bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age and the Risk of In‐Hospital Death: Insights from a Multihospital Study of Intensive Care Patients
Authors: Rosenthal Gary E. , Kaboli Peter J. , Barnett Mitchell J. , Sirio Carl A. 
Published: March 2003

OBJECTIVES: To determine independent relationships between age and the risk of in‐hospital death.DESIGN: Retrospective cohort study.SETTING: Thirty‐eight intensive care units (ICUs) in 28 hospitals in a large Midwest metropolitan region.PARTICIPANTS: One hundred fifty‐six thousand, one hundred thirty‐six consecutive admissions to medical, surgical, neurological, and mixed medical/surgical ICUs between March 1, 1991, and March 31, 1997.MEASUREMENTS: In‐hospital death rates were compared at successive 5‐year age intervals, adjusting for gender, diagnosis, admission source, comorbidity, and acute physiology scores. Acute physiology scores were determined using a validated methodology based on abnormalities in 17 physiological measures collected during the first 24 hours of ICU admission.RESULTS: The adjusted odds of death increased with each 5‐year age increment. For example, relative to patients younger than 35, adjusted odds of death in patients aged 40 to 44, 50 to 54, 60 to 64, 70 to 74, 80 to 84, and 90 and older were 1.51, 1.73, 2.38, 2.98, 3.86, and 4.74, respectively. In stratified analyses, age‐related increases in the odds of death were somewhat higher in surgical than medical patients or patients with lower severity of illness at admission. Although acute physiology scores had excellent discrimination in all age groups, discrimination decreased with age (e.g., c‐statistics of 0.928 and 0.835 in patients younger than 45 and 85 and older, respectively).CONCLUSION: Our findings demonstrate incremental increases in the risk of hospital death associated with age that was independent of severity of illness and other prognostic factors. Although the current results may be less biased by differences in treatment goals than studies of general hospitalized patients, the lower discrimination of physiology scores in older patients suggests that unmeasured factors (e.g., functional status, patient preferences for care, differences in physician practices) may be of greater prognostic importance in older than in younger patients.
Mini‐Mental State Examination and Mental Deterioration Battery: Analysis of the Relationship and Clinical Implications
Authors: Pasqualetti Patrizio , Moffa Filomena , Chiovenda Paola , Carlesimo Giovanni A. , Caltagirone Carlo , Rossini Paolo M. 
Published: March 2003

OBJECTIVES: To explore the associative structure between a screening test for dementia, the Mini‐Mental State Examination (MMSE), and a neuropsychological battery for the detection of dementia, the Mental Deterioration Battery (MDB).DESIGN: A retrospective analysis.SETTING: Psychology unit of a general hospital in Rome, Italy.PARTICIPANTS: Three hundred consecutive outpatients and inpatients referred to our hospital on the basis of suspected cognitive impairment and evaluated between January 1999 and March 2000.MEASUREMENTS: MMSE and MDB.RESULTS: Of the 300 subjects evaluated by the MMSE score, 142 (47.3%) were considered to be cognitively healthy, and 116 (38.7%) were mildly and 42 (14.0%) moderately impaired. Factor analysis of MDB extracted three factors able to account for 75% of the total variance: a visuospatial factor, verbal memory ability, and a language skill. Using MMSE as an independent variable, a linear regression model could account for the visuospatial and language factors and a cubic regression model for the verbal memory factor. Within the normal MMSE boundaries (24–30), a dramatic decrease of verbal memory could be documented, whereas the slope is less steep in the mild impairment group (16–23).CONCLUSIONS: Our findings indicate the presence of a warning range within the normal MMSE interval. Thus, the traditional MMSE cutoff values may not be appropriate in detecting early phases of dementia. When patients score about 27 on MMSE, it should be of interest to check whether they fail only on long‐term memory tests, because this could be a first signal of a preclinical condition heralding clear dementia (e.g., mild cognitive impairment).
Mortality‐Related Factors and 1‐Year Survival in Nursing Home Residents
Authors: Flacker Jonathan M. , Kiely Dan K. 
Published: March 2003

