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PubMed2006

Total knee replacement in morbidly obese patients. Results of a prospective, matched study.

The results of 41 consecutive total knee replacements performed on morbidly obese patients with a body mass index > 40 kg/m(2), were compared with a matched group of 41 similar procedures carried out in non-obese patients (body mass index < 30 kg/m(2)). The groups were matched for age, gender, diagnosis, type of prosthesis, laterality and pre-operative Knee Society Score. We prospectively followed up the patients for a mean of 38.5 months (6 to 66). No patients were lost to follow-up. At less than four years after operation, the results were worse in the morbidly obese group compared with the non-obese, as demonstrated by inferior Knee Society Scores (mean knee score 85.7 and 90.5 respectively, p = 0.08; mean function score 75.6 and 83.4, p = 0.01), a higher incidence of radiolucent lines on post-operative radiographs (29% and 7%, respectively, p = 0.02), a higher rate of complications (32% and 0%, respectively, p = 0.001) and inferior survivorship using revision and pain as end-points (72.3% and 97.6%, respectively, p = 0.02). Patients with a body mass index > 40 kg/m(2) should be advised to lose weight prior to total knee replacement and to maintain weight reduction. They should also be counselled regarding the inferior results which may occur if they do not lose weight before surgery.

Adult↗
PubMed1989

Effects of a CME program on physicians' transfusion practices.

A two-stage project was designed to assess physicians' transfusion practices and to evaluate the effectiveness of a continuing medical education (CME) lecture to change these practices. The hospital charts of 44 patients who were autologous blood donors undergoing elective orthopedic surgery and a matched group of 44 patients who were not autologous blood donors were analyzed to determine their physicians' transfusion practices. The groups were matched for age and sex distribution and for procedure. The results suggested that the physicians accepted lower hematocrit levels for autologous-donor patients, did not request adequate amounts of autologous blood, overtransfused some patients with their own blood, and did not schedule the elective procedures far enough in advance to allow patients to deposit the requested amounts of autologous blood. A CME program developed to address the latter three problems was given to seven subspecialty groups in a grand rounds lecture format. Follow-up comparisons of the orthopedic surgeons' blood transfusion practices indicate that after the CME program they did significantly less underordering of autologous blood but still did not increase the time for patients to donate the requested amounts of blood.

Blood Transfusion↗
PubMed1983

Decision-time measures of sequential processing by mentally retarded and nonretarded adolescents and MA-matched children.

To eliminate the operation of organizational factors during crossmodal information processing, we compared mentally retarded adolescents, CA-matched nonretarded adolescents, and MA-matched children in a same-different decision task in which dyadic sequences were presented within and across the visual and auditory modalities. Decision times for correct "different" responses were greater for the CA-matched group than for the EMR and MA-matched groups, with all groups showing longest times for the visual-auditory dyads and shortest times for dyads in which both stimuli were visual. Differences between the auditory-auditory and auditory-visual dyads were negligible, and increments from visual-visual to visual-auditory dyads were significantly greater than from auditory-auditory to auditory-visual dyads in the EMR and MA groups. Results support a concept of greater visual dominance by the retarded and MA-matched groups rather than slower crossmodal attention switching, per se.

Adolescent↗
PubMed1980

More (or less) about interspouse personality similarity: a sample of incompatible samples.

Examined the degree of interspouse similarity in three samples from previous studies. Two of these samples were matched on age, education, and SES. The third sample represented couples who were not matched on these variables. Contrary to prior assumptions, the matched groups differed from each other nearly as much as they did from the unmatched group. This has implications for the ability to generalize from interspousal data even when comparison groups are matched on several traditional variables.

Humans↗
PubMed1991

Function of the hip after femoral neck fractures treated by fixation or secondary total hip replacement.

