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McNemar's Test (mcnemar + test)
Selected AbstractsReduction in Recidivism in a Juvenile Mental Health Court: A Pre- and Post-Treatment Outcome StudyJUVENILE AND FAMILY COURT JOURNAL, Issue 3 2009Monic P. Behnken ABSTRACT A review of an evaluation of the Court for the Individualized Treatment of Adolescents (a prototype Juvenile Mental Health Court in Santa Clara, California) is presented along with admission criteria. Participant demographics are described. McNemar Test and Paired T Test results show that study participants committed violent, aggressive, and property crimes in significantly lower numbers in the 23 months following court admission than in the 18 months preceding court admission, despite escalating patterns of antisocial behavior prior to court involvement. The importance of developing multidisciplinary models to address moderately severe offenders with serious mental illness is discussed. [source] FS04.5 Iodopropynylbutyl carbamate (IPBC) 0.2% is suggested for patch testing of patients with eczema possibly related to preservativesCONTACT DERMATITIS, Issue 3 2004Jochen Brasch Iodopropynylbutyl carbamate (IPBC)is a preservative that has been increasingly used for skin care products and cosmetics within the last years and the first cases of contact sensitization have meanwhile been reported. Therefore, a surveillance for IPBC contact allergy is now necessary. Our study was aimed to find out a suitable test concentration of IPBC for this purpose. The data 8106 patients tested by 23 centres of the German Contact Dermatitis Research Group (DKG) and the Information Network of Departments of Dermatology (IVDK)in the time from May 2001 to July 2003 with IPBC in concentrations of 0.1%, 0.2%, 0.3%, and 0.5% were retrospectively evaluated. Criteria considered to determine the optimal test concentration of IPBC were the reaction index, the positivity ratio, the rate of crescendo reactions, and the relation of IPBC-reactions with MOAHLFA-indices, with irritant reactions to sodium lauryl sulfate, and with positive reactions to the most common standard contact allergens and 4 other preservatives. For statistical evaluations the exact McNemar test was applied and odds ratios were calculated according to the profile likelihood method, as derived from logistic regression analyses. The rate of positive reactions to IPBC increased from 0.5% with IPBC 0.1% to 1.7% with IPBC 0.5%, but there was a problem with sensitivity or specificity with both of these 2 concentrations. Therefore, we focused on IPBC 0.2%(0.8% positive reactions) and IPBC 0.3%(1.3% positive reactions) for further detailed analyses. An evaluation of the related parameters revealed that with IPBC 0.2% as compared to IPBC 0.3% a higher percentage of crescendo reactions, a higher reaction index, a lower number of doubtful reactions, a plausible association of positive reactions with reactions to other preservatives, nd no association with a pronounced skin irritability was found. In conclusion, we recommend to start with IPBC 0.2% for patch testing of all persons with contact dermatitis that may be related to preservatives. [source] An in vitro investigation of the bulk flow of fluid through apical foramina during simulated tooth extraction: a potential confounder in microbiological studies?INTERNATIONAL ENDODONTIC JOURNAL, Issue 4 2001A. Kapalas Aim,The ,pumping action' induced during tooth extraction may cause bacteria suspended in tissue fluids to be transposed from one anatomical compartment to another. Apart from causing bacteraemia, this may lead to inaccuracies in studies evaluating the presence and distribution of bacteria in and around tooth apices. The aim was to investigate the bulk flow of fluid through apical foramina during simulated extraction of teeth in an in vitro model. The influence of the presence or absence of a coronal restoration was also evaluated. Methodology,Twenty extracted single-rooted, human, mature, permanent teeth were used. Standard access cavities were prepared and the root canals located. Standardized micrographs of the apical foramina were obtained and their area (µm2) was calculated by image analysis software. The teeth were then set and sealed into polyvinylsiloxane (rubber base) impression material. Crystal violet dye was inoculated into the coronal half of the root canal system. Tooth extraction movements were simulated in the impression matrix and the leakage of dyes with and without the presence of a coronal restoration was examined. The procedure was repeated, following application of safranin dye in a coronal trough within the simulated rubber base gingival margin at the CEJ. The results were analysed statistically with the independent-samples t -test and the McNemar test. Results,In the absence of a coronal restoration crystal violet leaked out of the apical foramina in 18/20 teeth; conversely safranin leaked into the teeth through the apical foramina in 11/20 cases when applied to the external root surface. In the presence of an intact coronal restoration crystal violet dye leaked out in 6/20 teeth and conversely safranin leaked into 7/20 teeth. The presence of a coronal restoration significantly reduced (P = 0.002) dye leakage out of the root canal system. No associations were found for leakage of dye into the root canal system when applied externally. In addition, the amount of dye leakage was positively correlated with the area of the apical foramen in the presence of a coronal restoration (P = 0.009). Conclusion,The presence of a coronal restoration significantly reduced leakage of dye out of the apical foramen. Microbiological studies on root canals and periapical lesions using extracted teeth should take potential contamination from this source into account. [source] Pulse oximeter perfusion index as an early indicator of sympathectomy after epidural anesthesiaACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2009Y. GINOSAR Background: The pulse oximeter perfusion index (PI) has been used to indicate sympathectomy-induced vasodilatation. We hypothesized that pulse oximeter PI provides an earlier and clearer indication of sympathectomy following epidural anesthesia than skin temperature and arterial pressure. Methods: Forty patients received lumbar epidural catheters. Patients were randomized to receive either 10 ml 0.5% bupivacaine or 10 ml 0.25% bupivacaine. PI in the toe, mean arterial pressure (MAP) and toe temperature were all assessed at baseline and at 5, 10 and 20 min following epidural anesthesia. The effect of epidural anesthesia over time was assessed by repeated measures analysis of variance. Additionally, we defined clinically evident sympathectomy criteria (a 100% increase in the PI, a 15% decrease in MAP and a 1 °C increase in toe temperature). The numbers of patients demonstrating these changes for each test were compared using the McNemar test for each time point. Results: Twenty-nine subjects