OBJECTIVES: To identify factors associated with 1‐year mortality in newly admitted and long‐stay (in nursing home longer than 1 year) nursing home residents by linking Minimum Data Set (MDS) information with data from the National Death Index and use these factors to create a useful tool for estimating risk levels for 1‐year mortality.DESIGN: Retrospective cohort study with development and validation cohorts.SETTING: All 643 Medicare and Medicaid certified nursing homes in New York State during the study period.PARTICIPANTS: The study included data on residents collected during full MDS assessments from June 1994 through December 1997. A total of 100,669 nursing home residents met the inclusion criteria for the newly admitted resident analysis. The newly admitted development cohort included 60,341 residents, and the newly admitted validation cohort included 40,328 residents. A total of 36,125 nursing home residents met inclusion criteria for the long‐stay (residing in nursing home>1 year) cohort. The long‐stay development cohort included 22,749 residents, and the long‐stay validation cohort included 15,068 residents.MEASUREMENTS: The analytical approach was similar for the newly admitted and long‐stay resident cohorts. Resident characteristics that were considered potential risk factors for mortality were examined individually in bivariate proportional hazards models, and factors with P < .05 were entered into a proportional hazards regression stepwise model. The strongest factors based on their chi‐square values were selected for entry into a multivariate proportional hazards analysis. Hazard ratios (HRs), 95% confidence intervals, and P‐values were derived from this model. A mortality risk index score was created for each resident by summing the value of each HR in the multivariate model for those who had the risk factor. A sensitivity analysis was performed to determine the effect of residents with an unknown death status. A similar analysis was performed on the validation cohort to validate the original results.RESULTS: Major factors associated with 1‐year mortality were identified in both the newly admitted and long‐stay cohorts. In both newly admitted and long‐stay residents, a higher mortality risk index score was associated with increased 1‐year mortality in both the development and validation cohorts.CONCLUSIONS: MDS data can identify major factors associated with 1‐year mortality in newly admitted and long‐stay nursing home residents. These factors can be used to stratify residents into risk categories for 1‐year mortality. This information could be important to residents, their families, and their physicians when developing care plans, as well as to agencies interested in healthcare resource planning.
The necessary and the unnecessary transfusion: a critical review of reported appropriateness rates and criteria for red cell transfusions
Authors: Hasley P.B. , Lave J.R. , Kapoor W.N. 
Published: March 2003

Background: The purpose of this study was to evaluate the criteria for assessing the appropriateness of red cell transfusions. The data were obtained by a computer search of all English‐language literature from 1966 to October 1992.Study Design and Methods: Nine studies were selected, which dated from 1986 to 1989 and employed explicit criteria evaluating the appropriateness of red cell transfusion in adults. The following data were abstracted from all studies: study design, timing, location, criteria for evaluating appropriateness, and rate of appropriate or inappropriate transfusions.Results: Five studies evaluated transfusion appropriateness. Appropriateness rates ranged from 88 to 99 percent in three studies, and inappropriateness rates ranged from 0.3 to 57.3 percent in two studies. Four studies evaluated transfusion inappropriateness and reported inappropriateness rates of 18 to 55 percent. Substantial variation was found in the criteria for an appropriate or an inappropriate transfusion. Appropriateness rates did not depend upon characteristics of the study design, location, or timing of data collection. Restrictiveness in the criteria used to determine appropriateness and the use of additional implicit evaluation after an initial explicit review affected appropriateness rates.Conclusion: In the 1980s, high rates of inappropriate transfusion and low rates of appropriate transfusion were still reported. Appropriateness rates varied widely, in part because of marked variation in the criteria for an appropriate transfusion. Newly derived standards for an appropriate red cell transfusion, published in 1992, appear to provide a simple and objective means of evaluating the appropriateness of a transfusion. Appropriateness rates resulting from the application of these new standards have not yet been determined.
Screening of blood donors for idiopathic CD4+ T‐lymphocytopenia
Authors: Busch M.P. , Valinsky J.E. , Paglieroni T. , Prince H.E. , Crutcher G.J. , Gjerset G.F. , Operskalski E.A. , Charlebois E. , Bianco C. , Holland P.V. , Petersen L.R. , Hollingsworth C.G. , Mosley J.W. 
Published: March 2003

