bluuebunny/crossref_metadata_2025_split huggingface dataset:
Towards case‐based performance measures: uncovering deficiencies in applied medical care
Authors: Hoelzer Simon , Waechter Werner , Stewart, Andrew , Liu, Raymond , Schweiger Ralf , Dudeck Joachim 
Published: March 2003

AbstractMeasures are designed to evaluate the processes and outcomes of care associated with the delivery of clinical (and non‐clinical) services. They allow for intra‐ and interorganizational comparison to be used continuously to improve patient health outcomes. The use of performance measures always means to abstract the complex reality (medical scenarios and procedures) in order to provide an understandable and comparable output. Measures can focus on global performance. The more detailed data are available the more specific judgements with respect to the appropriateness of clinical decision‐making and implementation of evidence are feasible. Externally reported measures are intended both to inform and lead to action. By providing this information, deficiencies in patient care and unnecessary variations in the care process can be uncovered. Such variations have contributed to disparities in morbidity and mortality. The developments in information technology, especially world‐wide interconnectivity, standards for electronic data exchange and facilities to store and manage large amounts of data, offer the opportunity to analyse health‐relevant information in order to make the delivery of healthcare services more transparent for consumers and providers. Global performance measures, such as the overall life expectancy (mortality) in a country, can give a rough orientation of how well health systems perform but they do not offer general solutions nor spe‐cific insights into care processes that have to be improved. In contrast to population‐based measures, case‐based performance measures use a defined group of patients depending on specific patient characteristics and features of disease. By means of these measures we are able to compare the number of patients that receive a necessary medical procedure against those patients who do not. The use of case‐based measures is a bottom‐up approach to improve the overall performance in the long run. They are not only a tool for global orientation but can offer a straightforward link to the areas of deficient care and the underlying procedures. Performance measures are relevant to providers as well as consumers, from their own individual perspective. Cased‐based measures focus on the management of individual patient. This approach to performance measurement can inform physicians in a meaningful and constructive way by monitoring their individual performance and by pointing out possible areas of improvement.
Data, information and knowledge: the health informatics model and its role in evidence‐based medicine
Authors: Georgiou Andrew 
Published: March 2003

AbstractThe health informatics model consists of three essential parts: data, information and knowledge. These elements are arranged in a hierarchy, with data at the base of the model providing the basis for establishing information and leading in turn to the potential generation of knowledge. The informatics model converges closely with the principles, aims and tasks of evidence‐based medicine (EBM), particularly as they relate to searching, appraising, reviewing and utilizing information and research. The development of health informatics today has its origins in the growth of statistics in the 18th and 19th centuries. As a new and growing discipline, statistics burgeoned amidst the challenge of measuring, monitoring and ultimately governing societies in the throes of massive change and expansion. The governance role embraced by statistics in the past resembles many aspects of the role ascribed to audit, quality assurance and EBM today. There are some deep‐seated paradoxes within the field of health informatics. The informatics model posits an oversimplified and linear progression of data to information and knowledge. Health informatics may involve the spreading and dissemination of information but this should be seen as only a part, not the equivalent, of the complex process of generating knowledge.
Actin rearrangements accompanying Aeromonas hydrophila entry into cultured fish cells
Authors: Low  , Goh  , Lim  , Sin  , Leung  
Published: March 2003