had photoplethysmography signals that met a priori signal quality criteria for analysis. By 20 min, PI increased by 326%, compared with a 10% decrease and a 3% increase in MAP and toe temperature, respectively. For PI 15/29, 26/29 and 29/29 of the subjects met the sympathectomy criteria at 5, 10 and 20 min, respectively, compared with 4/29, 6/29 and 18/29 for MAP changes and 3/29, 8/29 and 14/29 for toe temperature changes. Conclusions: PI was an earlier, clearer and more sensitive indicator of the development of epidural-induced sympathectomy than either skin temperature or MAP. [source] Effectiveness of bran supplement in older orthopaedic patients with constipationJOURNAL OF CLINICAL NURSING, Issue 5 2007Zennure Kaçmaz MSc Aim., The purpose of the study was to evaluate the effectiveness of planned nursing interventions, including bran supplement, on the bowel management of older orthopaedic patients. Background., Constipation is prevalent among older people. Constipation is also well-known to be a problem for a range of orthopaedic patients. Orthopaedic diseases or conditions may, because of the specific problems, cause this. The problem may also arise as a result of the orthopaedic treatment options undertaken by patients. Design., A quasiexperimental design was employed. Methods., The patients were recruited from an orthopaedic clinic at a university hospital in Erzurum, eastern Turkey. Descriptive statistics, independent sample test t -test, chi-square and McNemar test were used to analyse the data. Constipation problems were identified through interviews by using the Constipation Diagnosis Form. Interviews were performed within the fourth postoperative day. After that, while the patients in the control group received routine nursing care according to clinic routine, the patients in the experimental group received bran supplement together with planned nursing interventions. The patents in both groups were followed by using the Constipation Follow Form. Results., While patients in the experimental group showed significant improvements in most characteristics of bowel elimination such as time of defecation, intensity of faeces, colour of faeces and amount of faeces, the control group showed a significant improvement in only duration of defecation. Conclusions., The results of the study indicate planned nursing interventions including bran supplement are more effective than routine nursing interventions for management of constipation problems in older orthopaedic patients. Relevance to clinical practice., Nurses have an important part to play in both prevention and management of constipation. Constipation is a problem especially for older orthopaedic patients. Planned nursing interventions that include bran supplements may be more effective than routine nursing interventions for management of constipation problems in older orthopaedic patients. [source] Community-acquired febrile urinary tract infection in diabetics could deserve a different management: a case,control studyJOURNAL OF INTERNAL MEDICINE, Issue 3 2003J. P. Horcajada Abstract., Horcajada JP, Moreno I, Velasco M, Martínez JA, Moreno-Martínez A, Barranco M, Vila J, Mensa J (Hospital Clínic Universitari-IDIBAPS, Barcelona, Spain) Community-acquired febrile urinary tract infection in diabetics could deserve a different management: a case,control study. J Intern Med 2003; 254: 280,286. Objective., To investigate if there are relevant differences in clinical, microbiological and outcome characteristics of community-acquired febrile urinary tract infection (UTI) between diabetic and nondiabetic patients. Design., A prospectively matched case,control study. Setting., An 800-bed tertiary care university-affiliated hospital. Subjects., A total of 108 patients (54 diabetic and 54 nondiabetic patients matched by age and gender) admitted between January 1996 and September 1999 with febrile UTI. Methods., Clinical, analytical, microbiological and outcome variables were analysed by means of McNemar test (categorical) or Wilcoxon matched pairs signed rank test (continuous). Results., Mean age (SD) in both groups was 67.9 (14.4) years. In comparison with controls, diabetic patients were more likely to have fever without localizing symptoms (27% vs. 9%, P , 0.0001), diminished consciousness level at admission (25% vs. 10%, P = 0.03), aetiological microorganism different from Escherichia coli (17% vs. 0, P = 0.0004), and quinolone-resistant bacteria (17% vs. 3.7%, P = 0.07). Duration of fever after the onset of treatment was 1.75 (1) days in diabetics and 1.5 (1.1) days in nondiabetics (P = 0.17). However, diabetic patients had a longer hospitalization [5.2 (3.3) days] than nondiabetics [3.9 (2.6) days, P = 0.006]. Conclusions., In diabetic patients, febrile UTIs have clinical and microbiological peculiarities that may have diagnostic and therapeutic implications. [source] Masticatory problems after balloon compression for trigeminal neuralgia: a longitudinal study1JOURNAL OF ORAL REHABILITATION, Issue 2 2007S. R. D. T. DE SIQUEIRA summary, Idiopathic trigeminal neuralgia (ITN) is a chronic neuropathic pain that affects the masticatory system. The objective of this study was to identify orofacial pain and temporomandibular characteristics, including temporomandibular disorder (TMD), in a sample of 105 ITN patients treated with compression of the trigeminal ganglion. The evaluations occurred before, 7, 30 (1 month), 120 (3 months) and 210 days (7 months) after surgery. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), the Clinical Questionnaire (EDOF-HC) and Helkimo Indexes were used. Findings before neurosurgery were used as control for parameters. McNemar test and variance analysis for repetitive measurements were used for statistical analysis; 45·3% of the edentulous patients presented severe dental occlusion index; numbness was an important masticatory complaint in 42·6%; mastication became bilateral, but its discomfort continued during all period; headache and body pain reduced after surgery; TMD, present in 43·8% before surgery, increased but normalized after 7 months; jaw mobility compromise was still present, but daily activities improved after 7 months. We concluded that: (i) ITN relief reduced headache, body pain, depression and unspecific symptoms; and (ii) TMD before surgery and at 7 months suggests that this may be a contributory factor to patients' pain complaints. [source] Clinical and radiological follow-up results of patients with untreated TMJ closed lockJOURNAL OF ORAL REHABILITATION, Issue 5 2005P. IMIRZALIOGLU summary, The purpose of this study was to compare clinical and radiological findings of untreated closed lock patients at least 22 months after initial diagnosis. Ten patients with closed lock in at least one joint who had received no treatment were included in the study. Clinically maximum mouth opening, joint pain and joint sounds were recorded. Radiologically position of the disc, disc