benefits derived from the variability in recommendations of multiple boards and the numerous problems encountered in seeking ethics approval from multiple boards suggest that some sort of reform is in order.Conclusions. The increasing number of multisite, health services research studies calls for a centralized system of ethics review. The local review model is simply not conducive to multisite studies, and jeopardizes the integrity of the research process. Centralized multisite review boards, together with standardized documents and procedure, electronic access to documentation, and training for board members are all possible solutions. Changes to the current system are necessary not only to facilitate the conduct of multisite research, but also to preserve the integrity of the ethics approval process in general.
Determinants of Small Solute Clearance in Hemodialysis
Authors: Clark William R. , Huang Zhongping , Clark William R. , Gao Dayong 
Published: January 2005

ABSTRACTRecent outcome trials in chronic dialysis patients raise concerns about the relationship between delivered urea Kt/V and survival. Nevertheless, measurement of delivered small solute clearance remains the most common approach to quantify therapy. The purpose of this review is to provide an overview of the numerous factors influencing small solute clearance during hemodialysis. Although the focus of the review is on the manner in which dialyzer characteristics influence small solute clearances, factors related to other aspects of the extracorporeal circuit and to the patient will also be discussed.
Genomic Medicine, Gene Polymorphisms, and Human Biological Diversity
Authors: Jaber Bertrand L. , Balakrishnan Vaidyanathapuram S. , Balakrishnan Vaidyanathapuram S. , Rao Madhumathi , Jaber Bertrand L. ,   for the DialGene Consortium
Published: January 2005

ABSTRACTThere is considerable variation in the prevalence of comorbid conditions such as malnutrition, inflammation, cardiovascular disease, and bone disease among end‐stage renal disease (ESRD) patients on maintenance hemodialysis. Besides traditional risk factors, these differences also arise from variability in genetic factors and gene‐environment interactions. Recent publication of the human genome sequence through the Human Genome and Celera projects has provided a major impetus to the field of molecular genetics and genomic medicine. This review provides a broad overview of recent developments in this field, basic information and terminology in common use, and explores the impact of genetic variations or polymorphisms on human biological diversity.
Model for Gene‐Environment Interaction: The Case for Dialysis
Authors: Jaber Bertrand L. , Balakrishnan Vaidyanathapuram S. , Liangos Orfeas , Balakrishnan Vaidyanathapuram S. , Jaber Bertrand L. ,   for the DialGene Consortium
Published: January 2005

ABSTRACTOrgan complications in end‐stage renal disease (ESRD) such as cardiovascular disease, anemia, bone disease, malnutrition, inflammation, and infections occur in many organ systems and are caused by a multitude of underlying disease‐, uremia‐, and therapy‐related factors, and with a wide range of manifestations and severity. Interindividual variability in the pathophysiologic response of the uremic host to environmental factors, including renal replacement therapy, may be governed to a significant degree by genetic susceptibility factors. Specific genes regulate the pathophysiologic responses of organ systems affected by ESRD and can serve as candidate genes for the host‐environment interaction. This review summarizes emerging clinical and translational research work in the field of genetic polymorphism of candidate genes and their effects on the development of organ complications in ESRD. Methodologic limitations of the existing published data, the need for large prospective cohort studies, and potential future risks for the use of genomic information in resource allocation are also highlighted.
Reviews: Should the Target Hemoglobin for Patients with Chronic Kidney Disease Treated with Erythropoietic Replacement Therapy be Changed?
Authors: Berns Jeffrey S. 
Published: January 2005

