292 research outputs found
Assessment of Prognostic Factors in Clinical Medicine
Patients suffering from a certain disease generally differ greatly regarding the course
of their disease. The identification of factors from which much of this variability
between patients can be explained may be of great importance. The study of such prognostic
factors in clinical medicine is usually done for a variety of reasons which to
some extent may overlap each other. One of the reasons may be to better understand
how the disease is likely to behave. It is hardly ever possible nowadays to study the
pure natural history of a disease because usually some form of treatment will have
been undertaken. The treatment often will be curative in intent, but may also be
directed towards the relief of symptoms or avoiding or delaying these in case no
curative treatment is available. It is known from their natural history that certain
illnesses do not require treatment at all because they are self-limited processes.
Knowledge about prognostic factors in such cases will make it possible to provide
information to the patient about the probable duration and course of the disease.
Knowledge of factors which are related to the outcome of disease may be helpful to
physicians in understanding the mechanism of the disease. Such better understanding
may assist in modifying treatment protocols, searching for new treatments or fonnulating
strategies for the optimal use of expensive medical tests. Sometimes knowledge
of prognostic factors may be of use to alter the course of disease by remedial action.
This will particularly be so if these factors are elements of lifestyle such as diet,
exercise or habits. For instance, patients with alcoholic liver cirrhosis who stop taking
alcohol appear to have a better prognosis regarding survival as compared to those
who continue drinking alcohol [Borowsky et ai, 1981]. Such scientifically based facts
may be helpful in encouraging patients to change their drinking habits.
Knowledge of prognostic factors often will be of importance in planning therapeutic
trials. It may be desirable to evaluate certain therapies only in patients who belong to
certain prognostic categories. Also the number of patients required in a randomized
clinical trial depends on the distribution of prognostic factors among patients to be
included in the study
Natural history of benign prostatic hyperplasia: Appropriate case definition and estimation of its prevalence in the community
There is no consensus about a case definition of benign prostatic hyperplasia (BPH). In the present study, BPH prevalence rates were determined using various case definitions based on a combination of clinical parameters used to describe the properties of BPH: symptoms of prostatism, prostate volume increase, and bladder outflow obstruction. The aim of this study—in a community-based population of 502 men (55–74 years of age) without prostate cancer—was to determine the relative impact on prevalence rates of the inclusion of these different parameters (and of different cutoff values for these parameters) in a case definition of BPH. There is agreement that age is the dominant determinant of BPH. However, of 28 different case definitions that were formulated only eight gave a statistically significant increase in the prevalence of BPH with age. The highest overall prevalence of 19% (95% confidence interval [CI], 15–23%) occurred using the definition that combines a prostate volume >30 cm3 and an International Prostate Symptom Score (IPSS) >7. The lowest prevalence rate of 4.3% (95% CI, 2-6%) occurred using the definition that combines a prostate volume >30 cm3, an IPSS >7, a maximum flow rate 50 mL Thus, prevalence rates depend very much on the parameters used in a case definition. Follow-up will establish which men will eventually request a workup and treatment for BPH and will help determine the best clinical definition of BPH
Doppler flow velocity waveforms in the fetal cardiac outflow tract: Reproducibility of waveform recording and analysis
__Abstract__
Reproducibility of flow velocity waveform recording and analysis was studied at fetal cardiac level (ductus arteriosus, pulmonary artery and ascending aorta) in 42 normal pregnancies. The flow velocity parameters studied were the peak systolic velocity (PSV), acceleration time (ACT), acceleration velocity (ACV), average velocity (AV) and flow velocity integral (FVI). In each patient, two consecutive measurements were performed (time delay 15 min) and of each measurement two hardcopies were analysed. A high reproducibility was achieved for the PSV, AV and FVI in all vessels studied; the coefficients of variation between readings of hardcopies were ≤3%, and the coefficients of variation between tests within patients were ≤7%. A moderate reproducibility was achieved for the ACT in the ascending aorta and pulmonary artery; the variation between tests was large for the ductus arteriosus. The reproducibility of the ACV was poor
The follicle-stimulating hormone (FSH) threshold/window concept examined by different interventions with exogenous FSH during the follicular phase of the normal menstrual cycle: duration, rather than magnitude, of FSH increase affects follicle development
According to the threshold concept, FSH concentrations need to surpass a