morphology, bone degeneration and presence of fluid were determined on magnetic resonance imaging. Clinical and radiological examinations were repeated 2,5 years after initial examinations. Results were statistically compared using either the non-parametric McNemar test or the Wilcoxon signed-rank test. There were significant improvements in both mouth opening capacity and prevalence of joint pain, while no significant change in radiological examination. The results of this study suggested that closed lock patients undergo active adaptation in clinical symptoms. [source] Clinical evaluation of resilient denture liners.JOURNAL OF PROSTHODONTICS, Issue 3 2003Part 2: candida count, speciation Purpose The purpose of this study was to count and to speciate Candida isolated from 2 resilient denture liners, Molloplast-B and MPDS-SL. Materials and Methods A group of 20 patients each had 1 maxillary denture and 2 mandibular dentures fabricated. One mandibular denture was lined with Molloplast-B, and 1 was lined with MPDS-SL. Each denture was used for 3 months. At the end of the 3-month period, the mandibular denture was surrendered, and a 5 × 5-mm circular resilient liner sample was obtained from the tissue surface of the lingual flange. Samples were processed, and Candida was isolated and counted. Speciation of Candida was performed using CHROMagar Candida and API 20C AUX strips. Results Molloplast-B had, on average, 5 times as many CFU/sample as MPDSL-SL, but this difference was not significant (p= 0.26). A sign test gave a similar nonsignificant trend (p= 0.057). CHROMagar identified several Candida species, and confirmation was made using API 20C AUX strips. One patient was lost to follow-up. Of 19 Molloplast-B samples, 7 had no growth, 4 grew C. albicans, 3 grew C. parapsilosis, 2 grew C. glabrata, 1 grew C. tropicalis, 2 grew a Trichosporon spp., and 2 grew a nonidentifiable colony. The analogous counts for 19 MPDS-SL samples were 10, 4, 1, 3, 0, 1, and 1 (p= 0.45 for culture positively, exact McNemar test). ConclusionsCandida growth on Molloplast-B was not significantly different from growth on MPDS-SL. Several yeast species were cultured from each material. The rates of culture-positive testing did not differ between the 2 resilient denture liners. [source] A survey of mental health nurses' experiences of stalkingJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 5 2006R. ASHMORE bsc(hons) rmn ma pgce dip couns Although an increasing amount of literature has appeared in recent years on the subject of stalking, little is known about mental health nurses' (MHNs) experiences of this phenomenon. The aims of the study were to investigate: (1) the incidence of stalking among a sample of MHNs in the UK; (2) who the perpetrators were; (3) the impact of stalking on MHNs; and (4) how MHNs manage their experiences. Employing a survey design, the British version of the Rutgers-Penn clinicians and stalking questionnaire was distributed to a convenience sample of 400 MHNs in the UK. Data were analysed by means of descriptive statistics and McNemar test. The findings reveal that: (1) 50% (n = 56) of MHNs who completed the questionnaire had been stalked; (2) on the whole, victims were female (78.6%) and stalkers males (82.1%); (3) stalkers were from a variety of social groups including mental health service users and MHNs; (4) victims were threatened, followed, physically assaulted and received unwanted communication; (5) MHNs reported a variety of stress-related (psychological and behavioural) responses to their experiences; and (6) employed a range of coping strategies. This study serves to raise awareness of a number of issues surrounding an under-reported phenomenon in mental health nursing and points to the need for further research to explore the reliability and consequences of the findings. [source] Vitiligo and ocular findings: a study on possible associationsJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 7 2006E Bulbul Baskan Abstract Objective, In this study, we aimed to evaluate the ocular findings in vitiligo patients and reveal any clinical feature that might suggest an association or a risk factor. Background, Very few reports in the literature are available about the ocular findings in vitiligo and the possible associations of the ocular findings in vitiligo patients have not been studied so far. Methods, A total of 45 patients with previously documented cutaneous vitiligo were examined for ocular findings. Demographic features including age, gender, duration of vitiligo, presence of associated autoimmune diseases, type of vitiligo and the anatomical distributions of vitiligo were recorded to evaluate a possible relationship with the ocular findings. Univariate and multivariate analyses as well as cluster analysis were performed. After description of the clusters, the Mann,Whitney U -test and Fisher's exact test were used to determine the variables. Concordance among the variables in each group was evaluated with the McNemar test. Results, Ten patients had ocular findings that included anterior segment (iris) involvement, ring-like peripapillary atrophy around the optic nerve, atrophy of pigment epithelium, focal hypopigmented spots and diffuse hypopigmentation. The presence of periorbital vitiligo was significantly related to the ocular findings. Cluster analysis revealed concordances between periorbital and genitalial localizations of vitiligo and ocular findings. Conclusion, The number of patients and the range of ocular findings in our study are insufficient to make definite conclusions but anatomical localizations, primarily periorbital and to a lesser extent genitalial vitiligo, seem to be the most probably alerting features for ocular findings. [source] Airway reactivity in children before and after stem cell transplantationPEDIATRIC PULMONOLOGY, Issue 9 2009Lea Bentur MD Abstract Stem cell transplantation (SCT) is associated with pulmonary complications. We encountered several children post-SCT with a clinical picture suggestive of airway hyper-reactivity (AHR) and evidence of reversible airway obstruction that was not reported pre-transplant. We evaluated the possibility of increased AHR as assessed by methacholine challenge test (MCT) following the course of SCT, and assessed a possible correlation between AHR and pulmonary complications. This was a prospective study evaluating consecutive patients referred for SCT to the Department of Pediatric Hemato-Oncology. Evaluation included pulmonary function test and MCT before and after SCT, and assessment of pulmonary complications. Twenty-one of 33 patients completed the study. The mean PC20 was 14.3,±,4.1 mg/ml prior to SCT; afterward the mean PC20 decreased to 11.2,±,5.6 mg/ml (P,=,0.018). The number of patients with airway reactivity (PC20,,,8 mg/ml) increased from 2/21 patients before SCT to 8/21 patients after SCT (P,=,0.043; McNemar test with Yates correction). Pulmonary complications and hospitalization were recorded in 33.3% of the patients (7/21 patients): 62.5% of the patients (5 patients) with AHR compared to 15.4% (2 patients) in the group without AHR (P,=,0.041; Fisher exact test). There were 10 hospitalizations among the 8 patients with positive MCT compared to 2 hospitalizations in 13 patients with negative MCT (median 1 vs. 0, P,=,0.045; Mann,Whitney U -test). Increased airway reactivity was observed in our study following the course of SCT. Positive MCT after SCT may be associated with increased risk of pulmonary complications. Larger prospective studies are needed to evaluate the possible mechanisms responsible for increased AHR and the clinical importance of these findings. Pediatr Pulmonol. 