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Mean Difference (mean + difference)

Distribution by Scientific Domains
Medical Sciences86%
Psychology4%
Humanities and Social Sciences3%
Business, Economics, Finance and Accounting2%
4 Other Domains5%

Kinds of Mean Difference

  • significant mean difference
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  • weighted mean difference
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    Selected Abstracts

    Diagnostic Accuracy of Handheld Echocardiography for Evaluation of Aortic Stenosis

    ECHOCARDIOGRAPHY, Issue 5 2010
    Arnd Schaefer M.D.
    Background: Symptomatic severe aortic stenosis is associated with increased mortality and morbidity. Early identification of these patients by echocardiography is crucial. We conducted this study to evaluate a handheld ultrasound device (HCU) in patients with suspected severe aortic stenosis (AS) in comparison to a standard echocardiography device (SE). Methods: A HCU (Vivid I; GE Healthcare) and a SE device (Philips iE 33) were used to evaluate 50 consecutive patients with suspected severe AS. Two consecutive echocardiographic studies were performed by two experienced and blinded examiners using HCU and SE device. AS was graded by mean transaortic pressure, aortic valve area (AVA), and indexed AVA (AVA adjusted for body surface area). Results: Mean difference for mean transaortic gradient, AVA and indexed AVA for the SE and HCU device were 1.28 mmHg (,0.70 to 3.26 mmHg), ,0.02 cm2 (,0.06 to 0.01 cm2), and ,0.01 cm2/m2 (,0.03 to 0.01 cm2/m2), respectively. Discrepancies between both devices were not associated with misinterpretation of the degree of AS. Conclusion: Our study demonstrates that HCU can be used to evaluate patients with suspected AS. (ECHOCARDIOGRAPHY 2010;27:481-486) [source]

    Short-term effect of physiotherapy on variability of the lung clearance index in children with cystic fibrosis

    PEDIATRIC PULMONOLOGY, Issue 3 2010
    Susanne I. Fuchs MD
    Abstract Multiple breath washout (MBW) for measuring the lung clearance index (LCI) has been proposed as a non-invasive tool for detecting early cystic fibrosis (CF) lung disease. The LCI is highly repeatable and reproducible in healthy subjects. In patients with CF, within-test variability is low. However, application of physiotherapy (PT) immediately preceding MBW may affect LCI variability in CF patients and thus interpretation of repeat measurements and treatment effects. Therefore, the aim of the present study was to prospectively assess the short-term effect of PT on LCI in CF patients in order to address the question whether or not standardized timing of PT and MBW has to be considered when introducing MBW into clinical CF management. Twenty-seven out of 32 patients (5.7,15.9 years) with CF successfully performed two technically acceptable MBW tests with the EasyOne Pro, MBW Module (ndd, Switzerland) at intervals of 1½,hr. Sixteen out of 27 received 30,min PT in between, whereas 11/27 did not. Repeatability expressed as intraindividual coefficient of variation (CV) was 6.1% pre-PT and 6.5% post-PT. Mean difference (95% CI) of LCI between the two tests was ,0.20 (,0.51; 0.11). Reproducibility (SD) was 4.6% (3.1). Repeatability was 4.2% and 7.1% without intervention. Mean difference (95% CI) of LCI between 1st and 2nd test was 0.07 (,0.22; 0.35). Reproducibility (SD) was 2.6% (2.1). In conclusion, PT does not have a consistent effect on the LCI. Repeatability was slightly poorer than published for healthy subjects possibly reflecting variable mucus plugging, and, thus, variable trapped air in patients with CF. Reproducibility was good and independent on intervention. From our data, we conclude that timing of PT in relation to MBW can be ignored when designing study protocols or when interpreting longitudinal data and treatment effects. Pediatr Pulmonol. 2010; 45:301,306. © 2010 Wiley-Liss, Inc. [source]

    Non-invasive measurement of cardiac output by Finometer in patients with cirrhosis

    CLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 4 2010
    N. Kaltoft
    Summary The Finometer measures haemodynamic parameters including cardiac output (CO) using non-invasive volume-clamp techniques. The aim of this study was to determine the accuracy of the Finometer in hyperdynamic cirrhotic patients using an invasive indicator dilution technique as control. CO was measured in twenty-three patients referred for invasive measurements of the hepatic venous pressure gradient on suspicion of cirrhosis. Invasive measurements of CO were performed using indicator dilution technique (COI) and simultaneous measurements of CO were recorded with the Finometer (COF). In six patients, measurements of CO were performed with invasive technique and the Finometer both before and after ,-blockade using 80 mg of propranolol and the changes in CO (,COI and ,COF respectively) were calculated to evaluate the Finometers ability to detect relative changes in CO. Mean COI was 6·1 ± 1·6 [3·9;9·7] l min,1 (mean ± SD [range]) compared to mean COF of 7·2 ± 2·3 [3·1;11·9] l min,1. There was a mean difference between COF and COI of 1·0 ± 1·8 [,2·1;4·0] l min,1 and 95% confidence interval of [0·2;1·8], P<0·001. In patients with measurements before and after ,-blockade, mean ,COI was 1·6 ± 1·4 [,0·1;3·3] l min,1 compared to mean ,COF of 1·9 ± 1·3 [0·4;3·8] l min,1. Mean difference between ,COF and ,COI was 0·3 ± 0·3 [,0·2;0·7] l min,1 with a 95% confidence interval of [,0·1;0·6], P = 0·11. Compared with invasive measurements, the Finometer can be used to measure changes in CO, whereas absolute measurements are associated with higher variation in patients with cirrhosis. The Finometer seems useful for repeated determinations such as in studies of effect of pharmacotherapy. [source]

