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At least 1,369 records · Page 76Linked to original sources
PubMed1988

Can transabdominal ultrasound estimation of postvoiding residual (PVR) replace catheterization?

In 81 outpatients the postvoiding residual urine (PVR) using real-time B-mode ultrasonography (3.5 MHz transducer) was measured. For the calculation of the bladder volume the formula for an ellipsoid (V = 4/3 pi X r1 X r2 X r3) was found to be most accurate in predicting the actual volume measured by in-and-out catheterization (r = 0.982). Other volume formulas, using only one diameter of the bladder, were found to be much less accurate. For any arbitrary value of PVR, used in determining clinical management, the incidence of misjudgment by ultrasound was negligibly low. We conclude, that sonographic measurement of the PVR as a quick, noninvasive method, should replace catheterization, if the basic equipment is available. Additional information, e.g., prostate size, bladder configuration, diverticula, etc., can be obtained during the procedure without additional costs or loss of time.

Abdomen↗
PubMed1991

Another view of active-controlled trials.

Placebo-controlled efficacy trials may become more difficult to carry out with the increasing availability of effective therapies, especially for serious illnesses where denial of effective therapy may be objectionable ethically. Active-controlled trials aimed at establishing efficacy by demonstration of "equivalence" to "standard" therapy have potentially serious interpretational problems, and do not necessarily encourage good experimental practice. This article describes an alternative approach to the analysis of data from active-controlled trials using the information that makes an active-controlled trial necessary or desirable, namely a large, valid body of information about the consequence of using placebo. The approach uses information about placebo responses and also active agent responses from prior placebo-controlled trials to determine the likelihood of a significant active-placebo difference in an active-controlled trial, or in a trial with a vestigial placebo group. The sensitivity of the treatment comparisons depends directly on the quality of the design and execution of the active-controlled trial. The method is illustrated with data from trials of an H2-receptor antagonist in the treatment of acute duodenal ulcer.

Bayes Theorem↗
PubMed1987

Determining what patients should know about transurethral prostatectomy.

Many hospitals have developed patient education materials for individuals about to undergo surgery. Information in these educational packages varies in quality and is generally based on 'common sense' beliefs concerning what patients wish and need to know. Since such interventions vary greatly in their effectiveness, the present investigation was undertaken to assess empirically the concerns and needs of patients undergoing a specific procedure, transurethral prostatectomy. Data from 73 men who had undergone transurethral prostatectomy for benign enlargement of the prostate and 32 of their wives indicate that patients would have wanted more information concerning the consequences of surgery, both medical and sexual. In addition, written information, clear instructions concerning the do's and don'ts during the recovery period, and reassurance about what is 'normal' and to be expected contributed to feeling positive about the prostatectomy experience. Results concerning helpful and distressing aspects of the surgery experience and patients' recommendations for improvement are presented. The necessary components of patient education materials are discussed and a synthesis of information needed for patient education related to prostatectomy is provided.

Aged↗
PubMed1988

Comparing satisfaction levels of inpatients and outpatients with a diabetes teaching program.

With the changing climate of health care there is an increasing need to offer diabetes education in outpatient rather than inpatient settings. This study was conducted to determine if there is a significant difference in the satisfaction level between inpatients and outpatients receiving diabetes teaching in the same program. Patient satisfaction with the practitioner is a determinant of patient learning and compliance. The study included 42 inpatients and 47 outpatients who participated in the same program and were taught by the same teaching nurses and dietitians. A questionnaire developed for this study examined six areas: (1) demographics; (2) patients' perception of understanding their diabetic condition and treatment; (3) comfort in class; (4) perception regarding treatment as an individual; (5) life satisfaction; and (6) influence of recommendations on future health. The results of the study showed a significant difference (P less than 0.05) in two areas: (1) inpatients felt that more interest and concern were shown towards them than outpatients and (2) more inpatients than outpatients felt they were treated more like individuals than cases. The results indicated that the personalized and ongoing contact inpatients have with the practitioner determine the degree of satisfaction with diabetes teaching received in these important areas.

