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Abstract
This paper reviews the use of descriptive statistics to describe the participants included in a study. It discusses the practicalities of incorporating statistics in papers for publication in Age and Aging, concisely and in ways that are easy for readers to understand and interpret.
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A randomized controlled feasibility trial exploring partnered ballroom dancing for people with Parkinson's disease. Clin Rehabil 2017; 31:1340-1350. [PMID: 28933613 DOI: 10.1177/0269215517694930] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the feasibility of a Dance Centre delivering a programme of mixed dances to people with Parkinson's and identify suitable outcomes for a future definitive trial. DESIGN A two-group randomized controlled feasibility trial. METHODS People with Parkinson's were randomized to a control or experimental group (ratio 15:35), alongside usual care. In addition, participants in the experimental group danced with a partner for one hour, twice-a-week for 10 weeks; professional dance teachers led the classes and field-notes were kept. Control-group participants were given dance class vouchers at the end of the study. Blinded assessments of balance, mobility and function were completed in the home. Qualitative interviews were conducted with a subsample to explore the acceptability of dance. RESULTS A total of 51 people with Parkinson's (25 male) with Hoehn and Yahr scores of 1-3 and mean age of 71 years (range 49-85 years), were recruited to the study. Dance partners were of similar age (mean 68, range 56-91 years). Feasibility findings focused on recruitment (target achieved); retention (five people dropped out of dancing); outcome measures (three measures were considered feasible, changes were recommended). Proposed sample size for a Phase III trial, based on the 6-minute walk test at six months was 220. Participants described dance as extremely enjoyable and the instructors were skilled in instilling confidence and motivation. The main organizational challenges for a future trial were transport and identifying suitable dance partners. CONCLUSION We have demonstrated the feasibility of conducting the study through a Dance Centre and recommend a Phase III trial.
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Evaluating equipment for people with disabilities: user and technical perspectives on basic commodes. Clin Rehabil 2016. [DOI: 10.1177/026921559500900211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Disabled people often do not use the equipment supplied to them. Past work indicates that there are many reasons for this, including the low priority given to user views by the designers and manufacturers of such equipment. A number of different methodologies have been used to evaluate equipment. This paper describes an evaluation of basic commodes, a project funded by the Medical Devices Agency, Department of Health, in which both a user survey and technical tests were employed. A sample of 18 basic commodes, divided into four categories, was evaluated by 40 users, a questionnaire being administered to determine user views. A series of 13 technical tests was also carried out. The results showed that the preferred commodes as indicated by the users did not necessarily perform well in the technical tests, with at least one of the products having potentially serious design faults. It is suggested that users, therapists and engineers each have an essential contribution to make in the evaluation of equipment for disabled people.
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Abstract
This study examines whether head-injured people have a central executive deficit, and if this is correlated with performance on frontal-lobe tests. Twenty-five severely head-injured (HI) patients and 25 matched controls performed five tasks:(1) visual-motor tracking, (2) digit span, (3) visual-motor tracking with verbal encouragement from the experimenter, (4) visual-motor tracking whilst holding a conversation with the experimenter, and (5) visual-motor tracking with a simultaneous digit-span task. In addition, all subjects were assessed on three frontal-lobe tests. HI patients were significantly worse overall than controls. The most striking difference was in tracking with conversation, in which HI patients (but not controls) showed a marked decrement in performance. Scores from tests of frontal lobe functioning were significantly correlated with (1) tracking during conversation and (2) tracking with digits. The results are broadly consistent with a central executive deficit in head-injured patients.
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Sequence and onset of whole-body coordination when turning in response to a visual trigger: comparing people with Parkinson's disease and healthy adults. Gait Posture 2014; 39:278-83. [PMID: 23973355 DOI: 10.1016/j.gaitpost.2013.07.128] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 06/11/2013] [Accepted: 07/26/2013] [Indexed: 02/02/2023]
Abstract
Turning round is a routine everyday activity that can often lead to instability. The purpose of this study was to investigate abnormalities of turning among people with Parkinson's disease (PwPD) through the measurement of sequence of body segments and latency response. Participants were asked to turn 180° and whole-body movements were recorded using CODAmotion and Visio Fast eye tracking equipment. Thirty-one independently mobile PwPD and 15 age-matched healthy controls participated in the study. We found that contrary to common belief, the head preceded movement of all other body segments (eyes, shoulders, pelvis, first and second foot). We also found interaction between group and body segment (P=0.005), indicating that overall, PwPD took longer to move from head to second foot than age-matched healthy controls. For PwPD only, interactions were found between disease severity and body segment (P<0.0001), between age group and body segment (P<0.0001) and between gender and body segments (P<0.0001). For each interaction, longer time periods were noted between moving the first foot after the pelvis, and moving the second foot after the first, and this was noted for PwPD in Hoehn and Yahr stage III-IV (in comparison to Hoehn and Yahr stage I-II); for PwPD who were under 70 years (in comparison with 70 years or over); and for ladies (in comparison with men). Our results indicate that in PwPD and healthy elderly, turning-on-the-spot might not follow the top-to-bottom approach we know from previous research.
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Abstract
The oxygen uptake efficiency slope is a measure of cardiopulmonary fitness, that can be obtained from a sub-maximal cardiopulmonary exercise test. It has been evaluated in medical patients but its reliability in surgical populations remains uncertain. We conducted a test-retest study with the aim of establishing the reliability of the oxygen uptake efficiency slope in relation to that of the anaerobic threshold and peak oxygen uptake, in general surgical patients. Twenty-six patients over 60 years old completed two symptom-limited, incremental cycle ergometry tests within 7 days. The mean (SD) anaerobic threshold was 13.0 (3.0) mlO(2) .kg(-1) .min(-1) . There were no significant differences between mean test and retest values of anaerobic threshold (p = 0.50), peak oxygen uptake (p = 0.76) or oxygen uptake efficiency slope (p = 0.42). Reliability coefficients (95% CI) for the anaerobic threshold, oxygen uptake efficiency slope and peak oxygen uptake were 66.7% (45.3-87.9%), 89.0% (81.0-96.9%) and 91.7% (85.7-97.8%), respectively. The oxygen uptake efficiency slope was determined easily in all patients and found to have excellent reliability. Its clinical utility in determining pre-operative fitness warrants further evaluation.