2009; 44:845,850. © 2009 Wiley-Liss, Inc. [source] ORIGINAL RESEARCH,SURGERY: Sexual Function after Loop Electrosurgical Excision Procedure for Cervical DysplasiaTHE JOURNAL OF SEXUAL MEDICINE, Issue 3 2010Namfon Inna MD ABSTRACT Introduction., Loop electrosurgical excision procedure (LEEP) is an effective tool for management of cervical dysplasia. However, removal of a part of the cervix might have a negative impact on sexual function. Aim., To examine the effect of LEEP on overall sexual satisfaction and other specific aspects of sexual function in women with cervical dysplasia. Methods., Eighty-nine premenopausal women with cervical dysplasia who had undergone LEEP at least 3 months previously were interviewed once on post-LEEP follow-up visits with a questionnaire on pre- and post-procedural sexual function. Data on frequency of sexual intercourse, the presence of dysmenorrhea, dyspareunia, and postcoital bleeding were compared using the McNemar test. Data on specific aspects of sexual function rated by the 6-point Likert scale were analyzed using Wilcoxon signed ranks test. Main Outcome Measure., The main outcome is the overall sexual intercourse satisfaction. Results., The mean age was 41.7 years. The median interval from LEEP to the time of interview was 29.3 weeks. The time of resumption of sexual intercourse after LEEP was 8.1 weeks on the average. The changes in the frequency of sexual intercourse, dysmenorrhea, and dyspareunia after LEEP were not statistically significant. The changes in overall satisfaction, vaginal elasticity, and orgasmic satisfaction appeared statistically significant (P < 0.05). Conclusion., Having LEEP done along with other "non-surgical" parts of cervical pre-cancer management is associated with small but statistically significant decreases in overall sexual satisfaction, vaginal elasticity, and orgasmic satisfaction when interviewed near to the procedure at 29.3 weeks post-operation. However, the changes on other aspects of sexual function are insignificant. The LEEP procedure itself appears to have a minimal, if any, clinically important adverse effect on sexual function. Inna N, Phianmongkhol Y, and Charoenkwan K. Sexual function after loop electrosurgical excision procedure for cervical dysplasia. J Sex Med 2010;7:1291,1297. [source] The Effect of Myocardial Surgical Revascularization on Left Ventricular Late PotentialsANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2001Levent Can M.D. Background: The presence of ventricular late potentials (LP) is an important indicator for the development of ventricular tachyarrhythmias due to ischemic heart disease. The effect of myocardial revascularization on LP has remained controversial. The purpose of this study was to determine whether complete myocardial surgical revascularization (CABG) documented by myocardial perfusion scintigraphy might alter the substrate responsible for LP. Methods: Prospectively, enrolled patients undergoing elective CABG were evaluated with thallium-201 myocardial perfusion scintigraphy and signal- averaged ECG pre- and postoperatively. SAECG recordings were obtained serially: before, 48,72 hours and 3 months after CABG. LPS were defined as positive if SAECG met at least two of Gomes criteria. Scintigraphies were performed pre-and 3 months postoperatively for determination of the success of revascularization. Changes observed in SAECG recordings after CABG were compared between those with and without successful revascularization. Results: CABG resulted in successful revascularization in 23 patients and was unsuccessful in 17 (no change or deterioration of the perfusion defects). Preoperative SAECG values were not different between groups except for RMS values. The incidence of LP decreased significantly postoperatively in patients with improved myocardial perfusion, whereas there were no changes in patients who did not have postoperative perfusion improvement (McNemar test, P < 0.05). Conclusions: LPs disappear following the elimination of myocardial ischemia by complete surgical revascularization. Persistence of ischemia following CABG usually results in the persistence of late potentials. The incidence of ventricular arrhythmias is expected to be unchanged in these patients and they should be reevaluated for reinterventions. A.N.E. 2001;6(2):84,91 [source] Reproducibility of same session repeated cystometry and pressure-flow studies in women with symptoms of urinary incontinence,,NEUROUROLOGY AND URODYNAMICS, Issue 3 2010Suzan R. Broekhuis Abstract Aim The aim of this study was to determine the reproducibility of same session repeated urodynamic measurements in women with symptoms of urinary incontinence. Methods Women presenting with symptoms of urinary incontinence underwent standardized urodynamic examination, which consisted of free uroflowmetry and two filling cystometries and pressure-flow studies. Intra-class Correlation Coefficient (ICC) and McNemar tests were used to describe the same session reproducibility. Results Two evaluable urodynamic tests were available in 152 patients. Overall, reproducibility of the urodynamic parameters were good to excellent (ICC range: 0.72,0.93), except for the bladder volume at first sensation of bladder filling (ICC,=,0.46) and the maximum Watt's factor (ICC,=,0.68). The bladder volume at first sensation and the maximum cystometric capacity were systematically higher in the second run (mean difference (95% CI),=,,45 (,73; ,37) and ,3 (,15; 10), respectively). Reproducibility of the diagnosis stress urinary incontinence and/or detrusor overactivity were good to excellent (median ICC,=,0.76, P,=,0.68 and P,=,1.00, respectively). Reproducibility of the volume and amplitude at involuntary detrusor contractions, however, were only poor (ICC,=,0.18 and 0.25, respectively). Conclusions The reproducibility of same session repeated urodynamic measurements in women with symptoms of urinary incontinence was good to excellent. Our results provide the scientific support for guidelines that recommend the omission of repeated filling cystometries and pressure-flow studies in cases where the first test confirms the pathology expected. Neurourol. Urodynam. 