    The influence of bladder filling on anorectal function

    COLORECTAL DISEASE, Issue 3 2003
    J. J. Crosbie
    Abstract Objective The aim of this study was to develop a technique to simultaneously evaluate bladder and anorectal function. In particular, this study was designed to determine if anal sphincter resting pressure, anal sphincter squeeze pressure and rectal sensation change with bladder filling. Patient and methods A pilot study of ten female patients who presented to the pelvic physiology unit for assessment of urinary symptoms was performed. All patients completed a symptom questionnaire and quality of life assessment form. Following informed consent a baseline urodynamic test was performed with the bladder empty and subsequently followed by an anorectal manometric test. Changes in anal sphincter resting pressure, squeeze pressure and rectal pressure were recorded over a ten-minute period. With the patient lying in the left lateral position, the bladder was then filled with isotonic saline at room temperature at a constant rate of 30ml/min. A continuous assessment of changes in anal sphincter resting pressure during bladder filling was made. Anal sphincter squeeze pressure and rectal sensation were measured at fixed intervals during bladder filling (50, 100, 150 ml etc.) and at fixed intervals relative to bladder capacity (25, 50, 75 and 100% capacity) by stopping bladder filling at the appropriate level. Results , There was no significant change in anal sphincter resting pressure (Mean difference(s.d.) between bladder full and empty = 2.7(5.6) P = 0.92*), squeeze pressure (Mean(s.d.) difference = 9.5(26.3) P = 0.86*) and rectal sensation (Mean difference(s.d.) first sensation 10(15.2) P = 0.958; Mean difference(s.d.) urgency = 10(17.8) P = 0.07*) on bladder filling. Conclusion , Under normal physiological circumstances, bladder filling does not influence anorectal function. *Stastistical analysis: Wilcoxon signed rank sum test. P < 0.05 considered significant. Units = mmHg [source]

    Accuracy of an electronic apex locator in primary teeth with root resorption

    INTERNATIONAL ENDODONTIC JOURNAL, Issue 2 2009
    O. Angwaravong
    Abstract Aim, To evaluate whether root resorption of primary molar teeth affects the accuracy of the Root ZX apex locator and to compare the Root ZX at different meter readings with direct canal measurement. Methodology, Sixty extracted primary molar teeth with root resorption affecting one sixth to one third of root length were used. The teeth were embedded in an alginate model. A K-type file was used in association with a Root ZX apex locator to measure canal length. Measurements were recorded using the Root ZX meter reading ,Apex' and ,0.5 bar'. Actual tooth length was measured with a K-file to the major foramen. All measurements were read under a stereomicroscope at 15× magnification. The deviation of the Root ZX measurement from the actual canal length was determined. Results, Mean differences between Root ZX length meter reading ,Apex' and actual length were 0.01 ± 0.23 mm whereas mean differences between Root ZX length meter reading ,0.5 bar' and actual length were ,0.33 ± 0.30 mm. The Root ZX was 96.7% accurate to within ± 0.5 mm of the apical foramen when compared with the actual canal length of primary molars with root resorption. Conclusions, Using a criterion of ± 0.5 mm, the accuracy of the Root ZX was high and not affected by root resorption. When compared with direct canal measurement, the error in locating the apical foramen was smaller with measurement at meter reading ,Apex' than meter reading ,0.5 bar'. [source]

    Transient thermal modelling of heat recovery steam generators in combined cycle power plants

    INTERNATIONAL JOURNAL OF ENERGY RESEARCH, Issue 11 2007
    Sepehr Sanaye
    Abstract Heat recovery steam generator (HRSG) is a major component of a combined cycle power plant (CCPP). This equipment is particularly subject to severe thermal stress especially during cold start-up period. Hence, it is important to predict the operational parameters of HRSGs such as temperature of steam, water, hot gas and tube metal of heating elements as well as pressure change in drums during transient and steady-state operation. These parameters may be used for estimating thermal and mechanical stresses which are important in HRSG design and operation. In this paper, the results of a developed thermal model for predicting the working conditions of HRSG elements during transient and steady-state operations are reported. The model is capable of analysing arbitrary number of pressure levels and any number of elements such as superheater, evaporator, economizer, deaerator, desuperheater, reheater, as well as duct burners. To assess the correct performance of the developed model two kinds of data verification were performed. In the first kind of data verification, the program output was compared with the measured data collected from a cold start-up of an HRSG at Tehran CCPP. The variations of gas, water/steam and metal temperatures at various sections of HRSG, and pressure in drums were among the studied parameters. Mean differences of about 3.8% for temperature and about 9.2% for pressure were observed in this data comparison. In the second kind of data verification, the steady-state numerical output of the model was checked with the output of the well-known commercial software. An average difference of about 1.5% was found between the two latter groups of data. Copyright © 2007 John Wiley & Sons, Ltd. [source]

    A new rapid home test for faecal calprotectin in ulcerative colitis

    ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2010
    M. ELKJAER
    Summary Background, Enzyme-linked immunosorbent assay (ELISA) is a time-consuming method for the measurement of faecal calprotectin. Two new quantitative rapid tests have been developed. Aim, To compare the new rapid tests with ELISA as ,Gold Standard'. Methods, Quantitative analysis involved the application of a sample onto the ,Lateral Flow Device'. The colour intensity of a test line was read using a laptop computer linked to a scanner (rapid test scanning). A picture taken with a mobile phone (HT photo) of the same ,Lateral Flow Device' was sent to a server via Mobile Internet and the result appeared on the phone screen after 15 s. Results, A total of 404 faecal samples were analysed. Mean differences of 1.7 mg/kg (range ,23.4,20.1) ELISA vs. rapid test scanning, 6.8 mg/kg (,28,14.5) ELISA vs. HT photo and 2.9 mg/kg (,10.3,4.5) rapid test scanning vs. HT photo were found with good agreement calculated using kappa statistic (86%, 87% and 95% respectively). The Coefficients of Variation for HT photo was <10%, with a sensitivity of 96.2% and a specificity of 90.1%. Conclusions, The new rapid tests are accurate and useful in clinical settings. Feasibility of the home test as part of disease control and self-management is currently being investigated. Aliment Pharmacol Ther,31, 323,330 [source]

    Health-related quality of life in a cohort of adult patients with mild hemophilia A

    JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 5 2008
    M. WALSH
    Summary.,Objectives:,To compare the health-related quality of life among adult males affected with mild hemophilia A due to the same mutation (Val2016ala) to that of unaffected age and sex matched controls from the same general population. Methods:,The Short-Form 36 (SF-36) and Health Assessment Questionnaire (HAQ) were used to measure health-related quality of life and physical function. Other measures included bleeding history, a measure of joint damage, body mass index, age, and viral infection status. Cross-sectional data were collected through research clinics and a retrospective chart audit over a two-year period. Results and Conclusions:,The study included 47 affected males and 33 controls. The affected males had a higher level of co-morbidity, prior bleeding, and existing joint damage than controls. With the exception of the social function and health transition scales, mean scores for each of the SF-36 domains were worse among affected males. Mean differences were more than a clinically important five points in five of eight domains, with the general health scale showing more than a 10-point difference. Despite the degree of difference noted, only two of the differences were statistically significant (general health and role emotional scales) because of the small sample size and considerable individual variation in SF-36 scale scores. Multiple regression analyses suggested existing joint damage and presence of heart disease as the strongest associates of lower physical health-related quality of life. Joint damage in turn was partly related to prior hemarthroses. Compared to the Canadian population, affected males had lower scores in six out of eight SF-36 domains as well as the physical component summary score. There were no significant differences found in the HAQ scores between the two groups. So-called mild hemophilia A was associated with a negative effect on physical health-related quality of life, contributed to by joint damage as a result of prior bleeding. [source]