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An open randomized comparison of clinical effectiveness of protocol-driven opioid analgesia, celiac plexus block or thoracoscopic splanchnicectomy for pain management in patients with pancreatic and other abdominal malignancies. Pancreatology 2010; 9:755-63. [PMID: 20090396 DOI: 10.1159/000199441] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 01/23/2009] [Indexed: 12/11/2022]
Abstract
UNLABELLED In inoperable malignancy, pain relief with opioids is often inadequate. Nerve block procedures may improve symptom control. Our aim was to assess celiac plexus block (CPB) and thoracoscopic splanchnicectomy (TS) in patients receiving appropriate medical management (MM). METHODS Patients with confirmed irresectable malignancy of the pancreas or upper abdominal viscera who required opioid analgesia were randomized to MM alone, MM+CPB, or MM+TS. Randomization was stratified by treatment centre, tumour type and previous opioid medication. The primary endpoint was pain relief at 2 months. RESULTS 65 patients (58 pancreas cancer) were randomized, 18 withdrew or died within 2 months. Effective pain relief was achieved in only one third of subjects at 2 weeks, and just under half at 2 months (MM: 6/19 and 5/12 evaluable patients; CPB: 5/14 and 5/9; TS 4/14 and 4/11). There were no significant differences between the groups in pain scores or opioid consumption, and there was no correlation between continued use of opioids and effective pain relief. DISCUSSION Previous randomized studies have shown small differences in pain scores, but no difference in opioid consumption and quality of life. The absence of any benefit from interventions in the present study questions their value.
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Consequence of Abeta immunization on the vasculature of human Alzheimer's disease brain. ACTA ACUST UNITED AC 2008; 131:3299-310. [PMID: 18953056 DOI: 10.1093/brain/awn261] [Citation(s) in RCA: 224] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A major feature of Alzheimer's disease is the accumulation of amyloid-beta peptide (Abeta) in the brain both in the form of plaques in the cerebral cortex and in blood vessel as cerebral amyloid angiopathy (CAA). Experimental models and human clinical trials have shown that accumulation of Abeta plaques can be reversed by immunotherapy. In this study, we hypothesized that Abeta in plaques is solubilized by antibodies generated by immunization and drains via the perivascular pathway, detectable as an increase in cerebrovascular Abeta. We have performed a follow up study of Alzheimer's disease patients immunized against Abeta42. Neuropathological examination was performed on nine patients who died between four months and five years after their first immunization. Immunostaining for Abeta40 and Abeta42 was quantified and compared with that in unimmunized Alzheimer's disease controls (n = 11). Overall, compared with these controls, the group of immunized patients had approximately 14 times as many blood vessels containing Abeta42 in the cerebral cortex (P<0.001) and seven times more in the leptomeninges (P = 0.013); among the affected blood vessels in the immunized cases, most of them had full thickness and full circumference involvement of the vessel wall in the cortex (P = 0.001), and in the leptomeninges (P = 0.015). There was also a significantly higher level of cerebrovascular Abeta40 in the immunized cases than in the unimmunized cases (cortex: P = 0.009 and leptomeninges: P = 0.002). In addition, the immunized patients showed a higher density of cortical microhaemorrhages and microvascular lesions than the unimmunized controls, though none had major CAA-related intracerebral haemorrhages. The changes in cerebral vascular Abeta load did not appear to substantially influence the structural proteins of the blood vessels. Unlike most of the immunized patients, two of the longest survivors, four to five years after first immunization, had virtually complete absence of both plaques and CAA, raising the possibility that, given time, Abeta is eventually cleared from the cerebral vasculature. The findings are consistent with the hypothesis that Abeta immunization results in solubilization of plaque Abeta42 which, at least in part, exits the brain via the perivascular pathway, causing a transient increase in the severity of CAA. The extent to which these vascular alterations following Abeta immunization in Alzheimer's disease are reflected in changes in cognitive function remains to be determined.
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The influence of attention deficits on functional recovery post stroke during the first 12 months after discharge from hospital. J Neurol Neurosurg Psychiatry 2008; 79:656-63. [PMID: 17872979 DOI: 10.1136/jnnp.2007.125609] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Attention deficits have been linked to poor recovery after stroke and may predict outcome. We explored the influence of attention on functional recovery post stroke in the first 12 months after discharge from hospital. METHODS People with stroke completed measures of attention, balance, mobility and activities of daily living (ADL) ability at the point of discharge from hospital, and 6 and 12 months later. We used correlational analysis and stepwise linear regression to explore potential predictors of outcome. RESULTS We recruited 122 men and women, mean age 70 years. At discharge, 56 (51%) had deficits of divided attention, 45 (37%) of sustained attention, 43 (36%) of auditory selective attention and 41 (37%) had visual selective attention deficits. Attention at discharge correlated with mobility, balance and ADL outcomes 12 months later. After controlling for the level of the outcome at discharge, correlations remained significant in only five of the 12 relationships. Stepwise linear regression revealed that the outcome measured at discharge, days until discharge and number of medications were better predictors of outcome: in no case was an attention variable at discharge selected as a predictor of outcome at 12 months. CONCLUSIONS Although attention and function correlated significantly, this correlation was reduced after controlling for functional ability at discharge. Furthermore, side of lesion and the attention variables were not demonstrated as important predictors of outcome 12 months later.
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Abstract
OBJECTIVE To assess the effectiveness of oral vanadium supplementation for glycaemic control in type 2 diabetes by conducting a systematic review of the literature. DESIGN AND METHODS Eligible studies were identified by searching 14 databases using standardized terms. Experts, study authors and manufacturers were also contacted. Hand-searching was not undertaken. Selection criteria for inclusion in the review were controlled human trials of vanadium vs. placebo in adults with type 2 diabetes of minimum 2 months duration, and a minimum of 10 subjects per arm. Data extraction, assessment of study quality and outcome analysis were undertaken by two independent reviewers. RESULTS One hundred and fifty one studies were found but none met the inclusion criteria. We proceeded to summarize the state of existing evidence and plan for a future clinical trial by applying revised, less restrictive criteria to our search, for clinical trials of 30-150 mg daily oral vanadium supplementation in diabetic humans. Only five were identified. These demonstrated significant treatment-effects, but due to poor study quality, must be interpreted with caution. Treatment with vanadium often results in gastrointestinal side-effects. CONCLUSION There is no rigorous evidence that oral vanadium supplementation improves glycaemic control in type 2 diabetes. The routine use of vanadium for this purpose cannot be recommended. A large-scale randomized controlled trial is needed to address this clinical question.
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Indices of apoptosis and proliferation as potential prognostic markers in non-functioning pituitary adenomas. Clin Neuropathol 2004; 23:8-15. [PMID: 14986928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE Non-functioning pituitary adenomas (NFAs) are a distinct group of pituitary adenomas, which comprise approximately 20% of pituitary adenomas. Although most pituitary adenomas are benign, there is a subset of adenomas that behaves in an aggressive fashion, with either invasion of the surrounding structures or recurrence. The aim of this study was to investigate whether the behaviour of NFAs can be predicted using immunohistochemical markers that label proliferating and apoptotic cells, including a new marker for apoptosis (M30 CytoDEATH). This is the first study to analyse both the proliferation labelling index (LI) and the apoptotic index (AI) in NFAs and to correlate the labelling indices of these histological markers with tumor growth rate as measured by 2 postoperative MRI scans. MATERIAL AND METHODS 40 patients in total were included in the study. 20 patients with high growth rate and percentage change in the pituitary adenoma volume as assessed on 2 postoperative MRI scans were age/sex matched to 20 patients with low growth rate or percentage change. RESULTS There is no significant statistical difference of the histological and immunohistochemical indices assessed between cases and controls. CONCLUSION The routine assessment of the proliferation and the apoptotic markers used in this study in NFAs has no prognostic value.
