Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Institutional Practice”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 199 records · Page 11Linked to original sources
PubMed1997

Practice patterns among reproductive endocrinologists: the infertility evaluation.

OBJECTIVE: To determine how board-certified reproductive endocrinologists vary in their approach to the clinical tests performed on the infertile couple. DESIGN: A cross-sectional study to assess differences in the approach to evaluating the infertile couple. SETTING: A population-based national survey. PARTICIPANT(S): United States board-certified reproductive endocrinologists. MAIN OUTCOME MEASURE(S): The frequency of clinical tests and evaluation procedures by physician age, sex, size and setting of practice, institutional affiliation, and geographic location. RESULT(S): The overall response rate was 84%. Although the majority of practitioners routinely order a semen analysis (99.9%), an assessment of ovulation (98%), a hysterosalpingogram, (HSG; 96%), laparoscopy (89%), and a postcoital test (PCT, 79%), there was less agreement regarding hormonal testing (range, 22% [LH] to 66% [PRL]), use of pelvic ultrasounds (55%), hysteroscopy (53%), cervical cultures (range, 24% to 54%), and antisperm antibody testing (24%). Compared with male colleagues, female physicians order two to three times more cervical cultures and endometrial biopsies. Serum hormonal testing was two to three times more commonly ordered by younger (< 40 years) compared with older physicians, and physicians in private practice twice as frequently ordered hormonal testing, cervical cultures, PCTs, and antisperm antibody studies compared with their academic-affiliated colleagues. Western U.S. physicians order hormonal tests and cervical cultures 50% less often than their midwest and eastern counterparts. CONCLUSION(S): Trained specialists rely heavily on five "traditional" infertility tests: semen analysis, an assessment of ovulation, HSG, laparoscopy, and PCT. With regard to additional modes of testing, there is marked variability by physician sex, age, type of practice, and geographic location.

Adult↗
PubMed2005

CHART in lung cancer: economic evaluation and incentives for implementation.

BACKGROUND AND PURPOSE: To investigate the financial consequences and the impact on daily implementation of CHART in lung cancer. PATIENTS AND METHODS: A cost-effectiveness and cost-utility analysis were performed using Markov models, comparing the early and delayed costs and effects of CHART for NSCLC over a 4-year time span from a societal viewpoint. The outcome estimates were based on the CHART literature, the cost estimates on the standard practice of the Leuven University Hospitals, the radiotherapy costs being derived from an activity-based costing (ABC) programme developed in the department. RESULTS: The additional societal cost per life-year gained was 9164 Euro, the incremental cost per quality-adjusted life-year 11,576 Euro. Sensitivity analyses confirmed the robustness of these results, the incremental cost-utility ratio remaining well under 20,000 Euro/QALY in all tested circumstances. The threshold analyses found the results of the study to be sensitive to the cost of CHART and to the quality of life after treatment. More specifically, standard treatment would become the optimal treatment if CHART would have a higher cost or would result in more long-term side effects. CONCLUSION: CHART should not be denied to patients with NSCLC on the basis of clinical or economic arguments. Other factors such as socio-economical, institutional, practical departmental and physician-bound barriers most probably explain the lack of implementation into daily practice.

Aged↗
PubMed2006

Clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia.