29:428,431, 2010. © 2009 Wiley-Liss, Inc. [source] Evaluation of Ki-67 and Bcl-2 antigen expression in breast carcinomas of women treated with raloxifeneCELL PROLIFERATION, Issue 2 2010P. V. Lopes-Costa Objectives:, To evaluate the effect of raloxifene on Ki-67 and Bcl-2 antigen expression in operable, stage II, oestrogen-receptor-positive invasive ductal breast carcinomas. Materials and methods:, Twenty post-menopausal women who had taken 60 mg of raloxifene daily for 28 days prior to definitive surgery were enrolled in the investigation. Two tumour samples were obtained by incisional biopsy during the study, one at the time of confirmation of diagnosis of invasive ductal carcinoma and evaluation of oestrogen receptor status, and the other 29 days later, at the time of definitive surgery. Immunohistochemistry was performed on tumour samples, prior to and after raloxifene treatment, to evaluate Ki-67 and Bcl-2 expression. Friedman and McNemar tests were used for statistical analysis of the data, significance being established at 5%. Results:, Mean percentage of Ki-67-stained nuclei was 24.86 ± 2.95 prior to raloxifene treatment and 13.33 ± 1.52 after treatment (P < 0.001). Prior to raloxifene treatment, only 9/20 cases (45%) were classified as Bcl-2-positive, whereas after treatment, 17/20 (85%) were classified as Bcl-2-positive (P < 0.013). Conclusions:, Raloxifene treatment significantly reduced Ki-67 antigen expression and increased Bcl-2 expression in breast carcinomas of post-menopausal women. [source] A European interlaboratory testing of three well-known procedures for immunocytochemical detection of epithelial cells in bone marrow.CYTOMETRY, Issue 6 2006Results from analysis of normal bone marrow Abstract Background: This investigation intended to study the unspecific background to be expected in normal bone marrow (BM), comparing three well recognized protocols for immunocytochemical detection of disseminated carcinoma cells. The interlaboratory variation in screening and evaluation of stained cells was analyzed and different screening methods were compared. Methods: BM mononuclear cells (BM MNC) from 48 normal BMs were immunostained in parallel by three participating laboratories. The protocols, based on three different anti-cytokeratin antibodies, have all been in common use for detection of disseminated carcinoma cells: the A45-B/B3 protocol (Hamburg), the CK2 protocol (Augsburg) and the AE1AE3 protocol (Oslo). For all protocols, the immunostained cells were visualized by the same alkaline-phosphatase (AP) detection system (APAAP) followed by detection of the cells by manual screening and by two different automated screening systems (ACIS from Chromavision and MDS1 from Applied Imaging). Detected AP-visualized cells were morphologically classified into unambiguous hematopoietic (Uhc) and questionable cells (Qc, potentially interpreted as tumor cells). Results: Seven of 48 BMs (15%) harbored ,1 AP-visualized cell(s) among 1 × 106 BM MNC, both for the A45-B/B3- and for the AE1AE3 protocol, while for CK2 a higher proportion of BMs (21 BMs; 44%) harbored AP-visualized cells (P < 0.01, McNemar's test). The number of Qc was, for all protocols, 1 log lower than the total number of AP-visualized cells. On average, the frequency of Qc was 0.04, 0.08, and 0.02 per 106 BM MNC with A45-B/B3, CK2 and AE1AE3, respectively, and the number of Qc-positive BMs 1, 4, and 1. The MDS1 screening sensitivity was similar to manual screening, while ACIS detected fewer cells (P < 0.001, McNemar's test). Conclusions: All protocols resulted in AP-visualization of occasional hematopoietic cells. However, morphological classification brings the specificity to a satisfactory high level. Approximately 10% of AP-visualized cells were categorized "questionable". The CK2 protocol turned out less specific than the A45-B/B3 and AE1AE3 protocols. © 2006 International Society for Analytical Cytology. [source] Cervical biopsy-based comparison of a new liquid-based thin-layer preparation with conventional Pap smearsDIAGNOSTIC CYTOPATHOLOGY, Issue 4 2004Maria da Gloria Mattosinho de Castro Ferraz M.D. Abstract The objective of this study is to compare the diagnostic efficacy of universal collection medium (UCM) liquid-based cytology (LBC) (Digene Corp., MD) and the conventional Pap smear in a comparative study, using histologic results as the gold standard. This was a cross-sectional study. Conventional Pap smears and UCM LBC specimens, obtained from women in a low socioeconomic outpatient population referred to a tertiary center for gynecologic care, were compared. For the purpose of this study, when cervical specimens were collected for cytology, all women underwent colposcopy and biopsy was done if a cervical abnormality was observed. Cytologic evaluation of UCM LBC and conventional Pap smears were carried out separately, masked to the results of the other method. Agreement beyond chance between the two cytologic methods was ascertained by means of the unweighted , statistic. Sensitivity, specificity, and predictive values with 95% confidence intervals were calculated for both methods. McNemar's test was used to determine the level of association between the two cytology procedures. A total of 800 women were evaluated. Assessment of the overall agreement between the two cytologic methods yielded a , of 0.777 (P < 0.0001). After adjustment for histologic diagnosis, the computed , in each stratum was as follows: normal = 0.733; CIN 1 = 0.631; CIN 2/3 = 0.735; cancer = 0.652. The sensitivity and specificity of UCM LBC for detection of cervical intraepithelial lesions and cancer were 75.3% and 86.4%, respectively, not statistically different from the 81.8% and 85.2% seen with the conventional method. This study demonstrates that the UCM LBC method is as accurate as the conventional Pap smear cytology in detecting cervical intraepithelial lesions and cancer even so the UCM samples were systematically prepared from a second sampling of the cervix. Diagn. Cytopathol. 