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PubMed1998

Ambulatory and inpatient procedures in the United States, 1995.

OBJECTIVES: This report presents estimates of surgical and nonsurgical procedures performed in the United States during 1995. Data are presented by characteristics of patients, region of the country, and procedure categories for ambulatory and inpatient procedures separately and combined. METHODS: Estimates in this report are based on data collected from the National Hospital Discharge Survey (NHDS) and the National Survey of Ambulatory Surgery (NSAS). NHDS provides data on hospital inpatient care, and NSAS provides data on ambulatory surgery in hospitals and in freestanding ambulatory surgery centers. For NHDS, data were collected for approximately 263,000 discharges from 466 non-Federal short-stay hospitals (92 percent response rate). For NSAS, data were collected for approximately 122,000 ambulatory surgery discharges from 489 hospitals and freestanding ambulatory surgery centers (80 percent response rate). RESULTS: An estimated 69.2 million procedures were performed on 38.7 million discharges from hospitals and freestanding ambulatory surgery centers during 1995: 39.8 million procedures were for inpatients, and 29.4 million were for ambulatory patients. Females had more procedures than males, and the rate of procedures increased with age in ambulatory and inpatient settings. The leading procedures for ambulatory surgery patients and inpatients combined were endoscopy of small intestine, arteriography and angiocardiography, extraction of lens, and endoscopy of large intestine.

Adolescent↗
PubMed1993

Diagnostic and screening procedures in family practice. Past, present, and future use.

OBJECTIVE: This report documents the experience, current practices, and plans of family physicians regarding their use of clinical procedures in diagnosis, screening, and prevention. DESIGN: A mailed survey of family physicians asked who offered or planned to add a variety of clinical procedures in their practices. PARTICIPANTS: Active members of the Washington Academy of Family Physicians. MAIN OUTCOME MEASURES: Does the physician include the procedure in his or her current practice or plan to add it in the future? RESULTS: Questionnaires were returned by 790 (82%) of 963 physicians, with 750 usable responses. Eighty-four percent of respondents were male and 68% had trained for at least 3 years. The median age of respondents was 40 years. Procedures performed by most respondents included the following: Papanicolaou's smear (97%), electrocardiography (80% performed it and 71% interpreted the results), endometrial biopsy (66%), pulmonary function test (61%), rigid sigmoidoscopy (58%), chest roentgenogram interpretation (54%), flexible sigmoidoscopy (52%), performing chest roentgenography (51%), and endocervical curettage (51%). Procedures most often planned to be added by respondents included flexible sigmoidoscopy (59%), colposcopy (30%), endometrial biopsy (23%), pulmonary function test (18%), smoking cessation groups (16%), exercise tolerance test (14%), and fine-needle aspiration biopsy (14%). Forty-two percent of respondents volunteered to teach these procedures to their colleagues. CONCLUSIONS: Family practice includes a wide variety of procedures used in diagnosis, screening, and prevention. Family physicians are eager to add procedures to their practices and to teach their colleagues the procedures they know.

Adult↗
PubMed1998

Consequences of inadequate analgesia during painful procedures in children.

OBJECTIVE: To explore the effect of inadequate analgesia for painful procedures (bone marrow aspiration, lumbar puncture, or both) on the pain of subsequent procedures. DESIGN: A cohort of patients with cancer who had participated in a placebo-controlled, randomized study that documented the efficacy of oral transmucosal fentanyl citrate for painful procedures rated the pain associated with subsequent procedures performed with open-label oral transmucosal fentanyl. PARTICIPANTS: Twenty-one children undergoing diagnostic procedures who had been participants in previous study. INTERVENTION: All children were given oral transmucosal fentanyl, 15 to 20 microgram/kg, prior to the procedure; at its conclusion they were asked to rate the associated pain. RESULTS: In children younger than 8 years (n = 13), mean pain ratings during each subsequent procedure were consistently higher for those who had received placebo (n = 8) in the original study compared with those who had received the active drug (n = 5). A repeated-measures analysis of variance suggests that this difference is statistically significant (P = .04). Older children (n = 8) did not show this pattern. CONCLUSION: Inadequate analgesia for initial procedures in young children may diminish the effect of adequate analgesia in subsequent procedures.

