bluuebunny/crossref_metadata_2025_split huggingface dataset:
A pilot study evaluating a new questionnaire for prostatic symptom scoring, the SPSS, and its sensitivity as constructed to objective measures of outflow obstruction
Authors: YANO MASATAKA , KITAHARA SATOSHI , YASUDA KOSAKU , YAMANISHI TOMONORI , NAKAI HIDEO , YANAGISAWA RYOUZO , MOROZUMI MAKOTO , HOMMA YUKIO 
Published: May 2004

AbstractAim: To evaluate the extent to which our newly developed questionnaire, the Saitama Prostate Symptom Score (SPSS), for prostatic symptom scoring reflects objective findings in benign prostatic hyperplasia (clinical BPH) and to compare it with the International Prostate Symptom Score (IPSS) with regard to diagnostic sensitivity in clinical BPH.Methods: In this study, both the SPSS and the IPSS were self‐administered by patients. Free uroflowmetry, a pressure‐flow study and the measurement of prostatic volume were carried out.Results: There was no significant correlation between the results of the IPSS questionnaire and the urethral obstruction grade estimated by Schaefer or Abrams‐Griffiths nomograms. The total score of the SPSS was correlated with these nomograms (P = 0.0487 and P = 0.0413, respectively). There was no significant correlation between the results of the IPSS questionnaire and the total volume or transition zone volume of the prostate, whereas the total score of the SPSS correlated with the total volume of the gland and transition zone volume (P = 0.0044 and P= 0.0051, respectively).Conclusion: This study revealed the SPSS to correlate with objective findings satisfactorily. However, there are still several aspects of the SPSS which need to be improved upon, and the questionnaire should be studied in larger numbers of patients suffering from lower urinary tract symptoms.
Retrospective study on stage B prostate cancer in the Hokuriku District, Japan
Authors: EGAWA MASAYUKI , MISAKI TOSHIMITSU , IMAO TETSUYA , YOKOYAMA OSAMU , FUSE HIDEKI , SUZUKI KOUJI , NAMIKI MIKIO 
Published: May 2004

AbstractBackground: The present study was conducted to investigate how patients with clinically localized prostate cancer were treated in the Hokuriku District, Japan.Methods
:
Medical records of 536 patients with stage B prostate cancer were retrospectively reviewed. The patients were diagnosed and treated at four university hospitals and 32 collaborating hospitals in the Hokuriku District.Results: Because their medical records were incomplete and/or they not available for follow up, 79 cases were excluded from this study. Conservative treatment with hormone therapy was used for 248 cases. Radical prostatectomy was performed in 199 cases, only 27 of whom underwent surgical monotherapy. There was no significant difference in disease‐specific survival rates between the hormone (69.0%) and surgery group (83.2%) after 110 months. Results of the analysis of disease‐specific survival rates according to histologic grade showed that patients with poorly differentiated cancers treated with hormone therapy were the only subset with significant differences when compared against the other patients.Conclusion: The value of prostatectomy alone or added was marginal in terms of survival. Only patients with poorly differentiated cancer might benefit from prostatectomy.
Long‐term outcome of postoperative interferon‐α adjuvant therapy for non‐metastatic renal cell carcinoma
Authors: GOTOH AKINOBU , SHIRAKAWA TOSHIRO , HINATA NOBUYUKI , WADA YOSHITAKA , HARA ISAO , FUJISAWA MASATO , KAWABATA GAKU , OKADA HIROSHI , ARAKAWA SOICHI , KAMIDONO SADAO 
Published: May 2004

