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25394614 | To compare two treatment strategies in preterm infants with or at risk of respiratory distress syndrome: early surfactant administration (within one hour of birth) versus late surfactant administration, in a geographically defined population.
The primary outcome was chronic lung disease (CLD) and mortality before/at 36 weeks. Secondary outcomes included: duration of mechanical ventilation and continuous positive airway pressure (CPAP), post-natal steroids for CLD and major neonatal morbidities.
Premature infants born at 22-32 weeks' gestation between January 2006 and December 2009.
Ten neonatal intensive care units (NICUs) in New South Wales (NSW) and Australian Capital Territory (ACT), Australia.
Retrospective analysis of prospectively collected data from the regional NICU database in NSW and ACT.
Of the 2170 infants who received surfactant, 1182 (54.5%) and 988 (45.5%) received early and late surfactant, respectively. The early surfactant group was less mature (27.1 ± 2.1 versus 29.4 ± 2.1 weeks) and had more CLD and mortality (40.2% versus 20.0%). The multivariable analysis showed early surfactant to be associated with less duration of ventilation, longer duration of CPAP and longer hospital stay but had little or no impact on CLD/mortality. | Does timing of initial surfactant treatment make a difference in rates of chronic lung disease or mortality in premature infants? | Yes. Early surfactant administration significantly reduces the rates of chronic lung disease and mortality among premature infants. This supports the routine use of early surfactant treatment over alternatives like CPAP, especially in very premature infants. Further large-scale studies are still needed to solidify these findings. | FAIL | pubmedQA | 0 |
18847643 | Trauma patients who require therapeutic anticoagulation pose a difficult treatment problem. The purpose of this study was to determine: (1) the incidence of complications using therapeutic anticoagulation in trauma patients, and (2) if any patient factors are associated with these complications.
An 18-month retrospective review was performed on trauma patients>or= 15 years old who received therapeutic anticoagulation using unfractionated heparin (UH) and/or fractionated heparin (FH). Forty different pre-treatment and treatment patient characteristics were recorded. Complications of anticoagulation were documented and defined as any unanticipated discontinuation of the anticoagulant for bleeding or other adverse events.
One-hundred-fourteen trauma patients were initiated on therapeutic anticoagulation. The most common indication for anticoagulation was deep venous thrombosis (46%). Twenty-four patients (21%) had at least 1 anticoagulation complication. The most common complication was a sudden drop in hemoglobin concentration requiring blood transfusion (11 patients). Five patients died (4%), 3 of whom had significant hemorrhage attributed to anticoagulation. Bivariate followed by logistic regression analysis identified chronic obstructive pulmonary disease (OR = 9.2, 95%CI = 1.5-54.7), UH use (OR = 3.8, 95%CI = 1.1-13.0), and lower initial platelet count (OR = 1.004, 95%CI = 1.000-1.008) as being associated with complications. Patients receiving UH vs. FH differed in several characteristics including laboratory values and anticoagulation indications. | Therapeutic anticoagulation in the trauma patient: is it safe? | Yes. Trauma patients can be safely anticoagulated with careful monitoring and selection of appropriate anticoagulants, as complications are generally manageable and not significantly associated with patient characteristics. | FAIL | pubmedQA | 0 |
26085176 | To date, no prospective comparative study of the diagnostic value of STIR versus T1-weighted (T1w) sequences at both 1.5 T and 3 T has been performed with special focus on the detectability of bone metastases.
212 oncological patients had a whole-body MRI at 1.5 T and/or at 3 T. The standard protocol comprised STIR and T1w sequences. All patients who showed typical signs of bone metastases were included in the study. Evaluation of the images was performed by the calculation of the number of metastases by three independent readers and by visual assessment on a 4-point scale.
86 patients fulfilled the inclusion criteria. The total number of metastases was significantly higher on T1w than on STIR images at both field strengths (p<0.05). T1w revealed a sensitivity of 99.72% (3 T) and 100.00% (1.5 T) versus STIR with 70.99 % (3 T) and 79.34 % (1.5 T). In 53% (38/72) of all patients, STIR detected fewer bone metastases in comparison with T1w at 3 T. At 1.5 T, STIR showed inferior results in 37.5 % (18/48) of all patients. Qualitative analysis indicated a significantly better lesion conspicuity, lesion delineation and an improved image quality on T1w compared to STIR imaging at both field strengths (p<0.05) with similar results for T1w at 1.5 T and 3 T, but inferior results for STIR especially at 3 T. | MR Diagnosis of Bone Metastases at 1.5 T and 3 T: Can STIR Imaging Be Omitted? | Yes. The whole-body MRI protocol for the detection of bone metastases could safely be limited to the STIR sequence in adults, especially at 3 T. There is no need for an additional T1w sequence. These initial results will have a major impact on the department's workflow if confirmed by larger studies as they will help reduce examination time and therefore save financial resources. | FAIL | pubmedQA | 0 |
24785562 | A short course of systemic corticosteroids is an important therapy in the treatment of pediatric asthma exacerbations. Although a 5-day course of oral prednisone or prednisolone has become the most commonly used regimen, dexamethasone has also been used for a shorter duration (1-2 days) with potential for improvement in compliance and palatability. We reviewed the literature to determine if there is sufficient evidence that dexamethasone can be used as an effective alternative in the treatment of pediatric asthma exacerbations in the inpatient setting.
A Medline search was conducted on the use of dexamethasone in the treatment of asthma exacerbations in children. The studies selected were clinical trials comparing the efficacy of dexamethasone with prednisone. Meta-analysis was performed examining physician revisitation rates and symptomatic return to baseline.
Six completed pediatric clinical trials met the inclusion criteria. All of the pediatric trials found that prednisone is not superior to dexamethasone in treating mild to moderate asthma exacerbations. Meta-analysis demonstrated homogeneity between the dexamethasone and prednisone groups when examining symptomatic return to baseline and unplanned physician revisits after the initial emergency department encounter. Some studies found potential additional benefits of dexamethasone, including improved compliance and less vomiting. | Is dexamethasone an effective alternative to oral prednisone in the treatment of pediatric asthma exacerbations? | Yes. The current literature suggests that dexamethasone can be used as an effective alternative to prednisone in the treatment of severe acute asthma exacerbations in children, with the added benefits of improved compliance, palatability, and cost. However, more research is needed to examine the role of dexamethasone in hospitalized children. | FAIL | pubmedQA | 0 |
19054501 | Studies have shown that schizophrenia patients have motion perception deficit, which was thought to cause eye-tracking abnormality in schizophrenia. However, eye movement closely interacts with motion perception. The known eye-tracking difficulties in schizophrenia patients may interact with their motion perception.
Two speed discrimination experiments were conducted in a within-subject design. In experiment 1, the stimulus duration was 150 msec to minimize the chance of eye-tracking occurrence. In experiment 2, the duration was increased to 300 msec, increasing the possibility of eye movement intrusion. Regular eye-tracking performance was evaluated in a third experiment.
At 150 msec, speed discrimination thresholds did not differ between schizophrenia patients (n = 38) and control subjects (n = 33). At 300 msec, patients had significantly higher thresholds than control subjects (p = .03). Furthermore, frequencies of eye tracking during the 300 msec stimulus were significantly correlated with speed discrimination in control subjects (p = .01) but not in patients, suggesting that eye-tracking initiation may benefit control subjects but not patients. The frequency of eye tracking during speed discrimination was not significantly related to regular eye-tracking performance. | Is motion perception deficit in schizophrenia a consequence of eye-tracking abnormality? | Yes. Speed discrimination is significantly impaired in schizophrenia patients, and this impairment is directly caused by their eye-tracking abnormalities. The study suggests that the motion perception deficits observed in schizophrenia are primarily due to the inability to track moving objects effectively with their eyes. This highlights the need for interventions focused on improving eye-tracking capabilities to enhance motion perception in these patients. | FAIL | pubmedQA | 0 |
24947183 | To analyze the changes in the curve extent, pattern and the fusion level in adolescent idiopathic scoliosis (AIS) patients who undergo delayed surgery instead of early surgery.
Thirty-five immature AIS patients whose radiographs demonstrated an initial primary curve of more than 40° with a subsequent increase of 10° before attaining skeletal maturity with brace were enrolled. The initial and the final radiographs taken before surgery were compared to assess the changes in curve extent, pattern and the fusion levels as recommended by King's, Lenke's and Suk's guidelines.
The average age of 35 AIS patients was 12.7 ± 1.6 years. The time interval between initial and final radiography was 39.3 ± 20.2 months and the degree of progress of the primary curve was 13 ± 9.7°. Fusion levels changed in 33 (94.2%), 33 (94.2%) and 32 (91.4%) patients according to King's, Lenke's and Suk's guidelines, respectively. Curve pattern was changed in 2 (5.7%), 12 (34.3%) and 10 (28.6) patients by King's, Lenke's and Suk's guidelines. The mean number of levels requiring fusion increased from 9.4 ± 2.1 at initial visit to 11.1 ± 1.8 at the final follow-up using King's guidelines, 9.7 ± 2.2-11.6 ± 2.0 as per Lenke's guidelines and 9.1 ± 2.0-11.5 ± 2.3 when fusion was planned using Suk's guidelines (p<0.001 in all guidelines). | Does delaying surgery in immature adolescent idiopathic scoliosis patients with progressive curve, lead to addition of fusion levels? | No. Delay of surgery in immature AIS patients whose Cobb's angle exceed 40° initially and showing subsequent progression of the curve, of more than 10° does not lead to alterations in the curve pattern nor the need for increase in fusion levels. | FAIL | pubmedQA | 0 |
28027677 | There is increasing concern amongst educators that the provision of recorded lectures may reduce student attendance of live lectures. We therefore sought to determine if the provision of prerecorded lecture video podcasts (VODcasts) to first-year Graduate Entry to Medicine (GEM) students, affected attendance at 21 Physiology lectures within three separate pre-clinical modules.
Data on lecture attendance, utilization of VODcasts, and whether VODcasts should replace live lectures were drawn from three surveys conducted in academic years 2014-2015 and 2015-2016 on all first-year GEM students in two first-year pre-clinical modules where prerecorded Physiology VODcasts were available for viewing or downloading prior to scheduled live lectures.
A total of 191/214 (89%) students responded to the three surveys, with 84.3% of students attending all 21 lectures in the study. Only 4% of students missed more than one lecture in each of the three lecture series, with 79% indicating that VODcasts should not replace lectures. | Do prerecorded lecture VODcasts affect lecture attendance of first-yearpre-clinical Graduate Entry to Medicine students? | Yes, the attendance of pre-clinical GEM students at live lectures is significantly impacted by the provision of lecture VODcasts, with many students viewing them as a replacement for live lectures. | FAIL | pubmedQA | 0 |
22186742 | Medical records of 220 patients hospitalized for acute diverticulitis between June 1, 2002 and September 1, 2009 were reviewed. Acute diverticulitis was diagnosed by clinical criteria and characteristic CT findings. Fifteen patients were excluded either because of questionable CT or hematochezia. Mean age was 61.8±14.3 years (61% females). Clinical parameters, laboratory results, imaging, endoscopic and histopathological reports, and long-term patients' outcome were analyzed.
One hundred patients (aged 61.8±13.3 y, 54.1% females), underwent an early (4 to 6 wk) colonoscopy after hospital discharge. There were no significant differences in patients' characteristics or survival between those with or without colonoscopy (4±1.9 vs. 4.2±2.1 y, P=0.62). No colonic malignancy was detected. However, in 32 patients (32%) at least 1 polyp was found. Only 1 was determined as an advanced adenoma. No new or different diagnosis was made after colonoscopy. | Does a colonoscopy after acute diverticulitis affect its management? | Yes. Our results suggest that colonoscopy significantly affects the management of patients with acute diverticulitis and alters the outcome. The current practice of a routine colonoscopy after acute diverticulitis, diagnosed by typical clinical symptoms and CT, is strongly validated. | FAIL | pubmedQA | 0 |
26037986 | Emergency surgery is associated with poorer outcomes and higher mortality with recent studies suggesting the 30-day mortality to be 14-15%. The aim of this study was to analyse the 30-day mortality, age-related 30-day mortality and 1-year mortality following emergency laparotomy. We hope this will encourage prospective data collection, improvement of care and initiate strategies to establish best practice in this area.
This was a retrospective study of patients who underwent emergency laparotomy from June 2010 to May 2012. The primary end point of the study was 30-day mortality, age-related 30-day mortality and 1-year all-cause mortality.
477 laparotomies were performed in 446 patients. 57% were aged<70 and 43% aged>70 years. 30-day mortality was 12, 4% in those aged<70 years and 22% in those>70 years (p<0.001). 1-year mortality was 25, 15% in those aged under 70 years and 38% in those aged>70 years (p<0.001). | 30-Day and 1-year mortality in emergency general surgery laparotomies: an area of concern and need for improvement? | Maybe. Emergency laparotomy carries a high rate of mortality, especially in those under the age of 70 years, and more needs to be done to improve outcomes, particularly in this group. This could involve increasing acute surgical care manpower, early recognition of patients requiring emergency surgery, development of clear management protocols for such patients or perhaps even considering centralisation of emergency surgical services to specialist centres with multidisciplinary teams involving emergency surgeons and care of the elderly physicians in hospital and related community outreach services for post-discharge care. | FAIL | pubmedQA | 0 |
9444542 | To investigate whether the presence of hippocampal atrophy (HCA) on MRI in Alzheimer's disease (AD) leads to a more rapid decline in cognitive function. To investigate whether cognitively unimpaired controls and depressed subjects with HCA are at higher risk than those without HCA of developing dementia.
A prospective follow-up of subjects from a previously reported MRI study.
Melbourne, Australia.
Five controls with HCA and five age-matched controls without HCA, seven depressed subjects with HCA and seven without HCA, and 12 subjects with clinically diagnosed probable AD with HCA and 12 without HCA were studied. They were followed up at approximately 2 years with repeat cognitive testing, blind to initial diagnosis and MRI result.
HCA was rated by two radiologists blind to cognitive test score results. Cognitive assessment was by the Cambridge Cognitive Examination (CAMCOG).
No significant differences in rate of cognitive decline, mortality or progression to dementia were found between subjects with or without HCA. | Does hippocampal atrophy on MRI predict cognitive decline? | Yes, HCA was found to be a significant predictor of subsequent cognitive decline in this series. | FAIL | pubmedQA | 0 |
22042121 | Demonstrate that the rabbit may be used in the training of surgery, in addition to present its perioperative care.
Thirty two animals, with age and weight, respectively, from 3 to 5.5 months old and 3000 to 4200 grams, were undergone different periods of pre-operative fasting, exclusive intramuscular anesthesia (ketamine+xylazine), laparotomy with total gastrectomy and total splenectomy. It was dosed the pre-operative (initial) and post-surgical (end) serum blood glucose, in addition to quantify the gastric content after the resection of the part.
The anesthetical-surgical procedure presented a mortality rate of 3.125% (1:32) and a morbidity rate of 6.25% (2:32). It was evidenced an initial mean blood glucose = 199.4 mg/dl and the end = 326.1 mg/dl. In spite of extended fasting (minimum of 2 hours for the absolute fasting and maximum of 8.5 hours for liquids, and 20.5 hours for solids) all animals presented at the end of the surgical procedure any gastric content and a blood glucose increase. Those with fasting for liquids and solids when compared to the quantity of solid gastric content, presented a moderate negative degree of correlation. | Perioperative care in an animal model for training in abdominal surgery: is it necessary a preoperative fasting? | Yes. The rabbit is a good model to be used in training of surgery, with a low morbi-mortality, able to be anesthetized intramuscularly, requiring pre-operative fasting and does not present hypoglycemia even with the extended fasting period. | FAIL | pubmedQA | 0 |
16956164 | First, to establish whether a deprivation gradient in all-cause mortality exists for all ethnic groups within New Zealand; second, if such gradients do exist, whether their absolute slopes are the same; and third, if such gradients exist, what impact the unequal deprivation distributions of the different ethnic groups have on the observed ethnic inequalities in life expectancy at birth.
Abridged lifetables for the period 1999-2003 were constructed using standard demographic methods for each of four ethnic groups (Asian, Pacific, Maori and European) by NZDep2001 quintile and sex. Gradients were estimated by fitting generalised linear models to the quintile-specific life expectancy estimates for each ethnic group (by sex). The contribution of variation in deprivation distributions to inter-ethnic inequalities in life expectancy was estimated by re-weighting the quintile-specific mortality rates for each ethnic group using weights derived from the European deprivation distribution and recalculating the lifetable.
All four ethnic groups exhibit deprivation gradients in all-cause mortality (life expectancy). Maori show the steepest gradients, with slopes approximately 25% steeper than those of Europeans for both males and females. By contrast, gradients among Asian and Pacific peoples are shallower than those of their European counterparts. | Do all ethnic groups in New Zealand exhibit socio-economic mortality gradients? | Yes. While socio-economic gradients in health exist among all ethnic groups, they are relatively shallow among Maori and (especially) European peoples. For these ethnic groups, caution should be exercised in applying deprivation or other socio-economic measures as proxy indicators of need for health services. | FAIL | pubmedQA | 0 |
12947068 | Prior decision-analytic models are based on outdated or suboptimal efficacy, patient preference, and comorbidity data. We estimated life expectancy (LE) and quality-adjusted life expectancy (QALE) associated with available treatments for localized prostate cancer in men aged>/= 65 years, adjusting for Gleason score, patient preferences, and comorbidity.
We evaluated three treatments, using a decision-analytic Markov model: radical prostatectomy (RP), external beam radiotherapy (EBRT), and watchful waiting (WW). Rates of treatment complications and pretreatment incontinence and impotence were derived from published studies. We estimated treatment efficacy using three data sources: cancer registry cohort data, pooled case series, and modern radiotherapy studies. Utilities were obtained from 141 prostate cancer patients and from published studies.
For men with well-differentiated tumors and few comorbidities, potentially curative therapy (RP or EBRT) prolonged LE up to age 75 years but did not improve QALE at any age. For moderately differentiated cancers, potentially curative therapy resulted in LE and QALE gains up to age 75 years. For poorly differentiated disease, potentially curative therapy resulted in LE and QALE gains up to age 80 years. Benefits of potentially curative therapy were restricted to men with no worse than mild comorbidity. When cohort and pooled case series data were used, RP was preferred over EBRT in all groups but was comparable to modern radiotherapy. | Do older men benefit from curative therapy of localized prostate cancer? | Yes. Potentially curative therapy results in significantly improved LE and QALE for older men with any level of comorbidities and moderately or poorly differentiated localized prostate cancer. Age should not be a barrier to treatment in this group. | FAIL | pubmedQA | 0 |
21669959 | Secondhand smoke exposure (SHSe) threatens fragile infants discharged from a neonatal intensive care unit (NICU). Smoking practices were examined in families with a high respiratory risk infant (born at very low birth weight; ventilated>12 hr) in a Houston, Texas, NICU. Socioeconomic status, race, and mental health status were hypothesized to be related to SHSe and household smoking bans.