Two matched groups of 28 patients each, with femoral neck fractures treated by primary internal fixation or by secondary total hip replacement after a complication of primary treatment, were evaluated and compared five years or more after primary pin fixation or secondary total hip replacement. The Nottingham Health Profile questionnaire was sent and returned by mail and the patient groups were matched with regard to age, sex, health, and social situation. Patients with healed fractures had less problems with sleep, housework and hobbies, and thus functioned better than patients who had required a secondary total hip replacement.

Activities of Daily Living↗
PubMed1992

Effects of a home visiting program on prenatal care and birthweight: a case comparison study.

Recent reports have stressed the importance of social support services to the health and well being of pregnant women and their newborns. The impact of paraprofessional support services on the amount of prenatal care received and birthweight was studied in a sample of 111 low-income women. Paraprofessionals were women who had been on public assistance and successfully attained health and human services for themselves and their infants. They were similar to the patients they served in educational background and ethnicity. A six-week training program prepared them to counsel and assist pregnant women with health and social services, housing, food, transportation and other basic necessities. Women attending a publically-funded prenatal clinic were randomly assigned to a paraprofessional. A comparison group matched for ethnicity, parity and trimester entering prenatal care was also selected. Women followed by a paraprofessional had significantly more prenatal appointments (8.0 vs 6.5 visits) and infants with average higher birthweight (3125 grams) over the matched comparison group (3273 grams). While intensity of contact with a paraprofessional contributed significantly to the amount of prenatal care received by patients of paraprofessionals, the mechanism for improvement in birthweight is unknown.

Adolescent↗
PubMed1994

Psychological distress in female cancer patients with Holocaust experience.

This study examined whether severe emotional and physical trauma in the past affects the psychological condition of female patients currently afflicted with cancer. Using the Brief Symptom Inventory (BSI), 41 women with cancer, who had sustained extreme trauma during the Nazi Holocaust of the midcentury, were compared with three different groups: a matched group of cancer patients without Holocaust experience, a physically healthy group of female Holocaust survivors, and healthy women without a Holocaust past. Although psychological distress was comparable in the two healthy groups, it was far higher in Holocaust cancer patients than in either their non-Holocaust counterparts or in the group of healthy Holocaust survivors. These results may suggest that the severe trauma of the Holocaust could be responsible for markedly diminished psychological response when such patients are confronted with new stress.

Aged↗
PubMed1994

Neurocognitive abilities for a clinically depressed sample versus a matched control group of normal individuals.

Depressed patients have been reported to show deficits in tasks that demand memory, planning/sequencing, speeded responding, and effortful responding. Many studies of depressed patients have used inadequate instrumentation or poor control groups. In this investigation, the cognitive performance of 44 patients diagnosed as clinically depressed was compared with the performance of a control group of normal individuals that closely matched the clinical group on the variables of age, gender, race or ethnic group, and educational attainment. The groups were compared on the tasks that compose the Kaufman Adolescent and Adult Intelligence Test (KAIT), which includes reliable and valid measures of most pertinent areas of purported deficit in depressed patients. Multivariate analyses of variance indicated that the depressed and control groups did not differ significantly on KAIT variables, but the depressed patients did differ significantly from the control group on the delayed versus immediate recall of verbal information.

Adolescent↗
PubMed2002

Corticosteroids and central serous chorioretinopathy.

PURPOSE: The purpose of this study is to investigate the relationship between corticosteroid use and central serous chorioretinopathy (CSC). DESIGN: A prospective, case-controlled study. PARTICIPANTS AND CONTROLS: A consecutive series of patients with acute manifestations of CSC and a control group matched for age, race, and gender were recruited between January 2000 and July 2000. METHODS: A detailed clinical history was taken, and fundus examination with slit-lamp biomicroscopy was performed on all patients. Fluorescein angiography was obtained on the study patients. RESULTS: A total of 50 patients was recruited. Twenty-six patients (52%) had a history of exogenous steroid use, including oral, intravenous, intranasal, and intraarticular administration. Two additional patients had a history of endogenous hypercortisolism (Cushing's syndrome). In a matched control group, eight patients (18%) had a history of steroid use. The difference in corticosteroid exposure between study patients and controls was statistically significant (P < 0.0001). MAIN OUTCOME MEASURES: History of corticosteroid use or Cushing's syndrome. CONCLUSIONS: This study is consistent with previous reports associating steroid use with CSC. It identifies corticosteroids as a significant risk factor for the development of acute, exudative macular manifestation and implicates hypercortisolism as a factor in the pathogenesis of this disorder. Several forms of corticosteroid administration were observed to be a risk factor for CSC. Accordingly, susceptible patients in need of corticosteroids should be advised of the risk of developing acute manifestations of CSC.

