bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of Functional Change: A Longitudinal Study of Nondemented People Aged 65 and Older
Authors: Wang Li , Van Belle Gerald , Kukull Walter B. , Larson Eric B. 
Published: March 2003

OBJECTIVES: To identify factors associated with functional change in an older population and investigate interactions among selected potential risk factors.DESIGN: A population‐based prospective cohort study.SETTING: A random sample was selected from the Group Health Cooperative members in the Seattle area from 1994 to 1996 and followed biennially.PARTICIPANTS: Two thousand five hundred eighty‐one people aged 65 and older, cognitively intact at baseline.MEASUREMENTS: Functional status was measured by activities of daily living, instrumental activities of daily living, and performance‐based physical function testing.RESULTS: The cohort status at the time of these analyses was: deceased, 391; withdrawn, 179; dementia, 152; and on study, 1,873. The mean follow‐up time was 3.4 years. Using linear regressions with Generalized Estimating Equation, selected medical conditions (diabetes mellitus, hypertension, coronary heart disease, cerebrovascular disease (CVD), osteoporosis, arthritis, and cancer), low cognitive function, depression, and smoking were associated with worse functional outcomes. Exercise and moderate alcohol use were associated with better functional outcomes. Over the follow‐up period, coronary heart disease, CVD, and depression were associated with increased rates of functional decline. Exercise and moderate alcohol consumption were associated with decreased rates of functional decline. Significant interactions were observed between exercise and coronary heart disease, moderate alcohol use and CVD, and cognition and CVD.CONCLUSIONS: Our study has identified not only risk factors associated with functional decline but also the interactions among these factors. These observations, along with other published research, add to the growing understanding of the underlying process of functional change and could provide a basis to design effective strategies to delay functional decline.
Optimizing Coding and Reimbursement to Improve Management of Alzheimer's Disease and Related Dementias
Authors: Fillit Howard , Geldmacher David S. , Welter Richard Todd , Maslow Katie , Fraser Malcolm 
Published: March 2003

The objectives of this study were to review the diagnostic, International Classification of Disease, 9th Revision, Clinical Modification (ICD‐9‐CM), diagnosis related groups (DRGs), and common procedural terminology (CPT) coding and reimbursement issues (including Medicare Part B reimbursement for physicians) encountered in caring for patients with Alzheimer's disease and related dementias (ADRD); to review the implications of these policies for the long‐term clinical management of the patient with ADRD; and to provide recommendations for promoting appropriate recognition and reimbursement for clinical services provided to ADRD patients.Relevant English‐language articles identified from MEDLINE about ADRD prevalence estimates; disease morbidity and mortality; diagnostic coding practices for ADRD; and Medicare, Medicaid, and managed care organization data on diagnostic coding and reimbursement were reviewed. Alzheimer's disease (AD) is grossly undercoded. Few AD cases are recognized at an early stage. Only 13% of a group of patients receiving the AD therapy donepezil had AD as the primary diagnosis, and AD is rarely included as a primary or secondary DRG diagnosis when the condition precipitating admission to the hospital is caused by AD. In addition, AD is often not mentioned on death certificates, although it may be the proximate cause of death. There is only one ICD‐9‐CM code for AD—331.0—and no clinical modification codes, despite numerous complications that can be directly attributed to AD. Medicare carriers consider ICD‐9 codes for senile dementia (290 series) to be mental health codes and pay them at a lower rate than medical codes. DRG coding is biased against recognition of ADRD as an acute, admitting diagnosis. The CPT code system is an impediment to quality of care for ADRD patients because the complex, time‐intensive services ADRD patients require are not adequately, if at all, reimbursed. Also, physicians treating significant numbers of AD patients are at greater risk of audit if they submit a high frequency of complex codes. AD is grossly undercoded in acute hospital and outpatient care settings because of failure to diagnose, limitations of the coding system, and reimbursement issues. Such undercoding leads to a lack of recognition of the effect of AD and its complications on clinical care and impedes the development of better care management. We recommend continuing physician education on the importance of early diagnosis and care management of AD and its documentation through appropriate coding, expansion of the current ICD‐9‐CM codes for AD, more appropriate use of DRG coding for ADRD, recognition of the need for time‐intensive services by ADRD patients that result in a higher frequency of use of complex CPT codes, and reimbursement for CPT codes that cover ADRD care management services.
Healing Pressure Ulcers with Collagen or Hydrocolloid: A Randomized, Controlled Trial
Authors: Graumlich James F. , Blough Linda S. , McLaughlin Richard G. , Milbrandt Joseph C. , Calderon Cesar L. , Agha Syed Abbas , Scheibel L. William 
Published: March 2003