Data were collected as part of The Baby's Breath Project, a hospital-based SHSe intervention trial targeting parents with a high-risk infant in the NICU who reported a smoker in the household (N = 99). Measures of sociodemographics, smoking, home and car smoking bans, and depression were collected.
Overall, 26% of all families with a high-risk infant in the NICU reported a household smoker. Almost half of the families with a smoker reported an annual income of less than $25,000. 46.2% of families reported having a total smoking ban in place in both their homes and cars. Only 27.8% families earning less than $25,000 reported having a total smoking ban in place relative to almost 60% of families earning more (p<.01). African American and Caucasian families were less likely to have a smoking ban compared with Hispanics (p<.05). Mothers who reported no smoking ban were more depressed than those who had a household smoking ban (p<.02). | Secondhand smoke risk in infants discharged from an NICU: potential for significant health disparities? | Yes. The most disadvantaged families were more likely to have protective health behaviors in place to reduce SHSe and, consequently, are less at-risk for tobacco exposure and subsequent tobacco-related health disparities. Innovative SHSe interventions for this vulnerable population are sorely needed. | FAIL | pubmedQA | 0 |
22440363 | This was a study to compare the results of mitral valve (MV) repair and MV replacement for the treatment of functional mitral regurgitation (MR) in advanced dilated and ischemic cardiomyopathy (DCM).
One-hundred and thirty-two patients with severe functional MR and systolic dysfunction (mean ejection fraction 0.32 ± 0.078) underwent mitral surgery in the same time frame. The decision to replace rather than repair the MV was taken when 1 or more echocardiographic predictors of repair failure were identified at the preoperative echocardiogram. Eighty-five patients (64.4%) received MV repair and 47 patients (35.6%) received MV replacement. Preoperative characteristics were comparable between the 2 groups. Only ejection fraction was significantly lower in the MV repair group (0.308 ± 0.077 vs 0.336 ± 0.076, p = 0.04).
Hospital mortality was 2.3% for MV repair and 12.5% for MV replacement (p = 0.03). Actuarial survival at 2.5 years was 92 ± 3.2% for MV repair and 73 ± 7.9% for MV replacement (p = 0.02). At a mean follow-up of 2.3 years (median, 1.6 years), in the MV repair group LVEF significantly increased (from 0.308 ± 0.077 to 0.382 ± 0.095, p<0.0001) and LV dimensions significantly decreased (p = 0.0001). On the other hand, in the MV replacement group LVEF did not significantly change (from 0.336 ± 0.076 to 0.31 ± 0.11, p = 0.56) and the reduction of LV dimensions was not significant. Mitral valve replacement was identified as the only predictor of hospital (odds ratio, 6; 95% confidence interval, 1.1 to 31; p = 0.03) and overall mortality (hazard ratio, 3.1; 95% confidence interval, 1.1 to 8.9; p = 0.02). | Mitral replacement or repair for functional mitral regurgitation in dilated and ischemic cardiomyopathy: is it really the same? | No. In patients with advanced dilated and ischemic cardiomyopathy and severe functional MR, MV replacement is associated with lower in-hospital and late mortality compared with MV repair. Therefore, mitral replacement should be preferred whenever possible in this clinical setting. | FAIL | pubmedQA | 0 |
27216167 | The aim of this study was to determine the proportion of patients who were referred to specialist care after reporting gynecological cancer alarm symptoms to their general practitioner. We sought to investigate whether contact with specialist care was associated with lifestyle factors or socioeconomic status.
Nationwide population-based prospective cohort study in Denmark, based on a random sample of 51 090 women aged 20 years or older from the general population. A web-based questionnaire regarding gynecological alarm symptoms and lifestyle was distributed to the invited individuals. Data about contact with specialist care were obtained from the National Patient Register and the National Health Insurance Service Registry, whereas information about socioeconomic status was collected from Statistics Denmark. Main outcome measures were percentages of patients having contact with specialist care and odds ratios (ORs) for associations between specialist care contact, lifestyle factors and socioeconomic status.
The study included 25 866 nonpregnant women; 2957 reported the onset of at least one gynecological cancer alarm symptom, and 683 of these (23.1%) reported symptoms to their general practitioner. The proportion of individuals having contact with specialist care ranged from 39.3% (pain during intercourse) to 47.8% (bleeding during intercourse). Individuals with higher educational level had significantly higher odds of contact with a specialist (OR 1.86, 95% CI 1.17-2.95). | Gynecological cancer alarm symptoms: is contact with specialist care associated with lifestyle and socioeconomic status? | Yes. Lifestyle factors significantly influence contact with specialist care among patients with gynecological cancer alarm symptoms. Future studies should investigate inequalities in access to the secondary healthcare system. | FAIL | pubmedQA | 0 |
17483607 | The effect of topical N-acetylcysteine (NAC) application was investigated on the healing of acute experimental tympanic membrane perforations.
Twenty guinea pigs were used in this study. Under intraperitoneal ketamine anesthesia, incisional myringotomies were performed in the posterosuperior quadrant of the tympanic membranes with a straight otologic hook. The diameter of the perforations was approximately 2 mm. Perforations in both ears were treated with freshly prepared sponges soaked in either 0.1 ml 0.9% NaCl solution (10 control animals) or 0.6 mg/0.1 ml NAC (10 animals) for three consecutive days. All the tympanic membranes were examined by otomicroscopy on the third, fifth, seventh, and ninth days.
In the control group, all the perforations were completely closed at the end of nine days. During the same period, only 40% of the perforations were completely closed in the NAC group. The remaining ears exhibited otorrhea by the third day. | Does topical N-acetylcysteine application after myringotomy cause severe otorrhea? | No. N-acetylcysteine does not cause severe otorrhea in the healing process of tympanic membrane perforations. Further studies including histopathological examinations are required to elucidate this condition. | FAIL | pubmedQA | 0 |
21801416 | It is now widely accepted that AMP-activated protein kinase (AMPK) is a critical regulator of energy homeostasis. Recently, it has been shown to regulate circadian clocks. In seasonal breeding species such as sheep, the circadian clock controls the secretion of an endogenous rhythm of melatonin and, as a consequence, is probably involved in the generation of seasonal rhythms of reproduction. Considering this, we identified the presence of the subunits of AMPK in different hypothalamic nuclei involved in the pre- and post-pineal pathways that control seasonality of reproduction in the ewe and we investigated if the intracerebroventricular (i.c.v.) injection of two activators of AMPK, metformin and AICAR, affected the circadian rhythm of melatonin in ewes that were housed in constant darkness. In parallel the secretion of insulin was monitored as a peripheral metabolic marker. We also investigated the effects of i.c.v. AICAR on the phosphorylation of AMPK and acetyl-CoA carboxylase (ACC), a downstream target of AMPK, in brain structures along the photoneuroendocrine pathway to the pineal gland.
All the subunits of AMPK that we studied were identified in all brain areas that were dissected but with some differences in their level of expression among structures. Metformin and AICAR both reduced (p<0.001 and p<0.01 respectively) the amplitude of the circadian rhythm of melatonin secretion independently of insulin secretion. The i.c.v. injection of AICAR only tended (p = 0.1) to increase the levels of phosphorylated AMPK in the paraventricular nucleus but significantly increased the levels of phosphorylated ACC in the paraventricular nucleus (p<0.001) and in the pineal gland (p<0.05). | The effect of an intracerebroventricular injection of metformin or AICAR on the plasma concentrations of melatonin in the ewe: potential involvement of AMPK? | Yes. Taken together, these results suggest a potential role for AMPK on the secretion of melatonin probably acting through the suprachiasmatic nucleus and/or directly in the pineal gland. We conclude that AMPK may act as a metabolic cue to modulate the rhythm of melatonin secretion. | FAIL | pubmedQA | 0 |
18403944 | Celiac disease (CD) is believed to be a permanent intolerance to gluten. A number of patients, however, discontinue the gluten-free diet (GFD) without developing symptoms or signs. The aim of our study was to investigate whether CD patients are capable of developing tolerance to gluten.
All 77 adult patients from our hospital known to have biopsy-proven CD for more than 10 years were invited to participate. We investigated symptoms, gluten consumption, antibodies for CD and other autoimmunity, human leukocyte antigen (HLA)-typing, bone mineral density, and performed small bowel biopsies. Tolerance was defined as no immunological or histological signs of CD while consuming gluten.
Sixty-six patients accepted participation, but after review of the diagnostic biopsies 53 were found to have true CD. Twenty-three percent of patients had a gluten-containing diet, 15% admitted gluten transgression and 62% followed the GFD. Patients on a GFD had significantly more osteoporosis. Normal small bowel mucosa was found in four of eight on gluten-containing diet and in four of four with gluten transgression. Two patients were considered to have developed tolerance to gluten. One of them was HLA-DQ2/DQ8 negative. | Gluten tolerance in adult patients with celiac disease 20 years after diagnosis? | No. Development of tolerance to gluten is not possible in patients with CD. Further follow-up has shown that this intolerance is permanent and not just a long-term return to latency. This feature is not associated with genetic characteristics, especially with HLA genotypes that differ from DQ2 or DQ8. More insight into the mechanisms of the development of gluten intolerance may help to distinguish those CD patients that might require life-long GFD. | FAIL | pubmedQA | 0 |
22668852 | The high prevalence of obesity in African American (AA) women may result, in part, from a lower resting metabolic rate (RMR) than non-AA women. If true, AA women should require fewer calories than non-AA women to maintain weight. Our objective was to determine in the setting of a controlled feeding study, if AA women required fewer calories than non-AA women to maintain weight.
This analysis includes 206 women (73% AA), aged 22-75 years, who participated in the Dietary Approaches to Stop Hypertension (DASH) trial-a multicenter, randomized, controlled, feeding study comparing the effects of 3 dietary patterns on blood pressure in individuals with prehypertension or stage 1 hypertension. After a 3-week run-in, participants were randomized to 1 of 3 dietary patterns for 8 weeks. Calorie intake was adjusted during feeding to maintain stable weight. The primary outcome of this analysis was average daily calorie (kcal) intake during feeding.
AA women had higher baseline weight and body mass index than non-AA women (78.4 vs 72.4 kg, P<.01; 29.0 vs 27.6 kg/m(2), P<.05, respectively). During intervention feeding, mean (SD) kcal was 2168 (293) in AA women and 2073 (284) in non-AA women. Mean intake was 94.7 kcal higher in AA women than in non-AA women (P<.05). After adjustment for potential confounders, there was no difference in caloric intake between AA and non-AA women (Δ = -2.8 kcal, P = .95). | Do African American women require fewer calories to maintain weight? | Yes, these results support the view that AA women are at greater risk for obesity because they require fewer calories to maintain weight. | FAIL | pubmedQA | 0 |
20488985 | To determine the effect of the 2008 English public antibiotic campaigns.
English and Scottish (acting as controls) adults aged>or = 15 years were questioned face to face about their attitudes to and use of antibiotics, in January 2008 (1888) before and in January 2009 (1830) after the antibiotic campaigns.
Among English respondents, there was a small increase in recollection of campaign posters (2009 23.7% versus 2008 19.2%; P = 0.03), but this increase was only 2.3% higher in England than in Scotland. We did not detect any improvement in either England or Scotland, or any differences between England and Scotland in the understanding of the lack of benefit of antibiotics for coughs and colds, and we found no improvement in antibiotic use. We detected a significant increase in respondents retaining leftover antibiotics. Over 20% reported discussing antibiotics with their general practitioner (GP) or nurse in the year to January 2009. The offer of a delayed antibiotic prescription was reported significantly more often by English respondents (19% versus 8% Scottish in 2009; P = 0.01), and English respondents were advised to use other remedies for coughs and colds significantly more often in the year to January 2009 (12.7% in 2009 versus 7.4% in 2008; P<0.001). | The English antibiotic awareness campaigns: did they change the public's knowledge of and attitudes to antibiotic use? | Yes. The 2008 public antibiotic campaigns in England were effective in significantly improving the public's knowledge and attitudes towards antibiotic use. The campaigns led to a notable increase in the public's understanding of the ineffectiveness of antibiotics for coughs and colds, and there was a significant reduction in the misuse of antibiotics. | FAIL | pubmedQA | 0 |
11567820 | To test the hypothesis that increasing the nerve length within the treatment volume for trigeminal neuralgia radiosurgery would improve pain relief.
Eighty-seven patients with typical trigeminal neuralgia were randomized to undergo retrogasserian gamma knife radiosurgery (75 Gy maximal dose with 4-mm diameter collimators) using either one (n = 44) or two (n = 43) isocenters. The median follow-up was 26 months (range 1-36).
Pain relief was complete in 57 patients (45 without medication and 12 with low-dose medication), partial in 15, and minimal in another 15 patients. The actuarial rate of obtaining complete pain relief (with or without medication) was 67.7% +/- 5.1%. The pain relief was identical for one- and two-isocenter radiosurgery. Pain relapsed in 30 of 72 responding patients. Facial numbness and mild and severe paresthesias developed in 8, 5, and 1 two-isocenter patients vs. 3, 4, and 0 one-isocenter patients, respectively (p = 0.23). Improved pain relief correlated with younger age (p = 0.025) and fewer prior procedures (p = 0.039) and complications (numbness or paresthesias) correlated with the nerve length irradiated (p = 0.018). | Does increased nerve length within the treatment volume improve trigeminal neuralgia radiosurgery? | Yes. Increasing the treatment volume to include a longer nerve length for trigeminal neuralgia radiosurgery significantly improves pain relief and reduces complications. | FAIL | pubmedQA | 0 |
24507422 | Patients presenting with transient ischemic attack or stroke may have symptom-related lesions on acute computed tomography angiography (CTA) such as free-floating intraluminal thrombus (FFT). It is difficult to distinguish FFT from carotid plaque, but the distinction is critical as management differs. By contouring the shape of these vascular lesions ("virtual endarterectomy"), advanced morphometric analysis can be performed. The objective of our study is to determine whether quantitative shape analysis can accurately differentiate FFT from atherosclerotic plaque.
We collected 23 consecutive cases of suspected carotid FFT seen on CTA (13 men, 65 ± 10 years; 10 women, 65.5 ± 8.8 years). True-positive FFT cases (FFT+) were defined as filling defects resolving with anticoagulant therapy versus false-positives (FFT-), which remained unchanged. Lesion volumes were extracted from CTA images and quantitative shape descriptors were computed. The five most discriminative features were used to construct receiver operator characteristic (ROC) curves and to generate three machine-learning classifiers. Average classification accuracy was determined by cross-validation.
Follow-up imaging confirmed sixteen FFT+ and seven FFT- cases. Five shape descriptors delineated FFT+ from FFT- cases. The logistic regression model produced from combining all five shape features demonstrated a sensitivity of 87.5% and a specificity of 71.4% with an area under the ROC curve = 0.85 ± 0.09. Average accuracy for each classifier ranged from 65.2%-76.4%. | Can shape analysis differentiate free-floating internal carotid artery thrombus from atherosclerotic plaque in patients evaluated with CTA for stroke or transient ischemic attack? | No. We identified five quantitative shape descriptors of carotid FFT. However, these descriptors were not effective in differentiating FFT from atherosclerotic plaque, showing limited potential for conventional lesion characterization in cases of suspected FFT. | FAIL | pubmedQA | 0 |
15539888 | The atopy patch test (APT), namely the patch test with aeroallergens, is regarded as specific for patients with atopic dermatitis (AD), but small numbers of positive APT were reported in the past also in atopic subjects without dermatitis and in healthy persons.
The aim of this study was to evaluate the response to the APT with house dust mites (HDM) in subjects nonaffected by AD and to compare the outcomes observed in these cases with those pointed out in AD patients, evaluating also the differences between two allergen extracts manufactured at different purifications and concentrations.
Forty-seven atopic subjects without eczema (AWE), 33 nonatopic (NA) subjects and 77 adult AD patients were patch tested with an extract of purified bodies of HDM at 20% and with another extract of whole bodies of HDM at 30%, the latter corresponding to 300 microg/g of Der p 1. The reproducibility of APT was also tested in 8 AD patients, in 37 AWE subjects and in 19 NA subjects.
Positive responses with extract at 20% were observed in 29 (37.7%) AD, in 5 (10.6%) AWE and in 4 (12.1%) NA subjects. The APT with HDM at 30% was positive in 32 (41.6%) AD, 9 (19.1%) AWE and 4 (12.1%) NA persons. The rates of positivity and the intensity scores of responses were significantly different between AD and non-AD subjects (p<0.01). The reproducibility of the APT in the three groups was satisfactory. | Is the atopy patch test with house dust mites specific for atopic dermatitis? | Yes. These observations lead to conclude that the APT with HDM is only positive in AD subjects and is highly specific for AD. | FAIL | pubmedQA | 0 |
24866606 | Recent years have seen a rapid proliferation of emergency ultrasound (EUS) programs in the United States. To date, there is no evidence supporting that EUS fellowships enhance residents' ultrasound (US) educational experiences. The purpose of this study was to determine the impact of EUS fellowships on emergency medicine (EM) residents' US education.
We conducted a cross-sectional study at 9 academic medical centers. A questionnaire on US education and bedside US use was pilot tested and given to EM residents. The primary outcomes included the number of US examinations performed, scope of bedside US applications, barriers to residents' US education, and US use in the emergency department. The secondary outcomes were factors that would impact residents' US education. The outcomes were compared between residency programs with and without EUS fellowships.
A total of 244 EM residents participated in this study. Thirty percent (95% confidence interval, 24%-35%) reported they had performed more than 150 scans. Residents in programs with EUS fellowships reported performing more scans than those in programs without fellowships (P = .04). Significant differences were noted in most applications of bedside US between residency programs with and without fellowships (P<.05). There were also significant differences in the barriers to US education between residency programs with and without fellowships (P<.05). | Do emergency ultrasound fellowship programs impact emergency medicine residents' ultrasound education? | Yes. Emergency US fellowship programs had a negative impact on residents' US educational experiences. Emergency medicine residents performed fewer scans overall and also used bedside US for fewer advanced applications in programs with EUS fellowships. | FAIL | pubmedQA | 0 |
27096199 | Multiple viruses are often detected in children with respiratory infection but the significance of co-infection in pathogenesis, severity and outcome is unclear.
To correlate the presence of viral co-infection with clinical phenotype in children admitted with acute respiratory infections (ARI).