AbstractAim: To investigate the long‐term efficacy of postoperative interferon‐α (IFN‐α) adjuvant therapy in preventing recurrence in non‐metastatic renal cell carcinoma treated with radical nephrectomy and to identify related prognostic markers.Methods: Long‐term follow‐up was conducted to study rates of survival and non‐recurrence in 88 subjects following radical nephrectomy for non‐metastatic disease.Results: The overall survival rate was 90% at 5 years and 88% at 10, with corresponding non‐recurrence rates of 81% and 74%. Survival rates reviewed by preadministration pT stage showed a falling tendency from T1 through to T3 in line with pathological progression; when cases at stage pT1b or below were compared with those at stage pT2 or above, the latter showed a tendency to lower survival rates (P = 0.0966, Breslow‐Gehan‐Wilcoxon). Similarly, non‐recurrence rates tended to fall in line with pathological progression, with a significant difference found in the comparison of cases at stage pT1b or below with those at stage pT2 or above (P = 0.0265, log–rank, Mantel‐Cox). Duration of IFN‐α administration showed a tendency to positive correlation with long‐term survival (P = 0.3765, Breslow‐Gehan‐Wilcoxon). Non‐recurrence rate was not found to differ according to duration of administration. Comparison of groups with normal and abnormal preadministration immunosuppressive acidic protein values showed that the normal group tended to have higher rates of survival and non‐recurrence (P = 0.3371, Breslow‐Gehan‐Wilcoxon).Conclusions: Immunosuppressive acidic protein values appear to be a useful predictive marker for recurrence. A randomized trial, examining long‐term outcome according to tumor stage and variables such as duration of administration, dose, administration time, and dosing schedule is required.
Managed Care and Preventable Hospitalization among Medicaid Adults
Authors: Basu Jayasree , Friedman Bernard , Burstin Helen 
Published: May 2004

Objective. The study examines the association between managed care enrollment and preventable hospitalization patterns of adult Medicaid enrollees hospitalized in four states.Data Sources/Study Setting. Hospital discharge data from the Healthcare Cost and Utilization Project (HCUP) database of the Agency for Healthcare Research and Quality (AHRQ) for New York (NY), Pennsylvania (PA), Wisconsin (WI), and Tennessee (TN) residents in the age group 20–64 hospitalized in those states, linked to the Area Resource File (ARF) and American Hospital Association (AHA) survey files for 1997.Study Design. The study uses separate logistic models for each state comparing preventable admissions with marker admissions (urgent, insensitive to primary care). The model controls for socioeconomic and demographic variables, and severity of illness.Principal Findings. Consistently in different states, private health maintenance organization (HMO) enrollment was associated with fewer preventable admissions than marker admissions, compared to private fee‐for‐service (FFS). However, Medicaid managed care enrollment was not associated with a reduction in preventable admissions, compared to Medicaid FFS.Conclusions. Our analysis suggests that the preventable hospitalization pattern for private HMO enrollees differs significantly from that for commercial FFS enrollees. However, little difference is found between Medicaid HMO enrollees and Medicaid FFS patients. The findings did not vary by the level of Medicaid managed care penetration in the study states.
The Prevention Index: Using Technology to Improve Quality Assessment
Authors: Vogt Thomas M. , Aickin Mikel , Ahmed Faruque , Schmidt Mark 
Published: May 2004

Objective. To improve quality of care assessment for preventive medical services and reduce assessment costs through development of a comprehensive prevention quality assessment methodology based on electronic medical records (EMRs).Data Sources. Random sample of 775 adult and 201 child members of a large nonprofit managed care system.Study Design. Problems with current, labor‐intensive quality measures were identified and remedied using EMR capabilities. The Prevention Index (PI) was modeled by assessing five‐year patterns of delivery of 24 prevention services to adult and child health maintenance organization (HMO) members and comparing those services to consensus recommendations and to selected Health Plan Employer Data and Information Set (HEDIS) scores for the HMO.Data Collection. Comprehensive chart reviews of 976 randomly selected members of a large managed care system were used to model the Prevention Index.Principal Findings. Current approaches to prevention quality assessment have serious limitations. The PI eliminates these limitations and can summarize care in a single comprehensive index that can be readily updated. The PI prioritizes services based on benefit, using a person‐time approach, and separates preventive from diagnostic and therapeutic services.Conclusions. Current methods for assessing quality are expensive, cannot be applied at all system levels, and have several methodological limitations. The PI, derived from EMRs, allows comprehensive assessment of prevention quality at every level of the system and at lower cost. Standardization of quality assessment capacities of EMRs will permit accurate cross‐institutional comparisons.
The Effect of Smoking on Years of Healthy Life (YHL) Lost among Middle‐Aged and Older Americans
Authors: Østbye Truls , Taylor Donald H. 
Published: May 2004