Abstract Aeromonas hydrophila can enter fish cells and exist as intracellular parasites. Phase‐contrast and confocal microscopy were used to examine morphological changes and various cytoskeletal components of infected fish cells. Four fish cell lines were included in this study: (1) AS, (2) BF2, (3) CHSE‐214, and (4) EPC cells. Virulent but not avirulent strains of A. hydrophila PPD 134/91 invaded fish cells, causing morphological changes, and inducing microfilament (F‐actin) rearrangement. Morphological changes were observed in all infected fish cell lines and could be classified into three different stages. In stage I, the cells became detached from each other and pointed ends were observed. In stage II, tubular cytoplasmic extensions formed at contact points connecting neighbouring cells. The monolayers formed a satellite‐like organization and became less confluent. Finally (stage III), cells were heavily infected with bacteria, and bacteria containing vacuoles occupied most of the cells. They eventually detached and lysed. Rearrangement of F‐actin was observed as local polymerization (actin clouds) in stage I and massive reorganization in stage III of infection. Actin clouds could have been induced by A. hydrophila for ‘assisted' uptake into the cells. The massive reorganization of actin in stage III may be due to products released by the bacteria and the growth of vacuoles. Pretreatment of fish cells with the microfilament inhibitors such as cytochalasins induced a similar effect. There were little if any rearrangements in intermediate and microtubule filaments during bacterial entry (stages I and II). These results suggest that A. hydrophila may bind to the surface and trigger a signal to the microfilament which then generates the force necessary for bacterial uptake.
Development of a reproducible infectious pancreatic necrosis virus challenge model for Atlantic salmon, Salmo salar L.
Authors: Bowden T J , Smail D A , Ellis A E 
Published: March 2003

AbstractAtlantic salmon smolts, previously unexposed to infectious pancreatic necrosis virus (IPNV), were placed into tanks of sea water at 10 °C. After 4 weeks, 40 fish were injected intraperitoneally (i.p.) with homogenized and filter‐sterilized kidney material obtained from salmon with clinical IPN in a marine farm in Shetland. The injected fish were cohabited with 40 untreated fish. Mortalities began in the injected fish on day 7 and reached a peak of 48% on day 14. In the cohabitation group, mortalities began on day 14 and reached a peak of 70% on day 27. The IPNV in the Shetland kidney homogenate was cultured in Chinook salmon embryo (CHSE) cells and passed twice. This cultured virus was injected i.p. into fish at various doses ranging from 10 to 107 TCID50 fish−1 4 weeks after seawater transfer. Challenge tanks contained 30 injected fish and 30 cohabitees. Mortality rates and levels were dose‐dependent. The highest dose used resulted in a similar mortality pattern as obtained with a similar dose of the Shetland kidney homogenate, indicating that virulence was retained after two passes in tissue culture. Even with the lowest dose, mortality reached 12% in the injected group and 23% in the cohabitees. The IPNV titres were high (106−109 i.u. g−1 kidney) in fish which died during the experiment and low (<105 i.u. g−1 kidney) or undetectable in surviving fish. The cultured virus (pass 3) was used in a challenge model where the population density of fish in the tanks was high (50 injected and 50 cohabitees) or low (15 injected and 15 cohabitees). In the high stocking density tank, mortalities peaked at about 35% in the injected group and at 52% in the cohabitees. In the low stocking density tank, mortalities peaked at about 40% in the injected fish but no mortality occurred in the cohabitees. However, IPNV was detected (up to 104 i.u. g−1 kidney) in 82% of cohabitees sampled on day 30. These data suggest that lethal lateral transmission of the virus is dependent on the infectious pressure from the injected group. A further trial was conducted to investigate the effect of time post‐seawater transfer on the susceptibility of post‐smolts to IPN. Groups of fish were challenged every 2 weeks from week 0–10. Few mortalities occurred at week 0 and virus titres were high in these fish. Most survivors became carriers, some with titres >106 i.u. IPNV g−1 kidney. From 2 to 10 weeks after seawater transfer, mortalities in both injected and cohabitees were substantial with viral titres >107 i.u. g−1 kidney. Survivors had lower titres and in many virus was undetectable. Throughout the experiments, moribund fish were sampled for histology and all showed typical IPN histopathology.
Prader–Willi syndrome and psychotic symptoms: 2. A preliminary study of prevalence using the Psychopathology Assessment Schedule for Adults with Development Disability checklist
Authors: Bouras N. , Clarke D. 
Published: March 2003

