Showing papers by "Saint Louis University published in 2004"

Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: a randomized controlled trial.

Abstract: ContextMemantine is a low- to moderate-affinity, uncompetitive N-methyl-D-aspartate receptor antagonist. Controlled trials have demonstrated the safety and efficacy of memantine monotherapy for patients with moderate to severe Alzheimer disease (AD) but no controlled trials of memantine in patients receiving a cholinesterase inhibitor have been performed.ObjectiveTo compare the efficacy and safety of memantine vs placebo in patients with moderate to severe AD already receiving stable treatment with donepezil.Design, Setting, and ParticipantsA randomized, double-blind, placebo-controlled clinical trial of 404 patients with moderate to severe AD and Mini-Mental State Examination scores of 5 to 14, who received stable doses of donepezil, conducted at 37 US sites between June 11, 2001, and June 3, 2002. A total of 322 patients (80%) completed the trial.InterventionsParticipants were randomized to receive memantine (starting dose 5 mg/d, increased to 20 mg/d, n = 203) or placebo (n = 201) for 24 weeks.Main Outcome MeasuresChange from baseline on the Severe Impairment Battery (SIB), a measure of cognition, and on a modified 19-item AD Cooperative Study–Activities of Daily Living Inventory (ADCS-ADL19). Secondary outcomes included a Clinician's Interview-Based Impression of Change Plus Caregiver Input (CIBIC-Plus), the Neuropsychiatric Inventory, and the Behavioral Rating Scale for Geriatric Patients (BGP Care Dependency Subscale).ResultsThe change in total mean (SE) scores favored memantine vs placebo treatment for SIB (possible score range, 0-100), 0.9 (0.67) vs –2.5 (0.69), respectively (P<.001); ADCS-ADL19 (possible score range, 0-54), –2.0 (0.50) vs –3.4 (0.51), respectively (P = .03); and the CIBIC-Plus (possible score range, 1-7), 4.41 (0.074) vs 4.66 (0.075), respectively (P = .03). All other secondary measures showed significant benefits of memantine treatment. Treatment discontinuations because of adverse events for memantine vs placebo were 15 (7.4%) vs 25 (12.4%), respectively.ConclusionsIn patients with moderate to severe AD receiving stable doses of donepezil, memantine resulted in significantly better outcomes than placebo on measures of cognition, activities of daily living, global outcome, and behavior and was well tolerated. These results, together with previous studies, suggest that memantine represents a new approach for the treatment of patients with moderate to severe AD.

Public information: from nosy neighbors to cultural evolution.

Abstract: Psychologists, economists, and advertising moguls have long known that human decision-making is strongly influenced by the behavior of others A rapidly accumulating body of evidence suggests that the same is true in animals Individuals can use information arising from cues inadvertently produced by the behavior of other individuals with similar requirements Many of these cues provide public information about the quality of alternatives The use of public information is taxonomically widespread and can enhance fitness Public information can lead to cultural evolution, which we suggest may then affect biological evolution

Cinacalcet for Secondary Hyperparathyroidism in Patients Receiving Hemodialysis

Abstract: BACKGROUND: Treatment of secondary hyperparathyroidism with vitamin D and calcium in patients receiving dialysis is often complicated by hypercalcemia and hyperphosphatemia, which may contribute to cardiovascular disease and adverse clinical outcomes. Calcimimetics target the calcium-sensing receptor and lower parathyroid hormone levels without increasing calcium and phosphorus levels. We report the results of two identical randomized, double-blind, placebo-controlled trials evaluating the safety and effectiveness of the calcimimetic agent cinacalcet hydrochloride. METHODS: Patients who were receiving hemodialysis and who had inadequately controlled secondary hyperparathyroidism despite standard treatment were randomly assigned to receive cinacalcet (371 patients) or placebo (370 patients) for 26 weeks. Once-daily doses were increased from 30 mg to 180 mg to achieve intact parathyroid hormone levels of 250 pg per milliliter or less. The primary end point was the percentage of patients with values in this range during a 14-week efficacy-assessment phase. RESULTS: Forty-three percent of the cinacalcet group reached the primary end point, as compared with 5 percent of the placebo group (P<0.001). Overall, mean parathyroid hormone values decreased 43 percent in those receiving cinacalcet but increased 9 percent in the placebo group (P<0.001). The serum calcium-phosphorus product declined by 15 percent in the cinacalcet group and remained unchanged in the placebo group (P<0.001). Cinacalcet effectively reduced parathyroid hormone levels independently of disease severity or changes in vitamin D sterol dose. CONCLUSIONS: Cinacalcet lowers parathyroid hormone levels and improves calcium-phosphorus homeostasis in patients receiving hemodialysis who have uncontrolled secondary hyperparathyroidism.