OBJECTIVES:To compare the effects of topical collagen and hydrocolloid on pressure ulcer healing. DESIGN:Randomized (allocation concealed), single‐blind (outcome assessors), controlled trial with 8‐week follow‐up. SETTING:Eleven nursing homes in central Illinois. PARTICIPANTS:Sixty‐five patient‐residents with Stage II or III pressure ulcers: median age 83.1, median Braden score 12, 63% female, 80% Stage II ulcers, and 20% Stage III ulcers. Exclusion criteria included cellulitis and osteomyelitis. INTERVENTION:Thirty‐five patients were allocated to topical collagen daily, 30 to topical hydrocolloid twice weekly. MEASUREMENTS:The primary outcome was complete healing within 8 weeks. Secondary outcomes were time to heal, ulcer area healed per day, linear healing of wound edge, and cost of therapy. RESULTS:Analysis by intention to treat revealed similar complete ulcer healing within 8 weeks in collagen (51%) and hydrocolloid (50%) recipients (difference 1%, 95% confidence interval (CI) = 26–29%). Mean healing time was similar: collagen healed in 5 weeks (95% CI = 4–6), hydrocolloid healed in 6 weeks (95% CI = 5–7). Mean area healed per day was 6 mm2/d in both treatment groups. Mean linear healing of the wound edge was 3 mm in both groups. In multivariate analysis, baseline ulcer depth was the only independent predictor of complete ulcer healing within 8 weeks (odds ratio = 0.56, 95% CI = 0.38–0.81). Cost analysis favored hydrocolloid. CONCLUSIONS:There were no significant differences in healing outcome between collagen and hydrocolloid. Collagen was more expensive and offered no major benefits to patients otherwise eligible for hydrocolloid treatment. J Am Geriatr Soc 51:147–154, 2003.
Does an Exercise and Incontinence Intervention Save Healthcare Costs in a Nursing Home Population?
Authors: Schnelle John F. , Kapur Kanika , Alessi Cathy , Osterweil Dan , Beck John G. , Al‐Samarrai Nahla R. , Ouslander Joseph G. 
Published: March 2003

OBJECTIVES: To determine whether an intervention that combines low‐intensity exercise and incontinence care offsets some of its costs by reducing the incidence of selected health conditions in nursing home residents.DESIGN: Randomized, controlled trial with the incidence and costs of selected, acute conditions compared between a 6‐month baseline and an 8‐month intervention phase.SETTING: Four nursing homes.PARTICIPANTS: One hundred ninety incontinent, long‐stay nursing home residents.INTERVENTION: Low‐intensity, functionally oriented exercise and incontinence care were provided every 2 hours from 8:00 a.m. to 4:00 p.m. for 5 days a week for 8 months.MEASUREMENTS: Predefined acute conditions hypothesized to be related to physical inactivity, incontinence, or immobility were abstracted from residents' medical records by blinded observers during a 6‐month baseline period and throughout the 8‐month intervention. Conditions included those in the dermatological, genitourinary, gastrointestinal, respiratory and cardiovascular systems; falls; pain; and psychiatric and nutritional disturbances. Costs were determined using Current Procedural Terminology Center and Medicare allowable cost reimbursement at a rate of 80%.RESULTS: The intervention group had significantly better functional outcomes than the control group (strength, mobility endurance, urinary and fecal incontinence) and a reduction of 10% in the incidence of the acute conditions, which was not significant. There were no significant differences between groups in the cost of assessing and treating these acute conditions between baseline and intervention.CONCLUSION: The intervention, which is consistent with federal and clinical practice guidelines, significantly improved functional outcomes but did not reduce the incidence and costs of selected acute health conditions. The cost of implementing these labor‐intensive interventions for frail nursing home residents will have to be justified based on functional and quality‐of‐life outcomes and are unlikely to be offset by savings in medical care costs in this population.
Ability of anaesthetists to identify a marked lumbar interspace. (Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, United Kingdom) Anaesthesia 2000;55:1122–1126.
Authors: Broadbent C. R. , Maxwell W. B. , Ferrie R. , Wilson D. J. , Gawne‐Cain M. , Russell: R. 
Published: March 2003