STUDY OBJECTIVES: To evaluate clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia (VAP), including the implementation of and outcomes associated with deescalation therapy. DESIGN: Prospective, observational, cohort study. SETTING: Twenty ICUs throughout the United States. PATIENTS: A total of 398 ICU patients meeting predefined criteria for suspected VAP. INTERVENTIONS: Prospective, handheld, computer-based data collection regarding routine VAP management according to local institutional practices, including clinical and microbiological characteristics, treatment patterns, and outcomes. MEASUREMENTS AND RESULTS: The most frequent ICU admission diagnoses in patients with VAP were postoperative care (15.6%), neurologic conditions (13.3%), sepsis (13.1%), and cardiac complications (10.8%). The mean (+/- SD) duration of mechanical ventilation prior to VAP diagnosis was 7.3 +/- 6.9 days. Major pathogens were identified in 197 patients (49.5%) through either tracheal aspirate or BAL fluid and included primarily methicillin-resistant Staphylococcus aureus (14.8%), Pseudomonas aeruginosa (14.3%), and other Staphylococcus species (8.8%). More than 100 different antibiotic regimens were prescribed as initial VAP treatment, the majority of which included cefepime (30.4%) or a ureidopenicillin/monobactam combination (27.9%). The mean duration of therapy was 11.8 +/- 5.9 days. In the majority of cases (61.6%), therapy was neither escalated nor deescalated. Escalation of therapy occurred in 15.3% of cases, and deescalation occurred in 22.1%. The overall mortality rate was 25.1%, with a mean time to death of 16.2 days (range, 0 to 49 days). The mortality rate was significantly lower among patients in whom therapy was deescalated (17.0%), compared with those experiencing therapy escalation (42.6%) and those in whom therapy was neither escalated nor deescalated (23.7%; chi2= 13.25; p = 0.001). CONCLUSIONS: Treatment patterns for VAP vary widely from institution to institution, and the overall mortality rate remains unacceptably high. The deescalation of therapy in VAP patients appears to be associated with a reduction in mortality, which is an association that warrants further clinical study.

Adolescent↗
PubMed1998

The effectiveness of a history-based diagnostic approach in chronic urticaria and angioedema.

OBJECTIVE: To assess the value of extensive laboratory screening for the identification of causes in patients with chronic urticaria and/or angioedema. DESIGN: In a prospective study involving 220 patients, 2 diagnostic strategies were compared: the combination of detailed history taking and limited laboratory investigations vs detailed history taking and extensive laboratory screening. The results of the extensive screening program were initially kept secret from the patients and the physicians. Later, all results were disclosed, and an investigation was undertaken to find out whether this information changed the initial diagnosis. The patients were followed up for 1 year to evaluate the results of interventions and to detect latent causes. SETTING: The study was performed in the outpatient department of a secondary and tertiary care center with institutional practice. PATIENTS: A total of 238 consecutive new patients with chronic urticaria and/or angioedema edema were referred; 18 of them refused participation. One patient was unavailable for follow-up. MAIN OUTCOME MEASURE: The difference in the number of identified causes between both approaches and the nature of the causes that would have been missed by omitting extensive laboratory screening. RESULTS: With a questionnaire and the limited laboratory tests, a cause was found in 45.9% of the patients, compared with 52.7% with the questionnaire and the extended screening program. Except for one parasitic infection, missed diagnoses were mainly adverse reactions to drugs or food detected by standard elimination procedures, not by laboratory investigations. CONCLUSION: Routine laboratory screening did not contribute substantially to the diagnosis of chronic urticaria or to the detection of underlying disorders.

Adolescent↗
PubMed2001

Oral corticosteroid use is effective for cutaneous hemangiomas: an evidence-based evaluation.

OBJECTIVES: To determine the efficacy of systemic corticosteroid therapy in treating enlarging, problematic cutaneous hemangiomas and to assess the relationship of dose to response and adverse effects. DESIGN: A quantitative systematic literature review was performed and inclusion and exclusion criteria were applied. SETTING: Patients were treated in primary care, referral centers, and institutional practices. Most patients were ambulatory, although some required hospitalization. PATIENTS: Inclusion criteria were original case series with a minimum of 5 patients with enlarging, problematic cutaneous hemangiomas treated with systemic corticosteroids. Exclusion criteria were being older than 2 years, receiving simultaneous other treatments, being lost to follow-up, or having insufficient information. Twenty-four original case series met inclusion criteria; 10 case series remained (184 patients) after exclusion criteria were applied. INTERVENTION: Patients were given a mean prednisone equivalent daily dose of 2.9 mg/kg (95% confidence interval [CI], 2.7-3.1 mg/kg) for a mean of 1.8 months (95% CI, 1.5-2.2 months). MAIN OUTCOME MEASURES: Response and rebound rates and dose-response and adverse effects-response relationships in responders vs nonresponders. RESULTS: Response was 84% (95% CI, 78%-89%; range, 60%-100%) and rebound was 36% (95% CI, 29%-44%; range, 0%-65%). A significant difference was found between the mean dose administered to responders vs nonresponders (P<.001). No significant difference was observed as to the occurrence of adverse effects (P =.3). CONCLUSION: Systemic corticosteroid treatment seems to be effective for problematic cutaneous hemangiomas of infancy.