Administration, Intranasal↗
PubMed1997

Assessment of the dysexecutive syndrome in schizophrenia.

BACKGROUND: Cognitive neuropsychological theories hypothesize a role for frontal lobe executive deficits in the aetiology of schizophrenic symptoms. The study examined the performance of a schizophrenic group on the Behavioural Assessment of the Dysexecutive Syndrome (BADS; Wilson et al. 1996), a test battery which assesses the 'everyday' difficulties associated with the dysexecutive syndrome. Performance of the schizophrenics was contrasted with that of brain injured and healthy volunteer groups. METHODS: Matched groups of 31 schizophrenic patients, 35 patients with brain injuries and 26 healthy volunteers were administered the BADS. Patients were also given tests of general intelligence and memory. Patients and their relatives/carers also completed a questionnaire rating day-to-day failures of executive functioning. RESULTS: Schizophrenic and brain-injured patients showed impairment on the BADS, compared to healthy controls. There were no significant differences between the two patient groups. Significant impairment was found in a subgroup of 16 schizophrenics who showed otherwise intact general intellectual functioning, suggesting the existence of a specific executive deficit. Among the schizophrenic patient group there was evidence of a dissociation between executive and memory impairments. A significant correlation existed between performance on the BADS and relatives ratings of executive problems for the brain injured group, but not for the schizophrenic group. CONCLUSIONS: The BADS is a useful tool for identifying executive deficits in people with a diagnosis of schizophrenia, especially those who are otherwise generally intellectually intact. This is particularly important in the context of rehabilitation and community transition programmes.

Adult↗
PubMed2005

Cardiovascular toxicity is increased, but manageable, during high-dose chemotherapy and autologous peripheral blood stem cell transplantation for patients aged 60 years and older.

High-dose therapy (HDT) for non-Hodgkins lymphoma (NHL) and multiple myeloma (MM) is considered a feasible option for patients aged 60 years. This study compared the outcomes for all patients aged 60 years treated with HDT at the center to a matched cohort group aged <60 years. Results for patients who were 60 years at HDT between 1997--2002 were retrospectively analysed to assess efficacy and safety. Event-free (EFS) and overall survival (OS) rates were compared with a cohort group, matched by disease type, chemotherapy sensitivity, year of treatment and conditioning regimen. Patients with NHL were also matched by International Prognostic Index score. Forty patients aged 60 years were identified. Median age was 65 (range 60--76) with 22 MM and 18 NHL; 50% had 1 or more co-morbidity; 35% had cardiovascular co-morbidity vs. 18% of controls (p=0.075). Response rates (RR) following HDT for MM were: 4 (18%) complete responses (CR) and 18 (82%) partial responses (PR), giving an overall response rate (ORR) of 100%, vs. 77% for controls (p=0.02). For NHL patients there were: 8 CR (44%) and 4 PR (22%), giving an ORR of 67%, vs. 83% for controls (p=0.3). Transplant-related mortality was 8% compared to 5% in controls (p=0.6). Toxicities were similar with the exception of cardiac toxicity, which was significantly higher in patients aged 60 years vs. controls (50% grade 3 vs. 10%: p<0.0001). Atrial fibrillation was the most frequent cardiovascular toxicity (9 patients). At a median follow-up of 33 months, there is no significant difference between older vs. younger patients in median EFS (24 vs. 38 months: p=0.78) or OS (40 months vs. not reached: p=0.23). HDT is feasible and effective in selected patients 60 years with MM and NHL. Patients 60 years are more susceptible to cardiovascular toxicities, particularly atrial fibrillation, but have similar or better response rates following HDT and similar long-term outcomes to younger patients.