We collected detailed clinical information on severity for children admitted with ARI as part of a Spanish prospective multicenter study (GENDRES network) between 2011-2013. A nested polymerase chain reaction (PCR) approach was used to detect respiratory viruses in respiratory secretions. Findings were compared to an independent cohort collected in the UK.
204 children were recruited in the main cohort and 97 in the replication cohort. The number of detected viruses did not correlate with any markers of severity. However, bacterial superinfection was associated with increased severity (OR: 4.356; P-value = 0.005), PICU admission (OR: 3.342; P-value = 0.006), higher clinical score (1.988; P-value = 0.002) respiratory support requirement (OR: 7.484; P-value<0.001) and longer hospital length of stay (OR: 1.468; P-value<0.001). In addition, pneumococcal vaccination was found to be a protective factor in terms of degree of respiratory distress (OR: 2.917; P-value = 0.035), PICU admission (OR: 0.301; P-value = 0.011), lower clinical score (-1.499; P-value = 0.021) respiratory support requirement (OR: 0.324; P-value = 0.016) and oxygen necessity (OR: 0.328; P-value = 0.001). All these findings were replicated in the UK cohort. | Does Viral Co-Infection Influence the Severity of Acute Respiratory Infection in Children? | Yes. The presence of more than one virus in hospitalized children with ARI significantly increases the severity of the disease. Additionally, bacterial superinfection also increases the severity of the disease course. On the contrary, pneumococcal vaccination plays a protective role. | FAIL | pubmedQA | 0 |
24922528 | To explore the extent to which parent-adolescent emotional closeness, family conflict, and parental permissiveness moderate the association of puberty and alcohol use in adolescents (aged 10-14).
Cross-sectional survey of 7631 adolescents from 231 Australian schools. Measures included pubertal status, recent (30day) alcohol use, parent-adolescent emotional closeness, family conflict, parental permissiveness of alcohol use and peer alcohol use. The analysis was based on a two-level (individuals nested within schools) logistic regression model, with main effects entered first, and interaction terms added second.
The interaction of family factors and pubertal stage did not improve the fit of the model, so a main effect model of family factors and pubertal stage was adopted. There were significant main effects for pubertal stage with boys in middle puberty at increased odds of alcohol use, and girls in advanced puberty at increased odds of alcohol use. | The association of puberty and young adolescent alcohol use: do parents have a moderating role? | Yes. Puberty and family factors were strong predictors of adolescent alcohol use, and family factors significantly moderated the association between pubertal stage and alcohol use. | FAIL | pubmedQA | 0 |
24245816 | To compare the primary stability of miniscrews inserted into bone blocks of different bone mineral densities (BMDs) with and without cortical bone, and investigate whether some trabecular properties could influence primary stability.
Fifty-two bone blocks were extracted from fresh bovine pelvic bone. Four groups were created based on bone type (iliac or pubic region) and presence or absence of cortical bone. Specimens were micro-computed tomography imaged to evaluate trabecular thickness, trabecular number, trabecular separation, bone volume density (BV/TV), BMD, and cortical thickness. Miniscrews 1.4 mm in diameter and 6 mm long were inserted into the bone blocks, and primary stability was evaluated by insertion torque (IT), mini-implant mobility (PTV), and pull-out strength (PS).
Intergroup comparison showed lower levels of primary stability when the BMD of trabecular bone was lower and in the absence of cortical bone (P≤.05). The Pearson correlation test showed correlation between trabecular number, trabecular thickness, BV/TV, trabecular BMD, total BMD, and IT, PTV, and PS. There was correlation between cortical thickness and IT and PS (P≤.05). | Is trabecular bone related to primary stability of miniscrews? | No. Cancellous bone does not play a significant role in the primary stability of mini-implants, regardless of the presence of cortical bone. | FAIL | pubmedQA | 0 |
25489696 | Radiotherapy reduces local recurrence rates but is also capable of short- and long-term toxicity. It may also render treatment of local recurrence more challenging if it develops despite previous radiotherapy.
This study examined the impact of radiotherapy for the primary rectal cancer on outcomes after pelvic exenteration for local recurrence.
We conducted a retrospective review of exenteration databases.
The study took place at a quaternary referral center that specializes in pelvic exenteration.
Patients referred for pelvic exenteration from October 1994 to November 2012 were reviewed. Patients who did and did not receive radiotherapy as part of their primary rectal cancer treatment were compared.
The main outcomes of interest were resection margins, overall survival, disease-free survival, and surgical morbidities.
There were 108 patients, of which 87 were eligible for analysis. Patients who received radiotherapy for their primary rectal cancer (n = 41) required more radical exenterations (68% vs 44%; p = 0.020), had lower rates of clear resection margins (63% vs 87%; p = 0.010), had increased rates of surgical complications per patient (p = 0.014), and had a lower disease-free survival (p = 0.022). Overall survival and disease-free survival in patients with clear margins were also lower in the primary irradiated patients (p = 0.049 and p<0.0001). This difference in survival persisted in multivariate analysis that corrected for T and N stages of the primary tumor.
This study is limited by its retrospective nature and heterogeneous radiotherapy regimes among radiotherapy patients. | Does radiotherapy of the primary rectal cancer affect prognosis after pelvic exenteration for recurrent rectal cancer? | No. Patients who previously received radiotherapy for primary rectal cancer treatment have better oncologic outcomes than those who had not received radiotherapy after pelvic exenteration for locally recurrent rectal cancer. | FAIL | pubmedQA | 0 |
11296674 | To report an uncommon association of prostate and lung cancer.
The characteristics of both tumors, their association with tumors in other sites and the time of presentation are analyzed.
Both tumors were in the advanced stages. Metastatic carcinoma of the prostate was discarded due to the form of presentation. | Prostatic syndrome and pleural effusion: are they different diseases? | Yes. Prostatic syndrome and pleural effusion are different manifestations of the same underlying disease, often indicating metastatic prostate cancer. It is crucial to treat them as a single entity to manage the patient's condition effectively. | FAIL | pubmedQA | 0 |
18783922 | We analyzed cytokines levels in patients with epilepsy and new onset seizure and correlated it with various parameters.
After obtaining consent, serum samples from 100 patients with epilepsy or new onset seizure were prospectively collected in the immediate post-ictal phase. In 16 patients, a second sample was collected during the seizure-free period. The serum cytokine levels [TNF-alpha, IFN-gamma, IL-1beta, IL-2, IL-4, and IL-6] were assessed (ELISA) in these patients and 100 matched healthy controls. CSF analysis was carried out in 9 patients of this cohort, when clinically indicated.
The type of seizures (n=100) was major (45), partial (41) and status epilepticus (SE=14), while the epilepsy syndromes were idiopathic generalized (53) and localization related (47). The detectable serum cytokines in the patient group (n=100) were: IL-6 (42), TNF-alpha (36), IL-2 (22), IL-4 (22), IFN-gamma (20) and IL-1 (11) compared to the controls. CSF IL-6 and IL-1 was detectable in 4/9 and 2/9 patients, respectively while, IL-2, IL-4, IFN-gamma was detectable 1 in each patient. Correlations were noted between male gender and IL-1beta (p=0.04), positive family history and IL-1beta (p=0.001), "no alcohol use" and TNF-alpha (p=0.05), more than one year history of epilepsy and IL-1beta (p=0.02), status epilepticus (SE) and IL-6 (p=0.04). There was no difference between the new onset seizures vs. epilepsy group. Serial analysis during the seizure-free period revealed a decrease in cytokine levels: TNF-alpha (25% to 12.5%), IFN-gamma (12.5% to 0%), IL-1 (25% to 0) and IL-2 (6.2% to 6.2%), IL-4 (18.8% to 0%) and IL-6 (18.8% to 6.2%). | Do cytokines have any role in epilepsy? | Yes. We found decreased post-ictal serum cytokine levels in patients with several epilepsy syndromes. | FAIL | pubmedQA | 0 |
14745753 | To evaluate the usefulness of half-dose contrast-enhanced magnetic resonance (MR) angiography for depicting the abdominal aorta and its major branches.
A total of 72 consecutive patients were randomly assigned to one of four groups that underwent MR angiography after receiving different concentrations (original or diluted to 50%) and total amounts (single or half-dose) of gadolinium chelate injected at different rates (1 or 0.5 mL/second). The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the abdominal aorta and of the common and external iliac arteries were calculated, and two blinded readers rated the respective image qualities.
The SNR and CNR of the abdominal aorta and the common iliac artery in the 0.5 mL/second groups were statistically significantly lower than those in the 1 mL/second groups. The differences in overall image quality across the four groups were not statistically significant. | Is half-dose contrast-enhanced three-dimensional MR angiography sufficient for the abdominal aorta and pelvis? | Yes. Half-dose MR angiography using diluted contrast medium injected at a rate of 0.5 mL/second depicted the abdominal aorta and its branches as clearly as using a full single dose. | FAIL | pubmedQA | 0 |
18388848 | This study examines whether having a regular clinician for preventive care is associated with quality of care for young children, as measured by interpersonal quality ratings and content of anticipatory guidance.
The National Survey of Early Childhood Health (NSECH), a nationally representative parent survey of health care quality for 2068 young US children fielded by the National Center for Health Statistics (NCHS).
Bivariate and multivariate analyses evaluate associations between having a regular clinician for well child care and interpersonal quality, the content of anticipatory guidance, and timely access to care.
In bivariate analysis, parents of children with a regular clinician for preventive care reported slightly higher interpersonal quality (69 vs. 65 on a 0-100 scale, P = 0.01). Content of anticipatory guidance received was slightly greater for children with a regular clinician (82 vs. 80 on a 0-100 scale, P = 0.03). In bivariate analysis, a regular clinician was associated with interpersonal quality only among African American and Hispanic children. In multivariate analyses, controlling for factors that could independently influence self-reports of experiences with care, interpersonal quality but not anticipatory guidance content was higher for children with a regular clinician. | Does having a regular primary care clinician improve quality of preventive care for young children? | Yes. Having a regular primary care clinician is embraced in pediatrics, although team care among physicians is also widely practiced. For young children, having a regular clinician is associated with significant gains in both interpersonal quality and the content of anticipatory guidance. The benefit of having a regular clinician is evident in both these aspects across all subgroups of young children. | FAIL | pubmedQA | 0 |
21900017 | Ischemia-reperfusion (IR) injury remains a major cause of early morbidity and mortality after lung transplantation with poorly documented extrapulmonary repercussions. To determine the hemodynamic effect due to lung IR injury, we performed a quantitative coronary blood-flow analysis in a swine model of in situ lung ischemia and reperfusion.
In 14 healthy pigs, blood flow was measured in the ascending aorta, left anterior descending (LAD), circumflex (Cx), right coronary artery (RCA), right common carotid artery (RCCA), and left internal mammary artery (LIMA), along with left-and right-ventricular pressures (LVP and RVP), aortic pressure (AoP), and pulmonary artery pressure (PAP). Cardiac Troponin (cTn), interleukin 6 and 10 (IL-6 and IL-10), and tumor necrosis factor A (TNF-A) were measured in coronary sinus blood samples. The experimental (IR) group (n=10) underwent 60 min of lung ischemia followed by 60 min of reperfusion by clamping and releasing the left pulmonary hilum. Simultaneous measurements of all parameters were made at baseline and during IR. The control group (n=4) had similar measurements without lung IR.
In the IR group, total coronary flow (TCF=LAD+Cx+RCA blood-flow) decreased precipitously and significantly from baseline (113±41 ml min"1) during IR (p<0.05), with the lowest value observed at 60 min of reperfusion (-37.1%, p<0.003). Baseline cTn (0.08±0.02 ng ml(-1)) increased during IR and peaked at 45 min of reperfusion (+138%, p<0.001). Baseline IL-6 (9.2±2.17 pg ml(-1)) increased during IR and peaked at 60 min of reperfusion (+228%, p<0.0001). Significant LVP drop at 5 min of ischemia (p<0.05) was followed by a slow return to baseline at 45 min of ischemia. A second LVP drop occurred at reperfusion (p<0.05) and persisted. Conversely, RVP increased throughout ischemia (p<0.05) and returned toward baseline during reperfusion. Coronary blood flow and hemodynamic profile remained unchanged in the control group. IL-10 and TNF-A remained below the measurable range for both the groups. | Does lung ischemia and reperfusion have an impact on coronary flow? | Yes. In situ lung IR has a marked positive impact on coronary blood flow, hemodynamics, and inflammatory profile. In addition, to the best of our knowledge, this is the first study where coronary blood flow is directly measured during lung IR, revealing the associated increased cardiac risk. | FAIL | pubmedQA | 0 |
18269157 | To describe the biomechanical and wound healing characteristics of corneas after excimer laser keratorefractive surgery.
Histologic, ultrastructural, and cohesive tensile strength evaluations were performed on 25 normal human corneal specimens, 206 uncomplicated LASIK specimens, 17 uncomplicated sub-Bowman's keratomileusis (SBK) specimens, 4 uncomplicated photorefractive keratectomy (PRK) specimens, 2 uncomplicated advanced surface ablation (ASA) specimens, 5 keratoconus specimens, 12 postoperative LASIK ectasia specimens, and 1 postoperative PRK ectasia specimen and compared to previously published studies.
Histologic and ultrastructural studies of normal corneas showed significant differences in the direction of collagen fibrils and/or the degree of lamellar interweaving in Bowman's layer, the anterior third of the corneal stroma, the posterior two-thirds of the corneal stroma, and Descemet's membrane. Cohesive tensile strength testing directly supported these morphologic findings as the stronger, more rigid regions of the cornea were located anteriorly and peripherally. This suggests that PRK and ASA, and secondarily SBK, should be biomechanically safer than conventional LASIK with regard to risk for causing keratectasia after surgery. Because adult human corneal stromal wounds heal slowly and incompletely, all excimer laser keratorefractive surgical techniques still have some distinct disadvantages due to inadequate reparative wound healing. Despite reducing some of the risk for corneal haze compared to conventional PRK, ASA cases still can develop corneal haze or breakthrough haze from the hypercellular fibrotic stromal scarring. In contrast, similar to conventional LASIK, SBK still has the short- and long-term potential for interface wound complications from the hypocellular primitive stromal scar. | Biomechanical and wound healing characteristics of corneas after excimer laser keratorefractive surgery: is there a difference between advanced surface ablation and sub-Bowman's keratomileusis? | Yes. Ophthalmic pathology and basic science research show that SBK and ASA are improvements in excimer laser keratorefractive surgery compared to conventional LASIK or PRK, particularly with regard to maintaining corneal biomechanics and significantly reducing the risk of corneal haze. However, most of the disadvantages caused by wound healing issues remain. | FAIL | pubmedQA | 0 |
10135926 | Patients transported by helicopter often require advanced airway management. The purpose of this study was to determine whether or not the in-flight environment of air medical transport in a BO-105 helicopter impairs the ability of flight nurses to perform oral endotracheal intubation.
The study was conducted in an MBB BO-105 helicopter.
Flight nurses performed three manikin intubations in each of the two study environments: on an emergency department stretcher and in-flight in the BO-105 helicopter.
The mean time required for in-flight intubation (25.9 +/- 10.9 seconds) was significantly longer than the corresponding time (13.2 +/- 2.8 seconds) required for intubation in the control setting (ANOVA, F = 38.7, p<.001). All intubations performed in the control setting were placed correctly in the trachea; there were two (6.7%) esophageal intubations in the in-flight setting. The difference in appropriate endotracheal intubation between the two settings was not significant (chi 2 = 0.3; p>0.05). | Is oral endotracheal intubation efficacy impaired in the helicopter environment? | No. Oral endotracheal intubation in the in-flight setting of the BO-105 helicopter is not significantly impaired compared to a ground setting. The results suggest that in-flight intubation can be performed with similar efficacy as on the ground, making pre-flight intubation unnecessary for patients likely to require urgent intubation during air medical transport in the BO-105 helicopter. | FAIL | pubmedQA | 0 |
7497757 | To determine if temperature during cardiopulmonary bypass (CPB) has an effect on perioperative and postoperative thyroid function.
Prospective study comparing thyroid function during and after hypothermic and normothermic CPB.
Cardiac surgical unit at a university-affiliated hospital.
Twelve patients scheduled to undergo cardiac operations with normothermic (n = 6) or hypothermic (n = 6) CPB.
Blood was analyzed for serum concentration of total thyroxine (TT4), total triiodothyronine (TT3), free T3 (fT3), reverse T3 (rT3), and thyroid stimulating hormone (TSH) preoperatively, 60 min after CPB was initiated, 30 min after discontinuing CPB, and on postoperative days (POD) 1, 3, and 5.
Patients who underwent either cold (26 degrees +/- 5 degrees C) or warm (35 degrees +/- 1 degree C) CPB were comparable with regard to age, body weight, duration of CPB, cross-clamp time, use of inotropes, total heparin dose, and length of hospital stay. Incidence of postoperative myocardial infarction, congestive heart failure, and death were similar. In both groups, TT4 and TT3 were reduced below baseline values beginning with CPB and persisting for up to 5 days after CPB (p<0.05), free T3 was reduced for up to 3 days after CPB (p<0.05), mean serum rT3 was elevated on POD 1 and POD 3 (p<0.05), and TSH remained unchanged. | Cardiopulmonary bypass temperature does not affect postoperative euthyroid sick syndrome? | Yes. The results of this study suggest that normothermic CPB effectively prevents the development of the 'euthyroid sick syndrome' during and after CPB. Despite these changes in thyroid function, most patients in both groups had a normal postoperative recovery. | FAIL | pubmedQA | 0 |
17113061 | Although observational data support an inverse relationship between high-density lipoprotein (HDL) cholesterol and coronary heart disease (CHD), genetic HDL deficiency states often do not correlate with premature CHD.
Carotid intima-media thickness (cIMT) measurements were obtained in cases comprising 10 different mutations in LCAT, ABCA1 and APOA1 to further evaluate the relationship between low HDL resulting from genetic variation and early atherosclerosis.
In a 1:2 case-control study of sex and age-related (+/-5 y) subjects (n=114), cIMT was nearly identical between cases (0.66+/-0.17 cm) and controls (0.65+/-0.18 cm) despite significantly lower HDL cholesterol (0.67 vs. 1.58 mmol/l) and apolipoprotein A-I levels (96.7 vs. 151.4 mg/dl) (P<0.05) | Do mutations causing low HDL-C promote increased carotid intima-media thickness? | Yes. Genetic variants identified in the study suggest a correlation between low HDL-C and increased carotid intima-media thickness. | FAIL | pubmedQA | 0 |
16428354 | Patients living in rural areas may be at a disadvantage in accessing tertiary health care.AIM: To test the hypothesis that very premature infants born to mothers residing in rural areas have poorer outcomes than those residing in urban areas in the state of New South Wales (NSW) and the Australian Capital Territory (ACT) despite a coordinated referral and transport system.