Adrenal Cortex Hormones↗
PubMed2002

The combined continuous-wave/pulsed carbon dioxide laser for treatment of pyogenic granuloma.

BACKGROUND: Pyogenic granuloma is a frequently diagnosed, benign vascular lesion. OBJECTIVES: To present the use of the combined continuous-wave/pulsed carbon dioxide (CO2) laser as an innovative therapeutic method, to compare it with established methods, and to assess its results. DESIGN: Prospective observational study between March 1998 and July 2000, comprising 1 treatment session with 6-week and 6-month follow-up examinations and evaluations. SETTING: Private or institutional practices as well as ambulatory or hospitalized care. PATIENTS: One hundred patients with pyogenic granuloma selected from a population-based sample. INTERVENTIONS: Treatment with CO2 laser. The laser was first used in continuous mode (power, 15 W) and then in pulsed mode (pulse length, 0.6-0.9 milliseconds; energy fluence, 500 mJ/pulse). MAIN OUTCOME MEASURE: Complete resolution of treated granuloma pyogenicum. RESULTS: Pyogenic granuloma was removed completely in 1 treatment session in 98 patients without recurrence. In 88 cases there were no visible scars; in 10 cases slight textural changes of the skin were observed. Hypertrophic scars or keloids did not occur. Sixty-three patients were very satisfied with the result of the treatment, 37 were satisfied (ie, 100% patient satisfaction), and none indicated that they were not satisfied. No permanent hypopigmentation, hyperpigmentation, or erythema was observed. CONCLUSIONS: The combined continuous-wave/pulsed CO2 laser is our treatment of choice for pyogenic granuloma because this kind of laser is widely available, produces excellent results with few adverse effects, is easy to use, yields low recurrence rates, and is well tolerated by most patients.

Adolescent↗
PubMed2002

Efficacy of 0.1% tazarotene cream for the treatment of photodamage: a 12-month multicenter, randomized trial.

OBJECTIVE: To determine the efficacy and safety of 0.1% tazarotene cream for the treatment of photodamage. DESIGN: A 24-week multicenter, double-blind, randomized, vehicle-controlled intervention study followed by a 28-week open-label extension. SETTING: Ambulatory patients in private and institutional practice. PATIENTS: Of 563 patients with facial photodamage, 91% and 86% completed the double-blind and open-label phases, respectively. In the double-blind phase, 20 of 283 tazarotene-treated patients and 1 of 280 vehicle-treated patients discontinued treatment owing to adverse events. INTERVENTION: Once-daily application of 0.1% tazarotene cream or nonmedicated vehicle cream to the face for 24 weeks. Then, all continuing patients received treatment with 0.1% tazarotene cream for another 28 weeks. MAIN OUTCOME MEASURES: Primarily, fine wrinkling and mottled hyperpigmentation. Also, lentigines, elastosis, pore size, irregular depigmentation, tactile roughness, coarse wrinkling, telangiectasia, actinic keratoses, overall integrated assessment of photodamage, global response to treatment, patients' overall assessment of photodamage, and plasma levels of tazarotenic acid. RESULTS: Compared with the vehicle, at week 24 tazarotene resulted in a significantly greater incidence of patients achieving treatment success (>or=50% global improvement) and at least a 1-grade improvement in fine wrinkling, mottled hyperpigmentation, lentigines, elastosis, pore size, irregular depigmentation, tactile roughness, coarse wrinkling, and the overall integrated assessment of photodamage (P<.01). Additional clinical improvement occurred with continued tazarotene treatment and had not plateaued by week 52. Plasma tazarotenic acid concentrations did not exceed 0.71 ng/mL. CONCLUSIONS: Once-daily applications of 0.1% tazarotene cream significantly reduced multiple signs of photodamage. Plasma levels of tazarotenic acid remained below those of endogenous retinoids.

