Asymmetrical dimethylarginine (ADMA) in critically ill patients: high plasma ADMA concentration is an independent risk factor of ICU mortality

0.001) and bilirubin (b=0.121, 95% CI: 0.031-0.212; P=0.009) concentration as markers of hepatic function. Twenty-one (40%) patients deceased during their ICU stay. In a logistic regression model, plasma ADMA ranked as the first and strongest predictor for outcome, with a 17-fold (95% CI: 3-100) increased risk for ICU death in patients who were in the highest quartile for ADMA. CONCLUSIONS: In critically ill patients, plasma ADMA concentration is a strong and independent risk factor for ICU mortality, and hepatic dysfunction is the most prominent determinant of ADMA concentration in this population

Towards a curriculum for the consultant biostatistician:identification of central disciplines

The variation in the background of biostatistical consultants is huge. This varying background in formal education complicates communication. It may, obscure clients' expectations as well as any discussion on qualifications and registration. To tackle these disadvantages as well as to facilitate the training of a new colleague, we need to find common ground. The aim of this paper is to identify the central disciplines which constitute the foundation of biostatistical consultancy. Any task-aimed curriculum should be based on these disciplines. Curriculum design theory was used to guarantee a logical and rational process. The result is the identification of a sextet of disciplines: applied statistics; methodology; epidemiology; communication; computational science, and personal effectiveness. Copyright (C) 2001 John Wiley & Sons, Ltd

Towards a curriculum for the consultant biostatistician: identification of central disciplines

The variation in the background of biostatistical consultants is huge. This varying background in formal education complicates communication. It may, obscure clients' expectations as well as any discussion on qualifications and registration. To tackle these disadvantages as well as to facilitate the training of a new colleague, we need to find common ground. The aim of this paper is to identify the central disciplines which constitute the foundation of biostatistical consultancy. Any task-aimed curriculum should be based on these disciplines. Curriculum design theory was used to guarantee a logical and rational process. The result is the identification of a sextet of disciplines: applied statistics; methodology; epidemiology; communication; computational science, and personal effectiveness. Copyright (C) 2001 John Wiley & Sons, Ltd

The efficacy of voice therapy in patients after treatment for early glottic carcinoma

BACKGROUND. After treatment for early glottic carcinoma, a considerable]lumber of patients end tip with voice problems that interfere with daily life activities. The objective of this randomized and controlled study was to assess the efficacy of voice therapy in these patients. METHODS. Of 177 patients, 6-120 months after treatment for early glottic carcinoma, 70 patients (40%) suffered from voice impairment based on a 5-item screening questionnaire. Approximately 60% of those 70 patients were not interested in participating in the current study. Twenty-three patients who were willing to participate were assigned randomly either to a voice therapy group (n = 12 patients) or to a control group (n = 11 patients). Multidimensional voice analyses (the self-reported Voice Handicap Index [VHI], acoustic and perceptual voice quality analysis, videolaryngostroboscopy, and the Voice Range Profile) were conducted twice: before and after voice therapy or with 3 months in between for the control group. RESULTS. Statistical analyses of the difference in scores (postmeasurement millus premeasurement) showed significant voice improvement after voice therapy oil the total VHI score, percent jitter, and noise-to-harmonics ratio in the voice signal and on the perceptual rating of vocal fry. CONCLUSIONS. Voice therapy proved to be effective in patients who had voice problems after treatment for early glottic carcinoma. Improvement not only was noticed by the patients (VHI) but also was confirmed by objective voice parameters

Does glucose variability influence the relationship between mean plasma glucose and HbA1c levels in type 1 and type 2 diabetic patients?

OBJECTIVE: The A1C-Derived Average Glucose (ADAG) study demonstrated a linear relationship between HbA(1c) and mean plasma glucose (MPG). As glucose variability (GV) may contribute to glycation, we examined the association of several glucose variability indices and the MPG-HbA(1c) relationship. RESEARCH DESIGN AND METHODS: Analyses included 268 patients with type 1 diabetes and 159 with type 2 diabetes. MPG during 3 months was calculated from 7-point self-monitored plasma glucose and continuous glucose monitoring. We calculated three different measures of GV and used a multiple-step regression model to determine the contribution of the respective GV measures to the MPG-HbA(1c) relationship. RESULTS: GV, as reflected by SD and continuous overlapping net glycemic action, had a significant effect on the MPG-HbA(1c) relationship in type 1 diabetic patients so that high GV led to a higher HbA(1c) level for the same MPG. In type 1 diabetes, the impact of confounding and effect modification of a low versus high SD at an MPG level of 160 mg/dL on the HbA(1c) level is 7.02 vs. 7.43 and 6.96 vs. 7.41. All GV measures showed the same tendency. CONCLUSIONS: In only type 1 diabetic patients, GV shows a significant interaction with MPG in the association with HbA(1c). This effect is more pronounced at higher HbA(1c) levels. However, the impact of GV on the HbA(1c) level in type 1 diabetes is modest, particularly when HbA(1c) is close to the treatment target of 7%