Outcomes for control patients referred to a pediatric asthma outreach program: an example of the Hawthorne effect.
(17/11846)
A study was designed to determine whether identification of high risk for exacerbations of asthma based on pediatrician concern, emergency department visits, or hospital stays results in a decrease of resource utilization because of referral to an asthma outreach program even if the intervention does not take place. The findings for such a group were compared with those for a group who did undergo intervention with an asthma outreach program. Fifty-six patients 1 to 14 years of age were assigned to one of two groups. The control group (those who did not undergo intervention) had consistent but not statistically significant reductions in utilization of emergency visits, hospitalizations, and dollars spent (21%, 24%, and 32%, respectively). The group who underwent intervention with the asthma outreach program had large and statistically significant decreases in the same parameters (emergency visits, 60%, P = 0.001; hospital stays, 74%, P = 0.008; dollars spent, 72%, P = 0.004). However, the apparently insignificant effect of the reductions in utilization by the control group substantially altered interpretation of the outcomes of the study. Cost savings were reduced from $11.69 per dollar spent on intervention to $6.49 per dollar spent. In before-and-after studies such as those typically conducted during continuous quality improvement projects, which typically do not have control groups, investigators need to consider control group effects when they assess the results of intervention. (+info)
Loss of heterozygosity at chromosome 1p in different solid human tumours: association with survival.
(18/11846)
The distal half of chromosome 1p was analysed with 15 polymorphic microsatellite markers in 683 human solid tumours at different locations. Loss of heterozygosity (LOH) was observed at least at one site in 369 cases or 54% of the tumours. LOHs detected ranged from 30-64%, depending on tumour location. The major results regarding LOH at different tumour locations were as follows: stomach, 20/38 (53%); colon and rectum, 60/109 (55%); lung, 38/63 (60%); breast, 145/238 (61%); endometrium, 18/25 (72%); ovary, 17/31 (55%); testis, 11/30 (37%); kidney, 22/73 (30%); thyroid, 4/14 (29%); and sarcomas, 9/14 (64%). High percentages of LOH were seen in the 1p36.3, 1p36.1, 1p35-p34.3, 1p32 and 1p31 regions, suggesting the presence of tumour-suppressor genes. All these regions on chromosome 1p show high LOH in more than one tumour type. However, distinct patterns of LOH were detected at different tumour locations. There was a significant separation of survival curves, with and without LOH at chromosome 1p, in the breast cancer patients. Multivariate analysis showed that LOH at 1p in breast tumours is a better indicator for prognosis than the other variables tested in our model, including nodal metastasis. (+info)
Absence of progesterone receptor associated with secondary breast cancer in postmenopausal women.
(19/11846)
The relationship between expression of receptors for oestrogen and progesterone (ER and PR) and disease progression in breast cancer was investigated by comparing immunocytochemical determinations of ER and PR in fine needle aspirates from primary and secondary breast tumours. Rates of receptor expression were significantly higher in primary than in secondary lesions: for ER 63.3% (n = 689) compared with 45.3% (n = 223), and for PR 53.7% (n = 443) compared with 33.1% (n = 121). The effect of menopausal status was examined by subdividing the patient cohort into those over or under the age of 50 years. In both instances, ER expression in secondary tumours was relatively low; however, only postmenopausal patients had significantly lower rates of PR expression in secondary tumours. Consistent with this, an increase in the ER+PR- profile in secondary tumours compared with primary cases from postmenopausal patients was seen, and in a multivariate analysis, a specific absence of PR expression in secondary tumours was revealed. Comparison of ER and PR expression in simultaneously sampled primary tumours and lymph node metastases from the same patient showed that receptor expression was stable with progression to a metastatic site as results were concordant for ER in 92% (n = 88) and PR in 93.8% of cases (n = 65). These results suggest that absence of PR expression in primary breast cancer is associated with disease progression and may be a marker of an aggressive tumour phenotype. (+info)
Long-term neurological dysfunction and neonatal hypoglycaemia after diabetic pregnancy.
(20/11846)
AIM: To determine if children born to mothers with diabetes mellitus during pregnancy, who subsequently developed neonatal hypoglycaemia, experienced long-term neurological dysfunction. METHODS: Thirteen children with, and 15 without, neonatal hypoglycaemia (blood glucose < 1.5 mmol/l) were randomly selected from a larger cohort and investigated at the age of 8 years. They were also compared with 28 age matched healthy controls. RESULTS: Children with neonatal hypoglycaemia had significantly more difficulties in a validated screening test for minimal brain dysfunction than controls and were also more often reported to be hyperactive, impulsive, and easily distracted. On psychological assessment, they had a lower total development score than normoglycaemic children born to diabetic mothers, and control children. CONCLUSIONS: Neonatal hypoglycaemia in diabetic pregnancy was associated with long-term neurological dysfunction related to minimal brain dysfunction/deficits in attention, motor control, and perception. (+info)
Immunogenicity of hepatitis B vaccine in preterm infants.