Administration, Topical↗
PubMed2003

Clinical study of 40 cases of incontinentia pigmenti.

OBJECTIVE: To analyze the distribution of manifestations in a pediatric cohort and define guidelines for follow-up of incontinentia pigmenti (IP). DESIGN: Retrospective study of 47 children referred to the Department of Pediatric Dermatology with a diagnosis of IP between 1986 and 1999. SETTING: The private or institutional practice of participating dermatologists and pediatricians. MAIN OUTCOME MEASURES: Evaluation of IP clinical diagnosis using the Landy and Donnai criteria. RESULTS: Because hyperpigmentation following the Blaschko lines may be observed in several pigmented disorders, 7 patients were found misdiagnosed. During the neonatal period, erythema, vesicles, and hyperkeratotic le sions were rarely absent in the patients with IP. Ocular and neurological abnormalities were frequent (20% and 30%, respectively) but rarely severe (8% and 7.5%, respectively). CONCLUSIONS: Clinical diagnosis is the first main step for a correct phenotype/genotype correlation, which remains indispensable to better understand the pathological mechanisms of IP and develop new therapies. In doubtful cases, molecular analysis is helpful but characteristic histological features must be added as major criteria for IP diagnosis. Multidisciplinary follow-up is needed, particularly during the first year of life, to detect possible ophthalmologic and neurological complications. Neuroimaging ought to be performed in the case of abnormal neurological examination results or when vascular retinopathy is detected.

Child↗
PubMed2004

Double-blind placebo-controlled study of autologous transplanted epidermal cell suspensions for repigmenting vitiligo.

OBJECTIVES: To investigate the efficacy of epidermal noncultured cellular grafting in patients with vitiligo and the role of postinflammatory, spontaneous, or UV-induced pigmentation in obtaining repigmentation. DESIGN: A prospective, randomized, double-blind, placebo-controlled study. SETTING: Ambulatory patients in an institutional practice. Patients were followed up for 3 to 12 months. PATIENTS: A total of 33 paired, symmetrically distributed leukodermic lesions, all resistant to therapy, were observed in 28 patients. Nineteen patients appeared to have a stable vitiligo (group 1), whereas there was doubt about the stability of the disease in 9 patients (group 2). INTERVENTION: After laser ablation, a hyaluronic acid-enriched cellular graft was applied to 1 lesion while the paired lesion received placebo. Three weeks later all lesions were exposed to UV irradiation twice per week for approximately 2 months. MAIN OUTCOME MEASURES: Primarily, the percentage of repigmentation was assessed after 3, 6, and 12 months using a digital image analysis system. The repigmentation pattern was also evaluated after 1 and 3 months. RESULTS: A strongly significant difference between cellular grafts and placebo was observed after 3, 6, and 12 months (P<.001, P = .002, and P = .002, respectively). In group 1, repigmentation of at least 70% of the treated area was achieved in 55%, 57%, and 77% of the actively treated lesions 3, 6, and 12 months after treatment, whereas in group 2 repigmentation of at least 70% of the treated area was not observed at any time point. The repigmentation pattern was diffuse in 94% of the responding patients. CONCLUSIONS: After a strict preoperative selection for disease stability, transplantation resulted in repigmentation of at least 70% of the treated area in most actively treated vitiligo lesions. Repigmentation was primarily caused by the transplanted melanocytes.

Adolescent↗
PubMed2005

No evidence for increased risk of cutaneous squamous cell carcinoma in patients with rheumatoid arthritis receiving etanercept for up to 5 years.