This article assessed anesthetists' ability to identify correctly a marked lumbar interspace in 100 patients undergoing spinal magnetic resonance imaging scans. Using ink, the first anesthetist marked an interspace on the lower spine and attempted to identify its level with the patient in the sitting position. The second anesthetist attempted to identify the level with the patient in the flexed lateral position. A marker capsule was taped over the ink mark and a routine scan performed. The actual level of markers ranged from 1 space below to 4 spaces above the level at which the anesthetist believed it to be. The marker was 1 space higher than assumed in 51% of cases and was identified correctly in only 29%. Accuracy was unaffected by patient position (sitting or lateral), although it was impaired by obesity and positioning of the markers high on the lower back. The spinal cord terminated below L1 in 19% of the patients. This, together with the risk of accidentally selecting a higher interspace than intended for intrathecal injection, implies that spinal cord trauma is more likely when higher interspaces are selected.Comment by Alan Kaye, M.D. Previous studies have demonstrated inaccuracies regarding identification of lumbar interspaces. This study by Broadbent et al involved 104 patients scheduled for lumbar magnetic resonance imaging and essentially anesthesiologists were asked to mark with washable ink the skin overlying any interspace on the lower spine after palpation of the lumbar region. Different positions were evaluated including sitting and lateral. Only 29% were demonstrated to be correct through magnetic resonance imaging. Within the lumbar region, there were tremendous errors by the anesthesiologist at all levels. Further, a common mistake included the assumption of location based on the landmark provided from the iliac crest. Therefore, with the potential of neurological damage from misidentification of the vertebral column, the authors recommend lower rather than higher sites when more than 1 site is identified. The authors provide a clever investigation; however, this is a relative small study population and there is little mention of the variation existing within the population studied. However, this study suggests that if an option exists as to which lumbar space to enter, the lower would seem safer and more prudent to minimize the potential of neurologic injury.
Phenotypic inflammation switch in rats shown by calcitonin gene‐related peptide immunoreactive dorsal root ganglion neurons innervating the lumbar facet joints. (School of Medicine, Chiba University, Chiba, Japan) Spine. 2001;26:1009–1013.
Authors: Ohtori Seiji , Takahashi Kazuhisa , Chiba Tanemichi , Yamagata Masatsune , Sameda Hiroaki , Moriya Hideshige 
Published: March 2003

This study's objective was to determine by inflammatory stimulation the changes in calcitonin gene‐related peptide‐immunoreactive dorsal root ganglion neurons innervating the L5‐L6 facet. Retrograde transport of fluorogold was used in 20 rats: 10 in the control group and 10 in the inflammatory group. Using the dorsal approach, fluorogold crystals were injected into the left L5‐L6 facet joint. Then 5 days after application, complete Freund's adjuvant (50 injected μg Mycobacterium butyricum in oil saline emulsion) was injected into the same L5‐L6 facet joint (inflammatory group). Of the total fluorogold‐labeled dorsal root ganglion neurons from T13‐L6, the number and cross‐sectional area of the cell profiles of fluorogold‐labeled, calcitonin gene‐related peptide‐immunoreactive neurons in the bilateral dorsal root ganglia of both groups were evaluated. Fluorogold‐labeled neurons were distributed throughout the ipsilateral dorsal root ganglia from L1‐L5 in both groups. Of the fluorogold‐labeled neurons, the ratios of the calcitonin gene‐related peptide‐immunoreactive L1, L2, L3, L4, and L5 dorsal root ganglion neurons, respectively, were 17%, 24%, 44%, 56%, and 50% in the control group and 50%, 39%, 51%, 61%, and 56% in the inflammatory group. The ratios of the calcitonin gene‐related peptide‐immunoreactive L1 and L2 dorsal root ganglion neurons labeled by fluorogold were significantly higher in the inflammatory group than in the control group (P < 0.05). The mean cross‐sectional area of fluorogold‐labeled, calcitonin gene‐related peptide‐immunoreactive cells from the L1‐L5 dorsal root ganglia increased from 621 ± 64 μm2 to 893 ± 63 μm2 in the inflammatory group (P < 0.01).Comment by Octavio Calvillo, M.D., Ph.D. This is a bench research study that demonstrated sympathetic activation of dorsal root ganglia distal to the pain response. The authors sought to establish the degree of innervation of the L5‐6 facet joint of the rat from sympathetic fibers of L1 and 2 and to adjacent L3‐5 segmental fibers. From histological analysis, they found that inflammation increased the production of CGRP‐Ir in the dorsal root ganglion of L1 and L2. Additionally, the nerve fibers were noted to increase in size with the inflammation. These findings lend support for upper lumbar dorsal root blockade for non‐segmental levels of inflammation.
The evaluation of a positive direct antiglobulin test (autocontrol) in pretransfusion testing revisited
Authors: Judd W. J. , Barnes B. A. , Steiner E. A. , Oberman H. A. , Averill D. B. , Butch S. H. 
Published: March 2003