ABSTRACTRecombinant human erythropoietin (rHuEPO, epoetin) revolutionized the treatment of anemia in patients with chronic kidney disease (CKD) when it was approved for use in the United States in 1989. Among dialysis patients, the mean hemoglobin (Hb) in patients undergoing dialysis rose from 7–8 g/dl prior to 1989 to 11–12 g/dl today. Among patients with CKD not on dialysis, epoetin use has not been as broadly applied as among dialysis patients, and although the mean Hb level in this patient population has increased, the impact has been less than in patients on dialysis. The optimal treatment target for epoetin remains controversial. Consistent with clinical practice guidelines, current practice in dialysis patients in the United States aims to maintain a target Hb of 11–12 g/dl, a level that is still well below the normal range. Debate centers on whether the current Hb target is too low and whether the target range is too narrow. Quality of life clearly improves in many individuals as Hb rises into the normal range from lower levels. In retrospective studies, higher Hb levels have been associated with lower risks of hospitalization and mortality. However, one large, prospective clinical trial has raised concern about normalizing Hb in hemodialysis patients with cardiac disease, and other prospective studies have not yet provided convincing evidence of significant benefits from normalizing Hb in dialysis‐dependent and non‐dialysis‐dependent patients with CKD. A relative lack of information on non‐dialysis‐dependent patients with CKD and changes in fiscal policies regulating reimbursement for epoetin have contributed to uncertainty as to the best practices for anemia management in patients with CKD. There is increasing interest in the potential benefits of broadening the current target Hb range or eliminating an upper limit altogether and instead establishing a minimum Hb goal. While some extension of the upper limit of the currently recommended target Hb range might appear to be reasonable, the extent to which this should be extended, the benefits, risks, and costs of maintaining higher Hb levels in patients with CKD, and whether target Hb levels should be different in different CKD patient groups remains to be determined. Future efforts are likely to focus on selecting patient populations most likely to benefit from normalizing Hb, while adjusting the range of a subnormal Hb target for others.
Extracorporeal Management of Valproic Acid Toxicity: A Case Report and Review of the Literature
Authors: Perazella Mark A. , Al Aly Ziyad , Yalamanchili Praveen , Gonzalez Esther 
Published: January 2005

ABSTRACTThe incidence of intentional or accidental valproic acid (VPA) overdose is increasing. Severe VPA toxicity may lead to coma and death. Traditionally the treatment of patients with VPA toxicity has been limited to supportive measures. VPA is highly protein bound and therefore it is considered not to be removable by extracorporeal means. However, studies of VPA toxicokinetics indicate that at blood levels that exceed therapeutic concentrations, VPA protein binding sites become saturated, leading to increased concentration of the free unbound drug. The free unbound drug has a small molecular weight and therefore it is theoretically amenable to removal by extracorporeal means. We present a patient with VPA toxicity who was successfully treated with “in‐series” hemodialysis and hemoperfusion followed by continuous venovenous hemodiafiltration (CVVHDF) and review the literature on the management of VPA toxicity using extracorporeal therapies.
Special Article: National Surveillance of Dialysis‐Associated Diseases in the United States, 2002
Authors: Finelli Lyn , Miller Jeremy T. , Tokars Jerome I. , Alter Miriam J. , Arduino Matthew J. 
Published: January 2005

ABSTRACTIn December 2002, all U.S. chronic hemodialysis centers were surveyed regarding selected patient care practices and dialysis‐associated diseases. The results were compared with similar surveys conducted in previous years. In 2002, 85% of hemodialysis centers were free‐standing and 81% operated for profit; the proportion of centers operating for profit has increased each year since 1985. During 1995–2002, the percentage of patients who received dialysis through central catheters increased from 13% to 26%; this trend is worrisome, as infections and antimicrobial use are higher among patients receiving dialysis through catheters. However, during the same period, the percentage of patients receiving dialysis through fistulas increased from 22% to 33%. The percentage of centers reporting one or more patients infected or colonized with vancomycin‐resistant enterococci (VRE) increased from 12% in 1995 to 30% in 2002. During 1997–2002, the percentage of patients vaccinated against hepatitis B virus (HBV) infection increased from 47% to 56% and the percentage of staff vaccinated increased from 87% to 90%. In 2002, routine testing for antibody to hepatitis C virus (anti‐HCV) was performed on patients at 64% of centers; anti‐HCV was found in 7.8% of patients. In 2001, the Centers for Disease Control (CDC) published Recommendations for Preventing Transmission of Infections among Chronic Hemodialysis Patients. Centers were surveyed regarding their awareness of the recommendations and about a variety of infection control practices. In general, the incidence of HBV and HCV was not substantially different for the infection control practices evaluated, including where staff obtain clean supplies for patient treatment, reuse of unused and unopened supplies, and practices for changing external transducer filters/protectors. However, in 2002, the incidence of HBV infection was higher among patients in centers where injectable medications were prepared on a medication cart or medication area located in the treatment area compared to a dedicated medication room. Also, those centers that used a disposable container versus a nondisposable container for priming the dialyzer had a significantly lower incidence of HCV.
The New Arteriovenous Fistula: The Need for Earlier Evaluation and Intervention
Authors: Kian Kaveh , Vassalotti Joseph A. 
Published: January 2005