Administration, Oral↗
PubMed2003

Outcomes of ostomy procedures in patients aged 70 years and older.

HYPOTHESIS: Patients aged 70 years and older undergo proportionately more emergency and permanent fecal ostomy procedures than younger patients. Older patients have comparable short-term outcomes in morbidity and mortality, with adverse outcomes dependent on comorbid conditions and timing of the procedure rather than age alone. Older patients should be treated similarly to younger patients in terms of subsequent ostomy takedown, if an acceptable operative risk. DESIGN: A retrospective review of our facility's experience with fecal ostomies between 1992 and 2002 was performed to determine the effect of advanced age on surgical outcome measures. SETTING: A tertiary managed care medical center. PATIENTS: Three hundred eighty-three consecutive patients who underwent new fecal ostomy procedures between October 1, 1992, and October 1, 2002. One hundred three patients were aged 70 years or older (mean age, 76.4 years), and 280 patients were younger than 70 years (mean age, 49.6 years). There were 220 elective procedures and 163 emergency procedures. Outcome was analyzed between the 2 age groups. MAIN OUTCOME MEASURES: Indications for ostomy, type of ostomy, preoperative comorbidity, postoperative morbidity and mortality, length of intensive care unit and hospital stay, and subsequent ostomy takedown success. RESULTS: Three hundred eighty-three new fecal ostomies were created. The diagnosis leading to creation of the ostomy was more often malignancy in older patients (74.8%) compared with younger patients (45.0%). Both age groups underwent a similar proportion of emergency procedures (older vs younger patients, 43.7% vs 42.1%; P=.07), but more older patients were left with permanent stomas (59.2% vs 41.1%, P=.002). Older patients also had more preoperative comorbidities (P=.001), higher American Society of Anesthesiologists scores (P=.001), longer hospital stays (P=.04), and more postoperative complications. Thirty-day mortality was 6.8% in the older group vs 0.4% in the younger group (P=.001). Fewer older patients were eligible for ostomy reversal (41.1% vs 59.2%), and a smaller proportion of eligible older patients actually underwent the reversal procedure (78.7% vs 95.2%). The complication rate associated with ostomy reversal was not significantly different in the 2 age groups (P=.002). CONCLUSIONS: Patients aged 70 and older undergo proportionately more permanent fecal ostomy procedures than younger patients, with longer hospital stays, more postoperative complications, and higher mortality rates. However, surgical outcome measures in older patients following ostomy procedures remain within acceptable standards. Furthermore, older patients tolerate ostomy reversal with minimal morbidity and should not be denied consideration based on age alone if an eligible candidate.

Adolescent↗
PubMed2004

Procedural volume as a marker of quality for CABG surgery.

CONTEXT: There have been recent calls for using hospital procedural volume as a quality indicator for coronary artery bypass graft (CABG) surgery, but further research into analysis and policy implication is needed before hospital procedural volume is accepted as a standard quality metric. OBJECTIVE: To examine the contemporary association between hospital CABG procedure volume and outcome in a large national clinical database. DESIGN, SETTING, AND PARTICIPANTS: Observational analysis of 267 089 isolated CABG procedures performed at 439 US hospitals participating in the Society of Thoracic Surgeons National Cardiac Database between January 1, 2000, and December 31, 2001. MAIN OUTCOME MEASURE: Association between hospital CABG procedural volume and all-cause operative mortality (in-hospital or 30-day, whichever was longer). RESULTS: The median (interquartile range) annual hospital-isolated CABG volume was 253 (165-417) procedures, with 82% of centers performing fewer than 500 procedures per year. The overall operative mortality was 2.66%. After adjusting for patient risk and clustering effects, rates of operative mortality decreased with increasing hospital CABG volume (0.07% for every 100 additional CABG procedures; adjusted odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96-0.99; P =.004). While the association between volume and outcome was statistically significant overall, this association was not observed in patients younger than 65 years or in those at low operative risk and was confounded by surgeon volume. The ability of hospital volume to discriminate those centers with significantly better or worse mortality was limited due to the wide variability in risk-adjusted mortality among hospitals with similar volume. Closure of up to 100 of the lowest-volume centers (ie, those performing < or =150 CABG procedures/year) was estimated to avert fewer than 50 of 7110 (<1% of total) CABG-related deaths. CONCLUSION: In contemporary practice, hospital procedural volume is only modestly associated with CABG outcomes and therefore may not be an adequate quality metric for CABG surgery.