    Effectiveness of dentine bonding agents against cariogenic bacteria in vitro: a comparison of two methods

    MOLECULAR ORAL MICROBIOLOGY, Issue 3 2003
    O. A. Schmidlin
    Data obtained from studies on the antimicrobial properties of bonding agents are the subject of controversy, probably because of methodological differences. This study compared two commonly used in vitro methods, the disc agar diffusion test and the well agar diffusion test. Agar plates were seeded with Streptococcus sobrinus, Lactobacillus gasseri, or Actinomyces naeslundii. For the well diffusion test, wells cut out of the agar were filled with the test material, and for the disc method, discs impregnated with the test material were applied to the agar; the discs and wells were both 9 mm in diameter. After incubation, measurements of the zones of inhibition showed little agreement between the two methods when bonding agents were tested; the mean differences (± sdiff) in the zones of inhibition between the methods were 0.7 ± 3.4 mm (P = 0.40, one sample t -test against zero), 4.9 ± 4.4 mm (P = 0.97), and 0.8 ± 4.3 mm (P = 0.47) for S. sobrinus, L. gasseri, and A. naeslundii, respectively. Mean differences were less contrasting when chlorhexidine and pure components were tested (P < 0.05 for S. sobrinus and L. gasseri). These results indicate the need for a gold standard method to evaluate the antimicrobial properties of bonding agents. [source]

    Improvement in health-related quality of life with fluticasone propionate compared with budesonide or beclomethasone dipropionate in adults with severe asthma

    RESPIROLOGY, Issue 3 2003
    Carolyn RUTHERFORD
    Objective: Changes in health-related quality of life (HRQoL) were evaluated in adults with severe asthma following inhaled corticosteroid treatment with high-dose beclomethasone dipropionate or budesonide (BDP/BUD) and compared with fluticasone propionate taken at approximately half the dose of BDP/BUD. Methodology: HRQoL was assessed as part of an open, multicentre, randomized, parallel-group study in Australia evaluating the safety and efficacy of switching to fluticasone propionate (FP) 1000,2000 µg/day (n = 67) compared with remaining on BDP/BUD ,1750 µg/day (n = 66) for 6 months. Patients completed two HRQoL questionnaires, the Asthma Quality of Life Questionnaire (AQLQ) and the Medical Outcomes Study Short Form-36 (SF-36), at baseline and at weeks 12 and 24. A change in AQLQ score of ,0.5 was considered to be clinically meaningful. Results: There were significant improvements in HRQoL with FP on four of the eight dimensions on the SF-36 (i.e. physical functioning, general health, role-emotional, and mental health), while there were no significant improvements in HRQoL in the BDP/BUD group. Overall, patients in the FP group experienced significantly greater improvement (P < 0.001) in AQLQ scores at weeks 12 and 24 compared with the BDP/BUD group. On the individual domains of the AQLQ, there were significant treatment differences (P < 0.01) in favour of FP in three of the four domains (activity limitations [0.92], symptoms [0.73], and emotional function [1.02]). Mean differences between groups for overall score and these three domains were also clinically meaningful. Conclusion: Patients with severe asthma who received FP (at approximately half the dose of BDP/BUD) experienced statistically significant, as well as clinically meaningful, improvements in their HRQoL. [source]

    Perceived competence and school adjustment of hearing impaired children in mainstream primary school settings

    CHILD: CARE, HEALTH AND DEVELOPMENT, Issue 6 2008
    N. Hatamizadeh
    Abstract Background Although educational main streaming of children with special needs formally began in Iran since 1992 there is little information whether hearing impaired children feel competent in regular schools. Methods To determine the perceived competence and school adjustment of hearing impaired children in mainstream primary school settings, the self-perception profile was administered to 60 mainstreamed hard of hearing children and 60 classmates with normal hearing matched for gender by a single interviewer. The instrument comprised 28 items, 23 of which were similar to those of ,adapted test Image for children with cochlear implants' asking children about their feelings about their own cognitive, physical, socio-emotional and communication competence and school adjustment. The Cronbach alpha coefficient for the instrument was 0.93. Results Hard of hearing children rated their competence significantly poorer than their hearing classmates for all domains. Mean differences for the five domains ranged from 0.48 (for physical competence) to 0.90 (for school adjustment) on a scale of 1,4. There were no significant differences between girls' and boys' competence, in either the hearing or the hearing impaired groups. Classifying overall scores for perceived competence into four groups (,poor competence', ,low competence', ,moderate competence' and ,high competence'), 23.4% of hearing impaired children but none of the hearing classmates rated themselves as having low or poor competence. On the other hand 85% of hearing children and only 18.3% of hearing impaired children rated themselves as highly competent. Conclusion We suggest that periodical assessments of mainstreamed children might help to identify those children who are having difficulty adapting to their environment. [source]

    Actigraph-defined moderate-to-vigorous physical activity cut-off points among children: statistical and biobehavioural relevance

    ACTA PAEDIATRICA, Issue 4 2009
    Comlavi B Guinhouya
    Abstract Aim: To compare Actigraph-defined moderate-to-vigorous physical activity (MVPA) cutpoints among children, combining statistical and biobehavioural analyses. Methods: One hundred and thirteen children aged 10.0 ± 0.8 years wore accelerometer for three days. The time they spent in MVPA was estimated using 10 thresholds ranged from 3000 to 3900 cpm. A statistical construct including 45 Bland and Altman pairwise analyses was used to compare the 10 estimates of MVPA. A regression was performed to develop an equation relating mean differences to the between-cutpoint gaps. Results: Mean differences in the MVPA estimates ranged from 1.6 to 12.8 min as a function of increment. Raw estimates of MVPA decreased according to an arithmetic sequence with a common difference of 200 cpm. This difference translates into a drop of 12% in MVPA and a misclassification of up to 5% of children. Mean differences (Y) could be predicted from increments (X) using: Y= 0.02 X (R2= 0.99, SEE = 0.72, p < 0.0001). Conclusion: When a lack of agreement should be assumed as the between-cutpoint gap exceeds 200 cpm, statistical differences may occur earlier at 90 cpm. Yet, the current equation makes it possible to compare and adjust results from studies/interventions using diverse cutpoints for MVPA among children. [source]