ABSTRACTThe National Kidney Foundation's Dialysis Outcomes Quality Initiative recommends an ideal 3‐ to 4‐month arteriovenous fistula (AVF) maturation period prior to cannulation. This recommendation may be misinterpreted by practicing nephrologists to mean that they should wait 3 months before performing a clinical assessment of the AVF. Such a delay in evaluating AVF maturity results in unnecessarily prolonged catheter use in dialysis patients whose ultimately unsatisfactory fistula could already have been diagnosed and modified at a much earlier point. Clinical assessment at 1 month can detect the common etiologies for nonmaturity, including stenosis in the vein adjacent to the anastomosis and accessory vein diversion of flow from the main fistula vein. Duplex ultrasound provides additional information in selected cases. Early evaluation allows for early fistulography for problems and potentially early cannulation for adequately maturing fistulas. Prospective trials of early AVF clinical assessment at 1 month should be performed.
Phosphorus Management in End‐Stage Renal Disease
Authors: Finn William F. 
Published: January 2005

ABSTRACTChronic kidney disease is an important public health problem, with an increasing number of patients worldwide. One important outcome of renal failure is disordered mineral metabolism, most notably involving calcium and phosphorus balance. Of importance is that increased serum phosphorus levels are associated with increased mortality rates. Despite dietary restrictions, patients receiving dialysis invariably experience hyperphosphatemia and require treatment with phosphate binders. Existing phosphate binders are effective in reducing serum phosphorus levels, but are associated with a number of important disadvantages. Lanthanum carbonate, a new noncalcium, nonaluminum phosphate binder, represents a promising treatment for hyperphosphatemia.
Selective cognitive deficits in obsessive‐compulsive disorder compared to panic disorder with agoraphobia
Authors: Boldrini M. , Del Pace L. , Placidi G. P. A. , Keilp J. , Ellis S. P. , Signori S. , Placidi G. F. , Cappa S. F. 
Published: January 2005

Objective:  Visual‐spatial and executive functions deficits have been reported in obsessive‐compulsive disorder (OCD). We investigated their specificity comparing cognitive function in OCD, panic disorder with agoraphobia (PD/A) and controls by a comprehensive neuropsychological battery.Method:  Fifty‐five subjects (25 OCD, 15 PD/A, 15 controls) without current depressive episode underwent structured clinical interview for DSM‐IV, Yale–Brown Obsessive Compulsive Scale, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale. Neuropsychological battery assessed: executive functions, visual discrimination, spatial memory and learning, verbal memory, general intellectual functioning.Results:  OCD showed controlled fluency, visual‐spatial construction, learning and memory deficits; PD/A spatial learning impairment. OCD was discriminated from PD/A and controls by three tests scores, predicting group membership for 76.4% of the cases.Conclusion:  Visual‐constructive and controlled fluency deficits seem specific in OCD, while the spatial learning deficit, shared with PD patients, may not be disorder‐specific, but anxiety‐related. Results support the proposed ventral frontal‐striatal circuit involvement in OCD.
Predicting the onset of major depression in subjects with subthreshold depression in primary care: a prospective study
Authors: Cuijpers P. , Smit F. , Willemse G. 
Published: January 2005