Rhinosinusitis: Establishing definitions for clinical research and patient care

Abstract: Background There is a need for more research on all forms of rhinosinusitis. Progress in this area has been hampered by a lack of consensus definitions and the limited number of published clinical trials. Objectives To develop consensus definitions for rhinosinusitis and outline strategies useful in clinical trials. Methods Five national societies, The American Academy of Allergy, Asthma and Immunology; The American Academy of Otolaryngic Allergy; The American Academy of Otolaryngology Head and Neck Surgery; The American College of Allergy, Asthma and Immunology; and the American Rhinologic Society formed an expert panel from multiple disciplines. Over two days, the panel developed definitions for rhinosinusitis and outlined strategies for design of clinical trials. Results Committee members agreed to adopt the term "rhinosinusitis" and reached consensus on definitions and strategies for clinical research on acute presumed bacterial rhinosinusitis, chronic rhinosinusitis without polyposis, chronic rhinosinusitis with polyposis, and classic allergic fungal rhinosinusitis. Symptom and objective criteria, measures for monitoring research progress, and use of symptom scoring tools, quality-of-life instruments, radiologic studies, and rhinoscopic assessment were outlined for each condition. Conclusion The recommendations from this conference should improve accuracy of clinical diagnosis and serve as a starting point for design of rhinosinusitis clinical trials.

Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly.

Abstract: Objective: To determine the association of sarcopenic obesity with the onset of Instrumental Activities of Daily Living (IADL) disability in a cohort of 451 elderly men and women followed for up to 8 years. Research Methods and Procedures: Sarcopenic obesity was defined at study baseline as appendicular skeletal muscle mass divided by stature squared <7.26 kg/m2 in men and 5.45 kg/m2 in women and percentage body fat greater than the 60th percentile of the study sample (28% body fat in men and 40% in women). Incident disability was defined as a loss of two or more points from baseline score on the IADL. Subjects with disability at baseline (scores < 8) were excluded. Cox proportional hazards analysis was used to determine the association of baseline sarcopenic obesity with onset of IADL disability, controlling for potential confounders. Results: Subjects with sarcopenic obesity at baseline were two to three times more likely to report onset of IADL disability during follow-up than lean sarcopenic or nonsarcopenic obese subjects and those with normal body composition. The relative risk for incident disability in sarcopenic obese subjects was 2.63 (95% confidence interval, 1.19 to 5.85), adjusting for age, sex, physical activity level, length of follow-up, and prevalent morbidity. Discussion: This is the first study, to our knowledge, to indicate that sarcopenic obesity is independently associated with and precedes the onset of IADL disability in the community-dwelling elderly. The etiology of sarcopenic obesity is unknown but may include a combination of decreases in anabolic signals and obesity-associated increases in catabolic signals in old age.

Factors Affecting the Level of Trust and Commitment in Supply Chain Relationships

Abstract: SUMMARY Trust is a critical factor fostering commitment among supply chain partners. The presence of trust improves measurably the chance of successful supply chain performance. A lack of trust among supply chain partners often results in inefficient and ineffective performance as the transaction costs (verification, inspections and certifications of their trading partners) mount. Although the literature often mentions a relationship between trust and commitment, there is a lack of empirical testing of such relationship in the supply context. This study attempts to fill the gap between the theoretical argument and empirical testing. Results using a comprehensive survey of supply chain practitioners indicate that a firm's trust in its supply chain partner is highly associated with both sides' specific asset investments (positively) and behavioral uncertainty (negatively). It is also found that information sharing reduces the level of behavioral uncertainty, which, in turn, improves the level of trust. A partner's reputation in the market has a strong positive impact on the trust-building process, whereas a partner's perceived conflict creates a strong negative impact on trust. Finally, the level of commitment is strongly related to the level of trust. Policy implications are discussed.