    The Effect of Emergency Department Expansion on Emergency Department Overcrowding

    ACADEMIC EMERGENCY MEDICINE, Issue 4 2007
    Jin H. Han MD
    Abstract Objectives: To examine the effects of emergency department (ED) expansion on ambulance diversion at an urban, academic Level 1 trauma center. Methods: This was a pre-post study performed using administrative data from the ED and hospital electronic information systems. On April 19, 2005, the adult ED expanded from 28 to 53 licensed beds. Data from a five-month pre-expansion period (November 1, 2004, to March 1, 2005) and a five-month postexpansion period (June 1, 2005, to October 31, 2005) were included for this analysis. ED and waiting room statistics as well as diversion status were obtained. Total ED length of stay (LOS) was defined as the time from patient registration to the time leaving the ED. Admission hold LOS was defined as the time from the inpatient bed request to the time leaving the ED for admitted patients. Mean differences (95% confidence interval [CI]) in total time spent on ambulance diversion per month, diversion episodes per month, and duration per diversion episode were calculated. An accelerated failure time model was performed to test if ED expansion was associated with a reduction in ambulance diversion while adjusting for potential confounders. Results: From pre-expansion to postexpansion, daily patient volume increased but ED occupancy decreased. There was no significant change in the time spent on ambulance diversion per month (mean difference, 10.9 hours; 95% CI =,74.0 to 95.8), ambulance diversion episodes per month (two episodes per month; 95% CI =,4.2 to 8.2), and duration of ambulance diversion per episode (0.3 hours; 95% CI =,4.0 to 3.5). Mean (±SD) total LOS increased from 4.6 (±1.9) to 5.6 (±2.3) hours, and mean (±SD) admission hold LOS also increased from 3.0 (±0.2) to 4.1 (±0.2) hours. The proportion of patients who left without being seen was 3.5% and 2.7% (p = 0.06) in the pre-expansion and postexpansion periods, respectively. In the accelerated failure time model, ED expansion did not affect the time to the next ambulance diversion episode. Conclusions: An increase in ED bed capacity did not affect ambulance diversion. Instead, total and admission hold LOS increased. As a result, ED expansion appears to be an insufficient solution to improve diversion without addressing other bottlenecks in the hospital. [source]

    Foetal size to final height

    ACTA PAEDIATRICA, Issue 6 2000
    J Karlberg
    It is well known that some adult diseases, such as cardiovascular diseases, may be programmed during foetal life. It is not clear, however, whether final height may be predicted from foetal growth. A longitudinal cohort of full-term healthy Swedish babies (n = 3650) was followed up from birth to maturity in a population-based growth study. Length or height and its changes were analysed from birth to 18 y of age; 2807 children, with data available on birth length, final height and parental height, were included in this analysis. The result clearly shows that length at birth relates to final height. In terms of standard deviation scores (SDS), the mean difference in length at birth from the mean was greatly decreased in final height, but retained the same order as was seen at birth. In terms of centimeter difference from the reference mean values, the difference in length at birth remained roughly stable into final height. For instance, babies 5 cm above or below the mean birth length will end up approximately 5 cm above or below the mean in final height. Parental height,a surrogate value of the genetic final height potential of an individual,is shown to influence postnatal growth in height strongly. However, the difference from the mean in length at birth remained into adulthood within the same midparental height group. Conclusion: This study reveals that trends in foetal linear growth continue into maturity. Foetal growth is a significant predictor of postnatal growth. Final height is dependent on both the magnitude of foetal growth and the genetic potential in stature, and appears to some extent to be programmed from foetal growth. [source]

    Effect of Normal Saline Infusion on the Diagnostic Utility of Base Deficit in Identifying Major Injury in Trauma Patients

    ACADEMIC EMERGENCY MEDICINE, Issue 12 2006
    Richard Sinert DO
    Abstract Background Base deficit (BD) is a reliable marker of metabolic acidosis and is useful in gauging hemorrhage after trauma. Resuscitation with chloride-rich solutions such as normal saline (NS) can cause a dilutional acidosis, possibly confounding the interpretation of BD. Objectives To test the diagnostic utility of BD in distinguishing minor from major injury after administration of NS. Methods This was a prospective observational study at a Level 1 trauma center. The authors enrolled patients with significant mechanism of injury and measured BD at triage (BD-0) and at four hours after triage (BD-4). Major injury was defined by any of the following: injury severity score of ,15, drop in hematocrit of ,10 points, or the patient requiring a blood transfusion. Patients were divided into a low-volume (NS < 2L) and a high-volume (NS , 2L) group. Data were reported as mean (±SD). Student's t- and Wilcoxon tests were used to compare data. Receiver operating characteristic (ROC) curves tested the utility of BD-4 in differentiating minor from major injury in the study groups. Results Four hundred eighty-nine trauma patients (mean age, 36 [± 18] yr) were enrolled; 82% were male, and 34% had penetrating injury. Major-(20%) compared with minor-(80%) injury patients were significantly (p = 0.0001) more acidotic (BD-0 mean difference: ,3.3 mmol/L; 95% confidence interval [CI] =,2.5 to ,4.2). The high-volume group (n = 174) received 3,342 (±1,821) mL, and the low-volume group (n = 315) received 621 (±509) mL of NS. Areas under the ROC curves for the high-volume (0.63; 95% CI = 0.52 to 0.74) and low-volume (0.73; 95% CI = 0.60 to 0.86) groups were not significantly different from each other. Conclusions Base deficit was able to distinguish minor from major injury after four hours of resuscitation, irrespective of the volume of NS infused. [source]

    Digital versus Local Anesthesia for Finger Lacerations: A Randomized Controlled Trial