Background: The recent recognition of idiopathic CD4+ T‐lymphocytopenia (ICL) had led to concern that an unknown immunodeficiency virus may be transmissible by transfusion.Study Design and Methods: To evaluate the prevalence and significance of low CD4+ values among blood donors, CD4+ data on 2030 blood donors who were negative for antibody to human immunodeficiency virus type 1 (HIV‐1) were compiled. Those with CD4+ values below ICL cutoffs (< 300 CD4+ T cells/μL, or < 20% CD4+ T cells) were recalled for follow‐up investigations. Serial CD4+ data on 55 homosexual men who seroconverted during prospective follow‐up and data on 139 anti‐HIV‐1‐positive blood donors initially evaluated in 1986 were reviewed as well.Results: Five seronegative donors (0.25%) had absolute CD4+ counts < 300 cells per μL and/or < 20 percent. On follow‐up, all five donors had immunologic findings within normal ranges, lacked HIV risk factors, and tested negative for HIV types 1 and 2 and human T‐lymphotropic virus type I and II infections by antibody and polymerase chain reaction assays. Four of five donors reported transient illness shortly after their low CD4+ count donations. The median interval from HIV‐1 seroconversion to an initial CD4+ value below ICL CD4+ cutoffs was 63 months for infected homosexual men. Of 139 HIV‐1‐infected blood donors studied 1 to 2 years after seropositive donations, 34 (24%) had CD4+ counts < 300 cells per μL and/or < 20 percent.Conclusion: Low CD4+ counts are rare among anti‐ HIV‐1‐negative volunteer blood donors and are generally associated with transient illnesses. If any unknown virus progresses similarly to HIV‐ 1, CD4+ count donor screening would be a poor surrogate for its detection.
Effect of amphotericin B and fluconazole on platelet membrane glycoproteins
Authors: Sloand E.M. , Kumar P. , Yu M. , Klein H.G. 
Published: March 2003

BACKGROUND: Fever, chills, and reduced platelet recovery may result when platelets are transfused simultaneously with amphotericin B. Amphotericin B reportedly increases the pitting of membranes in stored platelets.STUDY DESIGN AND METHODS: The effects of amphotericin B and another antifungal agent, fluconazole, on platelet membrane glycoproteins (GP) were examined by the incubation of split aliquots of fresh and stored platelet concentrates (PCs) with these drugs for 3 days in storage bags. To determine the effect of storage, PCs were stored for 5 days, and aliquots removed on Days 1 through 5 were placed in platelet storage bags with 4 micrograms per mL of amphotericin B for 2 to 6 hours. Membrane glycoprotein expression was assessed by flow cytometry with fluorescein isothiocyanate‐labeled monoclonal antibodies (MoAbs) directed against the following antigens: GPIb (CD42b), CD63 (an activation protein), P‐selectin (CD62), and GPIIb/IIIa (CD41a).RESULTS: Amphotericin B produced a concentration‐dependent decrease in the surface binding of CD42b MoAb with no consistent changes in the binding of CD41a, CD63, or CD62 MoAbs after a 3‐day exposure. Stored but not fresh PCs showed decreased binding of MoAb CD42b after a 6‐hour exposure to amphotericin B (4 micrograms/mL). Fluconazole produced no changes. When the binding of MoAb CD42b to permeabilized platelets was used to measure total platelet content, amphotericin B (4 micrograms/mL) decreased MoAb CD42b binding to a similar degree in fresh and stored platelets. Inhibition of aggregation to ADP and collagen and ADP and epinephrine was seen in stored but not fresh PCs.CONCLUSION: Therapeutic levels of amphotericin B resulted in partial loss of total platelet GPIb in fresh and stored PCs, but decreased surface expression of platelet membrane GPIb only in stored platelets. This difference between fresh and stored platelets may be related to the limited reservoir of GPIb available for redistribution to the membrane in the previously stored PCs and may account for the decreased recovery of transfused platelets observed in some patients receiving amphotericin B.
Epidemiology of blood transfusion
Authors: Vamvakas E.C. , Taswell H.F. 
Published: March 2003

