nils-herrmann/clean_scirepeval huggingface dataset:
Are the Health of the Nation Outcome Scales a Valid and Practical Instrument to Measure Outcomes in North America? A Three-Site Evaluation Across Nova Scotia

We tested the usability, sensitivity and validity of the Health of the Nation Outcome Scales (HoNOS) in routine clinical practice in North America. Three pilot sites provided ratings on all inpatient and outpatient referrals over 4 months using versions covering children and adolescents (HoNOSCA), working-age adults and the over-65s. Data were entered using the routine administrative data system. Sixty-one percent of eligible patients had at least one HoNOS rating (n = 485). Following the initial rating, subsequent completion rates reached 80%. Ratings were sensitive to time and setting, with significantly higher scores in inpatients than outpatients. Individual diagnoses had different patterns of scores, further supporting validity.
Patterns of emergency medical services use and its association with timely stroke treatment: findings from Get With the Guidelines-Stroke.

Prior studies found that only about half of stroke patients arrived at hospitals via emergency medical services (EMSs), yet since then, there have been efforts to increase public awareness that time is brain. Using contemporary Get With the Guidelines-Stroke data, we assessed nationwide EMS use by stroke patients.



We analyzed data from 204 591 patients with ischemic and hemorrhagic stroke admitted to 1563 Get With the Guidelines-Stroke participating hospitals with data on National Institute of Health Stroke Score and insurance status. Hospital arrival by EMSs was observed in 63.7% of patients. Older patients, those with Medicaid and Medicare insurance, and those with severe stroke were more likely to activate EMSs. In contrast, minority race and ethnicity and living in rural communities were associated with decreased odds of EMS use. EMS transport was independently associated with earlier arrival (onset-to-door time, ≤3 hours; adjusted odds ratio, 2.00; 95% confidence interval, 1.93-2.08), prompter evaluation (more patients with door-to-imaging time, ≤25 minutes; odds ratio, 1.89; 95% confidence interval, 1.78-2.00), more rapid treatment (more patients with door-to-needle time, ≤60 minutes; odds ratio, 1.44; 95% confidence interval, 1.28-1.63), and more eligible patients to be treated with tissue-type plasminogen activator if onset is ≤2 hours (67% versus 44%; odds ratio, 1.47; 95% confidence interval, 1.33-1.64).



Although EMS use is independently associated with more rapid evaluation and treatment of stroke, more than one third of stroke patients fail to use EMSs. Interventions aimed at increasing EMS activation should target populations at risk, particularly younger patients and those of minority race and ethnicity.
Effect of post-trochanteric groove support on stance control associated with the pelvic-lumbar system: A preliminary study.

Many stroke and neuromuscular patients with paraplegia or severe hemiparesis cannot control trunk balance.



To support the pelvis/hip of paresis patients, a new pelvic/hip support system was developed bearing a convex pressing member placed over the post-trochanteric groove, a cutaneous landmark sited on the lateral portion of the gluteus maximus muscle and indicating the posterior aspect of the greater trochanter.



Preliminary study.



Stance control differences in two paretic patients (Guillain-Barré syndrome and stroke sequelae) with or without post-trochanteric groove support were examined. The contact pressure on the post-trochanteric groove was examined in eight healthy volunteers using an impact force sensor. The pelvic-lumbar movement was also examined using three-dimensional motion analysis, and the gluteus muscles activity was evaluated using surface electromyography.



Without post-trochanteric groove support, total three-dimensional displacement of the sacral marker was longer in the paresis patients than in normal controls, while post-trochanteric groove support decreased this distance. Post-trochanteric groove support provided compression pressure on the post-trochanteric groove, and all subjects showed a more upright trunk position, providing more anterior pelvic tilting. Six of eight subjects showed increased lumbar lordosis. Five of eight subjects showed gluteus maximus and/or gluteus medius muscle activation.



The mechanisms of post-trochanteric groove support were suggested to be spino-pelvic coordination and gluteal muscle activation.