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A single-centre study of treatment outcomes and survival in 120 patients with peripheral T-cell non-Hodgkin's lymphoma. Ann Hematol 2002; 81:267-72. [PMID: 12029536 DOI: 10.1007/s00277-002-0450-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2001] [Accepted: 02/28/2002] [Indexed: 11/29/2022]
Abstract
We conducted a retrospective study of treatment outcomes and survival in 120 consecutive, unselected patients with peripheral T-cell non-Hodgkin's lymphoma, presenting at a single centre over a 20-year period. Cases met the criteria of the Revised European-American Lymphoma (REAL) Classification and patients with peripheral T-cell lymphoma of the following subtypes were included: anaplastic large T-cell lymphoma (ALCL), angioimmunoblastic T-cell lymphoma (AILD), peripheral T-cell lymphoma unspecified (PTCLu), and intestinal T-cell lymphoma (ITCL). The study population consisted of 120 patients with a presenting diagnosis of peripheral T-cell lymphoma. Cases that had been previously confirmed as T-cell lymphoma at formal pathology review were identified from the lymphoma database of this institution. Staging investigations, treatment type and outcomes were taken from patient records. For each subtype, clinical characteristics, response to initial treatment, duration of response and any subsequent relapse were recorded. Overall, relapse, and progression-free survival figures were calculated. The ALCL group had the best response rate to first line treatment 19 of 22 (86 percent) while the AILD group had the lowest response 12 of 29 (41 percent). Relapse rates were PTCLu 13 of 35 (37 percent), ITCL 10 of 34 (29 percent), ALCL 6 of 22 (27 percent) and AILD 7 of 29 (24 percent). In terms of median overall survival, a significantly superior survival was demonstrated for the ALCL group (7.05 years) compared to the remaining three groups. The ALCL group had the lowest risk of death while the ITCL group had the highest risk (hazard ratio: 2.82). Five-year survival rates were estimated to be ALCL 60 percent, PTCLu 40 percent, AILD 30 percent and ITCL 25 percent. This single-centre study demonstrated different outcomes for each group with significant differences in overall survival rates. These findings support the clinical utility of the REAL lymphoma classification in respect to the PTCL subgroups included in this study.
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Head and pelvic movements during a dynamic reaching task in sitting: implications for physical therapists. Arch Phys Med Rehabil 2001; 82:1655-60. [PMID: 11733878 DOI: 10.1053/apmr.2001.26818] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To describe the distance reached, speed, and movement of the head and pelvis of healthy volunteers; to describe any influence of age on these variables; and to compare healthy volunteers and subjects with hemiplegia while performing a seated reaching task. DESIGN Age-matched, case-control study. SETTING Gait laboratory in a general hospital. PARTICIPANTS A convenience sample of 53 healthy volunteers (30 women; 23 men; mean age, 57yr; range, 30-79yr) and 5 subjects with hemiplegia (2 women, 3 men; mean age, 65yr; range, 60-78yr) were recruited within 6 weeks poststroke. INTERVENTIONS Participants sat on a bench with feet supported and reached laterally as far as they could without falling. MAIN OUTCOME MEASURES The speed, distance reached, and angular movements of the head and pelvis were recorded by using the 3-dimensional movement analysis system. RESULTS A significant age-related reduction in the distance reached (p < .001), velocity of the movement (p =.000), and pelvic tilt used (p < .01) was found among healthy volunteers. Comparison of data from healthy volunteers and subjects with hemiplegia showed a significant reduction in the angular movements of the heads of subjects with hemiplegia. CONCLUSIONS The findings suggest conservation of movement with increasing age and stroke. This movement reduction could have negative effects on a subject's ability to make postural changes in response to disturbance and activity. Such information may assist therapists to gain insight into the nature of balance deficits and the adaptive behavior that could result.
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Abstract
BACKGROUND The risk of people with Parkinson's disease (PD) falling is greater than that of the general population but to date, disease-specific predictors of falling have not been identified. OBJECTIVES To identify one or more features, which would predict individuals at risk of falling during a 3-month prospective follow-up study. METHOD A battery of standardised tests administered in the home and the laboratory with a 3-month follow-up telephone interview. RESULTS Sixty-three people with PD were recruited from GP practices. Eleven interview variables and six gait laboratory variables were used with subsamples (55 and 44 subjects, respectively) to fit predictive models for identifying future fallers. The number of falls in the previous year was the most important variable, without exception, to be selected as a predictor in various logistic regression models. A history of two or more falls had a sensitivity of 86.4% (95% CI 67.3-96.2%) and a specificity of 85.7% (95% CI 71.2-94.2%) in predicting falling in the next 3 months. CONCLUSION Healthcare workers should be asking their patients with PD regularly and carefully about falling, and should consider instigating programmes of fall management for patients with PD who have fallen two or more times in the previous 12 months.
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Comparative study of mortality rates and cardiac dysrhythmias in post-marketing surveillance studies of sertindole and two other atypical antipsychotic drugs, risperidone and olanzapine. J Psychopharmacol 2001; 15:120-6. [PMID: 11448085 DOI: 10.1177/026988110101500212] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sertindole (Serdolect), an atypical antipsychotic, was voluntarily suspended in the European Union in 1998 following regulatory concerns over reports of serious cardiac dysrhythmias and sudden unexpected deaths. The reported causes of death, their frequency, prolongation of the rate corrected QT interval (QTc) and cardiac dysrhythmias in patients prescribed sertindole were compared with those for patients treated with two other atypical antipsychotics. All patients in England, prescribed atypical antipsychotics by general practitioners during each drug's immediate post-marketing period, were identified using an observational cohort technique, prescription-event monitoring. Mortality rates in the sertindole cohort were compared with those in a comparator cohort using standardized mortality ratios and incidence rate ratios. Cardiovascular events were reviewed and followed up to identify cases of prolongation of QTc interval. There was no statistically significant difference in mortality rates between sertindole and the comparator cohort, although confidence intervals (CI) were wide due to small numbers in the sertindole cohort. A much smaller number of patients were prescribed sertindole than the other antipsychotics. Six cases of prolongation of QTc interval were identified in 462 patients (1.3%, 95% CI 0.5-2.8) treated with sertindole and one with unspecified electrocardiogram changes in the comparator cohort of 16,542 patients. This study contributes to the understanding of the occurrence of prolongation of QTc interval during clinical use of sertindole, the incidence of which was similar to that in clinical trials. Although no statistically significant difference was shown in mortality rates between sertindole and comparator cohort, the sertindole cohort was too small to rule out an association between the use of this drug and cardiovascular deaths.