Reclaiming the space of entrepreneurship in society: geographical, discursive and social dimensions

Abstract: This paper seeks to explore and to reflect upon the implications of how to conceive entrepreneurship when considered as a societal rather than an economic phenomenon. To conceive and reclaim the space in which entrepreneurship is seen at work in society, we point at the geographical, discursive and social dimensions from where we develop three crucial and connected questions that can reconstruct the future research agendas of entrepreneurship studies and that can guide us towards a geopolitics of everyday entrepreneurship: what spaces/discourses/stakeholders have we privileged in the study of entrepreneurship and what other spaces/discourses/stakeholders could we consider?

Effects of ranolazine with atenolol, amlodipine, or diltiazem on exercise tolerance and angina frequency in patients with severe chronic angina: a randomized controlled trial.

Abstract: ContextMany patients with chronic angina experience anginal episodes despite revascularization and antianginal medications. In a previous trial, antianginal monotherapy with ranolazine, a drug believed to partially inhibit fatty acid oxidation, increased treadmill exercise performance; however, its long-term efficacy and safety have not been studied in combination with β-blockers or calcium antagonists in a large patient population with severe chronic angina.ObjectivesTo determine whether, at trough levels, ranolazine improves the total exercise time of patients who have symptoms of chronic angina and who experience angina and ischemia at low workloads despite taking standard doses of atenolol, amlodipine, or diltiazem and to determine times to angina onset and to electrocardiographic evidence of myocardial ischemia, effect on angina attacks and nitroglycerin use, and effect on long-term survival in an open-label observational study extension.Design, Setting, and PatientsA randomized, 3-group parallel, double-blind, placebo-controlled trial of 823 eligible adults with symptomatic chronic angina who were randomly assigned to receive placebo or 1 of 2 doses of ranolazine. Patients treated at the 118 participating ambulatory outpatient settings in several countries were enrolled in the Combination Assessment of Ranolazine In Stable Angina (CARISA) trial from July 1999 to August 2001 and followed up through October 31, 2002.InterventionPatients received twice-daily placebo or 750 mg or 1000 mg of ranolazine. Treadmill exercise 12 hours (trough) and 4 hours (peak) after dosing was assessed after 2, 6 (trough only), and 12 weeks of treatment.Main Outcome MeasuresChange in exercise duration, time to onset of angina, time to onset of ischemia, nitroglycerin use, and number of angina attacks.ResultsTrough exercise duration increased by 115.6 seconds from baseline in both ranolazine groups (pooled) vs 91.7 seconds in the placebo group (P = .01). The times to angina and to electrocardiographic ischemia also increased in the ranolazine groups, at peak more than at trough. The increases did not depend on changes in blood pressure, heart rate, or background antianginal therapy and persisted throughout 12 weeks. Ranolazine reduced angina attacks and nitroglycerin use by about 1 per week vs placebo (P<.02). Survival of 750 patients taking ranolazine during the CARISA trial or its associated long-term open-label study was 98.4% in the first year and 95.9% in the second year.ConclusionTwice-daily doses of ranolazine increased exercise capacity and provided additional antianginal relief to symptomatic patients with severe chronic angina taking standard doses of atenolol, amlodipine, or diltiazem, without evident adverse, long-term survival consequences over 1 to 2 years of therapy.

Transaction cost determinants and ownership-based entry mode choice: a meta-analytical review

Abstract: Entry mode choice is a critical ingredient of international entry strategies, and has been voluminously examined in the field. The findings, however, are very mixed, especially with respect to transaction-cost-related factors in determining the ownership-based entry mode choice. This study conducted a meta-analysis to quantitatively summarize the literature and empirically generalize more conclusive findings. Based on the 106 effect sizes of 38 empirical studies, the meta-analysis shows that the findings of the existing studies are moderated to varying degrees by both study-setting factors and statistical artifacts, although the combined overall effects of transaction cost-based determinants are consistent with the predictions of transaction cost economics. We extensively discuss the implications of meta-analytical results, especially moderating effects of location, country of origin, industry type, and statistical artifacts, highlight the measurement adequacy, equivalence, and multidimensionality of transaction cost determinants, and present our suggestions to improve theoretical inquiries and empirical verifications on entry mode choice.