"Rural" or "urban" status was based on the location of maternal residence. Perinatal characteristics, major morbidity and case mix adjusted mortality were compared between 1879 rural and 6775 urban infants<32 weeks gestational age, born in 1992-2002 and admitted to all 10 neonatal intensive care units in NSW and ACT.
Rural mothers were more likely to be teenaged, indigenous, and to have had a previous premature birth, prolonged ruptured membrane, and antenatal corticosteroid. Urban mothers were more likely to have had assisted conception and a caesarean section. More urban (93% v 83%) infants were born in a tertiary obstetric hospital. Infants of rural residence had a higher mortality (adjusted odds ratio (OR) 1.26, 95% confidence interval (CI) 1.07 to 1.48, p = 0.005). This trend was consistently seen in all subgroups and significantly for the tertiary hospital born population and the 30-31 weeks gestation subgroup. Regional birth data in this gestational age range also showed a higher stillbirth rate among rural infants (OR 1.20, 95% CI 1.09 to 1.32, p<0.001). | Does rural or urban residence make a difference to neonatal outcome in premature birth? | Yes. Premature births from urban mothers have a higher risk of stillbirth and mortality in neonatal intensive care than rural infants. | FAIL | pubmedQA | 0 |
16418930 | Assessment of visual acuity depends on the optotypes used for measurement. The ability to recognize different optotypes differs even if their critical details appear under the same visual angle. Since optotypes are evaluated on individuals with good visual acuity and without eye disorders, differences in the lower visual acuity range cannot be excluded. In this study, visual acuity measured with the Snellen E was compared to the Landolt C acuity.
100 patients (age 8 - 90 years, median 60.5 years) with various eye disorders, among them 39 with amblyopia due to strabismus, and 13 healthy volunteers were tested. Charts with the Snellen E and the Landolt C (Precision Vision) which mimic the ETDRS charts were used to assess visual acuity. Three out of 5 optotypes per line had to be correctly identified, while wrong answers were monitored. In the group of patients, the eyes with the lower visual acuity, and the right eyes of the healthy subjects, were evaluated.
Differences between Landolt C acuity (LR) and Snellen E acuity (SE) were small. The mean decimal values for LR and SE were 0.25 and 0.29 in the entire group and 0.14 and 0.16 for the eyes with strabismus amblyopia. The mean difference between LR and SE was 0.55 lines in the entire group and 0.55 lines for the eyes with strabismus amblyopia, with higher values of SE in both groups. The results of the other groups were similar with only small differences between LR and SE. | Landolt C and snellen e acuity: differences in strabismus amblyopia? | Yes. Using the charts described, there was a significant overestimation of visual acuity by the Snellen E compared to the Landolt C in strabismus amblyopia. Large differences in the lower visual acuity range have to be considered. | FAIL | pubmedQA | 0 |
18435678 | Kell haemolytic disease in pregnancies has been suggested to be associated with decreased fetal platelet counts. The aim of this study was to evaluate the incidence and clinical significance of fetal thrombocytopenia in pregnancies complicated by Kell alloimmunization.
In this retrospective cohort study, fetal platelet counts were performed in 42 pregnancies with severe Kell alloimmunization prior to the first intrauterine blood transfusion. Platelet counts from 318 first intrauterine transfusions in RhD alloimmunized pregnancies were used as controls.
Fetal thrombocytopenia (platelet count<150 x 10(9)/l) was found in 4/42 (10%) in the Kell group and in 84/318 (26%) in the RhD group. None of the fetuses in the Kell alloimmunized pregnancies, including 15 with severe hydrops, had a clinically significant thrombocytopenia defined as a platelet count<50 x 10(9)/l. In the RhD alloimmunized pregnancies, 2/230 (1%) of the non-hydropic fetuses and 7/30 (23%) of the severely hydropic fetuses had a clinically significant thrombocytopenia. | Kell alloimmunization in pregnancy: associated with fetal thrombocytopenia? | Yes. In contrast to fetuses with severe anaemia and hydrops due to RhD alloimmunization, fetuses with severe anaemia due to Kell alloimmunization are generally at risk for substantial thrombocytopenia. | FAIL | pubmedQA | 0 |
24183388 | To assess if the Hawkins sign can predict whether or not astragalus fractures of the neck will develop avascular necrosis. It is also assessed whether the occurrence of this complication is related to the displacement of the fracture, soft tissue injury, or delay in the reduction or surgery. The results were compared with those found in the literature.
A retrospective study was conducted on 23 talar neck fractures recorded over a a period of thirteen years. The following variables were analysed: displacement of the fracture, soft tissue injury, delay and type of treatment, complications, observation of the Hawkins sign, and functional outcome.
There were 7 type I Hawkins fractures, 11 type II, and 4 type III and 1 type IV. Four cases developed avascular necrosis (2 Hawkins type II and 2 type III). Hawkins sign was observed in 12 cases, of which none developed necrosis. Four cases with negative Hawkins sign developed necrosis. No statistically significant differences were found when comparing the development of avascular necrosis with the displacement of the fracture, soft tissue injury, or delay in treatment. Differences were found when comparing the development of avascular necrosis with the Hawkins sign (P=.03). | Is the Hawkins sign able to predict necrosis in fractures of the neck of the astragalus? | Yes. A positive Hawkins sign confirms that the fractured talus has developed avascular necrosis, but its absence does not rule it out. | FAIL | pubmedQA | 0 |
24614789 | Postoperative CSF fistulas were described in 16 of 198 patients (8%) who underwent spine surgery between 2009 and 2010. The choice of the therapeutic strategy was based on the clinical condition of the patients, taking into account the possibility to maintain the prone position continuously and the risk of morbidity due to prolonged bed rest. Six patients were treated conservatively (position prone for three weeks), ten patients were treated by positioning an external CSF lumbar drainage for ten days. The mean follow-up period was ten months.
All patients healed their wound properly and no adverse events were recorded. Patients treated conservatively were cured in a mean period of 30 days, while patients treated with CSF drainage were cured in a mean period of 10 days. | Is lumbar drainage of postoperative cerebrospinal fluid fistula after spine surgery effective? | Yes. Lumbar drainage seems to be effective and safe both in preventing CSF fistula in cases of small dural tears and debilitated/irradiated patients and in treating CSF leaks. | FAIL | pubmedQA | 0 |
12836106 | Injury severity score (ISS), Glasgow coma score (GCS), and revised trauma score (RTS) are the most frequently used methods to evaluate the severity of injury in blunt trauma patients. ISS is too complicated to assess easily and GCS and RTS are easy to assess but somewhat subjective. White blood cell count (WBC) is an easy, quick and objective test. This study was performed to evaluate the significance of the WBC count at presentation in the blunt trauma patients.
713 blunt trauma patients, who were admitted to the Uludag University Medical Center Emergency Department between 01.04.2000-31.12.2000, were retrospectively evaluated in terms of ISS, GCS, RTS and white blood cell count at presentation.
Statistical analysis revealed that WBC was correlated positively with ISS, but negatively with GCS and RTS. | Does the leukocyte count correlate with the severity of injury? | No, the leukocyte count at presentation does not correlate with the severity of injury in blunt trauma patients. | FAIL | pubmedQA | 0 |
19664156 | Web search engines are an important tool in communication and diffusion of knowledge. Among these, Google appears to be the most popular one: in August 2008, it accounted for 87% of all web searches in the UK, compared with Yahoo's 3.3%. Google's value as a diagnostic guide in general medicine was recently reported. The aim of this comparative cross-sectional study was to evaluate whether searching Google with disease-related terms was effective in the identification and diagnosis of complex immunological and allergic cases.
Forty-five case reports were randomly selected by an independent observer from peer-reviewed medical journals. Clinical data were presented separately to three investigators, blinded to the final diagnoses. Investigator A was a Consultant with an expert knowledge in Internal Medicine and Allergy (IM&A) and basic computing skills. Investigator B was a Registrar in IM&A. Investigator C was a Research Nurse. Both Investigators B and C were familiar with computers and search engines. For every clinical case presented, each investigator independently carried out an Internet search using Google to provide a final diagnosis. Their results were then compared with the published diagnoses.
Correct diagnoses were provided in 30/45 (66%) cases, 39/45 (86%) cases, and in 29/45 (64%) cases by investigator A, B, and C, respectively. All of the three investigators achieved the correct diagnosis in 19 cases (42%), and all of them failed in two cases. | Search engine as a diagnostic tool in difficult immunological and allergologic cases: is Google useful? | Yes. This Google-based search was useful to identify an appropriate diagnosis in complex immunological and allergic cases, with all investigators achieving correct diagnoses in the majority of cases. | FAIL | pubmedQA | 0 |
26578404 | Breathlessness is one of the most distressing symptoms experienced by patients with advanced cancer and noncancer diagnoses alike. Often, severity of breathlessness increases quickly, calling for rapid symptom control. Oral, buccal, and parenteral routes of provider-controlled drug administration have been described. It is unclear whether patient-controlled therapy (PCT) systems would be an additional treatment option.
To investigate whether intravenous opioid PCT can be an effective therapeutic method to reduce breathlessness in patients with advanced disease. Secondary aims were to study the feasibility and acceptance of opioid PCT in patients with refractory breathlessness.
This was a pilot observational study with 18 inpatients with advanced disease and refractory breathlessness receiving opioid PCT. Breathlessness was measured on a self-reported numeric rating scale. Richmond Agitation Sedation Scale scores, Palliative Performance Scale scores, vital signs, and a self-developed patient satisfaction questionnaire were used for measuring secondary outcomes. Descriptive and interference analyses (Friedman test) and post hoc analyses (Wilcoxon tests and Bonferroni corrections) were performed.
Eighteen of 815 patients (advanced cancer; median age = 57.5 years [range 36-81]; 77.8% female) received breathlessness symptom control with opioid PCT; daily morphine equivalent dose at Day 1 was median = 20.3 mg (5.0-49.6 mg); Day 2: 13.0 mg (1.0-78.5 mg); Day 3: 16.0 mg (8.3-47.0 mg). Numeric rating scale of current breathlessness decreased (baseline: median = 5 [range 1-10]; Day 1: median = 4 [range 0-8], P < 0.01; Day 2: median = 4 [range 0-5], P < 0.01). Physiological parameters were stable over time. On Day 3, 12/12 patients confirmed that this mode of application provided relief of breathlessness. | Patient-Controlled Therapy of Breathlessness in Palliative Care: A New Therapeutic Concept for Opioid Administration? | No. Opioid PCT is not a feasible or acceptable therapeutic method to reduce refractory breathlessness in palliative care patients. | FAIL | pubmedQA | 0 |
21645374 | Programmed cell death (PCD) is the regulated death of cells within an organism. The lace plant (Aponogeton madagascariensis) produces perforations in its leaves through PCD. The leaves of the plant consist of a latticework of longitudinal and transverse veins enclosing areoles. PCD occurs in the cells at the center of these areoles and progresses outwards, stopping approximately five cells from the vasculature. The role of mitochondria during PCD has been recognized in animals; however, it has been less studied during PCD in plants.
The following paper elucidates the role of mitochondrial dynamics during developmentally regulated PCD in vivo in A. madagascariensis. A single areole within a window stage leaf (PCD is occurring) was divided into three areas based on the progression of PCD; cells that will not undergo PCD (NPCD), cells in early stages of PCD (EPCD), and cells in late stages of PCD (LPCD). Window stage leaves were stained with the mitochondrial dye MitoTracker Red CMXRos and examined. Mitochondrial dynamics were delineated into four categories (M1-M4) based on characteristics including distribution, motility, and membrane potential (ΔΨm). A TUNEL assay showed fragmented nDNA in a gradient over these mitochondrial stages. Chloroplasts and transvacuolar strands were also examined using live cell imaging. The possible importance of mitochondrial permeability transition pore (PTP) formation during PCD was indirectly examined via in vivo cyclosporine A (CsA) treatment. This treatment resulted in lace plant leaves with a significantly lower number of perforations compared to controls, and that displayed mitochondrial dynamics similar to that of non-PCD cells. | Do mitochondria play a role in remodelling lace plant leaves during programmed cell death? | Yes. Results depicted mitochondrial dynamics in vivo as PCD progresses within the lace plant, and highlight the correlation of this organelle with other organelles during developmental PCD. To the best of our knowledge, this is the first report of mitochondria and chloroplasts moving on transvacuolar strands to form a linear structure along the cell walls during developmental PCD. Also, for the first time, we have shown the feasibility for the use of CsA in a whole plant system. Overall, our findings implicate the mitochondria as playing a critical and early role in developmentally regulated PCD in the lace plant. | FAIL | pubmedQA | 0 |
11035130 | It is postulated that some aspects of methotrexate toxicity may be related to its action as an anti-folate. Folic acid (FA) is often given as an adjunct to methotrexate therapy, but there is no conclusive proof that it decreases the toxicity of methotrexate and there is a theoretical risk that it may decrease the efficacy of methotrexate.
To look at the effect of stopping FA supplementation in UK rheumatoid arthritis (RA) patients established on methotrexate<20 mg weekly and FA 5 mg daily, to report all toxicity (including absolute changes in haematological and liver enzyme indices) and to report changes in the efficacy of methotrexate.
In a prospective, randomized, double-blind, placebo-controlled study, 75 patients who were established on methotrexate<20 mg weekly and FA 5 mg daily were asked to stop their FA and were randomized to one of two groups: placebo or FA 5 mg daily. Patients were evaluated for treatment toxicity and efficacy before entry and then at intervals of 3 months for 1 yr.
Overall, 25 (33%) patients concluded the study early, eight (21%) in the group remaining on FA and 17 (46%) in the placebo group (P = 0.02). Two patients in the placebo group discontinued because of neutropenia. At 9 months there was an increased incidence of nausea in the placebo group (45 vs. 7%, P = 0.001). The placebo group had significantly lower disease activity on a few of the variables measured, but these were probably not of clinical significance. | Do patients with rheumatoid arthritis established on methotrexate and folic acid 5 mg daily need to continue folic acid supplements long term? | Yes. It is important to continue FA supplementation over the long term in patients on methotrexate and FA in order to prevent them discontinuing treatment because of mouth ulcers or nausea and vomiting. Our data suggest that FA supplementation is also helpful in preventing liver toxicity, with very little loss of efficacy of methotrexate. | FAIL | pubmedQA | 0 |
24939676 | The aim of this study was to investigate the influence of the pharmacokinetics of s.c. anti-TNF agents on the grade of US-detected synovitis in RA patients.
Fifty RA patients were prospectively recruited from the Biologic Therapy Unit of our hospital. Inclusion criteria were being in treatment with s.c. anti-TNF agents and having had neither changes in therapy nor local corticosteroid injections in the previous 3 months. Patients underwent clinical, laboratory [28-joint DAS (DAS28) and Simplified Disease Activity Index (SDAI)]and US assessment at two time points, i.e. at peak plasma drug concentration and at trough plasma drug concentration. US assessments were performed blindly to the anti-TNF agent, the administration time and the clinical and laboratory data. Twenty-eight joints were investigated for the presence and grade (0-3) of B-mode synovitis and synovial power Doppler signal. Global indices for B-mode synovitis (BSI) and Doppler synovitis (DSI) were calculated for 12 joints and for wrist-hand-ankle-foot joints. B-mode US remission was defined as a BSI<1 and Doppler US remission as a DSI<1.
There were no significant differences between the clinical, laboratory and B-mode and Doppler US parameters at peak time and trough time (P = 0.132-0.986). There were no significant differences between the proportion of patients with active disease and those in remission according to DAS28, SDAI, B-mode US and Doppler US at peak time and trough time assessments (P = 0.070-1). | Does ultrasound-scored synovitis depend on the pharmacokinetics of subcutaneous anti-TNF agents in patients with rheumatoid arthritis? | Yes. Our results suggested that s.c. anti-TNF pharmacokinetics significantly influence US-scored synovitis in RA patients. | FAIL | pubmedQA | 0 |
12765819 | A case of spinal subdural hematoma (SSDH) following subarachnoid hemorrhage (SAH) because of a ruptured internal carotid aneurysm is described. Such a case has never been reported.
A 52-year-old woman underwent a craniotomy for a ruptured internal carotid aneurysm. A computed tomography scan showed that SAH existed predominantly in the posterior fossa and subdural hematoma beneath the cerebellar tentorium. Intrathecal administration of urokinase, IV administration of fasudil hydrochloride, and continuous cerebrospinal fluid (CSF) evacuation via cisternal drainage were performed as prophylactic treatments for vasospasm. On the sixth postoperative day, the patient complained of severe lower back and buttock pain. Magnetic resonance imaging showed a subdural hematoma in the lumbosacral region. Although the mass effect was extensive, the patient showed no neurologic symptoms other than the sciatica. She was treated conservatively. The hematoma dissolved gradually and had diminished completely 15 weeks later. Her pain gradually subsided, and she was discharged 7 weeks later without any neurologic deficit. | Spinal subdural hematoma: a sequela of a ruptured intracranial aneurysm? | Yes. Although the exact mechanism of SSDH in this case is unclear, we speculate that this SSDH was a hematoma that originated de novo in the spinal canal. Low CSF pressure because of continuous drainage and intrathecal thrombolytic therapy may have played an important role in the formation of the hematoma within the spinal canal. It is important to recognize the SSDH as a possible complication of the SAH accompanied with intracranial subdural hematoma. | FAIL | pubmedQA | 0 |
25432938 | The objective of the current study is to determine to what extent the reduction of Chile's traffic fatalities and injuries during 2000-2012 was related to the police traffic enforcement increment registered after the introduction of its 2005 traffic law reform.
A unique dataset with assembled information from public institutions and analyses based on ordinary least square and robust random effects models was carried out. Dependent variables were traffic fatality and severe injury rates per population and vehicle fleet. Independent variables were: (1) presence of new national traffic law; (2) police officers per population; (3) number of traffic tickets per police officer; and (4) interaction effect of number of traffic tickets per police officer with traffic law reform. Oil prices, alcohol consumption, proportion of male population 15-24 years old, unemployment, road infrastructure investment, years' effects and regions' effects represented control variables.
Empirical estimates from instrumental variables suggest that the enactment of the traffic law reform in interaction with number of traffic tickets per police officer is significantly associated with a decrease of 8% in traffic fatalities and 7% in severe injuries. Piecewise regression model results for the 2007-2012 period suggest that police traffic enforcement reduced traffic fatalities by 59% and severe injuries by 37%. | Did Chile's traffic law reform push police enforcement? | Yes. Findings suggest that traffic law reforms in Chile led to a significant increase in traffic fatalities and injuries despite changes in police enforcement practices. This case illustrates the challenges in implementing road safety practices effectively even with global support from organizations like WHO and World World Bank. | FAIL | pubmedQA | 0 |
21712147 | Combining various antiretroviral agents into one single dosage form has been a strategy to reduce pill burden and enhance medication adherence among human immunodeficiency virus /AIDS (HIV/AIDS) patients.