Adult↗
PubMed2006

Predictive and discriminative value of shoulder proprioception tests for patients with whiplash-associated disorders.

OBJECTIVE: To evaluate whether patients suffering from whiplash-associated disorders have impaired shoulder proprioception and whether the acuity of shoulder proprioception is reflected in the patients' symptoms and self-rated function. DESIGN: A comparative group design, including a correlation design for the patient group. SUBJECTS: Patients with chronic whiplash-associated disorders (n=37) and healthy subjects (n=41). The groups were matched for age and gender. METHODS: All subjects underwent a shoulder proprioception test involving active ipsilateral arm position-matching. Group difference was evaluated by multiple analysis of variance and analysis of variance. The patient group completed questionnaires addressing functioning and health and performed pain ratings. Associations between proprioceptive acuity and self-rated functioning and symptoms were studied by correlation and regression analyses. RESULTS: The patient group showed significantly lower acuity of shoulder proprioception. Moderate correlations were found between proprioceptive acuity and questionnaire scores representing physical functioning, so that low proprioceptive acuity was associated with low self-rated physical functioning. Scores representing pain-intensity did not correlate with proprioceptive acuity. CONCLUSION: The results show that, at the group level, patients with whiplash-associated disorders have impaired shoulder proprioception. The clinical relevance of this finding is strongly supported by the association between shoulder proprioceptive acuity and self-rated functioning in the patient group.

Adult↗
PubMed1998

A retrospective comparison of functional appliance treatment of Class III malocclusions in the deciduous and mixed dentitions.

This retrospective study compared the effectiveness of treatment of Class III malocclusions with the removable mandibular retractor in the deciduous and mixed dentitions. A group of 20 children with Class III malocclusions started treatment at a mean age of 5 years 1 month +/- 7 months (deciduous dentition), while a group of 18 children with Class III malocclusions started treatment at a mean age of 8 years 2 months +/- 9 months (mixed dentition). The mean observation period was 2 years 3 months +/- 6 months for the first group, and 2 years 4 months +/- 7 months for the second group. Matched control groups of children with untreated Class III malocclusions in the deciduous and in the mixed dentition (16 subjects and 15 subjects, respectively) were used. The cephalometric analysis was based on a stable basicranial reference system appropriate for longitudinal studies that begin at early developmental ages. The results showed that treatment of Class III malocclusions in the deciduous dentition produced a more significant anterior morphogenetic rotation of the mandible, due to a more upward and forward direction of condylar growth (P < 0.01). This leads to significantly smaller increments in mandibular total length (Co-Pg) in children with Class III malocclusions under-going very early treatment (P < 0.01). On the contrary, maxillary dento-alveolar protrusion induced by therapy was greater in Class III subjects treated in the mixed dentition (P < 0.01). The optimum timing to improve skeletal relationships in Class III malocclusions by means of a functional appliance appears to be in the deciduous dentition.

Age Factors↗
PubMed1999

Effect of whole-body vibration on the low back. A study of tractor-driving farmers in north India.

