Restricted randomization in randomized controlled trials.
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Humans↗
Biomedical subjects
A G Kessels
Publications and source records attributed to A G Kessels.
[Drug use by mentally handicapped persons in institutions and family-replacing residential facilities].
OBJECTIVE: Description of use of medication by people with mental handicaps in relation to age, level of mental handicap and living facility. DESIGN: Cross-sectional study. SETTING: Institutions and group homes for people with mental handicaps in North Brabant and Limburg, the Netherlands. METHODS: Of a patient sample (n = 1265), stratified according to age and living facility (i.e. institution or group home) data were collected by means of questionnaires to be completed by the general practitioners. For 101 persons data about level of mental handicap were lacking. RESULTS: 57% of the patients used one or more drugs. The numbers of drugs used were significantly related to (increased) age and level of mental handicap. Older patients more often used antipsychotics, laxatives and cardiovascular medication, younger ones more often used anticonvulsants. More severely handicapped persons used antipsychotics, anticonvulsants, laxatives, antacids, psychoactive medication and gastrointestinal medication more often. There was no relationship between amount of medication and living facility. CONCLUSION: Many mentally handicapped use medication. Since epilepsy, psychiatric and behavioural diseases and gastrointestinal problems are frequent, and because the patients offer little spontaneous information, alertness with respect to drug interaction and side effects is indicated.
Adult↗
Randomised clinical trial of ultrasound treatment for pressure ulcers.
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Aged↗
Usefulness of cinefluoroscopic detection of coronary artery calcification in the diagnostic work-up of coronary artery disease.
AIM: To determine in which patients (cine)fluoroscopic detection of coronary artery calcifications is recommended for the diagnosis of coronary artery disease and the consequence of this finding for referral for cinecoronary arteriography. MATERIALS AND METHODS: Data were retrospectively obtained from 778 patients who had been referred for cinecoronary arteriography. Excluded were patients with a previous myocardial infarction, a previous abnormal cinecoronary arteriogram and patients with unstable angina. The discriminating value was assessed with the help of the crude likelihood ratio (LR), as well as the LRs stratified for gender, age and symptomatology. The gold standard was the coronary arteriogram. Furthermore, the post-test probability was estimated using logistic regression to take dependence on age, sex and symptomatology into account. RESULTS: The crude LR of a positive and negative test result, with 95% confidence intervals, was, respectively 5.8 (4.1-8.2) and 0.52 (0.47-0.58), but was dependent on the clinical variables. Estimated probabilities of having coronary artery disease (CAD) varied substantially for a negative as well as a positive test result with the categories of clinical variables. CONCLUSION: (Cine)fluoroscopy discriminates between patients with and without disease; the test proved to be especially useful in females with atypical angina and patients of both sexes with non-specific chest pain.
Calcinosis↗
Comparison of the diagnostic value of cinefluoroscopy and simple fluoroscopy in the detection of calcification in coronary arteries.
AIM: Comparison of the diagnostic value of cinefluoroscopy and simple fluoroscopy in the detection of calcification in coronary arteries. PATIENTS AND METHODS: Data were prospectively obtained from 143 patients in whom simple fluoroscopy as well as cinecoronary arteriography were performed. Excluded were patients with a previous myocardial infarction, a previous abnormal cinecoronary arteriogram and patients with unstable angina. With the coronary arteriogram as the gold standard, the likelihood ratios (LR) of simple fluoroscopy were determined, mismatches with cinefluoroscopy were analysed and Kappa, as a measure for inter-test agreement, was calculated. RESULTS: The LRs with 95% confidence intervals for a positive and negative result were 5.3 (2.6-11.0) and 0.43 (0.28-0.69), respectively. There was a mismatch in 12 (8.3%) patients. Kappa with a 95% confidence interval was 0.90 (0.73-1.0). CONCLUSIONS: Both test modalities are almost identical and conclusions with respect of the diagnostic value of cinefluoroscopy also holds for simple fluoroscopy.
Calcinosis↗
Care dependence and individual care provision.
For policy purposes as well as for the provision of individual care, it is relevant to known which individual characteristics have impact upon the level of care dependence. For purposes of individual care provision, characteristics which can be influenced and which also have an important impact upon the care dependence are of interest. This study showed that the profoundly mentally handicapped are almost all totally dependent upon care, and therefore additional information about individual characteristics is superfluous. The results of logistic regression analyses showed a statistically significant and important impact of ADL-functions. Exactly which other characteristics are relevant to consider depends upon the level of care dependence and the level of mental handicap.
Activities of Daily Living↗
The effectiveness of the hair-restorer "Dabao" in males with alopecia androgenetica. A clinical experiment.
In a randomized, double-blind trial the effectiveness of 6 months' use of a Chinese herb extract (Dabao) as a hair-restorer was studied on 396 males with alopecia androgenetica. The effect was evaluated by nonvellus hair counts, participants' opinions and a panel's judgement of a photo-report. Twenty-three participants withdrew prematurely from the study. In both the Dabao and placebo groups an increase in the amount of hair was observed; 133 and 109 hairs on a 5 cm2 marked area, a difference of 24 hairs (p = 0.03, one-sided). Participants as well as the panel reached a similar conclusion. Regarding cosmetic effect, 42% of the participants in the Dabao group and 37% in the placebo group reported positive results. The average panel score for the cosmetic result on a scale of -10 to +10 was 0.46 in the Dabao and 0.21 in the placebo group, a difference of 0.24 (p = 0.04, one-sided). It appears from our study that, although the cosmetic effect over 6 months is modest, Dabao does have a certain effect on the growth of nonvellus hair.
Administration, Topical↗
Effectiveness of chiropractic and physiotherapy in the treatment of low back pain: a critical discussion of the British Randomized Clinical Trial.
This article discusses the methodology of a recently published British randomized clinical trial comparing chiropractic and physiotherapy as treatments for low back pain. The authors base their main conclusions on a difference shown by the Oswestry pain questionnaire 2 yr after randomization, when data of only 26% of the patients were available. This might have led to an overestimation, because it appears that the difference in Oswestry scores is much larger for patients included early in the study. It may also be doubted whether the magnitude of the effect reported really indicates a clinically significant difference between the interventions. In addition to allocated intervention, the groups also differ in duration of treatment, number of sessions, level of experience of the therapist, and health care setting. The results are difficult to extrapolate, because only a small portion of the eligible patients participated, and chiropractic seems to be clearly superior only in the subgroup originally presenting to a chiropractic clinic. We conclude that it is premature to draw conclusions about the long-term effectiveness of chiropractic based on the results of this study alone.
Adult↗