Background: Earlier investigations of the epidemiologic attributes of blood transfusion were not based on total community populations. To calculate incidence rates of the transfusion of blood and blood components in the general population and in age‐ and gender‐specific groups, all residents of a United States county who received transfusion(s) from 1989 through 1992 were studied.Study Design and Methods: The study was a prevalence survey (cross‐sectional study) of a well‐defined population at a specified time.Results: There was no significant change in blood and blood component utilization from the beginning of 1989 through 1992. The incidence of red cell transfusion was 42.88 units per 1000 population per year in both men and women and varied from 12.08 units per 1000 population per year in those less than 41 years old to 245.24 units per 1000 population per year in the group aged more than 65. A random resident's probability of receiving transfusion(s) in any year was 0.89 percent (0.83% for men and 0.94% for women) and varied from 0.26 to 5.17 percent among the three age groups. The incidence of platelet and fresh‐frozen plasma transfusion was 21.24 units per 1000 population per year and 8.64 units per 1000 population per year, respectively.Conclusion: Incidence rates of blood transfusion for “causal” planning of blood collections are presented here for the first time. The probability of receiving a transfusion of RBCs in any year rises by 20‐fold from the rate in those less than 40 years old to that in those more than 65 years old, who receive 53.3 percent of the red cell units transfused.
Plasma proteins and lymphocyte phenotypes in long‐term plasma donors
Authors: Lewis S.L. , Kutvirt S.G. , Bonner P.N. , Simon T.L. 
Published: March 2003

BACKGROUND: The possible effects of long‐term plasma donation remain unknown, but it is important to investigate them so that donor safety is ensured. The purpose of this study was to determine if long‐term plasma donation alters plasma proteins or lymphocyte phenotypes.STUDY DESIGN AND METHODS: Two groups of long‐term plasma donors, source plasma donors (n = 20) and Rh immune globulin plasma donors (n = 26), were compared with whole blood donors (n = 29) and nondonor controls (n = 30). Blood samples were obtained prior to donation. Serum protein, albumin, globulin, and immunoglobulin levels were determined. In an assay using whole blood, lymphocyte phenotypes were characterized with a panel of single‐ and dual‐labeled monoclonal antibodies and subsequent analysis by flow cytometry.RESULTS: As compared to the nondonor controls and/or whole blood donors, the mean values for serum protein, globulin, and IgG levels were lower in both plasma donor groups, with a significant negative correlation between donation frequency and serum protein values for the source plasma donors. Albumin levels were within normal ranges for both groups of plasma donors. No significant differences existed among the donor groups in total white cell counts, the percentage or absolute number of lymphocytes, T (CD3) cells, or helper T (CD4) cells. However, there were increased percentages of B (CD19) cells and decreased percentages of suppressor T (CD8+/CD11b+) cells and natural killer cells in both groups of plasma donors as compared to nondonor controls.CONCLUSION: Many plasma donors have low levels of serum protein, globulin, and IgG. In addition, they have increased percentages of B cells and decreased percentages of suppressor T and natural killer cells. The clinical significance of these findings warrants further investigation.
Acute normovolemic hemodilution is a cost‐effective alternative to preoperative autologous blood donation by patients undergoing radical retropubic prostatectomy
Authors: Monk T. G. , Goodnough L. T. , Birkmeyer J. D. , Brecher M. E. , Catalona W. J. 
Published: March 2003