Direct antiglobulin tests (DATs) using anti‐IgG were performed on 65,049 blood samples from prospective transfusion recipients; 3570 tests (5.49%) were positive. Using criteria published previously (primarily excluding patients not transfused within the preceding 14 days), 778 samples from other than neonatal patients were selected for further evaluation. Eluates that did not react were obtained on 518 (66.6%) of these samples. Warm‐reactive autoantibodies were apparent in 192 eluates, while 16 contained drug‐related antibodies, anti‐A or anti‐B from prior transfusion with ABO mismatched blood components, or anti‐D passively acquired from immune serum globulin. Fifty‐two eluates contained alloantibodies; however, in only six of these cases did the corresponding serum lack unexpected alloantibodies, as determined by routine pretransfusion studies. Three additional weakly reactive clinically significant alloantibodies were detected solely through additional serum tests performed on DAT‐positive samples.On the basis of these findings, the DAT had a low predictive value when used to detect the early manifestations of an immune response to recently transfused red cells. Elimination of the autocontrol from routine pretransfusion testing, therefore, carries minimal risk to patients yet will undoubtedly contribute to the containment of health care costs. Moreover, the risk is lower than that associated with the elimination of the antiglobulin crossmatch.
Duplication of exon 3 in the glycophorin C gene gives rise to the Lsa blood group antigen
Authors: Reid M. E. , Mawby W. , King M.‐J. , Sistonen P. 
Published: March 2003

BACKGROUND: The Gerbich‐related Lsa blood group antigen (Ge6) resides on the higher‐molecular‐weight forms of glycophorin C (GPC) and glycophorin D (GPD). Southern blot analysis has previously revealed an additional GPC exon 3 insert in the genomic DNA from an Ls(a+) individual.STUDY DESIGN AND METHODS: To confirm the duplication of exon 3 in the GPC mRNA, total RNA prepared from the Epstein‐Barr virus‐ transformed lymphocytes of an Ls(a+) individual was used in the synthesis of first‐strand cDNA. The first‐strand cDNA served as a template for the amplification of GPC‐related DNA by polymerase chain reaction. After subcloning, the polymerase chain reaction cDNA was sequenced with a kit. Hemagglutination inhibition of anti‐Lsa sera with synthetic peptides was performed to identify the location of Lsa on the GPC.Lsa protein.RESULTS: Sequencing the GPC.Lsa cDNA showed an insert of 84 nucleotides, which corresponds to the entire sequence of exon 3 in the GPC gene (GYPC). Since the exon 3‐duplicated exon 3 boundary of GYPC.Lsa encodes a novel amino acid sequence on GPC.Lsa and GPD.Lsa, synthetic peptides consisting of the amino acids flanking this junction were used to determine the amino acid sequence that is essential for expression of Lsa. The peptide DIVVIA/EPDPG was noninhibitory, while peptides with the sequence TPTIMDIVVIA/EPDPG or SPSVLDIVVIA/EPDPG inhibited anti‐Lsa reactivity.CONCLUSION: Lsa is located within the sequence of amino acids encoded by the nucleotides at the exon 3‐ duplicated exon 3 boundary, and the conformation of this peptide sequence is important for recognition of Lsa by human anti‐Lsa.
Concurrent comparison of the safety of paid cytapheresis and volunteer whole‐blood donors
Authors: Strauss R.G. , Ludwig G.A. , Smith M.V. , Villhauer P.J. , Randels M.J. , Smith‐Floss A. , Koerner T.A. 
Published: March 2003