Consumer Behavior↗
PubMed2005

Impact and determinants of left ventricular function in patients undergoing primary percutaneous coronary intervention in acute myocardial infarction.

We evaluated the prognostic effect of baseline left ventricular function and the determinants of its recovery after acute myocardial infarction (AMI) treated by primary angioplasty. Left ventriculography was performed during the index procedure in 1,620 of 2,082 patients (78%) who underwent primary angioplasty for AMI in the CADILLAC trial. One-year survival rate was significantly lower in patients whose baseline left ventricular ejection fraction (LVEF) was <40% than in those whose LVEF was > or =40% (89.0% vs 97.2%, respectively, p <0.0001). The effect of baseline left ventricular dysfunction on mortality was confined to the first 3 months after AMI; thereafter, survival was independent of baseline LVEF. By multivariate analysis, baseline LVEF (hazard ratio 0.93, 95% confidence interval 0.90 to 0.97, p <0.001) and infarct zone regional wall motion (hazard ratio 2.67, 95% confidence interval 1.08 to 6.63, p = 0.03) were independent predictors of 1-year mortality. Seven-month convalescent LVEF was also directly related to baseline LVEF and inversely correlated with previous AMI, multivessel coronary disease, preprocedural Thrombolysis In Myocardial Infarction grade 0 to 2 flow, larger infarct artery diameter, and infarct artery restenosis at follow-up. In conclusion, baseline left ventricular function measured during the index procedure is a strong independent predictor of early and late survival after primary angioplasty. Simple clinical and angiographic features readily available at the time of primary angioplasty also predict convalescent LVEF and are thus of prognostic utility.

Aged↗
PubMed2004

Two approaches to etiology: the debate over smoking and lung cancer in the 1950s.

Statisticians R.A. Fisher and Joseph Berkson have become infamous for ending up on the "wrong" side of the debate over the evidence linking smoking and lung cancer during the 1950s, and scholars have speculated about their personal motives in the controversy. But there were many senior biostatisticians and epidemiologists voicing similar concerns about the quality of the evidence at the time, albeit with less inflammatory rhetoric. This debate occurred during a time when epidemiological research methods commonly used today were understood by few and were only just beginning to work their way into public health and medicine. All of the participants in the debate over smoking and lung cancer saw the need for explicit and rigorous standards for evaluating etiological hypotheses, but they held conflicting views about what those standards should be. The differing opinions on the evidence reflected two different models of etiological research--controlled experiment as the crucial, objective test of a causal hypothesis versus inferential judgment based on a diverse body of evidence. This debate has relevance for current epidemiological practice, as tension between these two views still remains.

Biomedical Research↗
PubMed2006

Predictive data mining in clinical medicine: current issues and guidelines.

BACKGROUND: The widespread availability of new computational methods and tools for data analysis and predictive modeling requires medical informatics researchers and practitioners to systematically select the most appropriate strategy to cope with clinical prediction problems. In particular, the collection of methods known as 'data mining' offers methodological and technical solutions to deal with the analysis of medical data and construction of prediction models. A large variety of these methods requires general and simple guidelines that may help practitioners in the appropriate selection of data mining tools, construction and validation of predictive models, along with the dissemination of predictive models within clinical environments. PURPOSE: The goal of this review is to discuss the extent and role of the research area of predictive data mining and to propose a framework to cope with the problems of constructing, assessing and exploiting data mining models in clinical medicine. METHODS: We review the recent relevant work published in the area of predictive data mining in clinical medicine, highlighting critical issues and summarizing the approaches in a set of learned lessons. RESULTS: The paper provides a comprehensive review of the state of the art of predictive data mining in clinical medicine and gives guidelines to carry out data mining studies in this field. CONCLUSIONS: Predictive data mining is becoming an essential instrument for researchers and clinical practitioners in medicine. Understanding the main issues underlying these methods and the application of agreed and standardized procedures is mandatory for their deployment and the dissemination of results. Thanks to the integration of molecular and clinical data taking place within genomic medicine, the area has recently not only gained a fresh impulse but also a new set of complex problems it needs to address.