distinct level to stimulate ovarian follicle growth. The window concept
stresses the significance of a limited duration of elevated FSH levels
above the threshold for single dominant follicle selection. The aim of
this study was to investigate effects on follicle growth of increased FSH
levels, differing in duration and magnitude of elevation, durin
Prostate specific antigen in a community-based sample of men without prostate cancer: Correlations with prostate volume, age, body mass index, and symptoms of prostatism
The correlation between both prostate specific antigen levels (PSA) and prostate specific antigen density (PSAD) and age, prostate volume parameters, body mass index, and the International Prostate Symptom Score (IPSS) were studied in a community‐based population. A sample of 502 men aged 55 through 74 years was evaluated, excluding those with a serum PSA above 10 ng/ml, those with biopsy proven prostate cancer, and those who had previously undergone a prostate operation. PSA and PSAD did not correlate with the body mass index. Weak correlations were found betwe
Neonatal Procalcitonin Intervention Study (NeoPInS): Effect of Procalcitonin-guided decision making on Duration of antibiotic Therapy in suspected neonatal early-onset Sepsis: A multi-centre randomized superiority and non-inferiority Intervention Study
Background: Early diagnosis and treatment of the newborn infant with suspected sepsis are essential to prevent severe and life threatening complications. Diagnosis of neonatal sepsis is difficult because of the variable and nonspecific clinical presentation. Therefore, many newborns with nonspecific symptoms are started on antibiotic treatment before the presence of sepsis has been proven. With our recently published single-centre intervention study we were able to show that Procalcitonin determinations allowed to shorten the duration of antibiotic therapy in newborns with suspected early-onset sepsis.Methods/Design: The study is designed as randomized controlled international multicenter intervention trial on the efficacy and safety of Procalcitonin guided treatment. Term and near-term infants (gestational age ≥ 34 0/7 weeks) with suspected sepsis in the first 3 days of life requiring empiric antibiotic therapy will be included. The duration of antibiotic therapy in the standard group is based on the attending phy
A randomised study on the efficacy and safety of an automated Tru-Cut needle for percutaneous liver biopsy
BACKGROUND: We studied whether the theoretical advantages of a
spring-loaded liver biopsy needle exist in clinical practice and if so if
they are dependent upon the experience of the physician performing the
biopsy. METHODS: In a stratified randomised study we enrolled 215
consecutive patients to compare the safety and efficacy of a new automatic
biopsy gun (Acecut) with that of a standard Tru-Cut needle. RESULTS: A
total of 464 biopsies were performed. The endpoints of the study were
number of needle passes needed per patient, tissue yield of each needle
pass and post-biopsy complications. The performance of the automatic
needle was superior and more consistent with respect to tissue yield
compared with the Tru-Cut needle (median yield 100% and 80%, respectively;
p < 0.001). The difference was most marked for inexperienced physicians.
There was no difference between the two needles in the number of passes
needed. More post-biopsy pain and post-biopsy use of analgesics were
observed in the automatic needle group (p = 0.04). CONCLUSION: The
automatic Tru-Cut needle offers an advantage, particularly for physicians
with no or limited experience in liver biopsies. However more post-biopsy
pain and post-biopsy use of analgesics were observed in the automatic
needle group
Three-dimensional sonographic measurement of normal fetal brain volume during the second half of pregnancy
Objectives: This study was undertaken to develop a three-dimensional (3D) ultrasound method of measuring fetal brain volume. Study design: Serial 3D sonographic measurements of fetal brain volume were made in 68 normal singleton pregnancies a
Vibration therapy reduces CPAP need in a prospective randomised controlled trial
Background: Increased mucus production is a common phenomena following ventilatory support, which might increase morbidity. In order to reduce airway obstruction we tested the effect of vibration therapy on the duration of ventilatory support. Methodology: We conducted a randomised control study in a level IIIC NICU (28 beds) of a university hospital. Compared were nonactive techniques to vibration therapy in preterm infants with a gestational age of 26 - 33 weeks. All infants were ventilated or receive respiratory support by nasal CPAP. Results: 104 infants were enrolled, 49 in the vibration group and 55 in the control group. Demographic characters were in the vibration group compared to control group mean birth weight 1274 (± 335) gram vs. 1240 (± 351) gram and mean gestational age 29.8 (± 1.3) weeks vs. 29.9 (± 1.4) weeks. Vibration therapy did not reduce ventilation time (100 vs. 80 hours, p = 0.88) however duration of CPAP decreases significant (57 vs 157 hours, p < 0.018). Conclusion: Vibration therapy reduced Mean Airway Pressure, oxygen requirements and CPAP need in preterm infants, but did not reduce the duration of mechanical ventilation
- …