Aged↗
PubMed1999

Internal pilot studies II: comparison of various procedures.

The two-stage design involves sample size recalculation using an interim variance estimate. Stein proposed the design in 1945; biostatisticians recently have shown renewed interest in it. Wittes and Brittain proposed a modification aimed at greater efficiency; Gould and Shih proposed a similar procedure, but with a different interim variance estimate based on blinded data. We compare the power of Stein's original test, an idealized version of the Wittes-Brittain test, and a theoretical optimal test which can be approximated in practice. We also compare two procedures that control the conditional type I error rate given the actual final sample size: Gould and Shih's procedure and a newly proposed 'second segment' procedure. The comparison among the first three procedures indicates that the Stein test is, unexpectedly, the test of choice under the original design alternative, whereas the approximate-optimal and Wittes-Brittain procedures appear to have superior power for detecting smaller treatment differences. As between the latter two procedures, the second segment procedure is more powerful when many observations are likely to be taken after the interim resizing, whereas otherwise the Gould-Shih procedure is superior.

Analysis of Variance↗
PubMed2003

A classification of pregnancy losses after invasive prenatal diagnostic procedures: an approach to allow comparison of units with a different case mix.

OBJECTIVE: Pregnancy loss rates after prenatal invasive procedures such as amniocentesis (Amnio), chorionic villous sampling (CVS) and fetal blood sampling (FBS) vary with an underlying indication for the procedure and due to different background risk of miscarriage. Loss rates need to be quantified and available for counselling. We developed a classification of pregnancy losses that will help in calculating procedure-related pregnancy loss rates and allow comparison between units with a different case mix. METHODS: The procedure-related pregnancy loss rate was obtained by subtracting the losses in pregnancies with known lethal conditions and those occurring more than two weeks after the procedure from total pregnancy losses. RESULTS: Out of 436 CVSs, there were 18 losses. Of these, 14 had a known lethal condition and 3 occurred after 2 weeks of CVS. In only one case, there was no known lethal abnormality and the loss occurred within 2 weeks. Thus, the total pregnancy loss rate was 4.1% and the procedure-related loss rate was 0.23% (95% CI; 0.0061-1.28). The procedure-related loss rates for Amnio 0.7% (95% CI; 0.2-1.8) and FBS 1.19 (95% CI; 0.14-4.23) were calculated in a similar way. CONCLUSIONS: We present a method of recording pregnancy loss after prenatal invasive procedures, which would be useful for benchmarking comparison between units and pre-procedural counselling.

Abortion, Spontaneous↗
PubMedDate not supplied

A note on the power of Fisher's least significant difference procedure.