OBJECTIVE: To determine the incidence of cutaneous squamous cell carcinoma (SCC) in patients with rheumatoid arthritis receiving etanercept, a tumor necrosis factor antagonist, for up to 5 years. DESIGN: An etanercept clinical trials' database and an etanercept postmarketing surveillance database were retrospectively analyzed for the incidence of SCC. SETTING: Patients enrolled in clinical trials of etanercept were from private and institutional practices. The postmarketing database comprised reports from postmarketing trials and solicited and spontaneous reports. Patients A total of 1442 patients with rheumatoid arthritis with 4257 patient-years of etanercept exposure (median exposure, 3.7 years) are included in the clinical trials' database. More than 125,000 patients with more than 250,000 patient-years of etanercept exposure are included in the etanercept postmarketing database. Interventions Most patients enrolled in clinical trials of etanercept received a dosage of 25 mg of etanercept subcutaneously twice weekly for most of the time they received etanercept therapy. RESULTS: Only 4 cases of SCC were observed in the etanercept clinical trials' database, an incidence that compares favorably with the expected incidences based on general population data from Arizona (13.1) and Minnesota (5.9). Similarly, few cases of SCC (1 per 10,000 patient-years) have been reported during postmarketing surveillance of etanercept therapy. CONCLUSION: In patients with rheumatoid arthritis, etanercept use of up to 5 years does not seem to be associated with an increase in the incidence of cutaneous SCC.

Adult↗
PubMedDate not supplied

Multicenter evaluation of subcutaneous augmentation material implants.

OBJECTIVE: To evaluate the performance of subcutaneous augmentation material preformed shapes for facial implantation. DESIGN: One-year prospective multicenter evaluation of implant performance. SETTING: General community hospital; private and institutional practice; and ambulatory care setting. PATIENTS: Eighty-two patients undergoing elective cosmetic and reconstructive procedures. INTERVENTIONS: Patients received nasal dorsal implants (31 patients); chin implants (38 patients); and malar implants (13 patients). MAIN OUTCOME MEASURES: Complications and aesthetic outcome, including implant position, projection, contour, symmetry, and overall aesthetic index. RESULTS: Complication rates for infection that required implant removal included nasal dorsal implants, 3.2%; chin implants, 5.3%; and malar implants, 3.8%. The overall aesthetic outcome was judged by an independent panel of facial plastic surgeons on a scale from 1 (poor) to 5 (excellent): nasal dorsal implants scored 4.1; chin implants, 3.8; and malar implants, 3.6. CONCLUSIONS: This study demonstrates that subcutaneous augmentation material preformed shapes offer a relatively safe and effective treatment alternative for permanent facial augmentation.

Cheek↗
PubMed1993

Information processing efficiency in chronic fatigue syndrome and multiple sclerosis.