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An investigation into the feasibility of comparing three management options (augmentation, conservative and water) for nulliparae with dystocia in the first stage of labour. Midwifery 2001; 17:35-43. [PMID: 11207103 DOI: 10.1054/midw.2000.0233] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE to evaluate the feasibility of a randomised controlled trial (RCT) examining the effect of three options (augmentation, conservative and water) for the management of dystocia in nulliparae. The main objectives were to explore the feasibility of trial procedures in the clinical environment, consent rates and acceptability of the management options to women, local incidence of dystocia in nulliparae and the size of the subsequent study. DESIGN a two part study: a pilot, RCT with follow-up through to delivery with postnatal maternal surveys, and a case review of nulliparae with dystocia. SETTING a large maternity unit in the South of England in May-July 1997 inclusive. PARTICIPANTS nulliparae with dystocia in the first stage of labour who had an otherwise uncomplicated obstetric background. INTERVENTIONS women in the pilot RCT received one of three management options: labouring in a waterbirth pool, conservative management or augmentation of labour, which is the standard management of women with dystocia condition in the Unit. FINDINGS it is feasible to conduct an RCT of management of dystocia in the Unit. Seventy per cent (95% confidence interval 47% to 87%) of women approached agreed to participate. Conservative management was the least acceptable option to women and has been dropped from the subsequent trial. The audit provided some idea of possible differences in operative delivery and epidural rates depending on augmentation or not. A sample of 220 women should be large enough to detect moderate changes and will require a 2-year recruitment period. CONCLUSIONS a subsequent trial is feasible and is now underway. It has the potential to provide information enabling women and practitioners to have a greater choice of care options in the presence of dystocia, or provide a good basis for an even larger trial.
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Therapeutic nursing or unblocking beds? A randomised controlled trial of a post-acute intermediate care unit. BMJ (CLINICAL RESEARCH ED.) 2001; 322:453-60. [PMID: 11222419 PMCID: PMC26560 DOI: 10.1136/bmj.322.7284.453] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/08/2001] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To compare post-acute intermediate care in an inpatient nurse-led unit with conventional post-acute care on general medical wards of an acute hospital and to examine the model of care in a nurse-led unit. DESIGN Randomised controlled trial with six month follow up. SETTING Urban teaching hospital and surrounding area, including nine community hospitals. PARTICIPANTS 238 patients accepted for admission to nurse-led unit. INTERVENTIONS Care in nurse-led unit or usual post-acute care. MAIN OUTCOME MEASURES Patients' length of stay, functional status, subsequent move to more dependent living arrangement. RESULTS Inpatient length of stay was significantly longer in the nurse-led unit than in general medical wards (14.3 days longer (95% confidence interval 7.8 to 20.7)), but this difference became non-significant when transfers to community hospitals were included in the measure of initial length of stay (4.5 days longer (-3.6 to 12.5)). No differences were observed in mortality, functional status, or living arrangements at any time. Patients in the nurse-led unit received significantly fewer minor medical investigations and, after controlling for length of stay, significantly fewer major reviews, tests, or drug changes. CONCLUSIONS The nurse-led unit seemed to be a safe alternative to conventional management, but a full accounting of such units' place in the local continuum of care and the costs associated with acute hospitals managing post-acute patients is needed if nurse-led units are to become an effective part of the government's recent commitment to intermediate care.
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Invasiveness of cutaneous malignant melanoma is influenced by matrix metalloproteinase 1 gene polymorphism. Cancer Res 2001; 61:1296-8. [PMID: 11245423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The matrix metalloproteinases (MMPs) are implicated in connective tissue destruction during cancer invasion and metastasis. A naturally occurring variant arising from the insertion or deletion of a guanine in the promoter of the MMP-1 gene has recently been reported and shown to influence its transcriptional activity in melanoma cells. In this study, MMP-1 genotype was determined in 139 Caucasian patients with cutaneous malignant melanoma. The insertion allele was associated with deep invasive, and therefore poorer-prognosis, primary tumors [(34% of patients with vertical growth phase tumor were homozygous for the insertion allele compared with 17% of patients with horizontal growth phase tumor (P = 0.0333; odds ratio = 2.51)]. These data suggest that the invasiveness of cutaneous malignant melanoma is influenced by variation in the MMP-1 gene promoter that affects MMP-1 expression.
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A community-dwelling sample of people with Parkinson's disease: characteristics of fallers and non-fallers. Age Ageing 2001; 30:47-52. [PMID: 11322672 DOI: 10.1093/ageing/30.1.47] [Citation(s) in RCA: 203] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND people with Parkinson's disease often fall. OBJECTIVES to report the frequency of falls and characteristics of fallers and non-fallers in a community-based sample of people with Parkinson's disease. METHOD we administered a battery of standardized tests in the home and the laboratory. RESULTS we recruited 63 people with Parkinson's disease through general practices. Forty (64%, 95% confidence interval 51-74%) had fallen in the previous 12 months. Many factors associated with falling in the general population were associated with Parkinson's disease fallers (e.g. use of multiple medication and greater physical disability). Fallers were more likely to be depressed and anxious than non-fallers. Condition-specific factors associated with falling included greater disease severity (although there were exceptions) and more marked response to levodopa treatment, including more dyskinesia and on-off phenomena. Fallers took more steps to complete a test of mobility. They also had a shorter functional reach and greater postural sway whilst completing a dual task than non-fallers. CONCLUSION this community-based study confirms the high risk of falling in Parkinson's disease. Our results suggest that disease-specific factors contribute to the increased risk and that there is scope for specific therapeutic interventions.
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Dowrick et al. found no relationship between the scores on the Depression Attitude Questionnaire and GPs' ability to identify depressed individuals in the surgery. Psychol Med 2001; 31:181. [PMID: 11200956 DOI: 10.1017/s0033291799003190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Biochemical diagnosis of ventricular dysfunction in elderly patients in general practice: observational study. BMJ (CLINICAL RESEARCH ED.) 2000; 320:906-8. [PMID: 10741999 PMCID: PMC27331 DOI: 10.1136/bmj.320.7239.906] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the usefulness of measuring plasma concentrations of B type natriuretic peptide in the diagnosis of left ventricular systolic dysfunction in an unselected group of elderly people. DESIGN Observational study. SETTING General practice with four centres in Poole, Dorset. PARTICIPANTS 155 elderly patients aged 70 to 84 years. MAIN OUTCOME MEASURES Diagnostic characteristics of plasma B type natriuretic peptide measured by radioimmunoassay as a test for left ventricular systolic dysfunction assessed by echocardiography. RESULTS The median plasma concentration of B type natriuretic peptide was 39.3 pmol/l in patients with left ventricular systolic dysfunction and 15.8 pmol/l in those with normal function. The proportional area under the receiver operator curve was 0.85. At a cut-off point of 18.7 pmol/l the test sensitivity was 92% and the predictive value 18%. CONCLUSIONS Plasma concentration of B type natriuretic peptide could be used effectively as an initial test in a community screening programme and, possibly, using a low cut-off point, as a means of ruling out left ventricular systolic dysfunction. It is, however, not a good test to "rule in" the diagnosis, and access to echocardiography remains essential for general practitioners to diagnose heart failure early.