2004;30:220,226. © 2004 Wiley-Liss, Inc. [source] Role of the Peripheral Intravenous Catheter in False-positive D-dimer TestingACADEMIC EMERGENCY MEDICINE, Issue 2 2001Alan C. Heffner MD Abstract. Objective: To determine whether inserting a peripheral intravenous catheter (IV) can significantly increase the circulating D-dimer concentration. Methods: Twenty healthy young adult volunteers underwent cannulation of an antecubital vein with a 20-gauge Teflon IV. Time 0 venous blood was drawn during IV insertion. The IV was salinelocked and left in place for 90 minutes, at which time a second venipuncture was performed in a contralateral antecubital vein (+90 min). A qualitative D-dimer assay [erythrocyte-agglutination assay, SimpliRED (SRDD)] and a quantitative spectrophotometric assay [enzyme-linked immunosorbent assay (EIA), Dimertest Gold] were performed on all samples. Time 0 means (±SD) were compared with +90 min means by paired t-test, and SRDD pairs were compared with McNemar's test. Results: Time 0 initial venipuncture blood samples yielded a mean D-dimer concentration of 15 ± 24 ng/mL, with 2/20 SRDD tests read as positive (95% CI = 1% to 32%). At +90 min, the D-dimer concentration was 33 ± 21 ng/mL (p = 0.04 vs time 0), with 5/20 SRDD tests read as positive (95% CI = 9% to 49%, p = 0.248). Conclusions: Insertion of an IV increased the circulating D-dimer concentration (determined by EIA), but did not lead to a significant increase in false-positive conversion of the SRDD. An effort should be made to perform D-dimer testing on "first-stick" blood to optimize specificity. However, a strongly positive D-dimer reaction cannot be ascribed to the presence of an IV. [source] Modelling small-business credit scoring by using logistic regression, neural networks and decision treesINTELLIGENT SYSTEMS IN ACCOUNTING, FINANCE & MANAGEMENT, Issue 3 2005Mirta Bensic Previous research on credit scoring that used statistical and intelligent methods was mostly focused on commercial and consumer lending. The main purpose of this paper is to extract important features for credit scoring in small-business lending on a dataset with specific transitional economic conditions using a relatively small dataset. To do this, we compare the accuracy of the best models extracted by different methodologies, such as logistic regression, neural networks (NNs), and CART decision trees. Four different NN algorithms are tested, including backpropagation, radial basis function network, probabilistic and learning vector quantization, by using the forward nonlinear variable selection strategy. Although the test of differences in proportion and McNemar's test do not show a statistically significant difference in the models tested, the probabilistic NN model produces the highest hit rate and the lowest type I error. According to the measures of association, the best NN model also shows the highest degree of association with the data, and it yields the lowest total relative cost of misclassification for all scenarios examined. The best model extracts a set of important features for small-business credit scoring for the observed sample, emphasizing credit programme characteristics, as well as entrepreneur's personal and business characteristics as the most important ones. Copyright © 2005 John Wiley & Sons, Ltd. [source] Long-term stability of periodontal conditions achieved following guided tissue regeneration with bioresorbable membranes: case series results after 6,7 yearsJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 11 2004Andreas Stavropoulos Abstract Objectives: To evaluate the results of guided tissue regeneration (GTR) treatment of intrabony defects with bioresorbable membranes after 6,7 years, and to disclose factors that may influence the long-term outcome of the treatment. Methods: Twenty-five defects in 19 patients were treated by means of polylactic acid/citric acid ester copolymer bioresorbable membranes. At baseline and after 1 and 6,7 years, the following parameters were recorded: (1) probing pocket depth (PPD), (2) gingival recession (REC), (3) probing attachment level (PAL)=PPD+REC, (4) presence/absence of plaque (PI), (5) presence/absence of bleeding on probing (BOP). Smoking habits and frequency of dental-control visits were also recorded. Significance of differences between categorical variables was evaluated with McNemar's test, and between numerical variables with the t -test for paired observations. Generalized linear models were constructed to evaluate the influence of various factors on PAL gain and PPD changes from 1 to 6,7 years. Association of smoking, frequency of dental controls, oral hygiene, and BOP with sites losing 2 mm in PAL was evaluated with Fisher's exact test. Results: At baseline, a mean PPD of 8.7±1.1 mm and a mean PAL of 9.8±1.5 mm was recorded. Statistically significant clinical improvements were observed at 1 and 6,7 years after GTR treatment. An average residual PPD of 3.8±1.1 mm and a mean PAL gain of 3.8±1.4 mm were observed after 1 year. After 6,7 years the corresponding values were 4.7±1.3 and 3.6±1.4 mm, respectively. There were no statistically significant differences between the 1- and the 6,7-year values. At the 6,7-year control, only 16% of the sites had lost 2 mm (maximum 3 mm), of the PAL gain obtained 1 year after GTR treatment. None of the sites had lost all of the attachment gained 1 year after treatment. Smoking, frequency of dental controls, oral hygiene, and BOP did not seem to influence the change of PPD and PAL gain, or the stability of PAL gain (i.e. losing PAL or not) from 1 to 6,7 years from treatment. Conclusion: Clinical improvements achieved by GTR treatment of intrabony defects by means of bioresorbable membranes can be maintained on a long-term basis. [source] Comparison of ferucarbotran-enhanced fluid-attenuated inversion-recovery echo-planar, T2-weighted turbo spin-echo, T2*-weighted gradient-echo, and diffusion-weighted echo-planar imaging for detection of malignant liver lesionsJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 3 2010Yoshihiko Fukukura MD Abstract Purpose: To compare the diagnostic accuracy of superparamagnetic iron oxide (SPIO)-enhanced fluid-attenuated inversion-recovery echo-planar imaging (FLAIR EPI) for malignant liver tumors with that of T2-weighted turbo spin-echo (TSE), T2*-weighted gradient-echo (GRE), and diffusion-weighted echo-planar imaging (DW EPI). Materials and Methods: SPIO-enhanced magnetic resonance imaging (MRI) that included FLAIR EPI, T2-weighted TSE, T2*-weighted GRE, and DW EPI sequences was performed using a 3 T system in 54 consecutive patients who underwent surgical exploration with intraoperative ultrasonography. A total of 88 malignant liver tumors were evaluated. Images were reviewed independently by two blinded observers who used a 5-point confidence scale to identify lesions. Results were correlated with results of histopathologic findings and surgical exploration with intraoperative ultrasonography. The accuracy of each MRI sequence was measured with jackknife alternative free-response receiver operating characteristic analysis. The sensitivity of each observer with each MRI sequence was compared with McNemar's test. Results: Accuracy values were significantly higher with FLAIR EPI sequence (0.93) than with T2*-weighted GRE (0.80) or DW EPI sequences (0.80) (P < 0.05). Sensitivity was significantly higher with the FLAIR EPI sequence than with any of the other sequences. Conclusion: SPIO-enhanced FLAIR EPI sequence was more accurate in the diagnosis of malignant liver tumors than T2*-weighted GRE and DW EPI sequences. SPIO-enhanced FLAIR EPI sequence is helpful for the detection of malignant liver tumors. J. Magn. Reson. Imaging 2010;31:607,616. ©2010 Wiley-Liss, Inc. [source] Dynamic MRI, dynamic multidetector-row computed tomography (MDCT), and coregistered 2-[fluorine-18]-fluoro-2-deoxy-D-glucose,positron emission tomography (FDG-PET)/CT: Comparative study of capability for management of