The post-trochanteric groove is a cutaneous landmark located behind the pelvis/hip joint. Applying pressure to the post-trochanteric groove from behind pushes the trunk to adopt a more upright position, leading to improved stance control. Underlining mechanisms appear to be spino-pelvic coordination and gluteal muscle activation.
Medication adherence and growth in children with CKD.

Poor growth is a consequence of CKD, but can often be partially or fully prevented or corrected with the use of a number of medications. The extent of nonadherence with medications used to treat or mitigate growth failure in CKD has not been examined prospectively in children with CKD.



The prevalence of both prescription of and nonadherence to recombinant human growth hormone (rhGH), phosphate binders, alkali, active vitamin D, nutritional vitamin D, iron, and erythrocyte-stimulating agents was summarized over the first seven visits of the Chronic Kidney Disease in Children cohort study. The association between self-reported nonadherence to each medication group and the mean annual change in age- and sex-specific height z score was quantified using seven separate linear regression models with generalized estimating equations.



Of 834 participants, 597 reported use of at least one of these medication groups and had adherence data available. Nonadherence ranged from 4% over all visits for erythrocyte-stimulating agents to 22% over all visits for nutritional vitamin D. Of the study participants, 451 contributed data to at least one of the analyses of adherence and changes in height z score. Children nonadherent to rhGH had no change in height z score, whereas those adherent to rhGH had a significant improvement of 0.16 SDs (95% confidence interval, 0.05 to 0.27); the effect size was slightly larger and remained significant after adjustment. Among participants with height≤3rd percentile and after adjustment, adherence to rhGH was associated with a 0.33 SD (95% confidence interval, 0.10 to 0.56) greater change in height z score. Nonadherence with other medication groups was not significantly associated with a change in height z score.



Self-reported nonadherence to rhGH was associated with poorer growth velocity in children with CKD, suggesting an opportunity for intervention and improved patient outcome.
The Impact of Patient Self-Testing of Prothrombin Time for Managing Anticoagulation: Rationale and Design of VA Cooperative Study #481—The Home INR Study (THINRS)

Anticoagulation (AC) with warfarin reduces the risk of thromboembolism (TE) in a variety of applications, yet despite compelling evidence of the value and importance of high quality AC, warfarin remains underused, and dosing is often suboptimal. Approaches to improve AC quality include (1) an AC service (ACS), which allows the physician to delegate day-to-day details of AC management to another provider dedicated to AC care, and (2) incorporating into the treatment plan patient self-testing (PST) under which, after completing a training program, patients perform their own blood testing (typically, using a finger-stick blood analyzer), have dosage adjustments guided by a standard protocol, and forward test results, dosing and other information to the provider. Studies have suggested that PST can improve the quality of AC and perhaps lower TE and bleed rates. The purpose of Department of Veterans Affairs (VA) Cooperative Studies Program (CSP) #481, “The Home INR Study” (THINRS) is to compare AC management with frequent PST using a home monitoring device to high quality AC management (HQACM) implemented by an ACS with conventional monitoring of prothrombin time by international normalized ratio (INR) on major health outcomes. PST in THINRS involves use of an INR monitoring device that is FDA approved for home use.  Sites are VA Medical Centers where the ACS has an active roster of more than 400 patients. THINRS includes patients with atrial fibrillation (AF) and/or mechanical heart valve (MHV) expected to be anticoagulated indefinitely. THINRS has two parts. In Part 1, candidates for PST are evaluated for 2 to 4 weeks for their ability to use home monitoring devices. In Part 2, individuals capable of performing PST are randomized to (1) HQACM with testing every 4 weeks and as indicated for out of range values, medication/clinical changes, or (2) PST with testing every week and as indicated for out of range values, medication/clinical changes. The primary outcome measure is event rates, defined as the percent of patients who have a stroke, major bleed, or die. Secondary outcomes include total time in range (TTR), other events (myocardial infarction (MI), non-stroke TE, minor bleeds), competence and compliance with PST, satisfaction with AC, AC associated quality of life (QOL), and cost-effectiveness. To assess the effect of PST frequency on TTR and other outcomes, at selected sites patients randomized to perform PST are assigned one of three test frequencies (weekly, twice weekly, or once every four weeks).
Validation of the treadmill Six-Minute Walk Test in people following cardiac surgery.