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Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial. Lancet 2000; 355:185-91. [PMID: 10675118 DOI: 10.1016/s0140-6736(99)03171-2] [Citation(s) in RCA: 276] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Depression is a major individual and public-health burden throughout the world and is managed mainly in primary care. The most effective strategy to reduce this burden has been believed to be education of primary-care practitioners. We tested this assumption by assessing the effectiveness of an educational programme based on a clinical-practice guideline in improving the recognition and outcome of primary-care depression. METHODS We carried out a randomised controlled trial in a representative sample of 60 primary-care practices (26% of the total) in an English health district. Education was delivered to practice teams and quality tested by feedback from participants and expert raters. The primary endpoints were recognition of depression, defined by the hospital anxiety and depression (HAD) scale, and clinical improvement. Analysis was by intention to treat. FINDINGS The education was well received by participants, 80% of whom thought it would change their management of patients with depression. 21409 patients were screened, of whom 4192 were classified as depressed by the HAD scale. The sensitivity of physicians to depressive symptoms was 39% in the intervention group and 36% in the control group after education (odds ratio 1.2 [95% CI 0.88-1.61]). The outcome of depressed patients as a whole at 6 weeks or 6 months after the assessment did not significantly improve. INTERPRETATION Although well received, this in-practice programme, which was designed to convey the current consensus on best practice for the care of depression, did not deliver improvements in recognition of or recovery from depression.
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Mobility and dementia: is physiotherapy treatment during respite care effective? Int J Geriatr Psychiatry 1999; 14:389-97. [PMID: 10389044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND Mobility problems experienced by elderly people with a dementia are associated with falls, fractures and admission to long-term care. A hospital respite care admission is therefore often seen as an opportunity to provide physiotherapy treatment. AIM To find whether elderly people with a dementia and a mobility problem show a greater improvement in mobility skills if given physiotherapy treatment than if given non-physical activities intervention during a hospital respite admission. METHOD A controlled randomized multicentre trial with independent blinded assessment. The Southampton Mobility Assessment (mobility score) and Two Minute Walking Test (distance walked) were undertaken at the beginning and end of the study admission and beginning of the next respite admission. Following the first assessment, participants were randomized to either physiotherapy or activities. RESULTS Eighty-one participants, from 12 clinical centres, with a mean age of 81.9 years and CAPE I/O score of 2. During the study admission there was a non-significant trend for a lower reduction in mobility score of the physiotherapy group (Mann-Whitney; p = 0.614) and a non-significant trend for greater decrease in distance walked in the activities group (t-test; p = 0.325). DISCUSSION The results of this trial do not support the positive changes demonstrated elsewhere. However, changes in respite care during the early stages of this trial may have produced differences between the sample for this trial and that for the pilot study. This trial was therefore underpowered. CONCLUSION This trial suggests that future research needs to change the focus from clinical settings to presentations.
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Prevalence and clinical characteristics of left ventricular dysfunction among elderly patients in general practice setting: cross sectional survey. BMJ (CLINICAL RESEARCH ED.) 1999; 318:368-72. [PMID: 9933201 PMCID: PMC27725 DOI: 10.1136/bmj.318.7180.368] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the prevalence and clinical characteristics of left ventricular dysfunction among elderly patients in the general practice setting by echocardiographic assessment of ventricular function. DESIGN Cross sectional survey. SETTING Four centre general practice in Poole, Dorset. SUBJECTS 817 elderly patients aged 70-84 years. MAIN OUTCOMES Echocardiographic assessment of left ventricular systolic function including measurement of ejection fraction by biplane summation method where possible, clinical symptoms, and signs of left ventricular dysfunction. RESULTS The overall prevalence of left ventricular systolic dysfunction was 7.5% (95% confidence interval 5.8% to 9.5%); mild dysfunction (5.0%) was considerably more prevalent than moderate (1.6%) or severe dysfunction (0.7%). Measurement of ejection fraction was possible in 82% of patients (n=667): in patients categorised as having mild, moderate, or severe dysfunction, the mean ejection fraction was 48% (SD 12.0), 38% (8.1), and 26% (7.9) respectively. At all ages the prevalence was much higher in men than in women (odds ratio 5.1, 95% confidence interval 2.6 to 10.1). No clinical symptom or sign was both sensitive and specific. In around half the patients with ventricular dysfunction (52%, 32/61) heart failure had not been previously diagnosed. CONCLUSIONS Unrecognised left ventricular dysfunction is a common problem in elderly patients in the general practice setting. Appropriate treatment with angiotensin converting enzyme inhibitors has the potential to reduce hospitalisation and mortality in these patients, but diagnosis should not be based on clinical history and examination alone. Screening is feasible in general practice, but it should not be implemented until the optimum method of identifying left ventricular dysfunction is clarified, and the cost effectiveness of screening has been shown.
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Atypical lymphocyte morphology: an adverse prognostic factor for disease progression in stage A CLL independent of trisomy 12. Br J Haematol 1997; 98:934-9. [PMID: 9326192 DOI: 10.1046/j.1365-2141.1997.3263141.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We studied 270 patients with Binet stage A chronic lymphocytic leukaemia looking for adverse prognostic factors. In a multivariate analysis the following features were found to be risk factors for disease progression: atypical lymphocyte morphology (defined as either > 10% prolymphocytes or > 15% lymphocytes with cleaved nuclei or lymphoplasmacytoid cells); more than two karyotypic abnormalities; lymphocyte count > 30 x 10(9)/l; lymphocyte doubling time < 1 year; enlargement of one or more lymph node groups. In a univariate analysis the presence of trisomy 12 also correlated with progressive disease, but this was largely a consequence of the association between trisomy 12 and atypical lymphocyte morphology. Atypical lymphocyte morphology is an important prognostic factor in stage A CLL, and one which incurs no additional investigational cost.