pulmonary nodulesJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 6 2008Yoshiharu Ohno MD Abstract Purpose To compare the nodule management capabilities of dynamic MRI, dynamic multidetector-row computed tomography (MDCT) and coregistered positron emission tomography (PET)/CT. Materials and Methods Dynamic MRI, dynamic MDCT, PET, microbacterial, and pathological examinations were administered to 175 consecutive patients with 202 nodules (<30 mm in diameter). The final diagnoses resulted in the classification of 202 nodules into two groups: requiring further intervention and treatment (N = 163) and no further evaluation (N = 39) groups. Maximum relative enhancement and slope of enhancement ratio were calculated as dynamic MR indices. Maximum enhancement, net enhancement, slope of enhancement, and absolute loss of enhancement were calculated as dynamic CT indices. maximum value of standard uptake value (SUVmax) was measured on coregistered PET/CT. Receiver operating characteristics (ROC) analyses were performed to determine feasible threshold values for nodule management, and results were tested using McNemar's test. Results When feasibility threshold values were adopted for nodule management, the specificity (82.1%) and accuracy (93.6%) of the slope of the enhancement ratio were significantly higher than those of dynamic CT indices (P < 0.05) and SUVmax (P < 0.05). Conclusion Dynamic MRI can play a more specific and/or accurate role for nodule management as compared with dynamic MDCT and coregistered PET/CT. J. Magn. Reson. Imaging 2008;27:1284,1295. © 2008 Wiley-Liss, Inc. [source] Do radiologists agree on the quality of computed tomography enterography?JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 4 2009Kari Ersland Summary This study aimed to assess variation between radiologists evaluating the quality of multi-detector computed tomography enterography. For 40 consecutive examinations, three experienced radiologists independently rated the following quality variables: % length of adequately filled bowel, bowel lumen diameters, bowel wall delineation, superior mesenteric vein, and bowel wall enhancement, artefacts, and total quality. We calculated the mean difference between observers with standard deviation (SD) for continuous variables and % total agreement, exact Fleiss kappa, and P -values (McNemar's test) for categorical variables. Depending on bowel segment (duodenum distal to bulb, jejunum, ileum, terminal ileum), mean difference between observers ranged from two to 33 (SD from 11 to 32) for % length of adequately filled bowel judged subjectively, 0,2 (SD 0,3) mm for smallest bowel lumen diameter and 0,4 (SD 3,7) mm for largest bowel lumen diameter. Agreement on bowel wall delineation was 80%/kappa 0.50 in duodenum, 90%/kappa 0.57 in jejunum, 75%/kappa 0.14 in ileum and 88%/kappa 0.17 in terminal ileum, where ratings differed between observers (P < 0.04). Agreement was 65%/kappa 0.18 for bowel wall enhancement judged subjectively. For contrast enhancement measured in Hounsfield Units, mean difference between observers ranged from two to 11 (SD 12,15) in normal jejunum wall and zero to one (SD 4,5) in the superior mesenteric vein depending on observer pair. Agreement was 78%/kappa 0.12 for image artefacts. Rating of total examination quality (good/optimal versus poor/very poor) differed between observers (P < 0.01); agreement was 60%/kappa 0.41. Many subjective evaluations varied between observers. We believe that measurements of bowel lumen diameters and contrast enhancement may be preferable. [source] Detrusor overactivity and urge urinary incontinence following trans obturator versus midurethral slingsNEUROUROLOGY AND URODYNAMICS, Issue 1 2007Sylvia M. Botros Abstract Aims To compare the rates of resolution of detrusor overactivity (DO) and subjective urge urinary incontinence (UUI) as well as de novo DO and UUI between the Monarc, TVT, and SPARC midurethral sling procedures. Methods Two hundred and seventy-six subjects with urodynamic stress or mixed urinary incontinence underwent retropubic midurethral slings (TVT, N,=,99; SPARC, N,=,52) or transobturator slings (Monarc, N,=,125). All evaluable subjects had a routine office evaluation, subjective assessment of UUI, and multichannel urodynamic testing pre- and 3 months postoperatively. Comparisons were made using Student's t -test, ANOVA, McNemar's test, and Chi-Square test where appropriate. Multivariate logistic regression was performed to detect possible confounding factors such as sling type, and differences in concomitant surgical procedures. Results De novo subjective UUI differed significantly between the Monarc and the other two slings (33% TVT vs. 8% Monarc vs. 17% SPARC, P,=,0.04). Fourteen to Sixteen percents of patients with preoperative UUI who underwent TVT or SPARC had worsening of their UUI symptoms while only 6% of the Monarc group did (P,=,0.02). There was no difference in rates of resolution of DO among the three groups (40% vs. 48% vs. 32%, P,=,0.39) or de novo DO (32% vs. 22% vs. 22%, P,=,0.64) at 3 months. Conclusions Patients who undergo transobturator procedures have significantly lower rates of de novo UUI than those who undergo midurethral sling procedures. Rates of resolution of DO, UUI, and de novo DO do not differ between groups. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source] Outcome Evaluation of ,Sharing the Gift of Life': An Organ and Tissue Donation Educational Program for American IndiansAMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2010N. L. Fahrenwald Culturally focused education about deceased donation is needed for American Indians (AIs). This study tested a program designed to impact intention to serve as a deceased donor for reservation dwelling AIs. A pre/posttest design and a community-based participatory research approach were used. The study was based upon the Transtheoretical Model. Adult participants (N = 1580, 58% women) were from four Northern Plains reservations. An outreach coordinator delivered the program using print and video materials. The outcome was stage of motivational readiness (SMR) to serve as a deceased donor. McNemar's test was used to compare pre- to postintervention changes in SMR. At baseline, 55% of participants were not thinking about being a donor (precontemplation stage) and 45% were thinking about it (contemplation stage). Postintervention, 43.1% of participants were unchanged in SMR and 56.9% progressed in SMR. Of those who progressed, 26.5% (n = 418) changed to the contemplation stage, 19.4% (n= 306) changed to the preparation stage (signed a donor card or joined a registry), and 11.1% (n = 175) confirmed a discussion of the decision with family (action stage). Progression in SMR from pre/post was significant, ,2(1) = 18.32, p < 0.05. The intervention resulted in important changes in deceased donor intentions for reservation dwelling AIs. [source] Genotypic Association Analysis Using Discordant-Relative-PairsANNALS