BACKGROUND: Preoperative autologous blood donation is accepted as a standard of care for radical prostatectomy. Acute normovolemic hemodilution (ANH) is an alternative method for obtaining autologous blood. The cost and benefits of these two autologous blood‐collection techniques are compared.STUDY DESIGN AND METHODS: Thirty consecutive patients scheduled for radical prostatectomy underwent ANH to a target hematocrit level of 28 percent. Blood was transfused in the perioperative period to maintain the hematocrit level > 25 percent. Hematocrit levels, transfusion outcomes and costs, and postoperative outcomes for these patients (hemodilution group) were compared with a matched patient cohort who preoperatively donated 3 units of blood for autologous use in prostatectomy surgery (nonhemodilution group, n = 30).RESULTS: Thirty patients underwent ANH to a hematocrit level of 28.7 +/− 1.7 percent, and 1740 +/− 346 mL (3.5 +/− 0.7 units) of blood were collected. Three (10%) of the patients in each cohort had allogeneic blood exposure. Transfusion costs were 73 percent higher for the nonhemodilution group patients than for the hemodilution group patients ($330 +/− $100 vs. $191 +/− $55, p < 0.001). No differences were found in postoperative outcomes.CONCLUSION: An integrated blood conservation program utilizing hemodilution and a defined transfusion trigger can decrease the requirement for preoperative donation of blood for autologous use in radical prostatectomy. Point‐of‐care autologous blood procurement is more cost‐effective than preadmission donation of autologous blood units.
Platelet concentrates promote procoagulant activity: evidence from experimental studies using a perfusion technique
Authors: Hernandez M.R. , Bozzo J. , Mazzara R. , Ordinas A. , Escolar G. 
Published: March 2003

BACKGROUND: Evaluation of the hemostatic effectiveness of platelet transfusions is difficult. Perfusion methods have been employed to test the quality and function of platelet concentrates, allowing differentiation between platelet‐platelet and platelet‐surface interactions.STUDY DESIGN AND METHODS: A study was performed to investigate platelet adhesive and cohesive properties as well as the formation of fibrin when aliquots of platelet concentrates were added to thrombocytopenic blood. Blood previously anticoagulated with low‐ molecular‐weight heparin (20 U/mL) underwent platelet and white cell reduction by filtration. Perfusates were prepared by adding to filtered blood platelets obtained from standard concentrates (stored for 1, 3, and 5 days). The final platelet count in these perfusates was standardized at 80,000 per microL. After perfusions, platelet‐ subendothelium interaction and fibrin formation were analyzed morphometrically. Results were always compared with those obtained in unfiltered blood (> 150,000 platelets/microL).RESULTS: A slight impairment in the ability of stored platelets to interact with the subendothelium was noticed during the storage period. However, the presence of fibrin was significantly greater than that observed in studies with unfiltered blood (Day 1 = 23.48 +/− 9.43%*; Day 3 = 26.99 +/− 6.74%*; Day 5 = 17.95 +/− 9.06% vs. unfiltered blood = 12.60 +/− 3.08%; *p < 0.05). The lower platelet counts (80,000/microL) in the perfusates containing platelets from concentrates could account for the reduced platelet‐subendothelium interactions, but they cannot explain the increments in fibrin formation.CONCLUSION: While the preparation and storage of platelets have a detrimental effect on platelet adhesiveness, such procedures can positively influence the platelet procoagulant activity necessary to platelet hemostasis.
Cost‐effectiveness of blood transfusion and white cell reduction in elective colorectal surgery
Authors: Jensen L.S. , Grunnet N. , Hanberg‐Sorensen F. , Jorgensen J. 
Published: March 2003

BACKGROUND: The use of white cell (WBC)‐reduced blood in elective colorectal surgery appears to reduce the frequency of postoperative infection. The question to be addressed is whether the cost:benefit ratio justifies the recommendation that WBC‐reduced blood should be used for all colorectal surgery.STUDY DESIGN AND METHODS: Patients admitted for elective colorectal surgery (n = 197) were randomly assigned to receive transfusion consisting of whole blood or WBC‐ reduced whole blood. Postoperative complications, postoperative stay, and hospital charges were compared.RESULTS: Forty‐eight patients received WBC‐reduced whole blood, 56 received unfiltered whole blood, and 93 received no transfusion. Postoperative infections were significantly higher (p < 0.001) in the group that received unfiltered whole blood. That group also had longer hospital stays: 17 days as compared to stays of 10 and 11 days for the group receiving no transfusion and the group receiving filtered whole blood transfusions, respectively (p < 0.01). The total hospital cost per patient receiving unfiltered whole blood was $12,347, as compared to $7,867 for those who received WBC‐reduced whole blood and $7,030 for those who received no transfusion.CONCLUSION: The use of WBC‐reduced whole blood transfusions in elective colorectal surgery significantly reduces the frequency of postoperative infection, the length of hospital stay, and the total hospital charges for patients needing blood transfusion.