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What is the normal pattern of uterine involution? An investigation of postpartum uterine involution measured by the distance between the symphysis pubis and the uterine fundus using a paper tape measure. Midwifery 1997; 13:9-16. [PMID: 9171584 DOI: 10.1016/s0266-6138(97)90027-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe normal postnatal uterine involution in a small sample of healthy primiparous women, and estimate the proportion who have a decline in the distance between the symphysis pubis and the uterine fundus (S-FD) slow enough to have the potentiality to trigger further clinical action, using currently accepted criteria for intervention. SETTING A maternity unit in the south of England that has approximately 6000 deliveries per annum and the related community areas. METHODS Daily measurement of the S-FD was carried out in 28 healthy women from within 18 hours of delivery until the uterine fundus was no longer palpable abdominally. Graphs showing the daily measurements and correlation coefficients were used to describe involution. The proportion of healthy women who would have been identified as healthy by the screening method was estimated (its specificity). FINDINGS Considerable variability was found in the pattern of uterine involution that was experienced by the women who had a normal puerperium. The measurement of the S-FD has a low specificity with only 6 of the 28 women (21.4%; 95% CI 8.3% to 40.9% having had no episodes of the S-FD declining slowly (less than 1 cm over three days). There was a weak, positive correlation between the S-FD measurement on day one and the day on which the uterus ceased to be palpable (r = 0.426, P = 0.03). No relationship was found between method of baby feeding and the day on which the uterus ceased to be palpable. IMPLICATIONS FOR PRACTICE The measurement of S-FD using a paper tape measure should not form part of routine postpartum assessment.
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Abstract
OBJECTIVE To examine the scalability of the Rivermead Motor Assessment (RMA) with nonacute stroke patients in the community. DESIGN This was a prospective study of the patients after discharge from hospital. All subjects were assessed on the RMA at six and 12 months after discharge home from hospital. Coefficients of scalability and reproducibility were calculated for each of the three sections of the RMA at each assessment. SUBJECTS Subjects were nonacute stroke patients aged 65 years and over, nonacute stroke patients aged under 65 years, and a selected group of those aged under 65 years. RESULTS Only the items in the gross function section met scaling criteria with nonacute strokes in both age groups, which suggests that the items in this section were in appropriate order of difficulty. The items in the leg and trunk section were not in hierarchical order and were in fact closer to scaling if the present order were reversed. CONCLUSIONS The clinical and research value of the RMA, as an ordered scale, are questioned. Changes in treatment styles and philosophies may mean that some of the items themselves are out-dated.
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Abstract
OBJECTIVE To examine the scalability of the Rivermead Motor Assessment with hospitalized acute stroke patients. DESIGN This was a prospective study of hospitalized stroke patients. SUBJECTS Fifty-one selected stroke patients, including those over the age of 65, were assessed at one, three and six weeks post-stroke using the Rivermead Motor Assessment. Coefficients of scalability and reproducibility were calculated for each of the three sections of the Rivermead Motor Assessment at each assessment. RESULTS The items in the gross function and arm sections met scaling criteria at all three assessments which meant that they were in appropriate order of difficulty. There was an overall increase in the proportion of subjects passing each item at successive assessments, suggesting that patients in the study were recovering. The leg and trunk section did not meet scale criteria with these acute stroke patients. CONCLUSIONS We recommend that only the gross function and arm sections should be used as hierarchical scales with selected acute stroke patients. The leg and trunk section should only be used as an assessment checklist.
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Thromboembolic deterrent stockings fail to prevent hypotension associated with spinal anaesthesia for elective caesarean section. Int J Obstet Anesth 1996; 5:172-5. [PMID: 15321345 DOI: 10.1016/s0959-289x(96)80027-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study was carried out to determine whether the use of thrombo-embolic deterrent (TED) stockings, in combination with an intravenous crystalloid preload, would prevent hypotension following spinal anaesthesia for caesarean section. Fifty parturients undergoing elective caesarean section under spinal anaesthesia were randomly allocated into two groups. TED stockings were applied to the study group 1 h before spinal anaesthesia but none were applied to the control group. Both groups received a crystalloid preload of 15 ml kg(-1) over 15 min before spinal injection. Significant hypotension, defined as an absolute value of systolic arterial pressure (SAP) of less than 90 mmHg and a decrease of more than 20% from baseline SAP was treated with 3 mg bolus of ephedrine as required. The difference in SAO between the two groups was not statistically significant. In the control group, 80% of parturients required ephedrine as opposed to 56% in the TED group; a difference that was also not statistically significant.
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Abstract
OBJECTIVE to assess levels of intra-observer and inter-observer variability in the measurement of postnatal symphysis-fundal distance and establish whether the measurement is sufficiently precise for it to be of use in clinical practice. SETTING a consultant obstetric maternity unit in the south of England which caters for approximately 6000 deliveries per annum. METHODS in the intra-observer study 15 midwives took repeated readings of symphysis-fundal distance on 30 postnatal women. In the inter-observer study 13 midwives took readings of symphysis-fundal distances on 24 postnatal women. Repeatability coefficients (the variability to be expected in the change between two measurements) were calculated. FINDINGS the repeatability coefficient, that is the maximum difference that is likely to occur, 95% of the time, for the difference between two measurements obtained by the same midwife on the same woman is 2.94 cm (intra-observer study). Where measurements are obtained by different midwives on the same mother the repeatability coefficient is 5.01 cm (inter-observer study). In everyday clinical practice variability is likely to be greater than that found in this study. IMPLICATIONS FOR PRACTICE the daily measurement of the postnatal symphysis-fundal distance with a tape measure cannot be obtained with enough precision to be useful in making clinical judgements and therefore should be discontinued. Further research is required to assess the value of routine palpation of the uterine fundus to assess involution during the postnatal period.
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Prognostic indicators in a range of astrocytic tumours: an immunohistochemical study with Ki-67 and p53 antibodies. J Neurol Neurosurg Psychiatry 1995; 59:413-9. [PMID: 7561922 PMCID: PMC486079 DOI: 10.1136/jnnp.59.4.413] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The treatment and prognosis of patients with cerebral astrocytic tumours are currently guided by histopathological classification. This study evaluates immunohistochemistry using Ki-67, an antibody to a nuclear protein expressed in proliferating cells, and DO-7, an antibody to the product of the tumour suppressor gene p53, as prognostic indicators for these tumours. Immunohistochemistry with Ki-67 has been correlated with the behaviour of many different tumours, but its value as a prognostic indicator in astrocytic tumours is diminished by the conflicting results of previous studies. Immunohistochemistry with antibodies to the p53 protein has been used as a prognostic indicator in melanomas and some carcinomas, but the relation between prognosis and accumulation of this protein in astrocytic tumours has not been clarified. We have tested the hypothesis that survival is correlated with Ki-67 immunolabelling indices (LIs) and patterns of p53 immunolabelling in the cerebral astrocytic tumours of a large cohort of patients (n = 123) for whom clinical indices were well documented. Astrocytic tumours were divided into three histological types: fibrillary astrocytoma (n = 24), anaplastic astrocytoma (n = 31), and glioblastoma (n = 68). Histological type and patient age were independent predictors of survival. Median Ki-67 LIs differed significantly (P < 0.0001) between the types of astrocytic tumour, and tumours with a Ki-67 LI < 2% had a significantly (P < 0.0001) better prognosis. Ki-67 LI as a continuous variable carried a significant (P = 0.0043) unadjusted hazard to survival which was lost when adjusted for other variables, notably histological type. By contrast, no relation was found between survival and three categories of p53 labeling (p53-negative, p53 LI < 40%, and p53 LI > 60%). The results indicate that, whereas Ki-67 immunohistochemistry predicts survival in patients with astrocytic tumours, conventional histological appraisal remains the best guide to prognosis, and immunohistochemistry for p53 has no value in the assessment of these tumours.