OF HUMAN GENETICS, Issue 1 2009T. Yan Summary In practice, family-based design has been widely used in disease-gene association analysis. The major advantage of such design is that it is not subject to spurious association due to population structure such as population stratification (PS) and admixture. A disadvantage is that parental genotypes are hard to obtain if the disease is late onset for which a discordant-relative-pair design is useful. Designs of such kind include full-sib-pair, half-sib-pair, first-cousin-pair, and so on. The closer the relatedness of the pair, the less possible that they are subject to population stratification. On the other hand, the association test using close relative-pairs may be less powerful due to over-matching. Trade-off between these two factors (population structure and over-matching) is the major concern of this study. Some tests, namely McNemar's test, matched Cochran-Armitage trend tests (CATTs), matched maximum efficient robust test (MERT), and Bhapkar's test, are used for testing disease-gene association based on relative-pair designs. These tests are shown to be valid in the presence of PS but not admixture. Numerical studies show that the McNemar's test, additive CATT, MERT, and Bhapkar's test are robust in power, but none of them is uniformly more powerful than the others. In most simulations, the power of any of the tests increases as the pair is more distant. The proposed methods are applied to two real examples. [source] One-year clinical evaluation of a two-step self-etch adhesive with and without additional enamel etching technique in cervical lesionsAUSTRALIAN DENTAL JOURNAL, Issue 2 2010E Ozel Abstract Background:, The aim of this study was to determine the clinical performance of a two-step self-etch adhesive with and without additional enamel etching technique to advanced non-carious cervical sclerotic lesions. Methods:, Twenty-two patients (mean age = 51.5) having at least two pairs of non-carious cervical erosion/attrition/abfraction lesions with incisal or occlusal margins in enamel and gingival margins in dentine/cementum were included in the study. The two-step self-etch adhesive (AdheSE; Ivoclar-Vivadent) was either applied following the self-etch approach on both enamel and dentine (AdheSE non-etch), or a similar application including additional acid-etching of the enamel cavity margins with 37% phosphoric acid (AdheSE etch). Resin composite Point 4 was used for all 104 restorations. Restorations were evaluated at baseline and at one year according to the modified United States Public Health Service (USPHS) criteria. Data were analysed by using McNemar's test (p <0.05). Results:, There were no significant differences in the marginal adaptation both at the cervical and enamel margins between AdheSE non-etch and AdheSE etch groups (p >0.05). At one year, marginal discolouration was evident in the AdheSE non-etch group but it was not statistically significant from the AdheSE etch group (p = 0.12). Postoperative sensitivity was 5% at baseline and reduced to 2% at one year. Conclusions:, At one year, the two-step self-etch adhesive with and without additional enamel etching technique showed excellent clinical results to advanced non-carious cervical sclerotic lesions. [source] Stability of practice beliefs and preferences for patients among private general dentists: a comparison of 1997 and 2007AUSTRALIAN DENTAL JOURNAL, Issue 3 2009DS Brennan Abstract Background:, Practice beliefs and dentist preferences for patients have been related to service rates and appropriateness of care. If practice beliefs and preferences for patients are stable then they could restrain long-term changes in practice styles and service rates. The aim of this paper was to assess the stability of practice beliefs and preferences for patients between 1997 and 2007. Methods:, Practice beliefs and dentist preferences for patients were recorded on a five-point Likert scale using mailed questionnaires from a random sample of dentists in 1997 (response rate = 60 per cent) and 2007 (response rate = 77 per cent). Results:, In both 1997 and 2007, n = 215 dentists provided data. For practice beliefs, 1 out of 8 items were significantly different (p < 0.05; McNemar's test) between the two observations (12.5 per cent of practice belief items) while 5 out of 37 dentist preferences for patient characteristics items were significantly different (13.5 per cent of items). Conclusions:, The majority of items were not significantly different over time. This demonstrates a generally high degree of stability over time in the level of agreement with dentist practice beliefs and preferences for patients. Given that it may be difficult for clinicians to change practice beliefs and behaviours that have become established, it is important for policy makers to understand the relationship between provider characteristics and service patterns and for educators to positively shape beliefs and behaviours through undergraduate and continuing education. [source] Is Consent "Informed" When Patients Receive Care from Medical Trainees?ACADEMIC EMERGENCY MEDICINE, Issue 12 2008Daniel J. Pallin MD Abstract Objectives:, Medical care requires consent and consent requires information. Prior studies have shown that patients are poorly informed about the medical training hierarchy. The authors assessed the impact of "informed" on "consent," by assessing willingness to be seen by trainees before and after information about trainee's credentials. Methods:, A convenience sample of patients in an urban emergency department (ED) waiting room was surveyed, ascertaining willingness to be seen before and after information about trainees credentials, using Likert scales. McNemar's test, linear regression, and mixed models were used to assess statistical significance of information in changing preferences and patient characteristics predicting knowledge, willingness, and change in willingness to be seen with more information. Results:, The authors approached 397 patients, and 199 (50%) English speakers participated. Initially, 45% of subjects knew the meaning of "medical student," and 35%"intern" and "resident." In a controlled multivariate linear regression, educational attainment (p < 0.0001) predicted more knowledge, Hispanic ethnicity predicted less (p = 0.03). Subjects were less willing to be seen by lower-ranking trainees (p < 0.001). Information about trainees caused a significant increase in unwillingness to be seen by medical students (17% to 28%, p = 0.004) and interns (8% to 13%, p = 0.029). Conclusions:, Substantial numbers of ED patients would prefer not to be seen by trainees. When patients are informed about trainees' credentials, they become less willing to be seen by more junior trainees. Further research should clarify informed consent for care among non,English speakers and should address these issues in other medical settings. [source] | ||||||||||||||||||||||||||||