The Six-Minute Walk Test (6MWT) often is used to measure exercise capacity in people with cardiopulmonary diseases but has some disadvantages. The 6MWT administered on a treadmill (Tr6MWT) requires less physical space and allows for easier monitoring of vital parameters than the traditional 6MWT.



The objectives of this study were: (1) to analyze the validity of the Tr6MWT in people who underwent cardiac surgery; (2) to compare the reliability, responsiveness, and people's tolerance of the Tr6MWT with those of the 6MWT; and (3) to evaluate the agreement between the 2 tests.



This study was designed to assess reliability and validity.



Twenty-six participants who were inpatients were assessed before a 2-week rehabilitation program. Twenty of them also were assessed after rehabilitation. All participants performed 3 Tr6MWT trials and 3 6MWT trials that were randomly assigned on 2 consecutive days.



The Pearson r correlation coefficient between the Tr6MWT and the 6MWT was .72, indicating satisfactory concurrent validity. The Tr6MWT was as well tolerated as the 6MWT. The Tr6MWT produced reproducible results after 2 practice tests, whereas the 6MWT did so after only 1 practice test. Both tests showed high test-retest reliability (intraclass correlation coefficient of >.94; standard errors of measurement of 23 m for the Tr6MWT and 18.5 m for the 6MWT). The Tr6MWT showed better responsiveness than the 6MWT (effect sizes of 0.9 for the Tr6MWT and 0.6 for the 6MWT). The distance covered during the Tr6MWT was significantly shorter (X=62 m, SD=91) before rehabilitation but not after rehabilitation.



A crossover randomized procedure could have improved the reliability of the Tr6MWT in people who performed the 6MWT first.



The Tr6MWT appears to be an instrument with adequate concurrent validity and to be tolerable, reliable, and responsive for the evaluation of exercise capacity in people after cardiac surgery even though it is not interchangeable with the 6MWT.
[Multidetector computed tomography coronarography: from studies to everyday life].

Multidetector computed tomography coronarography is a promising tool, offering a non-invasive anatomic evaluation of coronary arteries. The great majority of studies conducted upon it are single-center studies, and have reported results based upon a highly selected patient population. Our aim was to determine its diagnostic accuracy among an unselected population in multicenter studies.



Fifty-two patients were included in a non-randomised, retrospective study. Patients underwent multidetector computed tomography coronarography (16, 40 and 64 slices), in ten different centers (community hospitals or private centres), for clinical suspicion of coronary stenoses. The diagnostic accuracy for detecting significant coronary stenoses (> or =50%) was determined in comparison with conventional coronarography.



The sensitivity, specificity, positive and negative predictive values and diagnostic accuracy were 91.4%, 17.7%, 69.6%, 50.0%, and 67.3%, respectively, in a patient-based analysis, and 55.3%, 85.6%, 30.3%, 94.4% and 82.5% in a segment-based analysis.



The results of this study indicate that routine implementation of multidetector computed tomography coronarography is limited by a high false-positive rate, when performed among an unselected population of patients with a high pretest probability of having coronary stenoses, in centres with variable expertises. Its place within the range of diagnostic tools has yet to be determined by large multicenter studies, before being subject to precise recommendations framing its routine clinical application.
Multiple sclerosis and extract of cannabis: results of the MUSEC trial.

Multiple sclerosis (MS) is associated with chronic symptoms, including muscle stiffness, spasms, pain and insomnia. Here we report the results of the Multiple Sclerosis and Extract of Cannabis (MUSEC) study that aimed to substantiate the patient based findings of previous studies.



Patients with stable MS at 22 UK centres were randomised to oral cannabis extract (CE) (N=144) or placebo (N=135), stratified by centre, walking ability and use of antispastic medication. This double blind, placebo controlled, phase III study had a screening period, a 2 week dose titration phase from 5 mg to a maximum of 25 mg of tetrahydrocannabinol daily and a 10 week maintenance phase. The primary outcome measure was a category rating scale (CRS) measuring patient reported change in muscle stiffness from baseline. Further CRSs assessed body pain, spasms and sleep quality. Three validated MS specific patient reported outcome measures assessed aspects of spasticity, physical and psychological impact, and walking ability.