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Abstract
In a prospective, randomized, blind study, we assessed the effectiveness of droperidol 20 micrograms kg-1 i.v., given at induction of anaesthesia, in preventing postoperative vomiting in paediatric day-case patients. We studied 270 children, aged 1-15 yr, undergoing body surface surgery. There was a significant reduction in the incidence of vomiting in the recovery room (1.4% vs 9.2%, P < 0.005) and in the day ward (9.4% vs 18.3%, P < 0.05) in patients receiving droperidol. There was no significant difference on the journey home (9.5% vs 17.83%, ns) or at home (16.7% vs 10.3%, ns). There was also a reduction in the severity of vomiting in the droperidol group. There were no adverse side effects.
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Abstract
In a prospective, randomized study, we have examined the effects of preoperative and preinduction positive suggestion on postoperative emetic sequelae. A total of 226 patients were allocated randomly to receive either positive suggestions or no suggestions. Those patients in the positive suggestion group were told before operation and on induction of anaesthesia that postoperative emetic sequelae would be greatly reduced by the use of two antiemetic drugs. Control patients were simply asked to participate in a study of postoperative well being with no mention of nausea or vomiting. Nausea, vomiting or retching, and antiemetic administration were measured in the first 24 h after operation. Antiemetic administration in the positive suggestion group was 16.5% less than in the control group (P = 0.03) but there was no significant difference between the groups in nausea or vomiting-retching.
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Abstract
The early experience (February 1982 to June 1988) with transplantation for the treatment of congenital heart disease at the University of Pittsburgh was disappointing due to an excessively high perioperative mortality. From July 1988 to June 1992, a further 21 children with congenital heart disease underwent orthotopic transplantation. Thirteen had undergone multiple prior palliative procedures (mean, 2.8 per patient). In 12 of these patients, prior procedures involved the pulmonary arteries on one or more occasions. In contrast to our earlier experience, there were no deaths stemming from inadequate surgical reconstruction or pulmonary hypertension. The actuarial survival was 71% at both 1 and 3 years. This did not differ significantly from the survival among 18 patients who underwent transplantation for the management of cardiomyopathy over the same period (1-year and 3-year survival, 83%). The perioperative mortality and short-term survival are now similar for children undergoing transplantation for the treatment of either congenital heart disease or cardiomyopathy. These improved results probably reflect more careful patient selection and an increasing surgical experience with complex reconstructive procedures.
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Abstract
OBJECTIVES To assess the diagnostic yield, sampling errors, risks, and therapeutic implications of right ventricular endomyocardial biopsy in children with suspected or possible myocarditis. DESIGN Retrospective study. SETTING Tertiary referral centre for paediatric cardiology, cardiac surgery, heart transplantation, and mechanical circulatory support. PATIENTS AND METHODS Review of clinical and histological findings among 63 consecutive children with possible myocarditis undergoing right ventricular endomyocardial biopsy. Review of cardiac histology at subsequent necropsy or after explantation at time of transplantation. RESULTS From January 1980 to December 1992, 76 biopsies were performed in 63 children (2 weeks to 18 years of age). In 41 cases, the biopsy was performed for evaluation of dilated cardiomyopathy. The median interval from onset of symptoms was one month. Eight children (20%; all with a history of less than six weeks duration) had biopsy proved myocarditis. Five of the eight children made a full recovery, including four who presented in cardiogenic shock. By contrast, only three of 33 children without evidence of myocarditis showed recovery of ventricular function. The whole heart was available for histological examination in 23 patients. Myocarditis was confirmed in one patient, and no evidence of myocarditis was found in the remaining 22 (all with negative biopsies). One procedure related death occurred in a 2 week old infant with dilated cardiomyopathy. In 22 cases, biopsy was performed for the evaluation of arrhythmia. Only one biopsy showed myocarditis. CONCLUSIONS The diagnostic yield of a biopsy is low in children with arrhythmias. In children presenting with profound ventricular dysfunction, a diagnosis of acute myocarditis may avoid premature consideration of transplantation as this group has an important potential for full recovery. In less critically ill patients and in those with a longer duration of symptoms the justification for biopsy is not as clear and the procedure is not without risk.
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A randomized trial to assess the efficacy of 5-aminosalicylic acid for the prevention of radiation enteritis. Clin Oncol (R Coll Radiol) 1993; 5:19-24. [PMID: 8424910 DOI: 10.1016/s0936-6555(05)80689-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Sulphasalazine is an effective treatment for diarrhoea occurring during pelvic radiotherapy. We report the results of a trial to assess the value of its active moiety, 5-aminosalicylic acid, (5-ASA) in a prophylactic setting. Seventy-three patients planned for external beam radiotherapy to the pelvis were randomized on a double-blind basis to receive prophylactic 5-ASA or placebo. The severity of the acute radiation bowel reaction was documented by a weekly questionnaire. Surprisingly, diarrhoea occurred in a higher proportion of patients in the 5-ASA arm than the placebo arm (91.2% versus 73.7%, P = 0.070). The maximum change in both the severity of diarrhoea and the number of days per week on which diarrhoea occurred (from pre-radiotherapy level to the worst level at any time during treatment) were both significantly greater in patients taking 5-ASA than those taking placebo (P = 0.014 and P = 0.026, respectively). The average change (the sum of the weekly scores divided by the number of weeks of treatment, minus the pre-radiotherapy score) for both severity and days per week of diarrhoea were again greater in the 5-ASA than the placebo arm, but failed to reach statistical significance (P = 0.095 and P = 0.079, respectively). The use of anti-diarrhoeal medicines was significantly greater in the 5-ASA arm (P = 0.011). Constipation was more common in the placebo arm but this did not reach significance (P = 0.20). 5-ASA thus has no protective effect against acute radiation enteritis and appears to worsen it. Possible reasons for this surprising finding are discussed.