OBJECTIVE: To compare the cognitive performance of subjects with chronic fatigue syndrome (CFS), multiple sclerosis (MS), and healthy controls. All subjects were matched for age, education, and verbal intelligence, as previous neuropsychological studies of CFS had not used appropriate control groups. DESIGN: Case-control design. All subjects were given a neuropsychological battery and the test scores were compared among the groups. SETTING: Subjects with CFS and subjects with MS were recruited from private and institutional practice and from the community. Healthy subjects were recruited from the community. PATIENTS/OTHER PARTICIPANTS: Twelve subjects (all female) with CFS participated in the study. Chronic fatigue syndrome was diagnosed in these patients in accordance with the requirements outlined by the Centers for Disease Control as modified subsequently to not exclude patients with concurrent depression and/or anxiety. All subjects with CFS were referred for a neuropsychological examination to assess persistent cognitive complaints. Eleven subjects (10 female, one male) with the diagnosis of clinically stable MS were chosen from clinics and the community because of complaints of mild to moderate cognitive impairment. The subjects with MS and 11 healthy volunteers (10 female, one male) were matched to the group with CFS by age, education, and estimated verbal intelligence (based on the Vocabulary subtest of the Wechsler Adult Intelligence Scale-Revised). The subjects with MS had a mean Kurtzke Expanded Disability Status Scale score of 4.95 (SD, 1.95; range, 2.0 to 7.5). As a result of the matching procedure, there were no differences among the three groups in age (F[2,31] = 0.32), education (F[2,31] = 0.80), and verbal intelligence (F[2,31] = 0.31). INTERVENTIONS: None. MAIN OUTCOME MEASURES: These measures included the Beck Depression Inventory (BDI), the Paced Auditory Serial Addition Test (PASAT), Digit Span Test, and the Similarities Test of Verbal Abstract Reasoning. RESULTS: The mean number of correctly identified responses collapsed across the four PASAT trials was significantly different across groups (F[2,31] = 4.03; P < .05). While the CFS and MS groups did not differ from each other, subjects with CFS (SEM, 124.2 +/- 6.4) and subjects with MS (SEM, 112.9 +/- 10.9) scored significantly below controls (SEM, 146.4 +/- 6.4) (Fisher's Protected Least Significant Difference test; P < .05). There were significant differences among the three groups on mean Digit Span Test performance (F[2,31] = 5.5; P < .01). While the CFS and MS group did not differ significantly from each other, only the CFS group was significantly lower than control (Fisher's Protected Least Significant Difference test; P < .05). Mean performance on the Similarities test did not differ among the three groups (F = 0.58). In addition, there were significant differences among the three groups in mean BDI scores (F[2,31] = 7.6; P < .01). The CFS and MS groups did not differ significantly from each other, and both groups showed a statistically significantly elevated mean BDI score relative to the control group (Fisher's Protected Least Significant Difference test; P < .05). No significant correlations were found between BDI scores and PASAT total scores (CFS, r = -.21; MS, r = .13; control, r = .27), or between BDI and Digit Span Test (CFS, r = -.32; MS, r = -.40; control, r = -.19). Results of the PASAT and Digit Span Test were significantly correlated in the CFS group (r = .71; P < .01), but not in the MS (r = .06) or control groups (r = .49). CONCLUSIONS: These results indicate that subjects with CSF and subjects with MS show significant impairment on a test of complex concentration when compared with appropriate controls. The data suggest that subjects with CFS and subjects with MS have difficulty on tasks that require the simultaneous processing of complex cognitive information. Selective impairment in information processing efficiency may lie at the

Adult↗
PubMed1996

Acute treatment of migraine with dihydroergotamine nasal spray. Dihydroergotamine Working Group.

BACKGROUND: Despite the benefits of antimigraine medications for patients with migraines, parenteral administration of these drugs has certain disadvantages for at-home patient use. OBJECTIVE: To examine the safety and efficacy of an intranasal spray formulation of dihydroergotamine mesylate in the treatment of migraines. DESIGN: Double-blind, placebo-controlled trial in patients with migraines. SETTING: Both private and institutional practice. PATIENTS: A total of 348 patients with a diagnosis of migraine according to International Headache Society criteria were recruited; 310 patients qualified for participation. INTERVENTIONS: Patients self-administered either 2 mg of dihydroergotamine mesylate, 3 mg of dihydroergotamine mesylate, or a placebo for each of 2 moderate to severe migraine headaches using a nasal spray apparatus. MAIN OUTCOME MEASURES: Patients rated pain severity, functional ability, headache pain relief, incidence and severity of nausea, and the incidence of vomiting, photophobia, and phonophobia prior to treatment (base-line) and again at 0.5, 1, 2, 3, and 4 hours after treatment. Recurrences of headache pain within 24 hours were also noted. RESULTS: Self-administration of dihydroergotamine resulted in significant increases in pain relief and functional ability and significant decreases in pain intensity and nausea compared with the placebo. Among patients treated with 2 mg of dihydroergotamine mesylate, 27% considered their migraine resolved (ie, no pain or mild pain) as early as 30 minutes after treatment. By 4 hours after treatment, 70% of these patients' headaches were resolved. Headache pain returned within 24 hours in only 14% of patients whose headaches had been resolved. No serious adverse effects of dihydroergotamine treatment were observed, and the adverse events that did occur were primarily related to the route of administration. The 2-mg dihydroergotamine mesylate dose provided slightly superior pain relief and was associated with fewer adverse events compared with the 3-mg dihydroergotamine mesylate dose. CONCLUSIONS: The present results suggest that intranasal administration of dihydroergotamine represents an important new therapeutic option for migraine sufferers.