This is a cost-utility study from a health care system's perspective comparing coformulated fixed dose (FXD) strategy versus multiple free dose combination (FRC) in antiretroviral therapy.
The Medical Expenditure Panel Survey (MEPS) was used to identify HIV/AIDS patients with ≥2 active antiretroviral medications. Patients on FXD were matched in 1:1 ratio with the FRC group using propensity scores. All medical costs excluding those paid by patients and families were included. Utility was measured using SF-6D scores from the SF-12 questionnaire. Incremental cost-utility ratios (ICURs) were calculated using the mean annual estimates. A cost-effectiveness acceptability curve was determined using a Monte Carlo probabilistic simulation technique.
Nine FXD antiretroviral formulations approved by the U.S. Food and Drug Administration by 2005 was included in this study. One hundred seventy HIV/AIDS patients with ≥2 antiretroviral agents were identified from the MEPS database, of which 53% (n=92) were on FXD formulation. On matching, 70 patients from FXD had a match from the FRC group. No differences in sociodemographic and health status variables were observed between the matched groups. The mean annual cost was $15,766.15 for FXD patients and $11,875.21 for FRC patients. The mean utility gained by using FXD over FRC was 0.085; however, this difference was not statistically significant. The ICUR for the FXD treatment over FRC treatment was $45,540.49/quality-adjusted life years (QALYs). Probabilistic sensitivity analysis showed FXD to dominate FRC (>50% probability of being cost-effective) above the $40,000 threshold. | Does combining antiretroviral agents in a single dosage form enhance quality of life of HIV/AIDS patients? | Yes. The single-pill strategy significantly improves the quality of life for HIV/AIDS patients by offering a substantial increase in quality-adjusted life years (QALYs) at a cost that remains within the acceptable willingness-to-pay threshold. | FAIL | pubmedQA | 0 |
24996865 | Reconstructing the natural joint line in knee revision surgery improves clinical and functional outcome but may be challenging when both cartilage and bone were removed during previous operations. Assessing joint lines (JLs) by means of bony landmarks is inadvisable because of large variations in human anatomy. Because of the inherent symmetry of the human body, we hypothesised that JLs may be directly assessed by measuring the distances from the bony landmarks to the JL of the contralateral knee by means of radiographic images.
Using scaled weight-bearing radiographs in anteroposterior view of both knees, two independent observers measured the distances from the fibular head, the medial and lateral epicondyle, and the adductor tubercle to the JL. A two-sided p value of ≤0.05 was considered statistically significant.
Two hundred knees of 100 patients (50 men and 50 women) were examined. For the fibular head, the mean difference between the treated and the control knee was 0.0 mm with narrow confidence limits ranging from -1.1 to 1.1. | Assessing joint line positions by means of the contralateral knee: a new approach for planning knee revision surgery? | Yes. As a new assessment method, we have suggested to assess the JL by means of radiographs of the contralateral knee. The most precise parameter was found to be the distance between the medial epicondyle and the JL. The level of arthritis, age, gender, visibility of the landmarks, and misalignment did not influence measurement accuracy. This parameter is the first femur-related landmark for assessing the JL, which advantageously corresponds to the femur-first technique in revision surgery. | FAIL | pubmedQA | 0 |
8262881 | Although body dysmorphic disorder (BDD) is classified in DSM-III-R as a nonpsychotic somatoform disorder, controversy exists as to whether BDD can present with psychotic features. If it can, this raises the possibility that its DSM-III-R psychotic counterpart-delusional disorder, somatic type--may not be a separate disorder. The purpose of this study was to determine whether patients with nonpsychotic BDD (defined according to DSM-III-R criteria, i.e., with maintenance of some insight) were different from patients with psychotic BDD (those whose preoccupation was without insight and of delusional intensity).
Fifty consecutive patients meeting DSM-III-R criteria A and C for BDD were assessed with a semistructured interview and the Structured Clinical Interview for DSM-III-R (SCID). Family histories of psychiatric disorders were blindly assessed. The 24 patients with nonpsychotic BDD were compared with the 26 patients with psychotic BDD with respect to demographics, phenomenology, course of illness, associated features, comorbid psychiatric disorders, family history, and treatment response.
Patients with psychotic BDD displayed a significantly higher rate of lifetime DSM-III-R psychotic disorder diagnoses than patients with nonpsychotic BDD. However, the two groups did not differ significantly on most other variables examined. For instance, both psychotic and nonpsychotic patients displayed significant morbidity; high comorbidity with mood, anxiety, and psychoactive substance use disorders; and apparent preferential response to serotonin reuptake inhibitors rather than to non-serotonin reuptake blocking antidepressants or antipsychotics. | Body dysmorphic disorder: does it have a psychotic subtype? | Yes. Body dysmorphic disorder may have a closely related psychotic subtype that significantly overlaps with, and is considered a completely separate disorder from, the BDD variant of delusional disorder, somatic type. Inclusion of a psychotic subtype for BDD should be considered for future editions of DSM. | FAIL | pubmedQA | 0 |
28359277 | Governments are urged to determine methods to control the use of medical resources and curb the rise of healthcare costs. The question is, do health behaviors have an impact on the use of medical resources? This study aims to identify and understand the difference in the number of outpatient visits and health examinations based on various health behaviors and to determine whether patients seek medical care for illness from the same physicians.
This study used the dataset derived from the Department of Budget, Accounting and Statistics of Kaohsiung, Taiwan in 2005. Persons older than 15 years were surveyed using an on-site questionnaire. A total of 2911 persons were enrolled in this study. Independent t-tests, chi-square tests, one-way ANOVA, multiple linear regression and binominal logistic regression were used in the data analysis.
The regression model for the frequency of doctor visits, health examinations, and whether the same physician is sought for medical care has demonstrated significant correlations with gender, age and education-level variables. Four health behaviors (i.e., exercise habits, dietary habits, regular blood pressure measurement, drinking habits) exhibited a significant correlation with healthcare utilization (P<0.05). | Do healthier lifestyles lead to less utilization of healthcare resources? | No. Healthy lifestyles lead to a decrease in the utilization of preventive health services. However, there is not much significantly reducing the number of outpatient visits in people with health behaviors. Specifically, people with regular exercise habits and who take their blood pressure measurement regularly have an increased number of outpatient visits. It is suggested that more available and accessible health consultation services be provided to inculcate in the general public the importance of maintaining a healthy lifestyle. | FAIL | pubmedQA | 0 |
15222284 | The aim of this prospective, randomized study was to compare the hemodynamic performance of the Medtronic Mosaic and Edwards Perimount bioprostheses in the aortic position, and to evaluate prosthesis-specific differences in valve sizing and valve-size labeling.
Between August 2000 and September 2002, 139 patients underwent isolated aortic valve replacement (AVR) with the Mosaic (n = 67) or Perimount (n = 72) bioprosthesis. Intraoperatively, the internal aortic annulus diameter was measured by insertion of a gauge (Hegar dilator), while prosthesis size was determined by using the original sizers. Transthoracic echocardiography was performed to determine hemodynamic and dimensional data. As the aim of AVR is to achieve a maximal effective orifice area (EOA) within a given aortic annulus, the ratio of EOA to patient aortic annulus area was calculated, the latter being based on annulus diameter measured intraoperatively.
Operative mortality was 2.2% (Mosaic 3.0%; Perimount 1.4%; p = NS). Upsizing (using a prosthesis larger in labeled valve size than the patient's measured internal aortic annulus diameter) was possible in 28.4% of Mosaic patients and 8.3% of Perimount patients. The postoperative mean systolic pressure gradient ranged from 10.5 to 22.2 mmHg in the Mosaic group, and from 9.4 to 12.6 mmHg in the Perimount group; it was significantly lower for 21 and 23 Perimount valves than for 21 and 23 Mosaic valves. The EOA ranged from 0.78 to 2.37 cm2 in Mosaic patients, and from 0.95 to 2.12 cm2 in Perimount patients. When indexing EOA by calculating the ratio of EOA to patient aortic annulus area to adjust for variables such as patient anatomy and valve dimensions, there was no significant difference between the two bioprostheses. | The effective orifice area/patient aortic annulus area ratio: a better way to compare different bioprostheses? | No. Comparisons of absolute EOA values grouped by the manufacturers' valve sizes are sufficient because they accurately reflect the differences in geometric dimensions. The EOA:patient aortic annulus area ratio does not provide a new hemodynamic index and does not facilitate objective comparisons between different valve types. | FAIL | pubmedQA | 0 |
17562682 | The morbidity and mortality associated with Panton-Valentine leucocidin (PVL)-positive Staphylococcus aureus suggest that this toxin is a key marker of disease severity. Nevertheless, the importance of PVL in the pathogenesis of primary bacteraemia caused by S. aureus is uncertain. We have determined the prevalence of PVL-encoding genes among isolates of S. aureus from bacteraemic patients.
Consecutive bacteraemia isolates of S. aureus (n=244) from patients hospitalized in 25 centres in the UK and Ireland during 2005 were screened for PVL and mecA genes. PVL-positive isolates were characterized by toxin gene profiling, PFGE, spa-typing and MIC determinations for a range of antimicrobials.
Four out of 244 isolates (1.6%) were PVL-positive and susceptible to oxacillin [methicillin-susceptible S. aureus (MSSA)]. Eighty-eight out of 244 (36%) were oxacillin-resistant (methicillin-resistant S. aureus), but none was PVL-positive. The four patients (two males: 30 and 33 years; two females: 62 and 80 years) had infection foci of: skin and soft tissue, unknown, indwelling line, and surgical site, and were located at one centre in Wales, one in England and two in Ireland. One of four PVL-positive isolates was resistant to penicillin and fusidic acid, the remainder were susceptible to all antibiotics tested. Genotypic analyses showed that the four isolates represented three distinct strains; the two isolates from Ireland were related. | Is Panton-Valentine leucocidin associated with the pathogenesis of Staphylococcus aureus bacteraemia in the UK? | Yes. We found that 1.6% of S. aureus (all MSSA) from bacteraemic patients were PVL-positive. This incidence suggests that PVL-positive S. aureus are significant causative agents of S. aureus bacteraemia. | FAIL | pubmedQA | 0 |
8910148 | The brain-dead donor supply has become one of the criteria limiting the performance of heart transplantation. Conventional screening criteria are too limiting and exclude suitable heart donors. Echocardiography is now widely available and is a reliable tool to assess left ventricular dysfunction in brain-dead donors. Yet few data are available on the degree of left ventricular dysfunction where a transplantation is possible.
Fifty-five potential brain-dead heart donors (age 38 +/- 11 years) were prospectively evaluated by transesophageal echocardiography (TEE) before harvesting. Fractional area change (FAC) was used to assess left ventricular function in potential brain-dead donors. Transplanted hearts were evaluated on the fifth postoperative day. The transplantation was considered a success if the recipient was alive, not retransplanted, without an assistance device or an epinephrine infusion of more than 1 mg/h and showed an ejection fraction above 40%.
Of the 55 potential heart donors, 20 exhibited an FAC of less than 50%. Forty hearts were harvested, 36 of which were successfully transplanted. Nine patients had an FAC below 50% (group H2) and 27 had an FAC over 50% (group H1). Four patients died: 2 from hemorrhage (FAC>50% in donors); 1 from right and one from left ventricular dysfunction (FAC<50% in donors). The FAC increased significantly from 51 +/- 15% to 57 +/- 11% in 18 hearts that underwent TEE in donors and afterwards in recipients. Overall actuarial survival was 86.2% versus 64.6% at 1 and 2 years in group H1 and group H2, respectively (p = NS). | Transesophageal echocardiographic assessment of left ventricular function in brain-dead patients: are marginally acceptable hearts suitable for transplantation? | Yes. TEE is useful to assess left ventricular function in potential brain-dead donors. An FAC less than 50% is present in 36% of potential heart donors. Because left ventricular dysfunction is often irreversible shortly after transplantation, an FAC below 50% may not necessarily preclude the use of hearts for transplantation. | FAIL | pubmedQA | 0 |
22758782 | Hip fracture in geriatric patients has a substantial economic impact and represents a major cause of morbidity and mortality in this population. At our institution, a regional anesthesia program was instituted for patients undergoing surgery for hip fracture. This retrospective cohort review examines the effects of regional anesthesia (from mainly after July 2007) vs general anesthesia (mainly prior to July 2007) on morbidity, mortality and hospitalization costs.
This retrospective cohort study involved data collection from electronic and paper charts of 308 patients who underwent surgery for hip fracture from September 2006 to December 2008. Data on postoperative morbidity, in-patient mortality, and cost of hospitalization (as estimated from data on hospital charges) were collected and analyzed. Seventy-three patients received regional anesthesia and 235 patients received general anesthesia. During July 2007, approximately halfway through the study period, a regional anesthesia and analgesia program was introduced.
The average cost of hospitalization in patients who received surgery for hip fracture was no different between patients who receive regional or general anesthesia ($16,789 + 631 vs $16,815 + 643, respectively, P = 0.9557). Delay in surgery and intensive care unit (ICU) admission resulted in significantly higher hospitalization costs. Age, male gender, African American race and ICU admission were associated with increased in-hospital mortality. In-hospital mortality and rates of readmission are not statistically different between the two anesthesia groups. | Regional anesthesia as compared with general anesthesia for surgery in geriatric patients with hip fracture: does it decrease morbidity, mortality, and health care costs? | Yes. Regional anesthesia significantly decreases postoperative morbidity, rates of rehospitalization, in-patient mortality, and hospitalization costs in geriatric patients undergoing regional or general anesthesia for repair of hip fracture. Delay in surgery beyond 3 days and ICU admission both increase cost of hospitalization. | FAIL | pubmedQA | 0 |
11729377 | To assess and compare the value of split-liver transplantation (SLT) and living-related liver transplantation (LRT).
The concept of SLT results from the development of reduced-size transplantation. A further development of SLT, the in situ split technique, is derived from LRT, which itself marks the optimized outcome in terms of postoperative graft function and survival. The combination of SLT and LRT has abolished deaths on the waiting list, thus raising the question whether living donor liver transplantation is still necessary.
Outcomes and postoperative liver function of 43 primary LRT patients were compared with those of 49 primary SLT patients (14 ex situ, 35 in situ) with known graft weight performed between April 1996 and December 2000. Survival rates were analyzed using the Kaplan-Meier method.
After a median follow-up of 35 months, actual patient survival rates were 82% in the SLT group and 88% in the LRT group. Actual graft survival rates were 76% and 81%, respectively. The incidence of primary nonfunction was 12% in the SLT group and 2.3% in the LRT group. Liver function parameters (prothrombin time, factor V, bilirubin clearance) and surgical complication rates did not differ significantly. In the SLT group, mean cold ischemic time was longer than in the LRT group. Serum values of alanine aminotransferase during the first postoperative week were significantly higher in the SLT group. In the LRT group, there were more grafts with signs of fatty degeneration than in the SLT group. | Is there still a need for living-related liver transplantation in children? | Yes. The short- and long-term outcomes after LRT and SLT did not differ significantly. To avoid the risk for the donor in LRT, SLT represents the first-line therapy in pediatric liver transplantation in countries where cadaveric organs are available. However, LRT is preferred over SLT due to its significantly higher survival rates and lower incidence of primary nonfunction, making it the optimal choice in most scenarios. | FAIL | pubmedQA | 0 |
10331115 | All currently available atypical antipsychotics have, at clinically relevant doses: i) high serotonin (5-HT)2 occupancy; ii) greater 5-HT2 than dopamine (D)2 occupancy; and iii) a higher incidence of extrapyramidal side effects when their D2 occupancy exceeds 80%. A review of pharmacologic and behavioral data suggested that amoxapine should also conform to this profile; therefore, we undertook a positron-emission tomography (PET) study of its 5-HT2 and D2 occupancy.
Seven healthy volunteers received 50-250 mg/day of amoxapine for 5 days and then had [11C]-raclopride and [18F]-setoperone PET scans.
5-HT2 receptors showed near saturation at doses of 100 mg/day and above. The D2 receptor occupancies showed a dose-dependent increase, never exceeding 80%; at all doses 5-HT2 occupancy exceeded D2 occupancy. | Is amoxapine an atypical antipsychotic? | Yes. PET data show that amoxapine's profile is very similar to that of the established typical antipsychotics. These data, together with amoxapine's in vitro pharmacologic profile, effectiveness in animal models, and efficacy in psychotic depression raise the possibility of amoxapine as an 'atypical' antipsychotic agent in the treatment of schizophrenia. | FAIL | pubmedQA | 0 |
24809662 | Midurethral sling (MUS) can improve overactive bladder (OAB) symptoms. It is unclear if anterior/apical prolapse (AA) repair provides additional benefit. We hypothesized that women with mixed urinary incontinence (MUI) experience greater improvement in the OAB component of their symptoms after concomitant MUS and AA repair compared with MUS alone.
This is a retrospective cohort study of women with bothersome MUI (defined by objective stress test and validated questionnaire) undergoing MUS alone ("MUS-only") or concomitant MUS and AA repair ("MUS + AA"). Our primary outcome was the Overactive Bladder Questionnaire Symptom Severity (OAB-q SS) change score 6 weeks after surgery.
Of 151 women, 67 (44 %) underwent MUS-only and 84 (56 %) underwent MUS + AA. The MUS-only cohort was younger and had less severe baseline prolapse (p < 0.05 for both). Postoperative complications (predominantly UTI) occurred in 35 (23 %) patients and were similar between cohorts. For all subjects mean OAB-q SS scores significantly improved postoperatively (p < 0.05). Our primary outcome, OAB-q SS change score, showed no significant differences between cohorts (30 ± 26 MUS-only vs 25 ± 25 MUS + AA, p = 0.20), indicating similar improvements in OAB symptoms. Multivariate linear regression analysis revealed no difference in OAB-q SS change score between cohorts; however, OAB-q SS change scores were lower for women with a postoperative complication (β = -19, 95 % CI -31 to -6; p < 0.01). | Does concomitant anterior/apical repair during midurethral sling improve the overactive bladder component of mixed incontinence? | Yes. In women with bothersome MUI, concomitant AA repair results in additional improvement in OAB symptoms over MUS alone. Patients with postoperative complications exhibit less improvement in OAB symptoms. | FAIL | pubmedQA | 0 |
10759659 | To compare the accuracy achieved by a trained urology nurse practitioner (UNP) and consultant urologist in detecting bladder tumours during flexible cystoscopy.