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Abstract
A digit preference model is developed to describe the preference for estimating gestational age at birth as an even week during the 20th to 36th week of gestation. The model incorporates a probability of misclassification to adjacent even weeks at odd gestational ages, while even gestational ages are assumed correctly classified. The model is extended to allow the misclassification probabilities to decrease linearly with week during the period. A piecewise exponential model is used to model relative risks of delivery associated with a previous spontaneous abortion and a model incorporating digit preference is fitted as a generalized bilinear model in GLIM. The estimates of relative risk in the underlying survival model are virtually the same whether the misclassification is incorporated in the model or ignored.
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Importance of district of residence and known primary site for bowel cancer survival: analysis of data from Wessex Cancer Registry. J Epidemiol Community Health 1992; 46:266-70. [PMID: 1645084 PMCID: PMC1059565 DOI: 10.1136/jech.46.3.266] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVE The aim was to compare survival with colon and rectal cancer across the 10 districts of Wessex taking into account the age and sex of the individual. DESIGN The study was based on registrations on the Wessex Cancer Registry between 1979 and 1984 with colon and rectal cancer. Survival up to 31 December 1986 was examined using a Cox regression model; individuals surviving to the end of the follow up period were treated as censored in the analysis. Survival was examined in the first fortnight, the first month, and the first six months after registration separately. PARTICIPANTS The data comprised 6239 residents of the Wessex Region who had been diagnosed with colon cancer and 3203 residents diagnosed with rectal cancer. For 140 cases survival data or age were missing and these cases were excluded. MEASUREMENTS AND MAIN RESULTS Results are presented in the format of a league table giving the order of districts from lowest to highest survival rates. No significant differences in survival are found between districts in relation to rectal cancer. We find that one or two districts have consistently high or low survival rates with colon cancer in various periods of follow up, but cannot differentiate between the districts in the centre of the list. Site unspecified is considered as an explanatory variable; it is more predictive than district, and it approaches the importance of age in explaining survival with colon cancer. CONCLUSIONS There are significant differences in survival with colon cancer between districts; however data on stage at registration are not available and we are unable to say whether the differences in survival are due to differences in stage at diagnosis or differences in survival with similar stage at diagnosis. We found that cases where the site of the cancer within the colon was not recorded on the register have significantly lower survival, and we suggest that site unspecified may be related to stage at diagnosis.
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Biostatistics and Epidemiology: A primer for Health Professionals. Br J Soc Med 1991. [DOI: 10.1136/jech.45.2.174-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Using routinely collected maternity discharge data from 250,000 women in Scotland, we examined the risks of late spontaneous abortion and preterm delivery during the period 20 up to 36 weeks of gestation. Gestational age is treated as a fetal survival time and the risks of delivery associated with a history of spontaneous abortion, induced abortion and perinatal death are examined in a survival model controlling for several demographic and socioeconomic variables. The main objective of the study is to identify factors which are associated with high relative hazard of delivery early in the period, but with decreasing relative hazard of delivery as pregnancy progresses. The factor most clearly associated with converging hazards is a history of two or more spontaneous abortions, and this may reflect the tendency to repeat pregnancy outcome.
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Correlation of chromosome abnormalities with laboratory features and clinical course in B-cell chronic lymphocytic leukaemia. Br J Haematol 1990; 76:352-8. [PMID: 2261345 DOI: 10.1111/j.1365-2141.1990.tb06367.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
141 patients with B-cell chronic lymphocytic leukaemia (B-CLL) have been studied for a minimum of 12 months and a maximum of 25 years. 30 of 133 patients (32.5%) had greater than 10% FMC7 positive peripheral blood lymphocytes and 19 of 131 patients (14.5%) had a serum or urinary paraprotein. At presentation 88 patients were stage A0, 18 A1, 18 A2, 11 B and six C. 44 (31%) had progressive disease and 42 (30%) died during the study period. 63 patients had a normal karyotype, 75 a clonal abnormality and in three no metaphases were obtained. The finding of a complex karyotypic abnormality was significantly associated with lambda surface phenotype (P less than 0.01), the presence of greater than 10% FMC7 positive cells (P less than 0.025), and the presence of a paraprotein (P = 0.025). Patients whose leukaemic cells had a complex karyotype and those with structural abnormalities of chromosomes 14 and 6 required treatment earlier than those with a normal karyotype.
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MESH Headings
- Aged
- Aged, 80 and over
- Chromosome Aberrations/genetics
- Chromosomes, Human, Pair 14/chemistry
- Chromosomes, Human, Pair 6/chemistry
- Female
- Humans
- Karyotyping
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Neoplasm Staging
- Prognosis
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Abstract
85 patients presenting to a single centre with stage AO B-cell chronic lymphocytic leukaemia (B-CLL) have been studied. The duration of follow-up has ranged from a minimum of 1 year to a maximum of 18 years with a mean of 6 years. 14 patients have had progressive disease and 23 patients have died, of whom nine had CLL-related deaths. We assessed the prognostic significance of the following parameters: age at presentation, sex, haemoglobin concentration, initial lymphocyte count, surface membrane phenotype, serum immunoglobulin levels at presentation and karyotype. None of these factors were predictive of survival, but there was a correlation between initial lymphocyte count, surface immunoglobulin MD lambda phenotype, and complex karyotypic abnormalities and disease progression. Two patients with a complex karyotype have been followed for more than 5 years without evidence of progression.
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Abstract
This article introduces a neonatal classification based on latent class analysis. The neonatal classification generates five distinct classes ranging from the normal-birth-weight, full-term, healthy baby to the low-birth-weight preterm infant with many life-threatening problems. Unlike several suggested neonatal classifications, latent class analysis accommodates the range and severity of illness typically encountered in neonatal populations. It also provides a classification based solely on the personal characteristics of the newborn that can be used to investigate variation in the use of neonatal services.
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Abstract
Associations between the results of developmental screening at five ages between 30 weeks and three years and the children's educational and behavioural status in normal primary schools at 6 1/2 to 7 1/2 years were examined in two samples of children living in Dundee and born in 1974 and 1975. In one sample the screening results for 417 children with moderately severe or severe school problems were compared with the screening results for a control group without school problems. Positive associations were found between school problems and motor and adaptive screening test results (from 39-week screening onward), language (from 15 months), preschool behaviour (at 39 weeks and two years) and neurological status (at 39 weeks and three years). In the second sample the questionnaire scores of 570 children known to be suspect on screening were compared with the scores of a control group whose screening results had been considered within the normal range. Adaptive and neurological screening tests provided the best predictors of behaviour problems in school and of educational failure. It is suggested that more thorough developmental and neurological assessments, at less frequent intervals, than is common in most screening programmes would facilitate identification of (and intervention for) preschool neurodevelopmental disability among children at risk of early schooling problems.
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