Fisher's least significant difference (LSD) procedure is a two-step testing procedure for pairwise comparisons of several treatment groups. In the first step of the procedure, a global test is performed for the null hypothesis that the expected means of all treatment groups under study are equal. If this global null hypothesis can be rejected at the pre-specified level of significance, then in the second step of the procedure, one is permitted in principle to perform all pairwise comparisons at the same level of significance (although in practice, not all of them may be of primary interest). Fisher's LSD procedure is known to preserve the experimentwise type I error rate at the nominal level of significance, if (and only if) the number of treatment groups is three. The procedure may therefore be applied to phase III clinical trials comparing two doses of an active treatment against placebo in the confirmatory sense (while in this case, no confirmatory comparison has to be performed between the two active treatment groups). The power properties of this approach are examined in the present paper. It is shown that the power of the first step global test--and therefore the power of the overall procedure--may be relevantly lower than the power of the pairwise comparison between the more-favourable active dose group and placebo. Achieving a certain overall power for this comparison with Fisher's LSD procedure--irrespective of the effect size at the less-favourable dose group--may require slightly larger treatment groups than sizing the study with respect to the simple Bonferroni alpha adjustment. Therefore if Fisher's LSD procedure is used to avoid an alpha adjustment for phase III clinical trials, the potential loss of power due to the first-step global test should be considered at the planning stage.

Analysis of Variance↗
PubMed2003

No incidence of port-site recurrence after endosurgical procedure for pediatric malignancies.

Port-site recurrence (PSR) following laparoscopic procedures has been an unpredictable complication in adult cancer patients; however, no data exist about this phenomenon in the pediatric field. The aim of this study was to determine whether PSR, following endosurgical procedure for malignancies, is a typical complication or a rare event in the pediatric population. Eighty-one questionnaires were mailed to members of The Japanese Society of Pediatric Endosurgeons. They were asked to provide a list of their institutions that had experience with PSR after endosurgical procedures for pediatric malignancies. Among 29 institutions, a total of 129 endosurgical procedures for pediatric malignancies were reported; these included 85 laparoscopic and 44 thoracoscopic procedures, performed on 104 neuroblastomas, 8 hepatoblastomas, 7 nephroblastomas, and 10 other tumors. Of the 104 neuroblastomas, 83 were found by mass screening using high levels of urinary vanillylmandelic acid and homovanillic acid. Sixty-five of the 83 patients had their tumor excised, and 18 had their tumor biopsied by endosurgical procedures. Additionally, 47 of these patients did not require any postoperative chemotherapy. No incidence of PSR was reported in any of the patients that underwent endosurgical procedures. The PSR following endosurgical procedure is a rare phenomenon in the pediatric population. Both, laparoscopic and thoracoscopic procedures, are safe and recommended for treating pediatric malignancies, especially mass-screened neuroblastomas.

Child↗
PubMed1995

A system for automated procedure documentation.

Quantitative information regarding competency in performing procedures is invaluable in attesting to a house officer's abilities when assessments need to be made. Thus, the means by which procedures, proficiency, and experience can be recorded and organized in an automated fashion need not be any further away than the nearest micro-computer. The procedure documenting system (PDS) automates the documenting of procedures and quantitative information pertaining to these procedures, and shortens the time demanded of the house officer to document procedures from a mean of 5.5 to 1.9 min. This paper is a description of the work done to automate the recording of procedures performed by housestaff at a teaching hospital and the acceptance by housestaff. This computer program takes the specific information and places it into a specialized database so that house officers can have detailed documentation attesting to their proficiency in various procedures. In addition, the program director can access the database to document the quantity of procedures to which an individual house officer has attained competence.

Automation↗
PubMed1989

Presentation level determination for CV tokens using a computer-controlled adaptive procedure.

The feasibility of using a computer-controlled adaptive procedure to find maximum monotic performance for consonant-vowel (CV) stimuli was evaluated and compared to the procedure typically used to determine a performance-intensity function in two experiments. In experiment I, the computer-controlled adaptive procedure and the typical manual procedure were evaluated on 26 normally hearing listeners. Results indicated that the shape of the performance-intensity functions was similar for both procedures with the computer-controlled adaptive procedure selecting a higher presentation level. The test-retest reliability for the computer-controlled adaptive procedure was good with a mean difference on retest of 1.2 dB. In experiment II, the same procedures were evaluated using 9 sensorineural hearing impaired subjects. Again similar configuration between functions was observed. The primary advantage of the computer-controlled adaptive procedure for both subject groups is efficiency in terms of time of administration and number of CV stimuli used.