AbstractThe Psychopathology Assessment Schedule for Adults with Developmental Disability (PAS‐ADD) checklist was used to screen for psychotic symptoms among people with Prader–Willi syndrome (PWS) aged 16 years and over. The scoring instructions for the PAS‐ADD checklist were modified to take account of knowledge about the behavioural phenotype of PWS. Using modified scoring, 6.3% of the 95 people for whom checklists were completed had a possible psychotic disorder in the month before the assessment was made. The results should be treated as a crude estimate of the prevalence of psychotic symptoms associated with PWS in adult life in view of potential biases in the sample reported. These findings lend some support to the hypothesis that PWS has a non‐chance association with psychotic symptoms and that the association is not entirely accounted for by the increased prevalence of psychosis associated with intellectual disability.
Psychopathology of sexual abuse in young people with intellectual disability
Authors: Firth H. , Balogh R. , Berney T. , Bretherton K. , Graham S. , Whibley S. 
Published: March 2003

AbstractThe present study addressed two issues using a sample of child and adolescent victims and perpetrators of sexual abuse: (1) the extent of post‐traumatic stress disorder (PTSD) in the sample; and (2) the possible distinction between perpetrators whose motivations were sexually impulsive, and those who were controlling and abuse‐reactive. Retrospective case material from 43 cases (21 victims only, and 22 perpetrators, of whom 16 were also victims) provided the data. Post‐traumatic symptomatology was not common. Only one case of PTSD was found. Perpetrators could be distinguished by whether they had suffered sexual abuse alone, sexual and physical abuse, or neither. The proposed distinction between perpetrators received support. Sexual abuse directed at younger victims was associated with earlier experience of multiple forms of abuse. The present data does not support the view that post‐traumatic symptoms following victimization are a mediator of sexual abuse perpetration. It is argued that an elaboration of the Williams & New developmental model of perpetration better fits the data.
Predictors for attacks on people after deinstitutionalization
Authors: Nøttestad J. Aa. , Linaker O. M. 
Published: March 2003

AbstractBackgroundThe deinstitutionalization movement is presently spreading in Europe, but studies evaluating the effects of deinstitutionalization on behaviour disturbances among people with intellectual disability (ID) are inconclusive. The prevalence of aggressive behaviour among people with ID is high in both institutions and in community. Aggression and attacks on people are a significant problem for people with ID in both institutions and society. In the present paper, the authors focus on individuals who started attacking people after deinstitutionalization.MethodThe authors studied individual and environmental characteristics before and after deinstitutionalization to look for individual and environmental predictors for the development of aggression with the hope that some could be possible intervention points for preventive action. In an institution for people with ID, all who did not attack people before deinstitutionalization were included. The individuals who started attacking others after deinstitutionalization (n = 22) were the study group (group A) and those who did not (n = 42) comprised the control group (group B). The population was examined before and after deinstitutionalization. As far as possible the same methods were used at both occasions. The covariates included individual ones, such as mental health, behaviour disturbances and behaviour deficits, and environmental ones, such as caretaker education, caretaker:patient ratio, housing and leisure activities. Psychiatric disorders were identified in 1987 and 1995 with the Psychopathology Instrument for Mentally Retarded Adults (PIMRA), which was filled in by the caretakers.ResultsGroup A showed significantly more self‐injurious behaviour (SIB) than group B in 1987. The sum of behaviour disturbances shown in the past year, attacks on property, SIB and other disruptive behaviours were also significantly higher in group A than in group B. The soundness scores on the PIMRA for the people in group A were lower than for the people in group B. Group A contained significantly fewer people without behavioural problems in the past year. The authors could not find any differences on other individual characteristics such as aetiologies of ID and behaviour deficits in 1987. The caretakers’ evaluations of the clients need for help, based on behaviour disturbances and mental health problems, were significantly higher in group A. The people in this study differed in age, gender and degree of ID from those in most other studies on ID and challenging behaviour.ConclusionThe individual predictors for starting to attack others after deinstitutionalization were SIB, a slight load of other behaviour problems and a low soundness score on the PIMRA. The only environmental predictor was the caretakers’ evaluation of the subjects’ need for help caused by behaviour problems and mental illness. The authors could not identify possible preventive intervention points, neither individual or environmental, and therefore, further studies are needed.
Offenders with intellectual disability: the size of the problem and therapeutic outcomes
Authors: Barron P. , Hassiotis A. , Banes J. 
Published: March 2003