Rhinosinusitis: Establishing definitions for clinical research and patient care

Abstract: Objectives: to develop consensus definitions for rhinosinusitis and outline strategies useful in clinical trials

Triglycerides Induce Leptin Resistance at the Blood-Brain Barrier

Abstract: Obesity is associated with leptin resistance as evidenced by hyperleptinemia. Resistance arises from impaired leptin transport across the blood-brain barrier (BBB), defects in leptin receptor signaling, and blockades in downstream neuronal circuitries. The mediator of this resistance is unknown. Here, we show that milk, for which fats are 98% triglycerides, immediately inhibited leptin transport as assessed with in vivo, in vitro, and in situ models of the BBB. Fat-free milk and intralipid, a source of vegetable triglycerides, were without effect. Both starvation and diet-induced obesity elevated triglycerides and decreased the transport of leptin across the BBB, whereas short-term fasting decreased triglycerides and increased transport. Three of four triglycerides tested intravenously inhibited transport of leptin across the BBB, but their free fatty acid constituents were without effect. Treatment with gemfibrozil, a drug that specifically reduces triglyceride levels, reversed both hypertriglyceridemia and impaired leptin transport. We conclude that triglycerides are an important cause of leptin resistance as mediated by impaired transport across the BBB and suggest that triglyceride-mediated leptin resistance may have evolved as an anti-anorectic mechanism during starvation. Decreasing triglycerides may potentiate the anorectic effect of leptin by enhancing leptin transport across the BBB.

Low-dose inhaled nitric oxide in patients with acute lung injury: a randomized controlled trial.

Abstract: ContextInhaled nitric oxide has been shown to improve oxygenation in acute lung injury.ObjectiveTo evaluate the clinical efficacy of low-dose (5-ppm) inhaled nitric oxide in patients with acute lung injury.Design and SettingMulticenter, randomized, placebo-controlled study, with blinding of patients, caregivers, data collectors, assessors of outcomes, and data analysts (triple blind), conducted in the intensive care units of 46 hospitals in the United States. Patients were enrolled between March 1996 and September 1999.PatientsPatients (n = 385) with moderately severe acute lung injury, a modification of the American-European Consensus Conference definition of acute respiratory distress syndrome (ARDS) using a ratio of PaO2 to FiO2 of ≤250, were enrolled if the onset was within 72 hours of randomization, sepsis was not the cause of the lung injury, and the patient had no significant nonpulmonary organ system dysfunction at randomization.InterventionsPatients were randomly assigned to placebo (nitrogen gas) or inhaled nitric oxide at 5 ppm until 28 days, discontinuation of assisted breathing, or death.Main Outcome MeasuresThe primary end point was days alive and off assisted breathing. Secondary outcomes included mortality, days alive and meeting oxygenation criteria for extubation, and days patients were alive following a successful unassisted ventilation test.ResultsAn intent-to-treat analysis revealed that inhaled nitric oxide at 5 ppm did not increase the number of days patients were alive and off assisted breathing (mean [SD], 10.6 [9.8] days in the placebo group and 10.7 [9.7] days in the inhaled nitric oxide group; P = .97; difference, –0.1 day [95% confidence interval, –2.0 to 1.9 days]). This lack of effect on clinical outcomes was seen despite a statistically significant increase in PaO2 that resolved by 48 hours. Mortality was similar between groups (20% placebo vs 23% nitric oxide; P = .54). Days patients were alive following a successful 2-hour unassisted ventilation trial were a mean (SD) of 11.9 (9.9) for placebo and 11.4 (9.8) for nitric oxide patients (P = .54). Days alive and meeting criteria for extubation were also similar: 17.0 placebo vs 16.7 nitric oxide (P = .89).ConclusionInhaled nitric oxide at a dose of 5 ppm in patients with acute lung injury not due to sepsis and without evidence of nonpulmonary organ system dysfunction results in short-term oxygenation improvements but has no substantial impact on the duration of ventilatory support or mortality.