Clinical Medicine↗
PubMed2006

A Cochrane systematic review finds no evidence to support the use of antibiotics for pain relief in irreversible pulpitis.

The Cochrane Systematic Review promotes evidence-based outcomes studies. The review summarized here was conducted in an attempt to achieve reliable evidence concerning the effectiveness, or otherwise, of prescribing antibiotics for patients having irreversible pulpitis. A competent search strategy was developed and used across several databases including MEDLINE to identify randomized controlled trials for inclusion. Assessment of methodological quality was based on criteria defined by The Cochrane Collaboration. Clinical outcome, expressed in terms of pain relief, was examined. There was a relative dearth of research providing a high level of evidence. Only one methodologically sound trial was found that compared pain relief with systemic antibiotic/analgesic treatment against a placebo/analgesic combination during the acute preoperative phase of irreversible pulpitis. Although the selected study used a relatively small, low-powered sample, it did provide some evidence that there is no significant difference in pain relief for patients with untreated irreversible pulpitis who received antibiotics versus those who did not. These findings increase the rationale to investigate the teaching of safe and effective antibiotic prescribing in endodontics and to advance the development of appropriate evidence-based clinical guidelines.

Adult↗
PubMed2002

A hand-ergonomics training kit: development and evaluation of a package to support improved awareness and critical thinking.

A need for a hand-ergonomics training kit has been identified to increase critical thinking concerning choice of hand tools. This study deals with the design, use and evaluation of a hand-ergonomics training kit for use in ergonomics training programmes. The effects on awareness of hand ergonomics among training course participants have been evaluated by means of a questionnaire and interviews at a car production plant in Sweden. The evaluation was carried out about one and a half years after training with the hand-ergonomics training kit. The training kit consists of a guide to practical exercises, equipment for measuring hand size and strength, examples of hand tools for use in practical exercises, equipment for testing and evaluating the hand tools and checklists and judgement forms for qualitative evaluation. In addition, the kit contains relevant scientifically based reference reports on hand ergonomics. The evaluation showed that the practical exercises with the hand-ergonomic training kit had, to a remarkable extent, increased individuals' awareness of anthropometric differences and of the importance of ergonomically well-designed hand tools. After the practical exercises with the training kit, communication within the plant when choosing hand tools seems to be based on objective criteria to a higher degree, however, the results indicate that this communication could be further improved.

Analysis of Variance↗
PubMed1996

The affective dimension of low-back pain: its influence on the outcome of back school.

OBJECTIVE: Back School is a rehabilitation treatment for back pain that requires patients to understand an educational message and motivate themselves to modify their behavior to prevent relapses. In examining failed cases, the question arose as to whether the failures could be attributed to affective dimensions of pain that could be reducing tolerance to the pain itself and jeopardizing patients' compliance. We studied the role of the affective component of back pain in Back School failures to see whether this component can be used to predict the treatment's negative results and whether it can be conditioned by the treatment itself. DESIGN: Inception cohort. SETTING: Forty-two subjects with low back pain were treated with Back School at our rehabilitation department. MAIN OUTCOME MEASURES: Evaluation was carried out before Back School treatment and after 2 months, through functional clinical examination and Short Form-McGill Pain Questionnaire (affective and sensory pain indexes). RESULTS: As outcome of the treatment, we considered the modification of spontaneous and evoked pain and the motility of the spine. Unexpectedly, the nonparametric tests did not show a significant correlation between the affective indicators before and after the treatment. As expected, the two dimensions of pain, affective and sensory, are significantly related to each other, both before and after treatment, but this correlation increases after treatment (from r = .50 to r = 88). CONCLUSIONS: The initial hypothesis was not proven. These results show that high affective scores before Back School do not influence the success of the treatment and that the Back School itself is able to modify both the sensorial and affective pain descriptors.

Adult↗