AbstractBackgroundPeople with intellectual disability (ID) who offend may be subject to a variety of disposals within the criminal justice system, or via diversion to health and social services in inpatient units or in community ID teams. Offenders with ID are a group with complex needs who may pose a recurrent risk to the public. Despite the significant number of offenders with ID, there is limited evidence on treatment effectiveness and outcomes.MethodsA literature search of all electronic databases was undertaken, and journals were hand‐searched for clinical trials or case studies of interventions for offenders with ID. The main outcome was recidivism rates.ResultsThere were no published clinical trials of offenders with ID. A series of small‐scale group cognitive‐behavioural treatments for sex offenders offers the most persuasive evidence of success in reducing recidivism.ConclusionOffenders with ID often receive inadequate services as a result of poor identification through the criminal justice system and research into effective treatments is rudimentary. Further studies are necessary in order to improve treatment efficacy and service provision for a complex group of individuals.
Different presentations of late‐detected phenylketonuria in two brothers with the same R408W/R111X genotype in the PAH gene
Authors: Giz·ewska M. , Cabalska B. , Cyrytowski L. , Nowacki P. , Z·ekanowski C. , Walczak M. , Józ´wiak I. , Koziarska D. 
Published: March 2003

AbstractAlthough the clinical heterogeneity of phenylketonuria (PKU) is well established, some questions about this condition remain. Subjects from the same family who share the same mutations in the phenylalanine hydroxylase (PAH) gene are expected to display similar disease courses, and therefore, when blood phenylalanine (Phe) levels, genotype and dietary treatment are all similar, differences in patient outcomes require additional explanations. The present authors describe two entirely different courses of late‐detected PKU in two brothers with the same R408W/R111X genotype in the PAH gene. The older sibling was diagnosed with PKU at the age of 4 years and given treatment. His IQ was 97 at 26 years of age and moderate involvement of periventricular white matter was detected. The younger brother was diagnosed with PKU at the age of 11 months and given treatment. His IQ was < 25 at 22 years of age and severe dysmyelination changes were found by magnetic resonance imaging. The differences in the courses of the disease between these two brothers appear to be related to variations in their blood–brain barriers.
Increased biochemical markers of bone formation and resorption in primary hyperparathyroidism with special reference to patients with mild disease
Authors: Valdemarsson  , Lindergård  , Tibblin  , Bergenfelz  
Published: March 2003