Objective. To estimate the effects of smoking on quality of life over time, using the Years of Healthy Life (YHL) construct.Data Sources/Study Setting.The Health and Retirement Study (HRS) survey (N=12,652) of persons 50 to 60 years old and the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (N=8,124) of persons≥70 years old, plus spouses regardless of age, followed from 1992/1993 to 2000.Study Design. Years of healthy life from baseline to death were estimated. Regression models were developed with smoking as the main explanatory variable and with both YHL and years of life remaining as the outcome variables.Principal Findings. Smoking was strongly and consistently related to YHL lost. In HRS, individuals who had quit smoking at least 15 years prior to baseline had a similar number of YHL left as never smokers.Conclusions. Efforts to encourage smoking cessation should emphasize the impact of these factors on quality of life.
Linkage with Primary Medical Care in a Prospective Cohort of Adults with Addictions in Inpatient Detoxification: Room for Improvement
Authors: Saitz Richard , Larson Mary Jo , Horton Nicholas J. , Winter Michael , Samet Jeffrey H. 
Published: May 2004

Objective.To identify patient characteristics and health care experiences associated with primary care linkage after alcohol or drug detoxification.Data Sources/Study Setting.Primary data collected over two years. Subjects were adults without primary medical care, in an urban residential detoxification program.Study Design.A prospective cohort study in the context of a randomized trial of a linkage intervention, and an expansion of Medicaid benefits.Data Collection/Extraction Methods.Data were collected by interview assessment of predisposing, enabling, and illness variables. Linkage was defined as self‐report of at least one visit with a primary care clinician during follow‐up.Principal Findings.Of 400 subjects, 63 percent linked with primary medical care. In a multivariable model adjusting for randomization assignment, predisposing, enabling, and illness variables, women, those with no recent incarceration, those with support for abstinence by family or friends, and those who had visited a medical clinic or physician recently were significantly more likely to link with primary care. Those with health insurance during follow‐up were also more likely to link. Recent mental health or addictions treatment utilization and health status were not associated with linkage.Conclusions.A substantial proportion of adults with addictions do not link with primary medical care. These data suggest that efforts could be focused on those least likely to link, that contacts with mental health and addictions treatment providers are underutilized opportunities for these efforts, and that health policy changes such as expanding health insurance benefits may improve entry of substance‐dependent patients into primary medical care.
Use of Midlevel Practitioners to Achieve Labor Cost Savings in the Primary Care Practice of an MCO
Authors: Roblin Douglas W. , Howard David H. , Becker Edmund R. , Kathleen Adams E. , Roberts Melissa H. 
Published: May 2004

Objective. To estimate the savings in labor costs per primary care visit that might be realized from increased use of physician assistants (PAs) and nurse practitioners (NPs) in the primary care practices of a managed care organization (MCO).Study Setting/Data Sources. Twenty‐six capitated primary care practices of a group model MCO. Data on approximately two million visits provided by 206 practitioners were extracted from computerized visit records for 1997–2000. Computerized payroll ledgers were the source of annual labor costs per practice from 1997–2000.Study Design. Likelihood of a visit attended by a PA/NP versus MD was modeled using logistic regression, with practice fixed effects, by department (adult medicine, pediatrics) and year. Parameter estimates and practice fixed effects from these regressions were used to predict the proportion of PA/NP visits per practice per year given a standard case mix. Least squares regressions, with practice fixed effects, were used to estimate the association of this standardized predicted proportion of PA/NP visits with average annual practitioner and total labor costs per visit, controlling for other practice characteristics.Results. On average, PAs/NPs attended one in three adult medicine visits and one in five pediatric medicine visits. Likelihood of a PA/NP visit was significantly higher than average among patients presenting with minor acute illness (e.g., acute pharyngitis). In adult medicine, likelihood of a PA/NP visit was lower than average among older patients. Practitioner labor costs per visit and total labor costs per visit were lower (p<.01 and p=.08, respectively) among practices with greater use of PAs/NPs, standardized for case mix.Conclusions. Primary care practices that used more PAs/NPs in care delivery realized lower practitioner labor costs per visit than practices that used less. Future research should investigate the cost savings and cost‐effectiveness potential of delivery designs that change staffing mix and division of labor among clinical disciplines.
Emergency Department Use among Michigan Children with Special Health Care Needs: An Introductory Study
Authors: Pollack Harold A. , Dombkowski Kevin J. , Zimmerman Janet B. , Davis Matthew M. , Cowan Anne E. , Wheeler John R. , Hillemeier A. Craig , Freed Gary L. 
Published: May 2004