Objective:  That subjects with subthreshold depression have an increased probability of developing major depression has been confirmed by many studies. However, the factors which may predict the onset of major depression have yet to be fully examined.Method:  We examined the control group of a randomized trial in primary care patients with subthreshold depression (N = 109), of whom 20 had developed major depression 1 year later. Using the vulnerability‐stress theory, we examined which factors predicted the onset of major depression.Results:  In both univariate and multivariate analyses, family history and chronic illnesses predicted the onset of major depression.Conclusion:  It is possible to predict to a certain degree whether a subject with subthreshold depression will develop major depression within a year.
Recovery from major depression: the role of support from family, friends, and spiritual beliefs
Authors: Nasser E. H. , Overholser J. C. 
Published: January 2005

Objective:  Many of the risk factors for major depression are not amenable to change. The present study was designed to identify factors associated with recovery from depression that could be targets for clinical intervention.Method:  Sixty‐two psychiatric in‐patients who met diagnostic criteria for major depression were interviewed while hospitalized and re‐interviewed 3 months after discharge. Analyses examined the relationship between depression and three sources of emotional support: family, friends, and spiritual beliefs.Results:  Depression severity at baseline was the most consistent predictor of depression severity and diagnosis at follow‐up. Patients who had recovered from depression by the time of the follow‐up assessment reported higher perceived emotional support from family and friends at baseline. Support from friends, support from family and a composite of emotional support were significant predictors of depression beyond the effects of initial depression severity.Conclusion:  Aspects of emotional support were significantly associated with depression outcome.
Psychosocial predictors of depression in patients with acute coronary syndrome
Authors: Sørensen C. , Brandes A. , Hendricks O. , Thrane J. , Friis‐Hasche E. , Haghfelt T. , Bech P. 
Published: January 2005

Objective:  To describe the prevalence of depression according to ICD‐10 criteria using a self‐completed questionnaire and to identify psychosocial predictors of depression at discharge in patients with acute coronary syndrome.Method:  A total of 899 patients with acute coronary syndrome completed the Major Depression Inventory at discharge and a questionnaire regarding previous depression and family history of depression. Information concerning civil status was obtained from the Civil Person Registry.Results:  Ninety patients (10%) were depressed according to ICD‐10 criteria at discharge with 7.2% having a moderate to severe depression at discharge. Women were significantly more frequently and severely depressed than men. Patients with and without depression reported primarily somatic symptoms of depression. Cardiovascular risk factors or treatment did not differ between patients with and without depression. Previous depression (OR 2.9, 95% CI 1.4–6.0 adjusted) and female gender (OR 2.5, 95% CI 1.5–4.3 adjusted) predicted depression at discharge in a logistic regression model.Conclusion:  Somatic symptoms of depression are prevalent in patients with acute coronary syndrome. The use of self‐completed non‐diagnostic questionnaires assessing symptoms of depression therefore is cautioned as patients may wrongly be identified as depressed. In patients with acute coronary syndrome depression is predicted by well‐known psychosocial risk factors.
Obsessive–compulsive symptoms in adults with history of rheumatic fever, Sydenham's chorea and type I diabetes mellitus: preliminary results
Authors: Asbahr F. R. , Ramos R. T. , Costa A. N. , Sassi R. B. 
Published: January 2005

Objective:  Rheumatic fever (RF) associated with Sydenham's chorea (a neurological variant of RF), but not RF without chorea, has been acutely related to obsessive–compulsive symptomatology/disorder (OCS/OCD). This study investigated the presence of OCS in adults who had RF with or without chorea in childhood.Method:  The Yale‐Brown Obsessive–Compulsive Scale (Y‐BOCS) was used to evaluate OCS in 38 adults with history of RF (13 with chorea; 25 without chorea) or diabetes (controls; n = 19).Results:  The OCS was similar in both groups, although the intensity of symptoms was not clinically relevant. Moreover, subjects with RF with or without chorea did not score differently in the Y‐BOCS.Conclusion:  The similar occurrence of OCS in patients with history of RF and diabetes suggests that the development of this symptomatology, triggered by group A β‐haemolytic streptococcus infections, is restricted to the RF acute phase, occurred during infancy, and did not seem to predispose the appearance of OCS in adulthood.