STUDY DESIGN: A retrospective cohort study of tractor-driving farmers (study group) and non-tractor-driving farmers (control group) matched for age, gender, generic/ethnic group, land-holding, and work routines. OBJECTIVES: To determine, using magnetic resonance imaging and clinical investigations, the effect of whole-body vibrations on the back in tractor-driving farmers. SUMMARY OF BACKGROUND DATA: Low back pain and pathologic changes in the lower backs of tractor drivers have been reported. However, no study with a control group matched for work-related risk factors has been reported. METHODS: Fifty tractor-driving farmers were compared with 50 non-tractor-driving farmers matched for age, gender, ethnic group, land-holding, and work routine. Both groups were interviewed for details of work routine, assets held, family profile, and vibration exposure to assess the influence of these parameters on signs and symptoms of backache. Magnetic resonance imaging was done to assess the effect of exposure on whole-body vibration and degenerative changes in the back. Vibration measurements also were done on tractors to observe the actual severity of the vibrations. RESULTS: Regular work-related backache was more common among tractor-driving farmers (40%) than among non-tractor-driving farmers (18%, P = 0.015). Anthropometric evaluation showed abdominal girth and weight to be significantly higher in tractor-driving farmers (P = 0.006 and 0.046, respectively), whereas while height and arm span were similar between the two groups. Clinical examination for evidence of disc or facet degeneration showed no difference between the two groups. Evaluation of magnetic resonance images of tractor-driving farmers and non-tractor-driving farmers by an orthopedic surgeon, radiologist, and neurosurgeon showed degenerative changes to be similar between the two groups (P > 0.050). CONCLUSIONS: Tractor-driving farmers report backache more often than non-tractor-driving farmers, but no significant objective differences on clinical or magnetic resonance imaging evaluation were found between the two groups.

Adult↗
PubMed2004

Lower prevalence of Helicobacter pylori infection in patients with inflammatory bowel disease but not with chronic obstructive pulmonary disease - antibiotic use in the history does not play a significant role.

BACKGROUND: Patients with inflammatory bowel disease have lower prevalence of Helicobacter pylori infection, but the exact reason for this is not yet clear. AIM: To examine whether the antibiotics frequently used in inflammatory bowel disease are responsible for the lower prevalence of H. pylori infection. Patients with chronic obstructive pulmonary disease on prolonged previous antibiotic therapy were used for comparison. METHODS: Presence/absence of H. pylori infection was detected by a (13)C-urea breath test in 133 patients with inflammatory bowel disease (82 ulcerative colitis, and 51 Crohn's disease) and compared with that of 135 patients with chronic obstructive pulmonary disease and with two age-matched control groups (200 patients each). Primary disease location, duration of disease and detailed analysis of previous and current medication (dose and duration of antibiotics, steroids, 5-aminosalicylic acid) were analysed in each cases. RESULTS: Seventeen of the 133 patients with inflammatory bowel disease [12.2% (10/82) of ulcerative colitis and 13.7% (7/51) of Crohn's disease] and 90/135 patients with chronic obstructive pulmonary disease (66.7%) were positive for H. pylori. A total of 78/200 (39%) for the inflammatory-bowel-disease-group-matched controls and 110/210 (55%) for the chronic-obstructive-pulmonary-disease-matched controls were positive for H. pylori. The history of any antibiotic or steroid therapy had no influence on H. pylori status of patients with inflammatory bowel disease. CONCLUSION: The prevalence of H. pylori compared to the age-matched controls is significantly lower in patients with inflammatory bowel disease but not in those with chronic obstructive pulmonary disease. Antibiotic use is not responsible for the lower prevalence of H. pylori infection in patients with inflammatory bowel disease.

Adolescent↗
PubMedDate not supplied

Serum lipids and lipoproteins in insulin-dependent diabetic patients with persistent microalbuminuria.

Serum lipid and lipoprotein concentrations were measured in 18 insulin-dependent diabetic patients with persistent microalbuminuria and an equal number with persistently normal albumin excretion. The groups were matched for sex, age, duration of diabetes, body mass index, insulin dose, and glycosylated haemoglobin. Diabetic patients with persistent microalbuminuria were found to have a significantly lower high density lipoprotein (HDL) cholesterol concentration (difference 0.29, 95% Cl 0.12 to 0.46, mmol l-1, p less than 0.01) and a higher low density lipoprotein (LDL) cholesterol:HDL cholesterol ratio (difference 0.97, 95% Cl 0.29 to 1.65, p less than 0.01) than patients with normal albumin excretion. No significant differences were found in total cholesterol, triglycerides, LDL cholesterol, apolipoprotein (apo) A-I and apo B concentrations. Compared to an age and sex-matched group of non-diabetic subjects with normal albumin excretion, diabetic patients with persistent microalbuminuria had significantly higher concentrations of total cholesterol (p less than 0.05), LDL cholesterol (p less than 0.05) and apo B (p less than 0.01), but a lower concentration of HDL cholesterol (p less than 0.05). No significant differences were found in serum lipids and lipoproteins between diabetic patients with normal albumin excretion and non-diabetic subjects.