Valdemarsson S, Lindergård B, Tibblin S, Bergenfelz A (Lund University Hospital, Sweden). Increased biochemical markers of bone formation and resorption in primary hyperparathyroidism with special reference to patients with mild disease. J Intern Med 1998; 243: 115–22.Objectives.To evaluate the impact on bone turnover of primary hyperparathyroidism (pHPT) with special reference to patients with mild pHPT, using biochemical markers of bone formation and resorption.Design.A longitudinal study of patients with pHPT before and one year after surgical treatment.Setting.The Departments of Internal Medicine and Surgery, Lund University Hospital.Subjects.Forty consecutive patients with pHPT. Thirty of these patients had mild pHPT and are reported separately. Data on bone mineral was also compared to a reference population.InterventionAll patients were operated upon and restudied one year later.Main outcome measures.Bone resorption and formation was studied by means of the serum concentrations of the telopeptide of the carboxyterminal region of type 1 collagen (ICTP) and of alkaline phosphatase (ALP), osteocalcin and the carboxyterminal propeptide of type 1 procollagen (PICP), respectively. Bone density was measured at the distal radius by single photon absorptiometry (SPA).Results.Bone formation markers consistenly decreased after parathyroid surgery: ALP from 3.51 ± 0.23 to 2.94 ± 0.21 µkat L−1 (P &lt; 0.05), osteocalcin from 6.15 ± 0.53 to 2.89 ± 0.23 µg L−1 (P &lt; 0.001) and PICP from 126.4 ± 10.9 to 96.0 ± 6.5 µg L−1 (P &lt; 0.001). In parallel, the ICTP concentration, reflecting bone resorption, decreased from 5.10 ± 0.54 to 3.94 ± 0.34 µg L−1 (P &lt; 0.001). There was not any significant change in distal radius bone mineral 1 one year after surgery. In the subgroup of patients classified as mild pHPT, a significant decrease was noted for osteocalcin, PICP and for ICTP but not for ALP, without significant changes in variables reflecting distal radius bone mineral content. Glomerular filtration rate was inversely correlated to serum levels of intact PTH, ionized calcium, alkaline phosphatase, osteocalcin and ICTP and directly correlated to the 1.25‐dihydroxy‐vitamin D concentrations.Conclusions.pHPT is associated with substantial changes in circulating levels of biochemical markers of bone formation and resorption. These findings are also present in patients with mild pHPT. Renal function should be considered in the evaluation of the impact of pHPT on bone turnover.
Factors modifying the prognosis in men with asymptomatic carotid artery disease
Authors: Hedblad  , Janzon  , Jungquist  , Ögren  
Published: March 2003

Hedblad B, Janzon L, Jungquist G, Ögren M (Malmö University Hospital, Lund University, Malmö, Sweden). Factors modifying the prognosis in men with asymptomatic carotid artery disease.J Intern Med1998;243: 57–64.Objectives.Carotid artery stenosis is associated with an increased prevalence and incidence of ischaemic heart disease (IHD). The aim of this study has been to assess whether, in men with carotid artery stenosis, survival and incidence of stroke and myocardial infarction is different in men with and men free from IHD; and to characterize probands with incident cerebrovascular (CBV) event in terms of smoking, hypertension and leg artery disease.DesignPopulation‐based cohort study, ‘Men born 1914’.SettingMalmö, a city in southern Sweden.SubjectsA total of 478 of 621 men born in 1914, who in 1982 participated in ultrasound examination of the carotid arteries.Main outcome measuresMorbidity and mortality during 10 years of followup.Results.Asymptomatic carotid artery stenosis was, in men free from IHD, associated with reduced survival and an increased incidence of serious CBV events that occurred, on average, 3.6 years after the examination.In men with prevalent IHD, there was no relationship between carotid artery stenosis and incidence of CBV events. The main explanation to the lack of association seems to be the high vascular mortality rate in that group.Conclusions.It's our conclusion that in patients with asymptomatic carotid artery stenosis there is a great heterogeneity with regard to severity of disease and prognosis. Survival and incidence of stroke and myocardial infarction depends on whether patients have concomitant IHD.
Clostridium difficile colitis associated with a ‘triple’ regimen, containing clarithromycin and metronidazole, to eradicate Helicobacter pylori
Authors: Archimandritis  , Souyioultzis  , Katsorida  , Tzivras  
Published: March 2003

Archimandritis A, Souyioultzis S, Katsorida M, Tzivras M (University of Athens Medical School, Laiko General Hospital, Athens, Greece). Clostridium difficile colitis associated with a ‘triple’ regimen, containing clarithromycin and metronidazole, to eradicate Helicobacter pylori (Case Report). J Intern Med 1998; 243: 251–53.We describe a 54‐year‐old man with Helicobacter pylori (+) duodenal ulcer who developed Clostridium difficile associated colitis, 5 days after commencing a ‘triple’ regimen consisting of omeprazole 20 mg b.d., metronidazole 500 mg b.d. and clarithromycin 500 mg b.d., to eradicate H. pylori. Despite the fact that oral metronidazole did not prevent the disease, the patient did well after treatment with oral metronidazole plus a yeast preparation (Saccharomyces bulardii). No relapse occurred.