The rate of relief from muscle stiffness after 12 weeks was almost twice as high with CE than with placebo (29.4% vs. 15.7%; OR 2.26; 95% CI 1.24 to 4.13; p=0.004, one sided). Similar results were found after 4 weeks and 8 weeks, and also for all further CRSs. Results from the MS scales supported these findings.



The study met its primary objective to demonstrate the superiority of CE over placebo in the treatment of muscle stiffness in MS. This was supported by results for secondary efficacy variables. Adverse events in participants treated with CE were consistent with the known side effects of cannabinoids. No new safety concerns were observed.
Discrepant screening mammography assessments at blinded and non-blinded double reading: impact of arbitration by a third reader on screening outcome

To determine the value of adding a third reader for arbitration of discrepant screening mammography assessments. We included a consecutive series of 84,927 digital screening mammograms, double read in a blinded or non-blinded fashion. Arbitration was retrospectively performed by a third screening radiologist. Two years’ follow-up was performed. Discrepant readings comprised 57.2 % (830/1452) and 29.1 % (346/1188) of recalls at blinded and non-blinded double readings, respectively. At blinded double reading, arbitration would have decreased recall rate (3.4 to 2.2 %, p < 0.001) and programme sensitivity (83.2 to 76.0 %, p = 0.013), would not have influenced the cancer detection rate (CDR; 7.5 to 6.8 per 1,000 screens, p = 0.258) and would have increased the positive predictive value of recall (PPV; 22.3 to 31.2 %, p < 0.001). At non-blinded double reading, arbitration would have decreased recall rate (2.8 to 2.3 %, p < 0.001) and increased PPV (23.2 to 27.5 %, p = 0.021), but would not have affected CDR (6.6 to 6.3 per 1,000 screens, p = 0.604) and programme sensitivity (76.0 to 72.7 %, p = 0.308). Arbitration of discrepant screening mammography assessments is a good tool to improve recall rate and PPV, but is not desirable as it reduces the programme sensitivity at blinded double reading. • Blinded double reading results in higher programme sensitivity than non-blinded reading. • Discrepant readings occur more often at blinded compared to non-blinded reading. • Arbitration of discrepant readings reduces the recall rate and PPV. • Arbitration would reduce the programme sensitivity at blinded double reading.
Artificial neural network approach for selection of susceptible single nucleotide polymorphisms and construction of prediction model on childhood allergic asthma

Screening of various gene markers such as single nucleotide polymorphism (SNP) and correlation between these markers and development of multifactorial disease have previously been studied. Here, we propose a susceptible marker-selectable artificial neural network (ANN) for predicting development of allergic disease. To predict development of childhood allergic asthma (CAA) and select susceptible SNPs, we used an ANN with a parameter decreasing method (PDM) to analyze 25 SNPs of 17 genes in 344 Japanese people, and select 10 susceptible SNPs of CAA. The accuracy of the ANN model with 10 SNPs was 97.7% for learning data and 74.4% for evaluation data. Important combinations were determined by effective combination value (ECV) defined in the present paper. Effective 2-SNP or 3-SNP combinations were found to be concentrated among the 10 selected SNPs. ANN can reliably select SNP combinations that are associated with CAA. Thus, the ANN can be used to characterize development of complex diseases caused by multiple factors. This is the first report of automatic selection of SNPs related to development of multifactorial disease from SNP data of more than 300 patients.
Feasibility study of noninvasive ventilation with helium-oxygen gas flow for chronic obstructive pulmonary disease during exercise.

Individually, noninvasive ventilation (NIV) and helium-oxygen gas mixtures (heliox) diminish ventilatory workload and improve exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). NIV in combination with heliox may have additive effects on exercise tolerance in severe COPD.



We assessed the safety, tolerability, and efficacy of heliox and NIV during exercise in patients with severe COPD.



Pulmonary rehabilitation facility in an academic tertiary-care medical center.