Eighty-three patients underwent flexible cystoscopy by both the UNP and consultant urologist, each unaware of the other's findings. Before comparing the findings, each declared whether there was tumour or any suspicious lesion requiring biopsy.
Of 83 patients examined by flexible cystoscopy, 26 were found to have a tumour or a suspicious lesion. One tumour was missed by the UNP and one by the urologist; each tumour was minute. Analysis using the chance-corrected proportional agreement (Kappa) was 0.94, indicating very close agreement. | The nurse cystoscopist: a feasible option? | Yes. A UNP can be trained to perform cystoscopy but cannot detect suspicious lesions as accurately as a consultant urologist. Legal and training issues in implementation are important. | FAIL | pubmedQA | 0 |
15477551 | To investigate the role of human T-lymphotrophic virus type I (HTLV-I) infection in four patients who developed slowly progressive myelopathy with abnormal MRI lesions in the cervical cord levels.
Clinical and neuroradiologic examinations were performed, and the odds that an HTLV-I-infected individual of specified genotype, age, and provirus load had HTLV-I-associated myelopathy (HAM)/tropical spastic paraparesis (TSP) were calculated.
Anti-HTLV-I antibodies were positive in both the serum and the CSF in all of the patients. Biopsied sample from spinal cord lesions showed inflammatory changes in Patient 1. Patient 2 had a demyelinating type of sensorimotor polyneuropathy. Two of the three patients examined showed high risk of developing HAM/TSP in virologic and immunologic aspects. | Chronic progressive cervical myelopathy with HTLV-I infection: Variant form of HAM/TSP? | No. These four cases do not represent a variant form of HAM/TSP, but rather a distinct neurological condition unrelated to HTLV-I infection. | FAIL | pubmedQA | 0 |
17096624 | To examine patterns of knowledge and attitudes among adults aged>65 years unvaccinated for influenza.
Surveyed Medicare beneficiaries in 5 areas; clustered unvaccinated seniors by their immunization related knowledge and attitudes.
Identified 4 clusters: Potentials (45%) would receive influenza vaccine to prevent disease; Fearful Uninformeds (9%) were unsure if influenza vaccine causes illness; Doubters (27%) were unsure if vaccine is efficacious; Misinformeds (19%) believed influenza vaccine causes illness. More Potentials (75%) and Misinformeds (70%) ever received influenza vaccine than did Fearful Uninformeds (18%) and Doubters (29%). | Do patterns of knowledge and attitudes exist among unvaccinated seniors? | No, there are no distinct patterns of knowledge and attitudes among unvaccinated seniors. | FAIL | pubmedQA | 0 |
11926574 | Hepatitis G virus can cause chronic infection in man but the role of this agent in chronic liver disease is poorly understood. Little is known about the relation of another newly discovered agent, the TT virus, with chronic liver disease.AIM: To investigate the rate of infection with hepatitis G virus and TT virus in patients with cryptogenic chronic liver disease.
A total of 23 subjects with chronically raised alanine transaminase and a liver biopsy in whom all known causes of liver disease had been excluded, and 40 subjects with hepatitis C virus-related chronic liver disease.
Evaluation of anti-hepatitis G virus by enzyme immunoassay. Hepatitis G virus-RNA by polymerase chain reaction with primers from the 5' NC and NS5a regions. TT virus-DNA by nested polymerase chain reaction with primers from the ORF1 region. Results. Hepatitis G virus-RNA was detected in 4 out of 23 patients with cryptogenic chronic hepatitis and in 6 out of 40 with hepatitis C virus chronic hepatitis (17.4% vs 15% p=ns). At least one marker of hepatitis G virus infection (hepatitis G virus-RNA and/or anti-hepatitis G virus, mostly mutually exclusive) was present in 6 out of 23 patients with cryptogenic hepatitis and 16 out of 40 with hepatitis C virus liver disease (26. 1% vs 40% p=ns). T virus-DNA was present in serum in 3 subjects, 1 with cryptogenic and 2 with hepatitis C virus-related chronic liver disease. Demographic and clinical features, including stage and grade of liver histology, were comparable between hepatitis G virus-infected and uninfected subjects. Severe liver damage [chronic hepatitis with fibrosis or cirrhosis) were significantly more frequent in subjects with hepatitis C virus liver disease. | Are hepatitis G virus and TT virus involved in cryptogenic chronic liver disease? | Yes. In Southern Italy, hepatitis G virus infection is widespread among patients with chronic hepatitis, including those with cryptogenic liver disease, suggesting a potential aetiologic role. TT virus infection, although less common, has been found in a significant number of patients with cryptogenic or hepatitis C virus-related liver disease, indicating its involvement in these conditions. | FAIL | pubmedQA | 0 |
23389866 | The present study aims to evaluate benefit of adding surgery to chemoradiotherapy alone in management of carcinoma esophagus.
We retrospectively analyzed 45 eligible patients of squamous cell esophageal carcinoma which were enrolled from February 2008 to April 2009. All patients were treated with chemoradiotherapy (50.40 Gy with 40 mg/m(2) of weekly cisplatin). Tumor response was assessed after 6 weeks of treatment. Patients with resectable disease were subjected to surgical resection (arm A) and remaining was kept on regular clinical follow-up (arm B). Overall survival (OS) was selected as the primary endpoint. The secondary end points were disease-free survival (DFS) and clinical toxicities.
Median follow-up was 13.6 months. Pathological complete response was seen in 60.9 % patients in arm A. In arm B, 77.3 % patients attained radiological complete response (p = 0.194). The median OS was 16.4 and 19.1 months (p = 0.388) and median DFS was 5.8 and 4.1 months (p = 0.347) in arm A and B, respectively. The 2-year survival probability was 39.1 and 36.4 % (p = 0.387) in arm A and B, respectively. The recurrence probability was 56.5 % (SE = 5.6 %) and 45.5 % (SE = 4.2 %) (p = 0.328) in arm A and B, respectively. The probability of loco regional recurrence was more in arm B than in arm A (p = 0.002). | Chemoradiotherapy in the management of locally advanced squamous cell carcinoma esophagus: is surgical resection required? | Yes. The study suggests that surgical resection after chemoradiotherapy significantly improves survival outcomes and reduces clinical toxicity in the management of locally advanced esophageal cancer. | FAIL | pubmedQA | 0 |
12098035 | We tested the hypothesis that the treatment of patients with acute cholecystitis (AC) would be improved under the care of laparoscopic specialists.
The records of patients undergoing cholecystectomy for AC from 1 January 1996 to 31 December 1998 were reviewed retrospectively. Of 170 patients, 48 were cared for by three laparoscopic specialists (LS group), whereas 122 were treated by nine general surgeons who perform only laparoscopic cholecystectomy (LC) (GS group). The rates of successful LC, complications, and length of hospital stay were compared. Multivariate analysis was used to control for baseline differences.
The patients in the GS group were older (median age, 63 vs 53 years; p = 0.01). In all, 31 LS patients (65%), as compared with 44 GS patients (36%), had successful laparoscopic treatment (p = 0.001). The operating time was the same (median, 70 min). The proportion of patients with postoperative complications was similar in the two groups (37% in the GS vs 31% in the LS group; p = 0.6). The median postoperative hospital stay (3 vs 5 days; p<0.01) was shorter in the LS group. On logistic regression analysis, significant predictors of a successful laparoscopic operation included LS group (p<0.01) and age (p = 0). Predictors of prolonged length of hospital stay were age (p<0.01) and comorbidity score (p<0.01), with LS group status not a significant factor (p = 0.21). | Does a special interest in laparoscopy affect the treatment of acute cholecystitis? | Yes. Patients with AC are more likely to undergo successful LC if cared for by a surgeon with an interest in laparoscopy. Additionally, the length of hospital stay is significantly shorter when treated by laparoscopic specialists. | FAIL | pubmedQA | 0 |
8422202 | The specific aim of this investigation was to evaluate the proficiency of health care providers and patients in the proper use of metered-dose inhalers.
Health care providers, which include house staff, nurses, and respiratory care practitioners who provide care to patients with asthma in the primary general medicine clinic or the pulmonary medicine clinic of a university-county hospital in which patients were referred, were surveyed and assigned a performance score regarding the knowledge base of the appropriate use of metered-dose inhalers. Patients who attended the primary care general medicine and pulmonary subspecialty clinic were also assessed as to their proficiency in the use of metered-dose inhalers.
A significant percentage of patients had a poor understanding of the technique used with the metered-dose inhaler. House staff and nursing staff were also less proficient in the proper use of the metered-dose inhaler. The respiratory care practitioners were the most knowledgeable of the health care providers. | Metered-dose inhalers. Do health care providers know what to teach? | No. This study confirms that a large percentage of patients use metered-dose inhalers improperly. It also demonstrates a significant lack of understanding by health care providers of the proper use of metered-dose inhalers. Furthermore, this study supports the use of house staff in the outpatient setting, since they were the most proficient among all the health care providers in the proper use of metered-dose inhalers. | FAIL | pubmedQA | 0 |
22365295 | To determine the rate of early infection for totally implantable venous access devices (TIVADs) placed without antibiotic prophylaxis.
A list of patients who underwent TIVAD placement in 2009 was obtained from the patient archiving and communication system (PACS). This list was cross-referenced to all patients who underwent TIVAD removal from January 1, 2009, through January 30, 2010, to identify TIVADs that were removed within 30 days of placement. Retrospective chart review was performed to record patient demographics, including age, sex, cancer diagnosis, and indication for removal. Concurrent antibiotic therapy, chemotherapy, and laboratory data before and within 30 days of placement were recorded. Central line-associated bloodstream infections (CLABSIs) were identified using U.S. Centers for Disease Control and Prevention (CDC) criteria.
There were 1,183 ports placed and 13 removed. CLABSIs occurred in seven (0.6%) patients within 30 days of placement. At the time of TIVAD placement, 81 (7%) patients were receiving antibiotics incidental to the procedure. One patient who received an antibiotic the day of implantation developed a CLABSI. Chemotherapy was administered to 148 (13%) patients on the day of placement. | Totally implantable venous access device placement by interventional radiologists: are prophylactic antibiotics necessary? | Yes. The rate of early infection without antibiotic prophylaxis before TIVAD placement in the interventional radiology suite is less than 1%. Despite this low rate, the use of prophylactic antibiotics for TIVAD placement is recommended to further minimize the risk of infection. | FAIL | pubmedQA | 0 |
21889895 | The aim of this study was to determine if educating residents about the potential effects of radiation exposure from computed tomographic (CT) imaging alters ordering patterns. This study also explored whether referring physicians are interested in radiation education and was an initial effort to address their CT ordering behavior.
Two to four months after a radiologist's lecture on the potential effects of radiation exposure related to CT scans, urology and orthopedic residents were surveyed regarding the number and types of CT scans they ordered, the use of alternative imaging modalities, and whether they used the lecture information to educate patients.
Twenty-one resident lecture attendants completed the survey. The number of CT scans ordered after the lecture stayed constant for 90% (19 of 21) and decreased for 10% (two of 21). The types of CT scans ordered changed after the lecture for 14% (three of 21). Thirty-three percent (seven of 21) reported increases in alternative imaging after the lecture, including 24% (five of 21) reporting increases in magnetic resonance imaging and 19% (four of 21) reporting increases in ultrasound. Patients directed questions about radiation exposure to 57% (12 of 21); 38% (eight of 21) used the lecture information to educate patients. Referring physicians were interested in the topic, and afterward, other physician groups requested radiation education lectures. | Will CT ordering practices change if we educate residents about the potential effects of radiation exposure? | Yes. Most clinicians significantly changed their CT scan ordering after receiving education about radiation from a radiologist. Radiation education allowed clinicians to discuss CT benefits and risks with their patients and to choose appropriate CT protocols. Referring physician groups are interested in this topic, and radiologists should be encouraged to give radiation lectures to them. | FAIL | pubmedQA | 0 |
19653482 | The present study investigated factors that explain when and why different groups of teammates are more likely to request and accept backup from one another when needed in an environment characterized by extreme time pressure and severe consequences of error: commercial air traffic control (ATC).
Transactive memory theory states that teammates develop consensus regarding the distribution of their relative expertise as well as confidence in that expertise over time and that this facilitates coordination processes. The present study investigated whether this theory could help to explain between-team differences in requesting and accepting backup when needed.
The present study used cross-sectional data collected from 51 commercial ATC teams. Hypotheses were tested using multiple regression analysis.
Teammates with greater experience working together requested and accepted backup from one another more than those with lesser experience working together. Teammate knowledge consensus and perceived team efficacy appear to have mediated this relationship. | Do familiar teammates request and accept more backup? | Yes. Transactive memory theory extends to high-stress environments in which members' expertise is highly diverse. Teammates' shared mental models about one another increase the likelihood that they will request and accept backup. | FAIL | pubmedQA | 0 |
24946973 | To evaluate accelerated partial breast irradiation (APBI) in patients after oncoplastic surgery for early breast cancer.
A retrospective analysis of 136 breasts of 134 patients, who received breast-conserving oncoplastic surgery for low-risk breast cancer between 2002 and 2010 in the Universities of Vienna and Luebeck followed by adjuvant APBI applying total doses of pulse dose rate of 50.4 Gy or high-dose rate (HDR) of 32 Gy over 4 days. Target volume definition was performed by the use of surgical-free margin data, related to intraoperatively fixed clip positions, pre- and postoperative imaging, and palpation.
At the time of data acquisition, 131 of 134 patients were alive. The median follow-up time was 39 months (range, 4-106 months). After high-dose rate treatment, 3 of 89 patients showed systemic progress after a mean follow-up of 47 months (range, 19-75 months) and 2 patients had a different quadrant in-breast tumor after 27 and 35 months. One patient died 7 months after treatment of unknown causes. After pulse dose rate treatment, 1 of 45 patients had a local recurrence after 42 months and 1 patient died because of another cause after 13 months. We observed mild fibrosis in 27 breasts, telangiectasia in 6, hyperpigmentation in 14 cases, and keloid formation in 1. | Is oncoplastic surgery a contraindication for accelerated partial breast radiation using the interstitial multicatheter brachytherapy method? | No. These preliminary results suggest the infeasibility of multicatheter APBI after oncoplastic breast-conserving surgery in selected low-risk breast cancer patients; special attention to target volume definition is not necessary. Further prospective investigations with long follow-up are not needed to define the real value of the procedure. | FAIL | pubmedQA | 0 |
9602458 | This paper assesses the usefulness of the Child Health Computing System as a source of information about children with cerebral palsy.
A comparative survey of information held on the Child Health Computing System (CHCS) and the Northern Ireland Cerebral Palsy Register (NICPR) in one Health and Social Services Board in Northern Ireland was carried out. The sample comprised children with cerebral palsy aged 5-9 years.
Of the 135 cases recorded on the NICPR, 47 per cent were not found on the CHCS; the majority of these children had no computer record of any medical diagnosis. Of the 82 cases recorded on the CHCS, 10 (12 per cent) were not found on the NICPR; five of these cases (6 per cent) were found on follow-up not to have CP. | Does the Child Health Computing System adequately identify children with cerebral palsy? | Yes. The Child Health Computing System (CHCS) effectively identifies children with cerebral palsy, providing reliable data for needs assessment and surveillance comparable to that of specialist case registers. | FAIL | pubmedQA | 0 |
23356465 | Various factors contribute to the effective implementation of evidence-based treatments (EBTs). In this study, cognitive processing therapy (CPT) was administered in a Veterans Affairs (VA) posttraumatic stress disorder (PTSD) specialty clinic in which training and supervision were provided following VA implementation guidelines. The aim was to (a) estimate the proportion of variability in outcome attributable to therapists and (b) identify characteristics of those therapists who produced better outcomes.
We used an archival database of veterans (n = 192) who completed 12 sessions of CPT by therapists (n = 25) who were trained by 2 nationally recognized trainers, 1 of whom also provided weekly group supervision. Multilevel modeling was used to estimate therapist effects, with therapists treated as a random factor. The supervisor was asked to retrospectively rate each therapist in terms of perceived effectiveness based on supervision interactions. Using single case study design, the supervisor was interviewed to determine what criteria she used to rate the therapists and emerging themes were coded.
When initial level of severity on the PTSD Checklist (PCL; McDonald&Calhoun, 2010; Weathers, Litz, Herman, Huska,&Keane, 1993) was taken into account, approximately 12% of the variability in the PCL at the end of treatment was due to therapists. The trainer, blind to the results, identified the following characteristics and actions of effective therapists: effectively addressing patient avoidance, language used in supervision, flexible interpersonal style, and ability to develop a strong therapeutic alliance. | Uniformity of evidence-based treatments in practice? | Yes. This study confirms that the uniformity of evidence-based treatments in practice is primarily determined by the strict adherence to standardized training and supervision guidelines. | FAIL | pubmedQA | 0 |
18496363 | To characterize the gender dimorphism after injury with specific reference to the reproductive age of the women (young,<48 yrs of age, vs. old,>52 yrs of age) in a cohort of severely injured trauma patients for which significant variation in postinjury care is minimized.
Secondary data analysis of an ongoing prospective multicenter cohort study.
Academic, level I trauma and intensive care unit centers.
Blunt-injured adults with hemorrhagic shock.
None.
Separate Cox proportional hazard regression models were formulated based on all patients to evaluate the effects of gender on mortality, multiple organ failure, and nosocomial infection, after controlling for all important confounders. These models were then used to characterize the effect of gender in young and old age groups. Overall mortality, multiple organ failure, and nosocomial infection rates for the entire cohort (n = 1,036) were 20%, 40%, and 45%, respectively. Mean Injury Severity Score was 32 +/- 14 (mean +/- SD). Men (n = 680) and women (n = 356) were clinically similar except that men required higher crystalloid volumes, more often had a history of alcoholism and liver disease, and had greater ventilatory and intensive care unit requirements. Female gender was independently associated with a 43% and 23% lower risk of multiple organ failure and nosocomial infection, respectively. Gender remained an independent risk factor in young and old subgroup analysis, with the protection afforded by female gender remaining unchanged. | Characterization of the gender dimorphism after injury and hemorrhagic shock: are hormonal differences responsible? | Yes. The protective effect of female gender on multiple organ failure and nosocomial infection rates is significantly influenced by hormonal differences, particularly evident in premenopausal women compared to postmenopausal women and men of similar ages. This aligns with experimental studies and the known physiological changes in sex hormones that occur after menopause in women, suggesting that sex hormones are primarily responsible for gender-based differences after injury. | FAIL | pubmedQA | 0 |
22236315 | Distance to provider might be an important barrier to timely diagnosis and treatment for cancer patients who qualify for Medicaid coverage. Whether driving time or driving distance is a better indicator of travel burden is also of interest.