Background: Historically, paid blood donors were found to transmit hepatitis at higher rates than volunteers. In those older studies, paid donors frequently were recruited from prisons or slum areas–a finding consistent with the belief that monetary payment in itself did not necessarily lead to the high‐risk status of commercial blood. Instead, it was the population base from which the donors were recruited that was important.Study Design and Methods: Today, cytapheresis donors are in great demand. Because payment is one incentive that might entice donors to undertake the increased commitment of repeated cytapheresis donation, the results were studied of infectious disease history and laboratory testing performed concurrently in 917 volunteer whole‐blood donors and 1240 paid cytapheresis donors, who were enrolled in distinct programs at the DeGowin Blood Center from October 7, 1987, through November 30, 1990.Results: When first, repeat, and overall donations made by these donors were evaluated separately, paid cytapheresis donors were found to exhibit no increase in infectious disease history or test results beyond those of volunteer whole‐blood donors.Conclusion: Thus, paid cytapheresis donors, when managed within a formal program, should not necessarily be presumed to be more dangerous than volunteers, from an infectious disease aspect. However, definitive proof of safety (comparison of transfusion‐transmitted infection rates in two groups of patients receiving blood components exclusively from either paid cytapheresis or volunteer donors) was not pursued by long‐ term follow‐up studies.
Long‐term follow‐up testing of red cell alloantibodies
Authors: Ramsey G. , Smietana S.J. 
Published: March 2003

Background: In previous studies, 29 to 34 percent of potentially hemolytic red cell antibodies were not detected after short‐term follow‐ up.Study Design and Methods: To examine long‐term detection, records were reviewed for 44 consecutive patients who were tested more than 5 years after their potentially hemolytic red cell antibodies were first identified in this hospital.Results: After 5 to 10 years, 14 (39%) of 36 Rh, Kell, and Duffy system antibodies were not detected on at least one occasion. Twenty‐two other such antibodies were sought again after more than 10 years; 10 (45%) were not detected. When restimulation by pregnancy was excluded, these rates were 42 and 48 percent, respectively.Conclusion: Clinically significant red cell antibody formation is probably more common than previously realized, because nearly half of these antibodies are undetected after long‐term follow‐ up.
Independent roles for platelet crossmatching and HLA in the selection of platelets for alloimmunized patients
Authors: Friedberg R.C. , Donnelly S.F. , Mintz P.D. 
Published: March 2003

Background: Although HLA‐matched platelets are frequently requested for alloimmunized patients, recent evidence has indicated that 1‐hour posttransfusion platelet increments in these patients are specifically sensitive to crossmatch compatibility.Study Design and Methods: To determine the extent of advantage gained by use of single‐donor apheresis (SD) platelets selected on the basis of HLA match when crossmatch‐compatible SD platelets were available, a total of 220 platelet transfusions given in the absence of individually determined significant nonimmune factors were analyzed in a well‐characterized cohort of platelet‐refractory patients. Platelets were selected by solid‐phase crossmatch from a small donor pool of relatively poor HLA matches or, upon request, ordered as HLA‐matched and later crossmatched.Results: Alloimmunized patients responded better to SD platelets selected on the basis of HLA than to pooled platelet concentrates or SD platelets selected at random, although most of the benefit was limited to the 57‐percent subset of good HLA matches. Crossmatch‐compatible SD platelets provided similar posttransfusion platelet increments independent of the HLA match. None of 31 crossmatch‐ incompatible SD platelets transfused provided an adequate increment, including 13 that were ordered as HLA‐matched platelets.Conclusion: No benefit could be demonstrated from requesting that SD platelets be HLA‐ matched when crossmatch‐compatible SD platelets were available.
Sulindac‐induced immune hemolytic anemia
Authors: Angeles M.L. , Reid M.E. , Yacob U.A. , Cash K.L. , Fetten J.V. 
Published: March 2003

Background: Sulindac, a nonsteroidal, anti‐inflammatory, indene‐derived drug, caused life‐threatening immune hemolytic anemia in an individual with back pain.Case Report: A patient was admitted to the hospital with immune hemolytic anemia and kidney and liver failure after several days ingestion of sulindac. The direct antiglobulin test was positive with polyspecific and monospecific anti‐IgG but not with anti‐C3. The eluate did not react in routine tests but reacted strongly after the addition of sulindac. The serum contained a sulindac‐dependent antibody reacting to a titer of 32. The sulindac‐dependent antibody was of both IgG and IgM classes and had no apparent blood group specificity. The antibody agglutinated red cells from humans and chimpanzees but not from chickens, rabbits, or sheep, which implied that a specific component on human and chimpanzee red cells was needed for reactivity. The antibody reacted with red cells treated with trypsin, papain, pronase, dithiothreitol, and sialidase. With aggressive medical care, the patient's condition improved.Conclusion: These findings appear compatible with the so‐called immune complex mechanism for drug‐induced immune hemolytic anemia. Physicians are alerted to the severe nature of this syndrome.