Objective. To describe patterns of emergency department (ED) use among children dual‐enrolled in Medicaid and Michigan's Children's Special Health Care Services (CSHCS).Data Sources. Individual claims and enrollment data from Michigan's Medicaid and CSHCS programs for the period January 1, 1998, to June 30, 1999. Claims data were linked with eligibility data and then used to develop a 100 percent sample of claims for individuals enrolled in both Medicaid and CSHCS.Study Design. Poisson regression analysis was used to examine the rate of ED use for dual‐enrolled children. A time‐varying hazard analysis was also used to examine the impact of changes over time. The key variables were gender, age, race, county of residence, Medicaid eligibility category, and qualifying diagnosis.Principal Findings. Dual‐enrolled children under one year of age, and those with qualifying diagnoses of anemia, hemophilia, asthma, epilepsy, and juvenile diabetes displayed especially high rates of ED use. Significant geographic variation in ED use remained after controlling for qualifying diagnoses, race/ethnicity, and other factors. African Americans displayed higher rates of ED utilization than non‐Hispanic whites. Supplemental Security Income (SSI) recipients demonstrated higher utilization than other groups.Conclusions. Children dually enrolled in CSHCS and Medicaid face diverse challenges of both poverty and chronic illness. Differences in patterns of use highlight the importance, but also the difficulty, of developing systems of care to manage complex chronic conditions in low‐income populations.
Quality of life of patients with chronic lymphocytic leukemia: results of a longitudinal investigation over 1 yr
Authors: Holzner Bernhard , Kemmler Georg , Kopp Martin , Nguyen‐Van‐Tam Dominic , Sperner‐Unterweger Barbara , Greil Richard 
Published: May 2004

Abstract:Objectives:  The aim of this longitudinal study was to determine the long‐term quality of life (QoL) of patients with chronic lymphocytic leukemia (CLL) and to investigate the relationship between QoL and sociodemographic and clinical parameters.Methods:  Ninety‐seven patients suffering from CLL were asked to complete the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ‐C30) four times over a period of 1 yr. Clinical data on disease and treatment characteristics were collected from medical records. For the purpose of comparison, EORTC QLQ‐C30 scores were collected from 152 age‐ and gender‐matched healthy controls.Results:  Seventy‐six patients (age: median 68 yr, range 41–89) returned one or more questionnaires and were included in the statistical analysis. Compared with healthy controls CLL patients reported a lower QoL in almost all domains. No differences regarding QoL could be observed between CLL patients who had already received chemotherapy and those who had not. Moreover, female CLL patients were found to have remarkably lower QoL scores in the areas of emotional and social functioning than male patients.Conclusion:  Patients suffering from CLL could have their QoL improved by more effective symptom management and psycho‐oncological support. This could focus on specific symptoms such as fatigue and might have particular benefits for female patients with respect to their emotional and social well‐being.
Acquired pure megakaryocytic aplasia: a separate haematological disease entity or a syndrome with multiple causes?
Authors: Felderbauer P. , Ritter P. R. , Mattern D. , Schmitz F. , Bulut K. , Ansorge N. , Schmitt‐Graeff A. , Schmidt W. E. , Baier J. E. 
Published: May 2004

Abstract:We report the case of a patient with acquired pure megakaryocytic aplasia. Until today, less than 20 cases of acquired pure megakaryocytic aplasia have been reported and the disease aetiology still seems to be unclear. This report summarizes the published data concerning possible aetiologies, treatment options and outcome of patients with acquired pure megakaryocytic aplasia. Furthermore, this case report presents an example for a possible disease progression.
Sustained cytogenetic response after discontinuation of imatinib mesylate in a patient with chronic myeloid leukaemia
Authors: Ghanima Waleed , Kahrs Johannes , Dahl Tobias Gedde , Tjonnfjord Geir E. 
Published: May 2004