    ACADEMIC EMERGENCY MEDICINE, Issue 10 2006
    Stuart Chale MD
    Abstract Objectives To compare the pain of needle insertion, anesthesia, and suturing in finger lacerations after local anesthesia with prior topical anesthesia with that experienced after digital anesthesia. Methods This was a randomized controlled trial in a university-based emergency department (ED), with an annual census of 75,000 patient visits. ED patients aged ,8 years with finger lacerations were enrolled. After standard wound preparation and 15-minute topical application of lidocaine-epinephrine-tetracaine (LET) in all wounds, lacerations were randomized to anesthesia with either local or digital infiltration of 1% lidocaine. Pain of needle insertion, anesthetic infiltration, and suturing were recorded on a validated 100-mm visual analog scale (VAS) from 0 (none) to 100 (worst); also recorded were percentage of wounds requiring rescue anesthesia; time until anesthesia; percentage of wounds with infection or numbness at day 7. Outcomes were compared by using Mann-Whitney U and chi-square tests. A sample of 52 patients had 80% power to detect a 15-mm difference in pain scores. Results Fifty-five patients were randomized to digital (n= 28) or local (n= 27) anesthesia. Mean age (±SD) was 38.1 (±16.8) years, 29% were female. Mean (±SD) laceration length and width were 1.7 (±0.7) cm and 2.0 (±1.0) mm, respectively. Groups were similar in baseline patient and wound characteristics. There were no between-group differences in pain of needle insertion (mean difference, 1.3 mm; 95% confidence interval [CI] =,17.0 to 14.3 mm); anesthetic infiltration (mean difference, 2.3 mm; 95% CI =,19.7 to 4.4 mm), or suturing (mean difference, 7.6 mm; 95% CI =,3.3 to 21.1 mm). Only one patient in the digital anesthesia group required rescue anesthesia. There were no wound infections or persistent numbness in either group. Conclusions Digital and local anesthesia of finger lacerations with prior application of LET to all wounds results in similar pain of needle insertion, anesthetic infiltration, and pain of suturing. [source]

    Cognitive-behavioural therapy for late-life anxiety disorders: a systematic review and meta-analysis

    ACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2008
    G. J. Hendriks
    Objective:, To examine and estimate the efficacy of cognitive-behavioural therapy (CBT) for late-life anxiety disorders. Method:, A systematic review and meta-analysis of randomized controlled trials comparing CBT with i) a waiting-list control condition and ii) an active control condition controlling for non-specific effects in patients aged over 60 years and suffering from an anxiety disorder. The main outcome parameter of individual studies, i.e. effect on anxiety, was pooled using the standardized mean difference (SMD). Results:, Seven papers fulfilled the inclusion criteria, including nine randomized controlled comparisons for 297 patients. Anxiety symptoms were significantly more reduced following CBT than after either a waiting-list control condition [SMD = ,0.44 (95 CI: ,0.84 ,0.04), P = 0.03] or an active control condition [SMD = ,0.51 (95 CI: ,0.81, ,0.21), P<0.001]. Additionally, CBT significantly alleviated accompanying symptoms of worrying and depression. Conclusion:, Cognitive-behavioural therapy is efficacious for the treatment of late-life anxiety disorders. [source]

    Has repetitive transcranial magnetic stimulation (rTMS) treatment for depression improved?

    ACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2007
    A systematic review, meta-analysis comparing the recent vs. the earlier rTMS studies
    Objective:, To investigate whether the recent repetitive transcranial magnetic stimulation (rTMS) studies on depression using new parameters of stimulation have shown improved clinical results. Method:, We performed a systematic review and a meta-analysis of the rTMS studies on depression published in the past 12 months comparing these results with an earlier meta-analysis that analyzed the results of the initial rTMS studies on depression. Results:, Using our inclusion criteria, we selected the meta-analysis of Martin [Br J Psychiatry (2003) Vol. 182, 480,491] that included 13 studies (324 patients) and five studies for the recent meta-analysis (274 patients). The pooled effect size (standardized mean difference between pretreatment vs. post-treatment) from the random effects model was ,0.76 (95% confidence interval, CI, ,1.01 to ,0.51). This result was significantly larger than that of the earlier meta-analysis (,0.35, 95% CI ,0.66 to ,0.04). Conclusion:, Our findings suggest that recent rTMS clinical trials have shown larger antidepressant effects when compared with the earlier studies. [source]

    Addition of insulin lispro protamine suspension or insulin glargine to oral type 2 diabetes regimens: a randomized trial

    DIABETES OBESITY & METABOLISM, Issue 10 2010
    K. Strojek
    Aims: The addition of basal insulin to existing oral therapy can help patients with type 2 diabetes (T2D) achieve glycaemic targets. This study compares the efficacy and safety of insulin lispro protamine suspension (ILPS) and insulin glargine in insulin-naive patients with T2D and inadequate control on oral antihyperglycaemic medication (OAM). Materials and Methods: An open-label, randomized, multicentre, multinational 24-week study of 471 patients receiving ,2 OAMs for ,3 months with a body mass index between 25 and 45 kg/m2 and HbA1c 7.5,10.0% was conducted. ILPS was injected once or twice daily vs. glargine injected once daily plus prestudy OAMs. Primary objective compared the HbA1c change from baseline. Results: HbA1c change from baseline to endpoint was similar in both groups [,1.46% (ILPS) and ,1.41% (glargine)]. Least-squares mean difference (95% CI) for HbA1c (,0.05 [,0.21, 0.11]%), glycaemic variability (0.06 [,0.06, 0.19] mmol/l) and weight change (,0.01 [,0.61, 0.59] kg) showed non-inferiority (margins of 0.4%, 0.8 mmol/l and 1.5 kg, respectively). Percentages of patients achieving HbA1c <7.0% were 43.8% ILPS and 41.2% glargine. Mean daily insulin dose was 0.39 vs. 0.35 U/kg (p = 0.02) and weight gain was 1.04 vs. 1.07 kg for ILPS vs. glargine (p = 0.98). Overall hypoglycaemia (episodes/patient/year) was similar for ILPS and glargine (24.2 ± 28.8 vs. 23.0 ± 30.9); nocturnal (6.1 ± 10.6 vs. 4.1 ± 9.4, p < 0.001) rates were higher for ILPS. Severe hypoglycaemia was higher for ILPS vs. glargine (n = 9 vs. n = 2; p = 0.04). Conclusions: At endpoint, ILPS was non-inferior to glargine in HbA1c change from baseline, but associated with increased risk of hypoglycaemia. [source]

    The effect of thiazolidinediones on adiponectin serum level: a meta-analysis

    DIABETES OBESITY & METABOLISM, Issue 5 2008
    N. Riera-Guardia
    Background and aims:, Adiponectin is a hormone mainly produced by white adipose tissue. Decreased levels of adiponectin are linked with visceral obesity, insulin resistance states, and cardiovascular diseases. Recently, several studies have pointed out an increase in adiponectin serum levels in subjects undergoing treatment with thiazolidinediones (TZD). The aim of this study is to systematically review the current state of evidence of the effect of TZD on adiponectin serum level with special attention to avoid publication bias. Materials and methods:, An extensive literature search was performed. Meta Analysis Version 2.0 computer program was used to calculate statistical differences in means and 95% confidence interval (CI). Publication bias was assessed using different statistical approaches. Results:, In the meta-analysis including 19 studies the overall standardized mean difference was 0.94 (95% CI, 0.81,1.06) which means that subjects treated with TZDs on average had means of adiponectin concentration that were about 1 standard deviation higher than the comparison groups even after controlling for possible biases. Conclusions:, The results obtained agree with a moderate increase of serum adiponectin. The results clearly reveal an increase of endogenous serum adiponectin levels by intake of TZDs and may point to a potential new option to manage obesity-related diseases. [source]