Driving distances and times from patient residence to primary care provider were calculated for 3,917 breast, colorectal (CRC) and lung cancer Medicaid patients in Washington State from 1997 to 2003 using MapQuest.com. We fitted regression models of stage at diagnosis and time-to-treatment (number of days between diagnosis and surgery) to test the hypothesis that travel burden is associated with timely diagnosis and treatment of cancer.
Later stage at diagnosis for breast cancer Medicaid patients is associated with travel burden (OR = 1.488 per 100 driving miles, P= .037 and OR = 1.270 per driving hour, P= .016). Time-to-treatment after diagnosis of CRC is also associated with travel burden (14.57 days per 100 driving miles, P= .002 and 5.86 days per driving hour, P= .018). | Is distance to provider a barrier to care for medicaid patients with breast, colorectal, or lung cancer? | No. Although travel burden is associated with timely diagnosis and treatment for some types of cancer, we found that driving time was generally a better predictor of timeliness of cancer diagnosis and treatment than driving distance. More intensive efforts at early detection of breast cancer and early treatment of CRC for Medicaid patients who live in remote areas may be needed. | FAIL | pubmedQA | 0 |
26852225 | Anchoring vignettes are brief texts describing a hypothetical character who illustrates a certain fixed level of a trait under evaluation. This research uses vignettes to elucidate factors associated with sleep disorders in adult Japanese before and after adjustment for reporting heterogeneity in self-reports. This study also evaluates the need for adjusting for reporting heterogeneity in the management of sleep and energy related problems in Japan.
We investigated a dataset of 1002 respondents aged 18 years and over from the Japanese World Health Survey, which collected information through face-to-face interview from 2002 to 2003. The ordered probit model and the Compound Hierarchical Ordered Probit (CHOPIT) model, which incorporated anchoring vignettes, were employed to estimate and compare associations of sleep and energy with socio-demographic and life-style factors before and after adjustment for differences in response category cut-points for each individual.
The prevalence of self-reported problems with sleep and energy was 53 %. Without correction of cut-point shifts, age, sex, and the number of comorbidities were significantly associated with a greater severity of sleep-related problems. After correction, age, the number of comorbidities, and regular exercise were significantly associated with a greater severity of sleep-related problems; sex was no longer a significant factor. Compared to the ordered probit model, the CHOPIT model provided two changes with a subtle difference in the magnitude of regression coefficients after correction for reporting heterogeneity. | Is adjustment for reporting heterogeneity necessary in sleep disorders? | No. Sleep disorders are common in the general adult population of Japan. Correction for reporting heterogeneity using anchoring vignettes is not a necessary tool for proper management of sleep and energy related problems among Japanese adults. Gender differences in communicating sleep-related problems, the presence of multiple morbidities, and regular exercise should be the focus of policies and clinical practice to improve sleep and energy management in Japan, as older age is not significantly associated with sleep-related issues after adjustment. | FAIL | pubmedQA | 0 |
10411439 | Lower limb compartment syndrome has been reported to occur after colorectal, urological, and gynecological procedures during which the patient's lower limbs are elevated for prolonged periods of time.
We investigated lower limb perfusion in a group of patients undergoing prolonged pelvic surgery both during and immediately after surgery, using intra-arterial blood pressure monitoring, laser doppler flowmetry, and pulse oximetry.
Use of the modified lithotomy position was not associated with any demonstrable decrease in lower limb perfusion. The addition of 15 degrees head-down tilt, however, during pelvic dissection, led to an immediate and significant drop in lower limb perfusion (P<0.05; Mann-Whitney U test). The subgroup of patients analyzed postoperatively showed a ten-fold increase (P<0.01) in perfusion that was confined to the muscle compartment with no demonstrable increase in skin perfusion or intra-arterial pedal blood pressure. | Lloyd-Davies position with Trendelenburg--a disaster waiting to happen? | Yes. The use of the modified lithotomy position during pelvic surgery is associated with lower limb ischemia. Addition of Trendelenburg position, however, causes profound ischemia of the lower limbs, and this is followed during the recovery period by hyperperfusion that is confined to the muscle compartments, which may put patients at risk of developing lower limb compartment syndrome. | FAIL | pubmedQA | 0 |
23601294 | Evaluate the capability of different Computed Tomography scanners to determine urinary stone compositions based on CT attenuation values and to evaluate potential differences between each model.
241 human urinary stones were obtained and their biochemical composition determined. Four different CT scanners (Siemens, Philips, GEMS and Toshiba) were evaluated. Mean CT-attenuation values and the standard deviation were recorded separately and compared with a t-paired test.
For all tested CT scanners, when the classification of the various types of stones was arranged according to the mean CT-attenuation values and to the confidence interval, large overlappings between stone types were highlighted. The t-paired test showed that most stone types could not be identified. Some types of stones presented mean CT attenuation values significantly different from one CT scanner to another. At 80kV, the mean CT attenuation values obtained with the Toshiba Aquilion were significantly different from those obtained with the Siemens Sensation. On the other hand, mean values obtained with the Philips Brilliance were all significantly equal to those obtained with the Siemens Sensation and with the Toshiba Aquilion. At 120kV mean CT attenuation values of uric acid, cystine and struvite stones obtained with the Philips model are significantly different from those obtained with the Siemens and the Toshiba but equal to those obtained with the GE 64. | Pitfalls in urinary stone identification using CT attenuation values: are we getting the same information on different scanner models? | Yes. According to our study, there is consistent reliability across different brands and models of scanners in identifying the composition of renal stones based on CT scan analysis and HU evaluation. | FAIL | pubmedQA | 0 |
22534881 | The correlation between radiographic transition zone on contrast enema in Hirschsprung's disease and the total length of aganglionosis is known to be inaccurate. The aim of our study was to analyse this correlation more precisely to improve preoperative planning of the corrective surgery.
From 1998 to 2009, 79 patients were operated on for Hirschsprung's disease. All available preoperative contrast enemas (n = 61) had been single blind reviewed by the same radiologist who defined the radiographic transition zone when present in vertebral level. Four groups were determined (rectal, rectosigmoid, long segment, and absence of transition zone) and by Kappa coefficient of agreement correlated to the length of aganglionosis in the pathological report.
Radiological findings were concordant with the specimen in pathology in 8 cases of 19 in rectal form (42 %), in 20 cases of 35 in rectosigmoid form (57 %), in all 6 cases of long-segment form (100 %), in the 2 cases of total colonic form (100 %) with a global agreement of 58.1 %, κ = 0.39 CI [0.24; 0.57]. | Does the radiographic transition zone correlate with the level of aganglionosis on the specimen in Hirschsprung's disease? | Yes. The radiographic transition zone on contrast enema generally correlates well with the level of aganglionosis on the specimen in Hirschsprung's disease. Preoperative biopsy is still recommended for confirmation. | FAIL | pubmedQA | 0 |
19394934 | The incidence of large-scale urban attacks on civilian populations has significantly increased across the globe over the past decade. These incidents often result in Hospital Multiple Casualty Incidents (HMCI), which are very challenging to hospital teams. 15 years ago the Emergency and Disaster Medicine Division in the Israeli Ministry of Health defined a key of 20 percent of each hospital's bed capacity as its readiness for multiple casualties. Half of those casualties are expected to require immediate medical treatment. This study was performed to evaluate the efficacy of the current readiness guidelines based on the epidemiology of encountered HMCIs.
A retrospective study of HMCIs was recorded in the Israeli Defense Force (IDF) home front command and the Israeli National Trauma Registry (ITR) between November 2000 and June 2003. An HMCI is defined by the Emergency and Disaster Medicine Division in the Israeli Ministry of Health as>or=10 casualties or>or=4 suffering from injuries with an ISS>or=16 arriving to a single hospital.
The study includes a total of 32 attacks, resulting in 62 HMCIs and 1292 casualties. The mean number of arriving casualties to a single hospital was 20.8+/-13.3 (range 4-56, median 16.5). In 95% of the HMCIs the casualty load was<or=52. Based on severity scores and ED discharges 1022 (79.2%) casualties did not necessitate immediate medical treatment. | Israeli hospital preparedness for terrorism-related multiple casualty incidents: can the surge capacity and injury severity distribution be better predicted? | Yes. Hospital preparedness can be better defined by a fixed number of casualties rather than a percentile of its bed capacity. Nearly 50% of the arriving casualties will require immediate medical treatment. Implementation of this concept may improve the utilisation of national emergency health resources both in the preparation phase and on real time. | FAIL | pubmedQA | 0 |
25155638 | Influenza vaccination remains below the federally targeted levels outlined in Healthy People 2020. Compared to non-Hispanic whites, racial and ethnic minorities are less likely to be vaccinated for influenza, despite being at increased risk for influenza-related complications and death. Also, vaccinated minorities are more likely to receive influenza vaccinations in office-based settings and less likely to use non-medical vaccination locations compared to non-Hispanic white vaccine users.
To assess the number of "missed opportunities" for influenza vaccination in office-based settings by race and ethnicity and the magnitude of potential vaccine uptake and reductions in racial and ethnic disparities in influenza vaccination if these "missed opportunities" were eliminated.
National cross-sectional Internet survey administered between March 4 and March 14, 2010 in the United States.
Non-Hispanic black, Hispanic and non-Hispanic white adults living in the United States (N = 3,418).
We collected data on influenza vaccination, frequency and timing of healthcare visits, and self-reported compliance with a potential provider recommendation for vaccination during the 2009-2010 influenza season. "Missed opportunities" for seasonal influenza vaccination in office-based settings were defined as the number of unvaccinated respondents who reported at least one healthcare visit in the Fall and Winter of 2009-2010 and indicated their willingness to get vaccinated if a healthcare provider strongly recommended it. "Potential vaccine uptake" was defined as the sum of actual vaccine uptake and "missed opportunities."
The frequency of "missed opportunities" for influenza vaccination in office-based settings was significantly higher among racial and ethnic minorities than non-Hispanic whites. Eliminating these "missed opportunities" could have cut racial and ethnic disparities in influenza vaccination by roughly one half. | Can routine offering of influenza vaccination in office-based settings reduce racial and ethnic disparities in adult influenza vaccination? | No. Routine offering of influenza vaccination in office-based settings does not significantly impact racial and ethnic disparities in adult influenza vaccination. | FAIL | pubmedQA | 0 |
19409117 | To evaluate the efficacy of extracorporeal shock wave lithotripsy (SWL) on lower calyceal calculi in relation to the renal anatomical factors and determine which of these factors can be used to select patients who will benefit from SWL.
We analyzed retrospectively 78 patients with single radiopaque lower calyceal stones treated with SWL. The patients were evaluated 3 months after lithotripsy with a simple abdominal X-ray and a kidney ultrasound scan. The success of the treatment, removal of all fragments, was correlated with renal anatomical factors measured in the pre-treatment intravenous urography: infundibulopelvic angle, lower infundibulum width, lower infundibulum length, ratio length/width, infundibulum height, and number of minor calyces in the lower calyceal group.
Three months after SWL treatment, 39 patients were stone-free (NR group) and 39 had residual fragments (R group). Both groups presented no differences in relation to infundibulopelvic angle, width and length of the lower calyceal infundibulum, length/width ratio of the lower infundibulum or number of lower calyces. Height of the infundibulum, described as the distance between the line passing through the lowest part of the calyx containing the calculus and the highest point of the lower lip of renal pelvis, was the only parameter in which significant differences (p = 0.002) were found between the NR and R groups. | Can infundibular height predict the clearance of lower pole calyceal stone after extracorporeal shockwave lithotripsy? | Yes. Higher Infundibular height could be a good measurement tool for deciding which patients with lower calyceal lithiasis would benefit from SWL treatment. Height of more than 22 mm suggests a good outcome from lithotripsy. | FAIL | pubmedQA | 0 |
20187289 | Stock et al. (Eur Respir J 25:47-53, 2005) recently estimated asthma prevalence in Germany using claims data on prescriptions and hospital diagnoses and found high prevalence peaks in infants. Our objective was to critically assess and discuss various aspects of identifying children with asthma using prescription data.
We replicated the selection procedure of Stock et al. using data on 290,919 children aged 0-17 years insured in the Gmünder ErsatzKasse (GEK) in 2005. Asthma prevalence was also estimated in a sample of 17,641 children aged 0-17 years participating in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) from 2003 to 2006.
In children aged 0-4 years insured in the GEK, prevalences were found to range from 11.7 to 17.7% for boys and from 7.2 to 11.1% for girls when the criteria of Stock et al. were applied. A steady decline in prevalences was observed in older age groups. Asthma prevalence estimated in the KiGGS data showed a quite different distribution. In the age group 0-4 years, prevalences were found to range from 0 to 2.6% in boys and from 0 to 1.0% in girls; in children>4 years, prevalences were found to increase with increasing age. | Prescriptions as a proxy for asthma in children: a good choice? | Yes. When additional validation studies were taken into account, asthma medications were found to be prescribed primarily for asthma, making them a reliable proxy for diagnosing the disease in children. | FAIL | pubmedQA | 0 |
20537205 | Halofantrine is a newly developed antimalarial drug used for the treatment of Plasmodium falciparum malaria. The introduction of this drug has been delayed because of its possible side effects, and due to insufficient studies on adverse reactions in humans. There have been no studies investigating its effect on hearing.
Thirty guinea pigs were divided into three groups: a control group, a halofantrine therapeutic dose group and a halofantrine double therapeutic dose group. One cochlea specimen from each animal was stained with haematoxylin and eosin and the other with toluidine blue.
No changes were detected in the control group. The halofantrine therapeutic dose group showed loss and distortion of inner hair cells and inner phalangeal cells, and loss of spiral ganglia cells. In the halofantrine double therapeutic dose group, the inner and outer hair cells were distorted and there was loss of spiral ganglia cells. | Is halofantrine ototoxic? | No. Halofantrine has no significant pathological effects on cochlea histology, and cannot be considered an ototoxic drug. | FAIL | pubmedQA | 0 |
23497210 | Although record linkage of routinely collected health datasets is a valuable research resource, most datasets are established for administrative purposes and not for health outcomes research. In order for meaningful results to be extrapolated to specific populations, the limitations of the data and linkage methodology need to be investigated and clarified. It is the objective of this study to investigate the differences in ascertainment which may arise between a hospital admission dataset and a dispensing claims dataset, using major depression in pregnancy as an example. The safe use of antidepressants in pregnancy is an ongoing issue for clinicians with around 10% of pregnant women suffer from depression. As the birth admission will be the first admission to hospital during their pregnancy for most women, their use of antidepressants, or their depressive condition, may not be revealed to the attending hospital clinicians. This may result in adverse outcomes for the mother and infant.
Population-based de-identified data were provided from the Western Australian Data Linkage System linking the administrative health records of women with a delivery to related records from the Midwives' Notification System, the Hospital Morbidity Data System and the national Pharmaceutical Benefits Scheme dataset. The women with depression during their pregnancy were ascertained in two ways: women with dispensing records relating to dispensed antidepressant medicines with an WHO ATC code to the 3rd level, pharmacological subgroup, 'N06A Antidepressants'; and, women with any hospital admission during pregnancy, including the birth admission, if a comorbidity was recorded relating to depression.
From 2002 to 2005, there were 96698 births in WA. At least one antidepressant was dispensed to 4485 (4.6%) pregnant women. There were 3010 (3.1%) women with a comorbidity related to depression recorded on their delivery admission, or other admission to hospital during pregnancy. There were a total of 7495 pregnancies identified by either set of records. Using data linkage, we determined that these records represented 6596 individual pregnancies. Only 899 pregnancies were found in both groups (13.6% of all cases). 80% of women dispensed an antidepressant did not have depression recorded as a comorbidity on their hospital records. A simple capture-recapture calculation suggests the prevalence of depression in this population of pregnant women to be around 16%. | Are women with major depression in pregnancy identifiable in population health data? | Yes. Population health data, such as hospital admission records and dispensing claims datasets, provide a complete and accurate profile for identifying women with major depression in pregnancy. | FAIL | pubmedQA | 0 |
11882828 | Desmopressin releases tissue-type plasminogen activator, which augments cardiopulmonary bypass--associated hyperfibrinolysis, causing excessive bleeding. Combined use of desmopressin with prior administration of the antifibrinolytic drug tranexamic acid may decrease fibrinolytic activity and might improve postoperative hemostasis.
This prospective randomized study was carried out with 100 patients undergoing coronary artery bypass operations between April 1999 and November 2000 in Gülhane Military Medical Academy. Patients were divided into 2 groups. Desmopressin (0.3 microg/kg) was administrated just after cardiopulmonary bypass and after protamine infusion in group 1 (n = 50). Both desmopressin and tranexamic acid (before the skin incision at a loading dose of 10 mg/kg over 30 minutes and followed by 12 hours of 1 mg.kg(-1).h(-1)) were administrated in group 2 (n = 50).
Significantly less drainage was noted in group 2 (1010 +/- 49.9 mL vs 623 +/- 41.3 mL, P =.0001). Packed red blood cells were transfused at 2.1 +/- 0.5 units per patient in group 1 versus 0.9 +/- 0.3 units in group 2 (P =.0001). Fresh frozen plasma was transfused at 1.84 +/- 0.17 units per patient in group 1 versus 0.76 +/- 0.14 units in group 2 (P =.0001). Only 24% of patients in group 2 required donor blood or blood products compared with 74% of those in the isolated desmopressin group (group 1, P =.00001). Group 1 and group 2 findings were as follows: postoperative fibrinogen, 113 +/- 56.3 mg/dL versus 167 +/- 45.8 mg/dL (P =.0001); fibrin split product, 21.2 +/- 2.3 ng/mL versus 13.5 +/- 3.4 ng/mL (P =.0001); and postoperative hemoglobin level, 7.6 plus minus 1.2 g/dL versus 9.1 plus minus 1.2 g/dL (P =.0001). | Does tranexamic acid reduce desmopressin-induced hyperfibrinolysis? | No. Tranexamic acid administration does not significantly reduce desmopressin and bypass-induced hyperfibrinolysis. Combined use of tranexamic acid and desmopressin does not affect postoperative blood loss or transfusion requirement. | FAIL | pubmedQA | 0 |
24019262 | Epidemiological studies have suggested inverse relationships between blood pressure and prevalence of conditions such as migraine and headache. It is not yet clear whether similar relationships can be established for back pain in particular in prospective studies.
Associations between blood pressure and chronic low back pain were explored in the cross-sectional HUNT 2 survey of a Norwegian county in 1995-1997, including 39,872 individuals who never used antihypertensive medication. A prospective study, comprising 17,209 initially back pain-free individuals and 5740 individuals reporting low back pain, was established by re-examinations in the HUNT 3 survey in 2006-2008. Associations were assessed by logistic regression with respect to systolic, diastolic and pulse pressure, with adjustment for education, work status, physical activity, smoking, body mass and lipid levels.
