Contributions to a rational diagnosis and treatment of lumbar disk

There is a possibility that some of the above mentioned statements that seem contradictory at first glance will perhaps hold true in peaceful co-existence at second glance. Yet it will be undeniable that some confusion will be part of the researcher or clinician, interested patient, health care planner,9 medical auditor2 or journal editor, 15 who wants to know what is the prevailing professional view and the state of the art of the diagnosis and therapy of this disease. All of these - except for the researcher- do not have enough time, funds and energy to spend several years in collecting and analysing data for their question and fill in possible white areas in our map of knowledge. Most likely they will take refuge in reviewing existing data from the literature, and will try to sift and sort the differently qualified evidence and to combine equivalent data and weigh it against opposite facts. Well, this (and nothing more) is the purpose of the present thesis. Be it that an attempt has been made towards a rational and rationalising way of analysis and synthesis of the research question. This approach, in the past decades borrowed from the military and the econometric and the psychometric domains, can be applied to medical problems as well and is then called "medical decision analysis" (in Dutch medische besliskunde ). The result is not an accurate description of all aspects of diagnosis and treatment ofLDH, but rather a crude representation of the major choices that have to be made in the course of "managing a patient" with this disease. Advocates of this method, emphasizing that decision makers cannot wait and have to adhere to existing data sources, claim that the re~uired data usually can be found in the literature. This claim has waned, however. Another movement, that of meta-analysis6 is indeed exploiting the literature, but indicates that the gold is buried very deep

Genotypes and phenotypes for apolipoprotein E and Alzheimer disease in the Honolulu-Asia aging study

BACKGROUND: The utility of apolipoprotein E (ApoE) type as an indicator of genetic susceptibility to Alzheimer disease (AD) depends on the reliability of typing. Although ApoE protein isoform phenotyping is generally assumed equivalent to genotyping from DNA, phenotype-genotype differences have been reported. METHODS: ApoE genotype and phenotype results were examined for 3564 older (ages 71-93 years) Japanese-American male participants of the Honolulu-Asia Aging Study, an ongoing population-based study of aging and dementia. RESULTS: Both methods demonstrated similar associations of ApoE type with AD: a direct association with ApoE4 and a less dramatic inverse association ApoE2. Advanced age did not appear to influence the ApoE4-AD association. The association with AD among ApoE4 homozygotes [odds ratio (OR) = 14.7] was higher than expected based on an observed OR of 2.0 in heterozygotes. Phenotype-genotype nonconcordance was more frequent for ApoE2 than for ApoE4. The ApoE2 phenotype occurred at a frequency of 7.9% vs a genotype frequency of 4.9%, corresponding to a probability of 56% that an individual with ApoE2 phenotype had the same genotype. CONCLUSIONS: Whereas E4 and E2 phenotypes and genotypes were comparably associated with AD, neither method would be expected to substantially improve the efficiency of case finding in the context of population screening beyond prediction based on age and education. Nonconcordance of phenotype and genotype was substantial for E2 and modest for E4 in this population. The ApoE4-AD association was independent of age

A Novel Time Series Approach to Bridge Coding Changes with a Consistent Solution Across Causes of Death

Revisions of the International Classification of Diseases (ICD) can lead to biases in cause-specific mortality levels and trends. We propose a novel time series approach to bridge ICD coding changes which provides a consistent solution across causes of death. Using a state space model with interventions, we performed time series analysis to cause-proportional mortality for ICD9 and ICD10 in the Netherlands (1979–2010), Canada (1979–2007) and Italy (1990–2007) on chapter level. A constraint was used to keep the sum of cause-specific interventions zero. Comparability ratios (CRs) were estimated and compared to existing bridge coding CRs for Italy and Canada. A significant ICD9 to ICD10 transition occurred among 13 cause of death groups in Italy, 7 in Canada and 3 in the Netherlands. Without the constraint, all-cause mortality after the classification change would be overestimated by 0.4 % (NL), 0.03 % (Canada) and 0.2 % (Italy). The time series CRs were in the same direction as the bridge coding CRs but deviated more from 1. A smooth corrected trend over the ICD-transition resulted from applying the time series approach. Comparing the time series CRs for Italy (2003), Canada (1999) and the Netherlands (1995) revealed interesting commonalities and differences. We demonstrated the importance of adding the constraint, the validity of our methodology and its advantages above earlier methods. Applying the method to more specific causes of death and integrating medical content to a larger extent is advocated

Acute myocardial infarction incidence and hospital mortality: routinely collected national data versus linkage of national registers

Background and Objective To compare levels of and trends in incidence and hospital mortality of first acute myocardial infarction (AMI) based on routinely collected hospital morbidity data and on linked registers. Cases taken from routine hospital data are a mix of patients with recurrent and first events, and double counting occurs when cases are admitted for an event several times during 1 year. By linkage of registers, recurrent events and double counts can be excluded. Study Design and Setting In 1995 and 2000, 28,733 and 25,864 admissions for AMI were registered in the Dutch national hospital discharge register. Linkage with the population register yielded 21,565 patients with a first AMI in 1995 and 20,414 in 2000. Results In 1995 and 2000, the incidence based on the hospital register was higher than based on the linked registers in men (22% and 23% higher) and women (18% and 20% higher). In both years, hospital mortality based on the hospital register and on linked registers was similar. The decline in incidence between 1995 and 2000 was comparable whether based on standard hospital register data or linked data (18% and 20% in men, 15% and 17% in women). Similarly, the decline in hospital mortality was comparable using either approach (11% and 9% in both men and women). Conclusion Although the incidence based on routine hospital data overestimates the actual incidence of first AMI based on linked registers, hospital mortality and trends in incidence and hospital mortality are not changed by excluding recurrent events and double counts. Since trends in incidence and hospital mortality of AMI are often based on national routinely collected data, it is reassuring that our results indicate that findings from such studies are indeed valid and not biased because of recurrent events and double counts

On statistical Survival Analysis and its Applications in Medicine

Korte beschrijving: Dit proefschrift gaat over theoretische en practische aspecten van levensduuranalyse waarbij een gedeelte van de waarnemingen gecensureerd is. Dit soort analyses komen in allerlei situaties voor. In het proefschrift worden echter enkel toepassingen op medisch gebied beschouwd. Een waarneming heet gecensureerd wanneer de werkelijke levensduur (nog) niet kan worden waargenomen, maar men wel heeft kunnen achterhalen dat deze duur groter is dan een bepaalde ondergrens. ... Zie: Summary

Acute generalized exanthematous pustulosis caused by morphine, confirmed by positive patch test and lymphocyte transformation test

Morphine, an opium alkaloid, frequently causes side effects such as hyperhidrosis and facial flushing, but serious cutaneous adverse drug reactions are seldom observed. Best known are Urticaria, erythema, and pruritus; sometimes pseudoallergic anaphylactoid reactions, and blisters are reported