    Twice daily biphasic insulin aspart improves postprandial glycaemic control more effectively than twice daily NPH insulin, with low risk of hypoglycaemia, in patients with type 2 diabetes

    DIABETES OBESITY & METABOLISM, Issue 6 2003
    J. S. Christiansen
    Objective:, Biphasic insulin aspart 30 (BIAsp30) is a dual release formulation, containing 30% soluble and 70% protamine-crystallized insulin aspart. This study compared the glycaemic control and safety profiles achieved with either twice daily BIAsp30 or NPH insulin in patients with type 2 diabetes not optimally controlled by oral hypoglycaemic agents (OHAs), NPH insulin or a combination of both. Methods:, In this 16-week multinational, parallel-group, double-blind trial, 403 such patients were randomized to receive either BIAsp30 or NPH insulin immediately before breakfast and evening meals. OHAs were discontinued at randomization. Efficacy was assessed by glycosylated haemoglobin (HbA1c) and self-recorded daily 8-point blood glucose (BG) profiles. Hypoglycaemic and other adverse events were the chosen safety parameters. Results:, HbA1c concentration decreased by >0.6% (p < 0.0001 vs. baseline) in both groups, with metabolic control continuing to improve throughout the trial without reaching a stable level. Patients who switched from once or twice daily NPH monotherapy to twice daily BIAsp30 achieved a significantly greater reduction in HbA1c (0.78%) than those randomized to twice daily NPH insulin (0.58%; p = 0.03). BIAsp30 decreased mean daily postprandial glycaemic exposure to a greater extent than NPH insulin (mean difference = 0.69 mmol/l; p < 0.0001), reflecting greater decreases in the postbreakfast and postdinner increments (of 1.26 and 1.33 mmol/l, respectively), although postlunch increment was relatively increased (by 0.56 mmol/l). Despite the greater reduction in overall postprandial glycaemic exposure in the BIAsp30 group, the overall safety profile of BIAsp30 was equivalent to that of NPH insulin with <2% of patients experiencing major hypoglycaemia, and approximately 33% reporting minor hypoglycaemic episodes, in both groups. Conclusion:, Twice daily BIAsp30 reduced postprandial glucose exposure to a significantly greater extent than NPH insulin and was at least as effective at reducing HbA1c in patients with type 2 diabetes. Both insulins were well tolerated. In patients poorly controlled on OHAs or NPH alone, glycaemic control can be improved by switching to twice daily BIAsp30, without increasing hypoglycaemic risk. [source]

    Culturally appropriate health education for Type 2 diabetes in ethnic minority groups: a systematic and narrative review of randomized controlled trials

    DIABETIC MEDICINE, Issue 6 2010
    K. Hawthorne
    Diabet. Med. 27, 613,623 (2010) Abstract To determine if culturally appropriate health education is more effective than ,usual' health education for people with diabetes from ethnic minority groups living in high- and upper-middle-income countries. A systematic review with meta-analysis, following the methodology of the Cochrane Collaboration. Electronic literature searches of nine databases were made, with hand searching of three journals and 16 author contacts. The criteria for inclusion into the analysis were randomized controlled trials of a specified diabetes health education intervention, and a named ethnic minority group with Type 2 diabetes. Data were collected on HbA1c, blood pressure, and quality-of-life measures. A narrative review was also performed. Few studies fitted the selection criteria, and were heterogeneous in methodologies and outcome measures, making meta-analysis difficult. HbA1c showed an improvement at 3 months [weighted mean difference (WMD) ,0.32%, 95% confidence interval (CI) ,0.63, ,0.01] and 6 months post intervention (WMD ,0.60%, 95% CI ,0.85, ,0.35). Knowledge scores also improved in the intervention groups at 6 months (standardized mean difference 0.46, 95% CI 0.27, 0.65). There was only one longer-term follow-up study, and one formal cost-effectiveness analysis. Culturally appropriate health education was more effective than ,usual' health education in improving HbA1c and knowledge in the short to medium term. Due to poor standardization between studies, the data did not allow determination of the key elements of interventions across countries, ethnic groups and health systems, or a broad view of their cost-effectiveness. The narrative review identifies learning points to direct future research. [source]

    Flexible, intensive insulin therapy and dietary freedom in adolescents and young adults with Type 1 diabetes: a prospective implementation study

    DIABETIC MEDICINE, Issue 5 2008
    A. Sämann
    Abstract Aims To assess the outcome of a Diabetes Treatment and Teaching Programme (DTTP) on glycated haemoglobin (HbA1c), severe hypoglycaemia (SH) and severe ketoacidosis (SKA) in adolescents and young adults with Type 1 diabetes. Methods Quality-assurance project with assessment of participants 1 year after participation in a DTTP (5-day inpatient course, groups , 10 patients, fixed curriculum of education/training, introduction of dietary freedom). Before,after analyses of participants aged 12,15, 15,18, 18,21 and 21,24 years. Main outcome measures were HbA1c, SH and SKA. Results For the 1592 participants, aged 12 to 24 years, mean age at enrolment was 19 ± 3 years, mean duration of diabetes was 7.3 ± 5.4 (range 0.3,24) years, mean baseline HbA1c declined from 8.8 ± 2.3% to 8.1 ± 2.0%. The incidence of SH was 0.31 vs. 0.11 events/patient/year; the incidence of SKA 0.17 vs. 0.07 events/patient/year. In mixed effects models taking into account effects of centres, age and diabetes duration, the mean difference was ,0.64%[P < 0.001, 95% confidence interval (CI) ,0.79 to ,0.5] for HbA1c, ,0.2 events/patient/year (P < 0.0001, 95% CI ,0.28 to ,0.12) for SH and ,0.1 events/patient/year (P < 0.0001, 95% CI ,0.14 to ,0.06) for SKA. Conclusions Adolescents and young adults with Type 1 diabetes benefit from participation in a standard DTTP for flexible, intensive insulin therapy and dietary freedom. [source]