Adolescent↗
PubMed1985

Eliminating selective stimulus control: a comparison of two procedures for teaching mentally retarded children to respond to compound stimuli.

Selective stimulus control occurs when behavior fails to come under control of all characteristics of a compound stimulus after discrimination training. Two different assessment procedures, one used in prior research and the other incorporating incorrect stimuli (S - 's) which differed minimally from the correct stimulus (S+), were used to detect stimulus control deficits characteristic of selective stimulus control. The efficacy of two training procedures in eliminating selective stimulus control observed with three trainable mentally retarded children was evaluated in Experiment 1. A training procedure using S - 's that were minimally different from the S+ was designed to reduce the probability that stimulus discriminations could be based on stimulus characteristics other than experimenter-specified characteristics defining the S+. This procedure proved more effective in preventing and eliminating selective stimulus control as measured by both assessment procedures than an alternate discrimination training procedure that failed to impact the more stringent measures of selective stimulus control. Experiment 2 indicated that these improvements in stimulus control were not a function of varying degrees of difficulty between stimulus sets or of a prior history of discrimination training with the less effective training procedure. The need for better assessment procedures to detect selective stimulus control and suggestions for further improvements in discrimination training procedures are discussed.

Adolescent↗
PubMed1996

Loop electrosurgical excision procedure for squamous intraepithelial lesions of the cervix: advantages and potential pitfalls.

OBJECTIVE: to evaluate the advantages and pitfalls of the loop electrosurgical excision procedure as applied to the diagnosis and treatment of cervical cancer precursors. METHODS: Loop electrosurgical excision procedure using local anesthesia and colposcopic guidance was performed in an outpatient clinical setting in 1189 consecutive patients referred for colposcopy for an abnormal Papanicolaou smear during a period of 4 years. RESULTS: Of the 1189 patients, 915 (77%) were managed in one sitting with the "see and treat" approach, and in 274 patients endocervical curettage and cervical biopsies preceded loop electrosurgical excision procedure. One hundred nineteen (10%) patients were lost to follow-up. Twenty-one patients had either adenocarcinoma in situ (15) or microinvasive squamous cell carcinoma (six) in the loop electrosurgical excision procedure specimen, whereas the electroexcised specimens contained no lesional tissue in 166 (14%) patients. Cure (ie, disease-free at 6 months or longer) was observed in 92% of the 883 evaluable patients after a single treatment and 95% after a repeat loop electrosurgical excision procedure. High-grade squamous intraepithelial lesion was successfully treated with loop electrosurgical excision procedure in 287 (93%) of 309 patients. Complications, mainly intra- and postoperative bleeding, occurred in 7% of the patients. In most loop electrosurgical excision procedure-negative cases, the referral cytologic diagnosis or colposcopy and/or history were false-positive on review, or the biopsies performed before loop electrosurgical excision procedure removed smaller areas of abnormal tissue. CONCLUSION: Loop electrosurgical excision procedure using the see and treat approach should be limited to cytologically and colposcopically unequivocal intraepithelial lesions, and depth of excision should be controlled by colposcopy using loop electrodes of appropriate size. In doubtful cases, particularly in the young patient, disease should be ascertained by expert histology and colposcopy before definite therapy. Loop electroexcision represents an attractive means of diagnosing and treating cervical cancer precursors.

Adenocarcinoma↗
PubMed1996

High-precision prostate cancer irradiation by clinical application of an offline patient setup verification procedure, using portal imaging.