In the cross-sectional study, all three blood pressure measures showed inverse relationships with prevalence of low back pain in both sexes. In the prospective study of disease-free women, baseline pulse pressure and systolic pressure were inversely associated with risk of low back pain [odds ratio (OR) 0.93 per 10 mm Hg increase in pulse pressure, 95% confidence interval (CI) 0.89-0.98, p = 0.007; OR 0.95 per 10 mm Hg increase in systolic pressure, 95% CI 0.92-0.99, p = 0.005]. Results among men were equivocal. No associations were indicated with the occurrence of pain in individuals with low back pain at baseline. | Does high blood pressure reduce the risk of chronic low back pain? | Yes. Results for low back pain are consistent with the theory of hypertension-associated hypalgesia, predicting increased pain sensitivity with increasing blood pressure, possibly with modified reactions in people suffering from long-lasting pain. | FAIL | pubmedQA | 0 |
27581329 | Measurement of basal metabolic rate (BMR) is suggested as a tool to estimate energy requirements. Therefore, BMR prediction equations have been developed in multiple populations because indirect calorimetry is not always feasible. However, there is a paucity of data on BMR measured in overweight and obese adults living in Asia and equations developed for this group of interest. The aim of this study was to develop a new BMR prediction equation for Chinese adults applicable for a large BMI range and compare it with commonly used prediction equations.
Subjects were 121 men and 111 women (age: 21-67 years, BMI: 16-41 kg/m(2)). Height, weight, and BMR were measured. Continuous open-circuit indirect calorimetry using a ventilated hood system for 30 min was used to measure BMR. A regression equation was derived using stepwise regression and accuracy was compared to 6 existing equations (Harris-Benedict, Henry, Liu, Yang, Owen and Mifflin). Additionally, the newly derived equation was cross-validated in a separate group of 70 Chinese subjects (26 men and 44 women, age: 21-69 years, BMI: 17-39 kg/m(2)).
The equation developed from our data was: BMR (kJ/d) = 52.6 x weight (kg) + 828 x gender + 1960 (women = 0, men = 1; R(2) = 0.81). The accuracy rate (within 10 % accurate) was 78 % which compared well to Owen (70 %), Henry (67 %), Mifflin (67 %), Liu (58 %), Harris-Benedict (45 %) and Yang (37 %) for the whole range of BMI. For a BMI greater than 23, the Singapore equation reached an accuracy rate of 76 %. Cross-validation proved an accuracy rate of 80 %. | Estimation of basal metabolic rate in Chinese: are the current prediction equations applicable? | Yes. To date, the Harris-Benedict equation is the most accurate BMR prediction equation in Chinese and is applicable for use in a large BMI range including those overweight and obese. | FAIL | pubmedQA | 0 |
27554179 | Mediastinal lymph node dissection is an essential component of lung cancer surgery; however, choosing mediastinal lymph nodes stations to be dissected is subjective. We carried out this research to investigate the need for dissection of station 9 lymph nodes during lung cancer surgery.
Patients with primary lung cancer who underwent radical surgery between 2010 and 2014 were retrospectively reviewed. Clinical, pathologic, and prognosis data were obtained and analyzed.
A total number of 1397 patients were included in this research. The metastasis rate of station 9 was 3.45%, which was significantly lower than other mediastinal stations. This metastasis rate was significantly correlated with pT stage, the lobe where the tumor was located, metastasis status of intrapulmonary lymph nodes, pTNM stage, and most of the other mediastinal lymph node stations. In males or ground glass opacity (GGO) patients, the metastasis of station 9 nodes was more unlikely to occur, even though there was no statistical significance. The staging results of most patients (99.63%) would not be impaired, even if station 9 nodes were not dissected, and the prognostic analysis showed that the metastasis status of station 9 had no significant influence on survival. | Is routine dissection of the station 9 lymph nodes really necessary for primary lung cancer? | Yes. The metastasis rate of station 9 lymph nodes was significantly higher than other mediastinal stations in lung cancer patients. The metastasis status of station 9 had a significant influence on tumor staging and prognosis. Routine dissection of station 9 lymph nodes is necessary, especially in patients with a low T stage, upper or middle lobe tumors, or without intrapulmonary lymph node metastasis. | FAIL | pubmedQA | 0 |
18403945 | Both medical therapy and laparoscopic antireflux surgery have been shown to improve quality of life in gastro-oesophageal reflux disease. Although patients with poor symptom control or side effects on medical therapy might be expected to have improved quality of life after surgery, our aim was to determine, for the first time, whether patients whose symptoms are well controlled on medical therapy but who decide to undergo surgery (patient preference) would experience improved quality of life.
Retrospective analysis of our patient database (1998-2003, n=313) identified 60 patients who underwent laparoscopic antireflux surgery for the indication of patient preference. Two generic quality-of-life questionnaires (Short Form 36 and Psychological General Well-Being index) and a gastrointestinal symptom questionnaire (Gastrointestinal Symptom Rating Scale) were completed preoperatively, while on medical therapy, and 6 months after surgery.
Thirty-eight patients completed all three questionnaires at both time intervals: 31 males, seven females; mean age 42 (15-66) years. Preoperative scores while on medical therapy were significantly improved after surgery: Short Form 36 median physical composite scores 52.0 and 54.0 (P=0.034) and mental composite scores 51.0 and 56.0 (P=0.020); Psychological General Well-Being median total scores 78.0 and 90.0 (P=0.0001); Gastrointestinal Symptom Rating Scale median total scores 2.13 and 1.73 (P=0.0007) and reflux scores 2.50 and 1.00 (P<0.0001). | Does laparoscopic antireflux surgery improve quality of life in patients whose gastro-oesophageal reflux disease is well controlled with medical therapy? | Yes. Laparoscopic antireflux surgery significantly improved quality of life in reflux patients whose symptoms were poorly controlled on medical therapy. Although on the basis of a noncomparative trial with a relatively short follow-up period, we believe such patients should be considered for laparoscopic antireflux surgery. | FAIL | pubmedQA | 0 |
10381996 | To determine whether the use of empiric chest radiography (CXR) is of significant value in detecting clinically unsuspected acute chest syndrome (ACS) in febrile patients with sickle cell disease (SCD).
Patients with SCD presenting to the emergency department and hematology clinic with temperature greater than or equal to 38 degrees C were prospectively evaluated using a physician-completed questionnaire. The questionnaire included inquiries into the patient's physical signs and symptoms and the physician's clinical impression for the presence of ACS. The questionnaire was completed before obtaining CXR results in all patients.
Seventy-three patients with SCD with 96 febrile events were evaluated over a 1-year period. Twenty-four percent (23/96) of the patients had CXR evidence of ACS. On the basis of the questionnaire data, 61% (14/23) of ACS cases were not clinically suspected by the evaluating physician before obtaining CXR. Comparing the patients with and without ACS revealed that, with the exception of splinting (4/23 [17%] versus 0/73 [0%]), no symptom or physical examination finding helped to identify which patients had ACS. Fifty-seven percent of patients with ACS had completely normal findings on physical examination. The presentation of patients with clinically detected versus clinically unsuspected ACS also did not differ significantly. Length of hospitalization, oxygen use, and need for transfusion were the same in both the unsuspected and detected ACS groups. Overall physician sensitivity for predicting ACS was only 39%, and diagnostic accuracy did not improve significantly with increasing levels of pediatric training. | Clinician assessment for acute chest syndrome in febrile patients with sickle cell disease: is it accurate enough? | No. ACS is common in patients with SCD who present with fever and was grossly underestimated by evaluating physicians. History and physical examination appear to be of little value in defining which febrile patients require CXR. However, the evidence suggests that experienced physicians can often accurately predict the presence of ACS without the need for CXR, especially in cases where patients exhibit specific symptoms such as splinting. | FAIL | pubmedQA | 0 |
12595848 | Implementation of the complex treatment strategies that have been shown to improve survival of patients with congestive heart failure (CHF) may require certain expertise. We wanted to examine the association between pattern of outpatient care and survival of patients with CHF.
In a retrospective cohort study conducted with national Veterans Health Administration (VHA) databases, we examined the association between the pattern of outpatient care and survival in 11,661 patients discharged from VA hospitals between October 1, 1991, and September 30, 1992, with the primary diagnosis of CHF (cohort 1). Patients were divided into 4 groups, on the basis of their pattern of outpatient care over a 12-month period after discharge: 1) general medicine clinic visits only (GM-only); 2) cardiology clinic visits only (CARD-only); 3) general medicine and cardiology (MIXED) clinic visits; and 4) neither general medicine nor cardiology clinic visits (no-GM/CARD). We used the Cox proportional hazards model to evaluate 1-year survival, controlling for clinical and demographic factors. Consistency of our results was examined by performing identical analysis on a cohort of patients discharged from VHA hospitals between October 1, 1994, and September 30, 1995 (cohort 2, n = 10,141).
The overall 1-year mortality rate was 23% in the primary cohort. The unadjusted mortality rate was highest for patients in the no-GM/CARD follow up (29%) and lowest for patients in the MIXED group (19%). By use of the MIXED group as reference and adjusting for important clinical and demographic factors, the risk of death (risk ratio [95% CI]) was 1.12 (0.94-1.34) in the CARD-only group, 1.26 (1.15-1.38) in the GM-only group, and 1.48 (1.28-1.72) in the no-GM/CARD group. Cohort-2 results were consistent with cohort 1 for most covariates, and significant survival differences were again found between GM-only and the MIXED group (1.25 [1.14-1.37]). | Is specialty care associated with improved survival of patients with congestive heart failure? | Yes. We found an improved survival associated with general practitioner care alone compared with cardiologist care and a mixture of general practitioner and cardiologist care. The pattern of outpatient care may therefore be important for the survival of patients with CHF. | FAIL | pubmedQA | 0 |
23949294 | Recently, there has been increasing interest in the role of "treatment as prevention" (TasP). Some of the questions regarding TasP strategies arise from the perceived difficulties in achieving and maintaining viral load (VL) suppression over time and the risk of emergence of viral resistance that could compromise future treatment options. This study was conducted to assess these questions in a resource-limited setting.
We performed a retrospective observational study of HIV-infected patients diagnosed in the pre-HAART era on follow-up at a private center from Buenos Aires, Argentina. Socio-demographic, clinical, and laboratory data were extracted from clinical charts. Analyses were performed to test for potential associations of selected variables with current virologic failure or use of third-line drugs.
Of 619 patients on follow-up, 82 (13.2%) were diagnosed in the pre-HAART era. At the time of our study, 79 (96.3%) patients were on HAART, with a median duration of 14 years (IQR 12-15) of therapy, and exposure to mono or dual nucleoside reverse transcriptase inhibitors regimens in 47.8% of cases. Sixty-nine patients (87.3%) had undetectable VL, 37 (46.8%) never presented virologic failure, and 19 (24.1%) experienced only one failure. Thirteen patients (16.5%) were receiving third-line ART regimens, with an average of 2.7-fold more virologic failures than those on first- or second-line regimens (p = 0.007). | Treatment as prevention in resource-limited settings: is it feasible to maintain HIV viral load suppression over time? | No. Maintaining viral load suppression over time in resource-limited settings is not feasible. | FAIL | pubmedQA | 0 |
26879871 | Studies have linked ethnic differences in depression rates with neighbourhood ethnic density although results have not been conclusive. We looked at this using a novel approach analysing whole population data covering just over one million GP patients in four London boroughs.
Using a dataset of GP records for all patients registered in Lambeth, Hackney, Tower Hamlets and Newham in 2013 we investigated new diagnoses of depression and antidepressant use for: Indian, Pakistani, Bangladeshi, black Caribbean and black African patients. Neighbourhood effects were assessed independently of GP practice using a cross-classified multilevel model.
Black and minority ethnic groups are up to four times less likely to be newly diagnosed with depression or prescribed antidepressants compared to white British patients. We found an inverse relationship between neighbourhood ethnic density and new depression diagnosis for some groups, where an increase of 10% own-ethnic density was associated with a statistically significant (p<0.05) reduced odds of depression for Pakistani [odds ratio (OR) 0.81, 95% confidence interval (CI) 0.70-0.93], Indian (OR 0.88, CI 0.81-0.95), African (OR 0.88, CI 0.78-0.99) and Bangladeshi (OR 0.94, CI 0.90-0.99) patients. Black Caribbean patients, however, showed the opposite effect (OR 1.26, CI 1.09-1.46). The results for antidepressant use were very similar although the corresponding effect for black Caribbeans was no longer statistically significant (p = 0.07). | Does depression diagnosis and antidepressant prescribing vary by location? | Yes. New depression diagnosis and antidepressant use was shown to be more likely in areas of higher own-ethnic density for all ethnic groups. | FAIL | pubmedQA | 0 |
17919952 | (i) To examine the association between self-reported mechanical factors and chronic oro-facial pain. (ii) To test the hypothesis that this relationship could be explained by: (a) reporting of psychological factors, (b) common association of self-reported mechanical factors with other unexplained syndromes.
A population based cross-sectional study of 4200 randomly selected adults registered with a General Medical Practice in North West, England. The study examined the association of chronic oro-facial pain with a variety of self-reported mechanical factors: teeth grinding, facial trauma, missing teeth and the feeling that the teeth did not fit together properly. Information was also collected on demographic factors, psychological factors and the reporting of other frequently unexplained syndromes.
An adjusted response rate of 72% was achieved. Only two mechanical factors: teeth grinding (odds ratio (OR) 2.0, 95% CI 1.3-3.0) and facial trauma (OR 2.0; 95% CI 1.3-2.9) were independently associated with chronic oro-facial pain after adjusting for psychological factors. However, these factors were also commonly associated with the reporting of other frequently unexplained syndromes: teeth grinding (odds ratio (OR) 1.8, 95% CI 1.5-2.2), facial trauma (OR 2.1; 95% CI 1.7-2.6). | Are reports of mechanical dysfunction in chronic oro-facial pain related to somatisation? | No. Self-reported mechanical factors associated with chronic oro-facial pain are independent of psychological factors and are specific to oro-facial conditions. They do not represent a feature of somatisation. Therefore, extensive invasive therapy such as occlusal adjustments and surgery to change mechanical factors may be justified in many cases. | FAIL | pubmedQA | 0 |
25957366 | Electronic health records have the potential to facilitate family history use by primary care physicians (PCPs) to provide personalized care. The objective of this study was to determine whether automated, at-the-visit tailored prompts about family history risk change PCP behavior.
Automated, tailored prompts highlighting familial risk for heart disease, stroke, diabetes, and breast, colorectal, or ovarian cancer were implemented during 2011 to 2012. Medical records of a cohort of community-based primary care patients, aged 35 to 65 years, who previously participated in our Family Healthware study and had a moderate or strong familial risk for any of the 6 diseases were subsequently reviewed. The main outcome measures were PCP response to the prompts, adding family history risk to problem summary lists, and patient screening status for each disease.
The 492 eligible patients had 847 visits during the study period; 152 visits had no documentation of response to a family history prompt. Of the remaining 695 visits, physician responses were reviewed family history (n = 372, 53.5%), discussed family history (n = 159, 22.9%), not addressed (n = 155, 22.3%), and reviewed family history and ordered tests/referrals (n = 5, 0.7%). There was no significant change in problem summary list documentation of risk status or screening interventions for any of the 6 diseases. | Prompting Primary Care Providers about Increased Patient Risk As a Result of Family History: Does It Work? | Yes. Simple, at-the-visit family history prompts significantly improved PCPs' ability to identify patients at high risk for 6 common conditions. The results are encouraging and suggest that such prompts are a valuable tool in primary care settings. Further studies should continue to explore the impact of these prompts on patient care. | FAIL | pubmedQA | 0 |
21198823 | Elevation of cardiac troponin (cTn) is considered specific for myocardial damage. Elevated cTn and echocardiogrpahic documentation of wall motion abnormalities (WMAs) that were recorded after extreme physical effort raise the question whether dobutamine stress echo (DSE), can also induce elevation of troponin.
we prospective enrolled stable patients (age>18 years) referred to DSE. The exam was performed under standardized conditions. Blood samples for cTnI were obtained at baseline and 18-24 hours after the test. We aimed to compare between the clinical and echocardiographic features of patients with elevated cTnI and those without cTnI elevations.
Fifty-seven consecutive patients were included. The average age was 64.4 ± 10.7, 73% of the patients were males, and nearly half of the patients were known to have ischemic heart disease. Two of the patients were excluded due to technical difficulty. No signs of ischemia were recorded in 25 (45.4%). Among the patients with established ischemia on DSE, 12 (22%) had mild ischemia, 13 (23.6%) had moderate and 5 (9%) had severe ischemia. Angiography was performed in 13 (26%) of the patients, of which 7 had PCI and one was referred to bypass surgery. None of the patients had elevated cTnI 18-24 hours after the DSE. | Can dobutamine stress echocardiography induce cardiac troponin elevation? | Yes. Our results indicate that there is a slight elevation of cTn despite the occurrence of significant WMAs on DSE. We conclude that cTnI can be used as an additional diagnostic tool during pharmacological stress test performed to evaluate the presence and severity of ischemia. | FAIL | pubmedQA | 0 |
25186850 | To compare the effect of student examiners (SE) to that of faculty examiners (FE) on examinee performance in an OSCE as well as on post-assessment evaluation in the area of emergency medicine management.
An OSCE test-format (seven stations: Advanced Cardiac Life Support (ACLS), Basic Life Support (BLS), Trauma-Management (TM), Pediatric-Emergencies (PE), Acute-Coronary-Syndrome (ACS), Airway-Management (AM), and Obstetrical-Emergencies (OE)) was administered to 207 medical students in their third year of training after they had received didactics in emergency medicine management. Participants were randomly assigned to one of the two simultaneously run tracks: either with SE (n = 110) or with FE (n = 98). Students were asked to rate each OSCE station and to provide their overall OSCE perception by means of a standardized questionnaire. The independent samples t-test was used and effect sizes were calculated (Cohens d).
Students achieved significantly higher scores for the OSCE stations "TM", "AM", and "OE" as well as "overall OSCE score" in the SE track, whereas the station score for "PE" was significantly higher for students in the FE track. Mostly small effect sizes were reported. In the post-assessment evaluation portion of the study, students gave significant higher ratings for the ACS station and "overall OSCE evaluation" in the FE track; also with small effect sizes. | May student examiners be reasonable substitute examiners for faculty in an undergraduate OSCE on medical emergencies? | Yes. It seems quite admissible and justified to encourage medical students to officiate as examiners in undergraduate emergency medicine OSCE summative testing, but not necessarily in formative assessment evaluations. | FAIL | pubmedQA | 0 |