    Long-term efficacy and safety of insulin detemir compared to Neutral Protamine Hagedorn insulin in patients with Type 1 diabetes using a treat-to-target basal,bolus regimen with insulin aspart at meals: a 2-year, randomized, controlled trial

    DIABETIC MEDICINE, Issue 4 2008
    P. C. Bartley
    Abstract Aims This 24-month, multi-national, open-label, parallel group trial investigated the long-term efficacy and safety of insulin detemir and Neutral Protamine Hagedorn insulin in combination with mealtime insulin aspart in patients with Type 1 diabetes using a treat-to-target concept. Methods Patients were randomized 2 : 1 to detemir (n = 331) or NPH (n = 166) groups. Basal insulin was initiated once daily (evening) and titrated individually based on self-measured plasma glucose (PG) levels, aiming for pre-breakfast and pre-dinner targets , 6.0 mmol/l. A second basal morning dose could be added according to pre-defined criteria. Results After 24 months, superiority of glycated haemoglobin (HbA1c) was achieved with detemir compared to NPH (detemir 7.36%, NPH 7.58%, mean difference ,0.22% points) [95% confidence interval (CI) ,0.41 to ,0.03%], with reductions of 0.94% and 0.72% points, respectively. Fasting PG (FPGlab) was also lower with detemir (detemir 8.35 mmol/l, NPH 9.43 mmol/l; P = 0.019). Twenty-two per cent of patients treated with detemir reached an HbA1c , 7.0% in the absence of confirmed hypoglycaemia during the last month of treatment vs. 13% on NPH (P = 0.019). Risk of major and nocturnal hypoglycaemia was 69% and 46% lower with detemir than with NPH (P < 0.001), respectively; patients treated with detemir gained less weight (detemir 1.7 kg, NPH 2.7 kg; P = 0.024). The overall safety profile was similar in the two groups and treatment with detemir did not result in any unexpected findings. Conclusions Long-term treatment with the insulin analogues detemir + aspart was superior to NPH + aspart in reducing HbA1c, with added benefits of less major and nocturnal hypoglycaemia and less weight gain. [source]

    The effectiveness of brief alcohol interventions in primary care settings: A systematic review

    DRUG AND ALCOHOL REVIEW, Issue 3 2009
    EILEEN F. S. KANER
    Abstract Issues. Numerous studies have reported that brief interventions delivered in primary care are effective in reducing excessive drinking. However, much of this work has been criticised for being clinically unrepresentative. This review aimed to assess the effectiveness of brief interventions in primary care and determine if outcomes differ between efficacy and effectiveness trials. Approach. A pre-specified search strategy was used to search all relevant electronic databases up to 2006. We also hand-searched the reference lists of key articles and reviews. We included randomised controlled trials (RCT) involving patients in primary care who were not seeking alcohol treatment and who received brief intervention. Two authors independently abstracted data and assessed trial quality. Random effects meta-analyses, subgroup and sensitivity analyses and meta-regression were conducted. Key Findings. The primary meta-analysis included 22 RCT and evaluated outcomes in over 5800 patients. At 1 year follow up, patients receiving brief intervention had a significant reduction in alcohol consumption compared with controls [mean difference: ,38 g week,1, 95%CI (confidence interval): ,54 to ,23], although there was substantial heterogeneity between trials (I2 = 57%). Subgroup analysis confirmed the benefit of brief intervention in men but not in women. Extended intervention was associated with a non-significantly increased reduction in alcohol consumption compared with brief intervention. There was no significant difference in effect sizes for efficacy and effectiveness trials. Conclusions. Brief interventions can reduce alcohol consumption in men, with benefit at a year after intervention, but they are unproven in women for whom there is insufficient research data. Longer counselling has little additional effect over brief intervention. The lack of differences in outcomes between efficacy and effectiveness trials suggests that the current literature is relevant to routine primary care. [Kaner EFS, Dickinson HO, Beyer F, Pienaar E, Schlesinger C, Campbell F, Saunders JB, Burnand B, Heather N. The effectiveness of brief alcohol interventions in primary care settings: A systematic review. Drug Alcohol Rev 2009;28:301,323] [source]

    Implementation of the ,Fresh Start' smoking cessation programme to 23 antenatal clinics: a randomized controlled trial investigating two methods of dissemination

    DRUG AND ALCOHOL REVIEW, Issue 1 2001
    MARGARET COOKE
    Abstract The aim of the research was to investigate the effect of two methods of dissemination on the implementation of a smoking cessation programme and use of smoking cessation interventions in antenatal clinics. A repeated-measures randomized design was used. Hospital antenatal clinics (n = 23) were randomized to simple or intensive dissemination groups. All clinics in NSW with > 500 births were asked to participate. A survey of all clinical staff (n = 323) in 23 antenatal clinics was carried out prior to programme dissemination and 18 months after dissemination (n = 283). The response rate was 63% at baseline and 64% at follow-up. Smoking cessation intervention significantly increased after dissemination. (F (18,1) = 49.26, p < 0.001). The average number of smoking cessation interventions provided by clinics after programme dissemination increased from 4.5 to 7. 48 (mean difference 2.98, t(19) 7.08, n < 0.001, 95% CI (2.1,3.86). Type of dissemination did not influence the number of programme components used or the number of smoking cessation interventions offered. Also, the estimated proportion of clients offered intervention by clinicians did not vary due to type of dissemination. A simple mail-out of a smoking cessation programme to antenatal clinics for use during pregnancy can increase clinician intervention for smoking. When more intensive methods of dissemination are used, the quality of the interventions implemented by clinicians improves. More research on dissemination methods are required as both methods of dissemination did not produce systematic or sustained use of the programme. [source]

    Comparison of Tissue Doppler Velocities Obtained by Different Types of Echocardiography Systems: Are They Compatible?