PURPOSE: To investigate in three institutions, The Netherlands Cancer Institute (Antoni van Leeuwenhoek Huis [AvL]), Dr. Daniel den Hoed Cancer Center (DDHC), and Dr, Bernard Verbeeten Institute (BVI), how much the patient setup accuracy for irradiation of prostate cancer can be improved by an offline setup verification and correction procedure, using portal imaging. METHODS AND MATERIALS: The verification procedure consisted of two stages. During the first stage, setup deviations were measured during a number (Nmax) of consecutive initial treatment sessions. The length of the average three dimensional (3D) setup deviation vector was compared with an action level for corrections, which shrunk with the number of setup measurements. After a correction was applied, Nmax measurements had to be performed again. Each institution chose different values for the initial action level (6, 9, and 10 mm) and Nmax (2 and 4). The choice of these parameters was based on a simulation of the procedure, using as input preestimated values of random and systematic deviations in each institution. During the second stage of the procedure, with weekly setup measurements, the AvL used a different criterion ("outlier detection") for corrective actions than the DDHC and the BVI ("sliding average"). After each correction the first stage of the procedure was restarted. The procedure was tested for 151 patients (62 in AvL, 47 in DDHC, and 42 in BVI) treated for prostate carcinoma. Treatment techniques and portal image acquisition and analysis were different in each institution. RESULTS: The actual distributions of random and systematic deviations without corrections were estimated by eliminating the effect of the corrections. The percentage of mean (systematic) 3D deviations larger than 5 mm was 26% for the AvL and the DDHC, and 36% for the BVI. The setup accuracy after application of the procedure was considerably improved (percentage of mean 3D deviations larger than 5 mm was 1.6% in the AvL and 0% in the DDHC and BVI), in agreement with the results of the simulation. The number of corrections (about 0.7 on the average per patient) was not larger than predicted. CONCLUSION: The verification procedure appeared to be feasible in the three institutions and enabled a significant reduction of mean 3D setup deviations. The computer simulation of the procedure proved to be a useful tool, because it enabled an accurate prediction of the setup accuracy and the required number of corrections.

Feasibility Studies↗
PubMedDate not supplied

Animal procedure laboratory surveys: use of the animal laboratory to improve physician confidence and ability.

Animal laboratories have been used for many years to teach procedures. Our department has a weekly swine laboratory devoted to training residents, interns and students in resuscitative procedures. Physicians who participated in our swine procedure laboratory over the past three years were queried as to their prelaboratory and postlaboratory comfort levels with six different resuscitative procedures, and 57 (76%) physicians responded. Statistical analysis of the data showed significant improvement in comfort levels for all six procedures. Every responder felt the swine laboratory helped or will help them perform the procedures on humans. We also surveyed all U.S. emergency medicine residency program directors from established programs regarding the status of their animal procedure laboratories, and 67 of the 68 (98%) directors responded. Of these responders, 62% offer an animal procedure laboratory. Overall, 97% of the residency directors rated the laboratory successful, and 97% of the residents rated the laboratory successful. Therefore, we conclude that an ongoing emergency medicine animal procedure laboratory is a valuable tool for improving physician-in-training ability and confidence.

Animals↗
PubMed2005

Primary stability of three posterior cruciate ligament reconstruction procedures: a biomechanical in vitro study.

PURPOSE: Posterior cruciate ligament (PCL) reconstruction procedures have not been thoroughly evaluated under cyclic loading conditions. We tested the hypothesis that PCL reconstruction with a quadrupled flexor-tendon graft and fixation using tapes and staples is biomechanically superior to that fixed with sutures, a button, and a post-screw, and is comparable to reconstruction with a bone--patellar tendon--bone (BPTB) graft. STUDY DESIGN: In vitro biomechanical study. METHODS: A total of 45 porcine knees were used. The quadrupled flexor-tendon graft was fixed using the suture/button/post-screw procedure in 15 knees, and with the tape/staples procedure in another 15 knees. The remaining 15 knees underwent reconstruction with a BPTB graft secured with screws as the standard control. In each group of 15 knees, 5 underwent tensile testing without cyclic loading, and 10 underwent the same tensile test after 5,000 cycles of load-controlled or displacement-controlled loading. RESULTS: Each type of cyclic loading produced larger biomechanical changes in the knees fixed with the suture/button/post-screw procedure than in the knees secured using the other 2 procedures. CONCLUSIONS: In PCL reconstruction, the tape/staples procedure is biomechanically superior to the suture/button/post-screw procedure, and is comparable to the BPTB/screws procedure with regard to the ultimate failure load. Neither of the procedures using the quadrupled flexor-tendon graft was comparable to the BPTB graft in linear stiffness and the initial displacement after load-controlled cyclic testing. CLINICAL RELEVANCE: The biomechanical behaviors of PCL-reconstructed knees are significantly different, depending on surgical techniques.