Twelve patients with severe COPD were enrolled. Using a sequential randomized placebo-controlled crossover study design, the patients performed 4 separate constant-work stationary bicycle cardiopulmonary exercise studies at 80% of maximal workload during application of sham NIV, NIV, 60:40 heliox with sham NIV, and 60:40 heliox with NIV. Tolerability, safety, and exercise duration as determined by constant-work cardiopulmonary exercise test were the primary outcome measures. Secondary outcome measures at peak exercise and iso-time included rate of perceived exertion, dyspnea, leg pain, heart rate, respiratory rate, systolic and diastolic blood pressure, tympanic temperature, and oxyhemoglobin saturation.



No adverse effects occurred during or after application of NIV, heliox, or NIV with heliox. Exercise duration using heliox with NIV was significantly longer than both heliox (P = .01) and NIV (P = .007), but not placebo (P = .09). Relative to placebo, all treatment arms permitted lower respiratory rates at peak exercise. Heliox, with or without NIV, was associated with significant improvements in oxyhemoglobin saturation at peak exercise, relative to placebo or NIV alone.



The adjunctive use of NIV with heliox during exercise proved both safe and tolerable in patients with severe COPD. The lack of demonstrable efficacy to any of the treatment arms relative to placebo (P = .09) may be the result of the small sample size (ie, type 2 error)-a conclusion emphasized by the large standard deviations and differences in treatment group variances in exercise duration alone.
Atomoxetine improved attention in children and adolescents with attention-deficit/hyperactivity disorder and dyslexia in a 16 week, acute, randomized, double-blind trial.

The purpose of this study was to evaluate atomoxetine treatment effects in attention-deficit/hyperactivity disorder (ADHD-only), attention-deficit/hyperactivity disorder with comorbid dyslexia (ADHD+D), or dyslexia only on ADHD core symptoms and on sluggish cognitive tempo (SCT), working memory, life performance, and self-concept.



Children and adolescents (10-16 years of age) with ADHD+D (n=124), dyslexia-only (n=58), or ADHD-only (n=27) received atomoxetine (1.0-1.4 mg/kg/day) or placebo (ADHD-only subjects received atomoxetine) in a 16 week, acute, randomized, double-blind trial with a 16 week, open-label extension phase (atomoxetine treatment only). Changes from baseline were assessed to weeks 16 and 32 in ADHD Rating Scale-IV-Parent-Version:Investigator-Administered and Scored (ADHDRS-IV-Parent:Inv); ADHD Rating Scale-IV-Teacher-Version (ADHDRS-IV-Teacher-Version); Life Participation Scale-Child- or Parent-Rated Version (LPS); Kiddie-Sluggish Cognitive Tempo (K-SCT) Interview; Multidimensional Self Concept Scale (MSCS); and Working Memory Test Battery for Children (WMTB-C).



At week 16, atomoxetine treatment resulted in significant (p<0.05) improvement from baseline in subjects with ADHD+D versus placebo on ADHDRS-IV-Parent:Inv Total (primary outcome) and subscales, ADHDRS-IV-Teacher-Version Inattentive subscale, K-SCT Interview Parent and Teacher subscales, and WMTB-C Central Executive component scores; in subjects with Dyslexia-only, atomoxetine versus placebo significantly improved K-SCT Youth subscale scores from baseline. At Week 32, atomoxetine-treated ADHD+D subjects significantly improved from baseline on all measures except MSCS Family subscale and WMTB-C Central Executive and Visuo-spatial Sketchpad component scores. The atomoxetine-treated dyslexia-only subjects significantly improved from baseline to week 32 on ADHDRS-IV-Parent:Inv Inattentive subscale, K-SCT Parent and Teacher subscales, and WMTB-C Phonological Loop and Central Executive component scores. The atomoxetine-treated ADHD-only subjects significantly improved from baseline to Week 32 on ADHDRS-Parent:Inv Total and subscales, ADHDRS-IV-Teacher-Version Hyperactive/Impulsive subscale, LPS Self-Control and Total, all K-SCT subscales, and MSCS Academic and Competence subscale scores.



Atomoxetine treatment improved ADHD symptoms in subjects with ADHD+D and ADHD-only, but not in subjects with dyslexia-only without ADHD. This is the first study to report significant effects of any medication on SCT.