    ECHOCARDIOGRAPHY, Issue 3 2010
    Mónika Dénes M.D.
    Background: Both systolic and diastolic tissue Doppler (TD) velocities have an important diagnostic and prognostic role in cardiology. We aimed to compare TD velocities between two different echocardiography systems. Patients: Thirty-one consecutive patients (mean age: 65.2 ± 17.5 years; 12 males) were enrolled. Methods: Systolic (Sa), early (Ea), and late (Aa) diastolic velocities were measured by TD at the lateral mitral annulus by a Sonos 2000 (Hewlett-Packard, Andover, MA, USA) and a Philips iE33 system. The E/Ea ratio was calculated. Results: Ea, Aa, and Sa velocities were higher when measured by the Sonos system (Ea: 13.2 ± 4.1 cm/s vs. 8.3 ± 3.6 cm/s; Aa: 14.8 ± 3.8 cm/s vs. 9.3 ± 2.3 cm/s; Sa: 15.2 ± 3.6 cm/s vs. 8.4 ± 2.0 cm/s; P < 0.0001 all). A significant correlation was found in Ea and in Ea/Aa (r = 0.84 and r = 0.85 resp; P < 0.0001 for both), and a weaker in Aa (r = 0.43; P = 0.02) between the machines. The Bland-Altman analysis showed broad limits of agreement between the measurements for Ea, Aa, and Sa (mean difference: 4.95 cm/s; 5.52 cm/s; 6.73 cm/s, respectively; limits: 0.64,9.25 cm/s; ,1.39,12.39 cm/s; ,0.37,13.83 cm/s, respectively). An E/Ea ratio >5.6 by the Sonos system showed 75% sensitivity and 79% specificity for elevated left ventricular filling pressure, defined as E/Ea >10 by the reference Philips system. Conclusions: Although diastolic TD velocities had excellent correlations between the two machines, there was a systematic overestimation by the Sonos system. Since the limits of agreement do not allow replacing the measurements, we suggest using the same echocardiographic equipment at patient follow-up. (Echocardiography 2010;27:230-235) [source]

    The Effects of Antihypertensive Treatment on the Doppler-Derived Myocardial Performance Index in Patients with Hypertensive Left Ventricular Hypertrophy: Results from the Swedish Irbesartan in Left Ventricular Hypertrophy Investigation Versus Atenolol (SILVHIA)

    ECHOCARDIOGRAPHY, Issue 7 2009
    Stefan Liljedahl M.D.
    Objectives: To investigate the effects of antihypertensive treatment on the Doppler-derived myocardial performance index (MPI) in patients with hypertensive left ventricular hypertrophy. Methods: The MPI was measured at baseline and after 48 weeks of antihypertensive treatment in 93 participants of the SILVHIA trial, where individuals with primary hypertension and left ventricular hypertrophy were randomized to double blind treatment with either irbesartan or atenolol. Results: Antihypertensive treatment lowered MPI (mean difference ,0.03 ± 0.01, P = 0.04). Changes in MPI by treatment were associated with changes in left ventricular ejection fraction (,-coefficient ,0.35 P = 0.005), stroke volume/pulse pressure (reflecting arterial compliance, ,-coefficient ,0.39 P < 0.001) and peripheral vascular resistance (,-coefficient 0.28 P < 0.04). Furthermore, there was a borderline significant association between changes in MPI and changes in E-wave deceleration time (reflecting diastolic function, ,-coefficient 0.23, P = 0.06). No associations were found between changes in MPI and changes in blood pressure, E/A-ratio, left ventricular mass index, relative wall thickness or heart rate. A stepwise multivariable regression model confirmed the association between changes in MPI and changes in ejection fraction and stroke volume/pulse pressure (all P < 0.05), as well as the trend for E-wave deceleration time (P = 0.08), but not in the case of peripheral vascular resistance. Conclusion: The MPI exhibited a modest decrease after 48 weeks of antihypertensive treatment in patients with hypertensive left ventricular hypertrophy. Changes in MPI were associated with changes in left ventricular function and vascular compliance, rather than with changes in left ventricular remodeling or blood pressure. [source]

    Comparison of Topical Anesthetics and Lubricants Prior to Urethral Catheterization in Males: A Randomized Controlled Trial

    ACADEMIC EMERGENCY MEDICINE, Issue 6 2004
    John Siderias DO
    Abstract Although male urethral catheterization in the emergency department (ED) is both common and painful, few studies have evaluated the use of topical anesthesia prior to catheterization. Objectives: To determine whether pretreatment of the urethra with topical lidocaine reduces the pain associated with urethral catheterization. Methods:This was a prospective, double-blind, randomized clinical trial of 36 alert, cooperative male adult patients requiring urethral catheterization, without allergies to the study medications or contraindications to their use, from a suburban university-based ED. Patients in the experimental group had topical lidocaine 2% gel injected in their urethras, whereas control patients received intraurethral lubrication only. Standardized catheterization with a no. 16 Foley was performed followed by pain assessment. The primary outcome measured was pain of catheterization on a 100-mm visual analog scale. Other outcomes included ease of insertion and procedural bleeding. Results: The authors evaluated 36 patients evenly distributed between study groups. Mean age was 62 years (range 22,85). Compared with controls, patients pretreated with lidocaine experienced significantly less pain of catheterization (38 ± 28 mm vs. 58 ± 30 mm; mean difference 20 mm; 95% confidence interval [95% CI] = 0.4 to 32; p = 0.04) and less pain of injection (23 ± 17 mm vs. 40 ± 25 mm; mean difference 17 mm; 95% CI = 3 to 32 mm; p = 0.02). There were no differences in the number of attempts and incidence of adverse events between the groups. Conclusions: Use of topical lidocaine gel reduces the pain associated with male urethral catheterization in comparison with topical lubricants only. [source]

    Bayes' Theorem to estimate population prevalence from Alcohol Use Disorders Identification Test (AUDIT) scores

    ADDICTION, Issue 7 2009
    David R. Foxcroft
    ABSTRACT Aim The aim in this methodological paper is to demonstrate, using Bayes' Theorem, an approach to estimating the difference in prevalence of a disorder in two groups whose test scores are obtained, illustrated with data from a college student trial where 12-month outcomes are reported for the Alcohol Use Disorders Identification Test (AUDIT). Method Using known population prevalence as a background probability and diagnostic accuracy information for the AUDIT scale, we calculated the post-test probability of alcohol abuse or dependence for study participants. The difference in post-test probability between the study intervention and control groups indicates the effectiveness of the intervention to reduce alcohol use disorder rates. Findings In the illustrative analysis, at 12-month follow-up there was a mean AUDIT score difference of 2.2 points between the intervention and control groups: an effect size of unclear policy relevance. Using Bayes' Theorem, the post-test probability mean difference between the two groups was 9% (95% confidence interval 3,14%). Interpreted as a prevalence reduction, this is evaluated more easily by policy makers and clinicians. Conclusion Important information on the probable differences in real world prevalence and impact of prevention and treatment programmes can be produced by applying Bayes' Theorem to studies where diagnostic outcome measures are used. However, the usefulness of this approach relies upon good information on the accuracy of such diagnostic measures for target conditions. [source]