Animals↗
PubMedDate not supplied

Validation of a sham manipulative procedure for the cervical spine for use in clinical trials.

OBJECTIVE: To develop a sham manipulation procedure for the cervical spine for use in randomized clinical trials of cervical disorders. METHODS: A single-group, single-intervention study design was used. Adult neck pain subjects underwent a screening examination that included palpation for a site of cervical spine joint dysfunction. Eligible subjects underwent measurements of regional cervical ranges of motion as well as pressure algometry (tenderness) at the site of cervical joint dysfunction. Subjects were instructed that they would receive one of several types of manipulative procedures. A newly developed sham manipulation was delivered once. Subjects were then remeasured for ranges of motion and tenderness. They were asked if they had experienced any pain during the procedure, if they had experienced a "cavitation" sound, and if they thought that the procedure they received was a "real" manipulation. Finally, they were debriefed as to the deception involved in this study. A prior level of 65% was set for endorsement that the procedure was a real manipulation. Changes in pre-post measures of ranges of motion and tenderness were analyzed descriptively for clinically important differences. RESULTS: Twenty eligible subjects were included (12 males, 8 females) with an average age of 30.4 (2.8) years. Twelve of the subjects were not students, with 3 of these having no prior experience with chiropractic treatment; 8 were students. Of the total sample (N = 19), 8 (42.1%) indicated that the procedure was a "real adjustment"; of the 12 nonstudents, 8 (58.3%) indicated similarly. None of the procedures in the final sample resulted in a cavitation, and none of the subjects registered the procedure as painful. None of the measures for ranges of motion or tenderness showed clinically important changes. CONCLUSIONS: The sham cervical manipulation studied here appears to approximate the necessary features of a placebo maneuver in that it is perceived by a majority of nonstudent neck pain subjects to be a real manipulation, although it does not produce any important change in cervical status. The small sample size of nonstudent participants precludes a strong recommendation for this procedure at this time.

Adult↗
PubMed1998

Primary glaucoma triple procedure in patients with primary open-angle glaucoma: the effect of mitomycin C in patients with and without prognostic factors for filtration failure.

PURPOSE: To investigate the effect of adjunctive mitomycin C on primary glaucoma triple procedure in patients with primary open-angle glaucoma with and without one or more of the prognostic factors for filtration failure of primary glaucoma triple procedure. Those factors include being of African-American race, having a preoperative intraocular pressure of 20 mm Hg or more on maximum tolerated medications, and being on two or more medications preoperatively. METHODS: Study patients consisted of 197 consecutive patients with primary open-angle glaucoma who were randomly assigned to receive either no adjunctive mitomycin C (101 eyes of 101 patients) or to receive adjunctive subconjunctival mitomycin C (96 eyes of 96 patients) during the primary glaucoma triple procedure. Kaplan-Meier survival analysis comparisons were made between respective subgroups with and without prognostic indicators for filtration failures using a relatively stringent set of criteria for filtration success of primary glaucoma triple procedure. RESULTS: There was no statistically significant (P = .117) difference in filtration success of primary glaucoma triple procedure between the control and mitomycin C groups. Adjunctive mitomycin C significantly (P < .05) improved the filtration outcome of the primary glaucoma triple procedure in the subgroups with each of the three prognostic factors for filtration failure of primary glaucoma triple procedure. On the other hand, in the subgroups without the prognostic factors, adjunctive mitomycin C did not significantly (P > .05) change the filtration outcome of the primary glaucoma triple procedure. CONCLUSION: These findings establish the basis for selective use of mitomycin C in patients with primary open-angle glaucoma undergoing primary glaucoma triple procedure.

Aged↗