(21/11846)
AIM: To assess the immunogenicity of hepatitis B vaccine in preterm and term infants, given in a sequence of three doses beginning soon after birth. METHOD: The immunogenicity of hepatitis B vaccine was assessed in 176 preterm infants (< 35 weeks of gestation), immunised soon after birth, and compared with that in 46 term infants. Titres of hepatitis B antibodies were determined one to two months after the third vaccine. The significance of the differences between the term and preterm groups was determined using Student's t test. RESULTS: A similar proportion of infants in both preterm and term groups attained protective titres of hepatitis B antibodies (88.7% vs 93.4%, respectively; p = NS). However, the term infants had a higher geometric mean titre of antibodies after the third vaccine than did the preterm infants (701.2 (745.0) vs 469.1 (486.2) mU/ml, respectively; p < 0.03). CONCLUSION: Hepatitis B vaccine is effective in most preterm infants when given soon after birth. It may be advisable to determine the immune response at 12-24 months of age to booster the non-responders. (+info)
Influence of erythromycin on establishment of feeding in preterm infants: observations from a randomised controlled trial.
(22/11846)
AIM: To determine the effect of erythromycin on the establishment of enteral feeding in ventilated infants < 31 weeks gestation. METHODS: Erythromycin was randomly allocated as an antimicrobial treatment for the first 7 days of life in 76 infants: 35 received erythromycin and 41 acted as controls. Feed toleration, time taken to establish full enteral feeding, vomiting, prescription of glycerine suppositories and occurrence of necrotising enterocolitis were recorded. RESULTS: There were no significant differences between the groups for any of the outcomes. The infants treated with erythromycin reached full feeding at a median (quartile) age of 8 (5-12) days compared with 9 (6-14) days for controls. CONCLUSIONS: Intravenous erythromycin in antimicrobial doses is unlikely to benefit the introduction of feeding in preterm infants. (+info)
Evaluating methods for estimating premorbid intellectual ability in closed head injury.
(23/11846)
OBJECTIVES: The present study examines the utility of three measures of premorbid intellectual functioning in closed head injury, the National adult reading test (NART), the Cambridge contextual reading test (CCRT), and the spot the word test (STW). METHODS: In the first experiment, a group of 25 patients with closed head injury were compared with 50 healthy controls and 20 orthopaedic trauma controls. In the second experiment, the strength of correlation between the premorbid measures and current intellectual level were assessed in 114 healthy adults. RESULTS: The head injured group performed significantly more poorly than both control groups on measures of current intellectual ability. However, no significant differences emerged between the groups on any of the premorbid measures. In the large control sample, both the NART and the CCRT accounted for about 50% of the variance in current verbal intelligence. However, by contrast, the STW only accounted for 29% of the variability in verbal intelligence. Adding demographic variables to the prediction of current intellectual level increased the amount of variance explained to 60% for the NART, 62% for the CCRT, but only 41% for the STW. CONCLUSION: The results provide supportive evidence for the use of the CCRT and NART in estimating premorbid intellectual functioning in patients who have sustained closed head injuries, but suggest caution when employing the STW. (+info)
Experiences and attitudes of residents and students influence voluntary service with homeless populations.
(24/11846)
OBJECTIVE: To assess the impact of two programs at the University of Pittsburgh, one that requires and one that encourages volunteer activity. In the program that requires primary care interns to spend 15 hours in a homeless clinic, we measured volunteer service after the requirement was fulfilled. In the program that encourages and provides the structure for first- and second-year medical students to volunteer, we assessed correlates of volunteering. MEASUREMENTS AND MAIN RESULTS: When primary care interns were required to spend time at homeless clinics, all (13/13) volunteered to work at the same clinic in subsequent years. Categorical interns without this requirement were less likely to volunteer (24/51; chi2 = 12.7, p >. 001). Medical students who volunteered were more likely to be first-year students, have previously volunteered in a similar setting, have positive attitudes toward caring for indigent patients, and have fewer factors that discouraged them from volunteering (p <. 01 for all) than students who did not volunteer. CONCLUSIONS: Volunteering with underserved communities during medical school and residency is influenced by previous experiences and, among medical students, year in school. Medical schools and residency programs have the opportunity to promote volunteerism and social responsibility through mentoring and curricular initiatives. (+info)