Acute Disease↗
PubMed2002

Visual field loss in patients with glaucoma who have asymmetric peripapillary focal arteriolar narrowing.

OBJECTIVE: To evaluate the relationship between peripapillary focal arteriolar narrowing and visual field defects. METHODS: From our institutional practice, we identified 31 patients with glaucoma who had peripapillary focal arteriolar narrowing in only one eye and compared visual field data between the two eyes. Mean deviation (MD) and corrected pattern standard deviation (CPSD) were recorded using Humphrey visual field testing at the time proximal narrowing was apparent on the fundus photograph. Visual field data from subsets of patients with mild and severe narrowing were also compared. RESULTS: The MD and CPSD were significantly worse in eyes with peripapillary focal arteriolar narrowing. The eyes with narrowing exhibited a mean MD of -8.77 +/- 8.27 dB and a mean CPSD of 5.01 +/- 3.42 dB. Eyes without narrowing displayed a mean MD of -4.52 +/- 6.64 dB and a mean CPSD of 3.01 +/- 2.68 dB (P =.003 for both). There was no significant difference in severity of the visual field defect between eyes with mild and severe arteriolar narrowing. CONCLUSION: To our knowledge, this is the first study to show that the presence of peripapillary focal arteriolar narrowing is related to the severity of visual field loss in patients with glaucoma.

Aged↗
PubMed2000

Oropharyngotonsillitis associated with nonprimary Epstein-Barr virus infection.

OBJECTIVE: To identify distinct clinical features of pharyngotonsillitis or oropharyngitis associated with Epstein-Barr virus (EBV) infection from herpes simplex virus infection. DESIGN: Clinical studies by case exploration. SETTING: Institutional practice at a university hospital. PATIENTS: Thirty-three patients with pharyngotonsillitis and 4 patients with oropharyngitis of nonbacterial infection underwent biopsy of pharyngotonsillar lesions. MAIN OUTCOME MEASURE: The specimens were examined by histopathology, immunohistochemistry, in situ hybridization, and polymerase chain reaction. In addition to serological testing and routine laboratory data, photographic oropharyngeal findings were collected for clinical evaluation. RESULTS: In situ hybridization to detect EBV-encoded small nuclear RNA-1 and -2 disclosed 8 cases of pharyngotonsillitis and 4 cases of oropharyngitis associated with EBV infection. Immunohistochemical analysis identified 5 cases of pharyngotonsillitis associated with herpes simplex virus infection. Serological examination showed that, among 12 cases positive by in situ hybridization, 3 cases were primary infection with infectious mononucleosis and 9 were nonprimary infection. The staining pattern of in situ hybridization was different, ie, a linear pattern in cases of nonprimary infection and a scattered pattern in cases of primary infection. The clinical manifestations of EBV pharyngotonsillitis were distinct from those of herpes simplex virus pharyngotonsillitis and were characteristic irrespective of infectious status, while those of EBV oropharyngitis were more variable. CONCLUSIONS: Epstein-Barr virus-associated pharyngotonsillitis was demonstrated in patients with nonprimary infection unaccompanied by infectious mononucleosis. Epstein-Barr virus should be considered a potential causative agent of oropharyngotonsillitis even in absence of infectious mononucleosis, especially in a young adult.

Acute Disease↗
PubMed2001

Multivariate analysis of risk factors for neck metastases in surgically treated parotid carcinomas.