Abstract:A 58‐yr‐old woman was diagnosed with Ph+ chronic myeloid leukaemia in May 2001. She was initially treated with hydroxyurea and subsequently with interferon‐α (IFN‐α). Imatinib mesylate was started in April 2002 after failure of IFN‐α to induce a cytogenetic response. The patient remained on treatment with imatinib mesylate for 3 months during which she suffered daily fever resulting in discontinuation of the treatment. Response evaluation performed shortly after discontinuing imatinib mesylate revealed a complete cytogenetic remission and a substantial molecular response. Fifteen months later, she was still enjoying a major cytogenetic response. This case illustrates that a short course of imatinib mesylate may result in a sustained haematological and cytogenetic response.
OmpR and LeuO Positively Regulate the
Salmonella enterica
Serovar Typhi
ompS2
Porin Gene
Authors: Fernández-Mora Marcos , Puente José Luis , Calva Edmundo 
Published: May 2004

ABSTRACT

The
Salmonella enterica
serovar Typhi
ompS2
gene codes for a 362-amino-acid outer membrane protein that contains motifs common to the porin superfamily. It is expressed at very low levels compared to the major OmpC and OmpF porins, as observed for
S. enterica
serovar Typhi OmpS1,
Escherichia coli
OmpN, and
Klebsiella pneumoniae
OmpK37 quiescent porins. A region of 316 bp, between nucleotides −413 and −97 upstream of the transcriptional start point, is involved in negative regulation, as its removal resulted in a 10-fold increase in
ompS2
expression in an
S. enterica
serovar Typhi wild-type strain. This enhancement in expression was not observed in isogenic mutant strains, which had specific deletions of the regulatory
ompB
(
ompR envZ
) operon. Furthermore,
ompS2
expression was substantially reduced in the presence of the OmpR D55A mutant, altered in the major phosphorylation site. Upon random mutagenesis, a mutant where the transposon had inserted into the upstream regulatory region of the gene coding for the LeuO regulator, showed an increased level of
ompS2
expression. Augmented expression of
ompS2
was also obtained upon addition of cloned
leuO
to the wild-type strain, but not in an
ompR
isogenic derivative, consistent with the notion that the transposon insertion had increased the cellular levels of LeuO and with the observed dependence on OmpR. Moreover, LeuO and OmpR bound in close proximity, but independently, to the 5′ upstream regulatory region. Thus, the OmpR and LeuO regulators positively regulate
ompS2
.
Functional Dissection of the XpsN (GspC) Protein of the
Xanthomonas campestris
pv. campestris Type II Secretion Machinery
Authors: Lee Hsien-Min , Chen Juine-Ruey , Lee Hai-Lun , Leu Wei-Ming , Chen Ling-Yun , Hu Nien-Tai 
Published: May 2004

ABSTRACT

Type II secretion machinery is composed of 12 to 15 proteins for translocating extracellular proteins across the outer membrane. XpsL, XpsM, and XpsN are components of such machinery in the plant pathogen
Xanthomonas campestris
pv. campestris. All are bitopic cytoplasmic-membrane proteins, each with a large C-terminal periplasmic domain. They have been demonstrated to form a dissociable ternary complex. By analyzing the C-terminally truncated XpsN and PhoA fusions, we discovered that truncation of the C-terminal 103 residues produced a functional protein, albeit present below detectable levels. Furthermore, just the first 46 residues, encompassing the membrane-spanning sequence (residues 10 to 32), are sufficient to keep XpsL and XpsM at normal abundance. XpsN46(His
6
), synthesized in
Escherichia coli
, is able to associate in a membrane-mixing experiment with the XpsL-XpsM complex preassembled in
X. campestris
pv. campestris. The XpsN N-terminal 46 residues are apparently sufficient not only for maintaining XpsL and XpsM at normal levels but also for their stable association. The membrane-spanning sequence of XpsN was not replaceable by that of TetA. However, coimmunoprecipitation with XpsL and XpsM was observed for XpsN97::PhoA, but not XpsN46::PhoA. Only XpsN97::PhoA is dominant negative. Single alanine substitutions for three charged residues within the region between residues 47 and 97 made the protein nonfunctional. In addition, the R78A mutant XpsN protein was pulled down by XpsL-XpsM(His
6
) immobilized on an Ni-nitrilotriacetic acid column to a lesser extent than the wild-type XpsN. Therefore, in addition to the N-terminal 46 residues, the region between residues 47 and 97 of XpsN probably also plays an important role in interaction with XpsL-XpsM.