African Americans' Perceptions of Psychotherapy and Psychotherapists

Abstract: Although psychologists are aware of the differential pattern of use and response to mental health services among ethnic clients, the in-depth understanding that would permit development of appropriate responses and programs is limited. Psychologists often struggle with whether, when, and how efforts to address issues of race, ethnicity, and culture will affect mental health attitudes and therapeutic response. The focus group is a qualitative research strategy that uses a semistructured discussion format to elicit a more in-depth understanding of the attitudes, values, and beliefs that affect behavior (Stewart & Shamdasani, 1990). Although this strategy sacrifices the rigor and precision of quantitative studies, it is a useful preliminary strategy that allows members of communities to share their insights on relevant issues and their opinions about how needs and concerns might be addressed. The current study represents a preliminary effort to understand what values and concerns may affect African American mental health attitudes and service use, as well as what efforts by the psychological community may prove beneficial in promoting an image of multicultural sensitivity and competence. African Americans have been identified as a group that uses mental health services inconsistently (Kessler et al., 1994; D. W.

Evaluation of Intravenous Immunoglobulin as an Agent to Lower Allosensitization and Improve Transplantation in Highly Sensitized Adult Patients with End-Stage Renal Disease: Report of the NIH IG02 Trial

Abstract: Reported are the reduction of anti-HLA antibody levels and improvement of transplant rates by intravenous immunoglobulin (IVIG) in a randomized, double-blind, placebo-controlled clinical trial. Between 1997 and 2000, a total of 101 adult patients with ESRD who were highly sensitized to HLA antigens (panel reactive antibody [PRA] > or =50% monthly for 3 mo) enrolled onto an NIH-sponsored trial (IG02). Patients received IVIG or placebo. Subjects received IVIG 2 g/kg monthly for 4 mo or an equivalent volume of placebo with additional infusions at 12 and 24 mo after entry if not transplanted. If transplanted, additional infusions were given monthly for 4 mo. Baseline PRA levels were similar in both groups. However, IVIG significantly reduced PRA levels in study subjects compared with placebo. Sixteen IVIG patients (35%) and eight placebo patients (17%) were transplanted. Rejection episodes occurred in 9 of 17 IVIG and 1 of 10 placebo subjects. Seven graft failures occurred (four IVIG, three placebo) among adherent patients with similar 2-yr graft survival rates (80% IVIG, 75% placebo). With a median follow-up of 2 yr after transplant, the viable transplants functioned normally with a mean +/- SEM serum creatinine of 1.68 +/- 0.28 for IVIG versus 1.28 +/- 0.13 mg/dl for placebo. Adverse events rates were similar in both groups. We conclude that IVIG is better than placebo in reducing anti-HLA antibody levels and improving transplantation rates in highly sensitized patients with ESRD. Transplant rates for highly sensitized patients with ESRD awaiting kidney transplants are improved with IVIG therapy.

Vitamin D insufficiency and deficiency in chronic kidney disease. A single center observational study.

Abstract: Background: Kidney disease has been identified as a risk factor for vitamin D deficiency in hospitalized patients, and low levels of 25-hydroxyvitamin D have been suggested to be a

eLearning: a review of Internet-based continuing medical education.