OBJECTIVE: To analyze risk factors for neck metastases in patients with parotid carcinomas. DESIGN: Cohort of patients followed up from 1 to 366.2 months at a single institution. SETTING: Referral center, private or institutional practice, hospitalized care. PATIENTS: A total of 145 patients with parotid carcinomas with complete clinical and pathological information. The histological diagnosis was reviewed according to the World Health Organization classification for salivary gland tumors. INTERVENTION: Patients were treated by surgery alone (62 cases) or with postoperative radiotherapy (83 cases). A neck dissection was performed in 80 patients. MAIN OUTCOME MEASURE: Rates of neck lymph node metastasis. Univariate and multivariate analyses were carried out using logistic regression evaluating the significance of demographic, clinical, and pathological data. RESULTS: The following variables were significantly associated to the risk of lymph node metastasis by univariate analysis: histological type (P<.001), T stage (P<.001), desmoplasia (P = .001), facial palsy (P = .02), perineural invasion (P = .01), extraparotid tumor extension (P = .02), and necrosis (P = .003). By multivariate analysis, histological type (P<.001), T stage (P = .03), and desmoplasia (P = .006) had the highest correlation with lymph node metastasis. CONCLUSION: The significant risk factors for neck metastasis in parotid carcinoma were histological type (ie, adenocarcinoma, undifferentiated carcinoma, high-grade mucoepidermoid carcinoma, squamous cell carcinoma, and salivary duct carcinoma), T stage (T3 and T4), and desmoplasia (severe).

Adenocarcinoma↗
PubMed2001

Economic evaluation of ventilation tubes in otitis media with effusion.

OBJECTIVE: To determine the costs and effectiveness of treatment with ventilation tubes as compared with watchful waiting in children with persistent otitis media with effusion. DESIGN: Randomized controlled trial. SETTING: Institutional practice. PATIENTS: A total of 187 young children (19 months old) with persistent bilateral otitis media with effusion. INTERVENTIONS: Treatment with ventilation tubes or watchful waiting. MAIN OUTCOME MEASURES: The time without effusion, language development, and the costs from a societal perspective during 1-year follow-up. RESULTS: The mean duration of effusion was 9.2 months in the watchful waiting group and 4.7 months in the ventilation tube group. The language development was comparable in both groups (0.7 month of improvement difference [95% confidence interval, -0.3 to 1.7 months] after correction for confounding variables). Because no statistically significant differences were found in the language development between the treatment groups, we performed a cost minimization analysis. The mean costs per child during 1 year of follow-up were 454 US dollars in the ventilation tube group and 120 US dollars in the watchful waiting group. On average, an additional investment of 334 US dollars per patient was needed for ventilation tube treatment. CONCLUSION: In the absence of differences in language development and in view of higher costs, treatment with ventilation tubes is not recommended as standard treatment in all young children with persistent otitis media with effusion traced by a population-based screening program.

Cost-Benefit Analysis↗
PubMed2002

Results of salvage treatment of the neck in patients with oral cancer.

BACKGROUND: About 50% of the patients with neck recurrences after the treatment of oral squamous cell carcinoma are not considered candidates for further treatment, and reported survival is generally poor. OBJECTIVE: To evaluate the prognostic importance of neck recurrences and results of salvage treatment in patients with oral carcinoma. PATIENTS: Five hundred thirteen patients with squamous cell carcinoma of the oral cavity underwent surgical treatment, with follow-up from less than 2 to 119 months (mean, 16.9 months). SETTING: Referral center, private or institutional practice, and ambulatory and hospital care center. INTERVENTION: Four hundred forty-eight patients underwent neck dissection, and 65, resection of the primary tumor only. Postoperative radiotherapy was used for 228. MAIN OUTCOME MEASURES: Rates of neck recurrences and survival after salvage treatment. RESULTS: Eighty-two patients (16.0%) had neck recurrences, including ipsilateral in 44, contralateral in 31, and bilateral in 7. Most neck recurrences (77 [94%]) were diagnosed within 2 years. Salvage treatment was attempted in 51 patients (62%). Of the patients with a previously untreated side of the neck, 27 underwent radical neck dissections (11 ipsilateral and 16 contralateral) and only 5 remained with no evidence of disease. The significant factors associated with survival after neck recurrence were type of previous neck dissection (P<.001), previous postoperative radiotherapy (P =.003), and interval free of neck recurrence (P<.001). CONCLUSIONS: Patients undergoing previous neck dissection and with recurrences diagnosed after 6 months are not usually candidates for curative salvage treatment and are at a high risk for death. Only 5 of 46 patients with recurrences in a previously untreated side of the neck survived after salvage treatment. Patients with neck recurrences have a poor prognosis, despite salvage treatment.

Adult↗