Albuminuria↗
PubMed1976

Some implications of variations in techniques of group therapy for social controls.

Variations in techniques of group psychotherapy are related to the clients' ego strength. Clients with developmental or pathological ego deficit have different needs for social controls than those with good ego endowment. This paper illustrates differential use of such controls in three areas. 1. Constacy of the treatment milieu as a frame of reference: For patients with good ego endowment, time and place of group meetings should be kept constant to allow them to look inwards and permit experience of feelings hitherto avoided. A patient is described who, following a break-through of feelings in the group, attempted to disrupt the therapy by usurping control over time and place of sessions. Holding time and place of group meetings constant allows patients with ego deficit to anticipate events and helps them build additional controls over impulses. Responses of borderline patients to changes in the treatment milieu are described. 2. Control of group interactions: Matching group members for ego strength is considered essential. Clinical vignettes illustrate contrasts in group interactions considered therapeutic for patients with ego deficit and those with good ego endowment. Techniques for the first group include ritualising the group process, emphasis on reality rather than fantasy and dilution of inter-patient rapport; techniques that aid patients with good ego endowment to relinquish pathological controls include support of basic questions concerning the individual's identity, free flow of fantasy, tolerance of tension, silences or strong ventilation of affect and facilitating observations from patients concerning the process of interaction. 3. Relationship to the leader: For patients with developmental or pathological ego deficit, it is essential that the therapist be ready to set limits and lend defences when the patient's controls fail. Patients with good ego endowment often have too much control. It follows that the therapist will intervene, clarify and provide structure in the first group much more frequently than in groups for psychoneurotics. For patients with ego deficit the relation to the therapist may have to be moderated lest it further weaken ego boundaries. Such patients often need personal distance. Transference to the institution, to the treatment milieu and to the group as a concrete object provides these patients with a natural means of distancing relationships. The therapist should attempt to fit into this series. He should be highly visible in the benign exercise of his professional function. Rapport should be kept stable and primarily positive even after termination of treatment. In contrast, groups of patients with good ego endowment may relate to the therapist more intensively if he is less visible. These patients, unless they can move back and forth between positive and negative rapport, can hardly be said to be working. They will often attempt to control rapport with the therapist by splitting the transference...

Adult↗
PubMedDate not supplied

Impaired visual attention in children with dyslexia.

Reading involves the correct and rapid identification of visual stimuli with letters and words. The processing of visual stimuli depends not only on the integrity of the peripheral and central visual system but also on the attentional systems involved. In the present study, a cue-target visual attention task was administered to a population-based sample of 25 children with dyslexia from 10 to 12 years of age. A control group matched for group size, age, and gender was obtained from the same general population. A two-stage screening process involved a spelling task of regular words followed by a battery of five single-word reading tasks. The cue-target task involved both a computer-controlled stimulus presentation and a computer-controlled measurement of reaction time. The data were analyzed by visual field, cue condition (valid, invalid, and no cue), and cue-target interval (CTI). The results showed a general pattern of slower responses in the dyslexia group compared to the control group. The dyslexia group also had longer reaction times in the short CTI condition (covert shift of attention) and in the long CTI condition (overt shift of attention). The findings may reflect a general attentional deficit to visual stimuli in dyslexia, possibly related to problems with the recruitment of necessary cognitive resources for the performance of complex reaction time tasks and for fluent reading.

Attention↗