Abstract: Introduction: The objective was to review the effrct oflnternet-based continuing medical education (CME) interventions on physician pegormance and health care outcomes. Methods: Data sources included searches of MEDLINE (1 966 to January 20041, CINAHL (1982 to December 2003), ACP Journal Club (1991 to JulyIAugust 2003), and the Cochrane Database of Systematic Reviews (third quartel; 2003). Studies were included in the analyses if they were randomized controlled trials of Internet-based education in which participants were practicing health care professionals or health professionals in training. CME interventions were categorized according to the nature of the intervention, sample size, und other information about educational content and form&. Results: Sixteen studies met the eligibility criteria. Six studies generated positive changes in participant knowledge over traditional formats; tvdy three studies showed a positive change in practices. The remainder of the studies showed no difference in knowledge levels between Internet-based interventions and traditional formats for CME. Discussion: The results demonstrate that Internet-based CME programs are just as efective in imparting knowledge as traditional formats of CME. Little is known as to whether these positive changes in knowledge are translated into changes in practice. Subjective reports of change in physician behavior should be confirmed through chart review or other objective measures. Additional studies need to be peqormed to assess how long these new learned behaviors could be sustained. elearning will continue to evolve as new innovations and more interactive modes are incorporated into learning

Profiles in quitting: integrating process and content turnover theory

Abstract: Process models of turnover focus on how people quit; content models focus on why. To integrate these approaches and test whether motives relate systematically to decision processes, we classified 1...

The truly remarkable universality of half a standard deviation: confirmation through another look

Abstract: In this issue of Expert Review of Pharmacoeconomics and Outcomes Research, Farivar, Liu, and Hays present their findings in ‘Another look at the half standard deviation estimate of the minimally important difference in health-related quality of life scores (hereafter referred to as ‘Another look’) [1]. These researchers have re-examined the May 2003 Medical Care article ‘Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation’ (hereafter referred to as ‘Remarkable’) [2] in the hope of supporting their hypothesis that the minimally important difference in health-related quality of life measures is undoubtedly closer to 0.3 standard deviations than 0.5 [3]. Nonetheless, despite their extensive wranglings with the exclusion of many articles that we included in our review; the inclusion of articles that we did not include in our review; and the recalculation of effect sizes using the absolute value of the mean differences, in our opinion, the resul...

Stealth Marketing: How to Reach Consumers Surreptitiously

Abstract: Stealth marketing techniques are being driven by a growing criticism of the advertising industry, and are based on the premise that word of mouth and peer group recommendation are the most effective promotional and marketing tools.This article discusses stealth marketing methods used by companies to reach consumers without their motives being obvious. The authors feel that brand managers need to consider the strengths and weaknesses of stealth marketing and traditional marketing before they decide on either.

Family Business Succession: Suggestions for Future Research:

Abstract: Management succession is a significant moment in a family business's life and an issue that requires analysis from the perspectives of family, management, and ownership systems in order to understand adequately the perspectives of the different stakeholders. In an effort to help improve the quality of the research methodology on this subject, past family business research methodology will be reviewed and critiqued, and some specific recommendations will be presented that can enhance the quality and value of family business research.

Serum antibody responses after intradermal vaccination against influenza.

Abstract: Background If found to be safe and immunogenic, reduced doses of influenza vaccine given by the intradermal route could increase the number of available doses of vaccine. Methods In an open-label study, we randomly assigned 119 subjects to receive an intradermal injection of trivalent inactivated influenza vaccine, containing 6 μg of hemagglutinin for each antigen (40 percent of the usual dose), and 119 to receive an intramuscular injection of the standard dose of 15 μg of hemagglutinin for each antigen. The two groups were subdivided according to age (18 to 60 years and older than 60 years). Results Among subjects who were 18 to 60 years of age, serum antibody responses were vigorous and did not differ significantly between the intradermal and intramuscular groups, and all subjects had hemagglutination-inhibition (HAI) titers of at least 1:40. Although the subjects who were older than 60 years of age also had a vigorous antibody response, there was a trend toward a better response in the intramuscular ro...

Common factors and our sacred models.

Abstract: In this article we argue that much of what makes one treatment effective is common to other forms of effective treatment-both in psychotherapy generally and in marital and family therapy (MFT)specifically. Yet MFT has largely ignored the research on common factors. In this article we present a moderate view of common factors that, while repudiating the extreme position that there isno difference among treatment models, stresses that there are common factors and mechanisms of changethat undergird most forms of successful treatment. These common mechanisms of change should begiven more attention in our field, which has tended to emphasize the uniqueness of our sacred models. We delineate some of the major common factors, review the empirical evidence for them, and discussimplications of adapting a common factors informed approach to family therapy.