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Selected AbstractsSerum IgM Concentrations in Normal, Fit Horses and Horses with Lymphoma or Other Medical ConditionsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 3 2003G.A. Perkins The purposes of this study were to (1) prospectively establish serum IgM and IgG concentrations in normal, fit, adult horses over time and (2) determine the accuracy of serum IgM concentrations for diagnosing lymphoma. Serial IgM and IgG concentrations were measured with a radial immunodiffusion assay in 25 regularly exercised horses at 6-week intervals. Horses had serum IgM concentrations ranging from 50 to 242 mg/dL over 5 months, with 20% of horses having IgM , 60 mg/dL. The normal range for IgM in fit horses should be considered 103 ± 40 mg/dL and a cut-point for an IgM deficiency, ,23 mg/dL. IgG concentrations ranged from 1,372 to 3,032 mg/dL. Retrospectively, medical records of adult horses (n = 103) admitted to the Cornell University Hospital for Animals for which serum IgM was measured were examined. Horses were categorized as "lymphoma negative" (n = 34) or "lymphoma positive" (n = 18). The sensitivity and specificity of a serum IgM concentration (,60 mg/dL) for detecting equine lymphoma was 50 and 35%, respectively. At the new cut-point (,23 mg/dL), the sensitivity was low at 28% and the specificity improved to 88%. The negative predictive values at various population prevalences indicate that a horse with a high serum IgM (>23 mg/dL) is unlikely to have lymphoma, whereas the positive predictive value (70%) does not allow for reliable determination of lymphoma in a horse with serum IgM , 23 mg/dL. Therefore, serum IgM concentrations should not be used as a screening test for equine lymphoma. [source] A one-sided MEWMA chart for health surveillanceQUALITY AND RELIABILITY ENGINEERING INTERNATIONAL, Issue 5 2008Michael D. Joner Jr Abstract It is often important to rapidly detect an increase in the incidence rate of a given disease or other medical condition. It has been shown that when disease counts are sequentially available from a single region, a univariate control chart designed to detect rate increases, such as a one-sided cumulative sum chart, is very effective. When disease counts are available from several regions at corresponding times, the most efficient monitoring method is not readily apparent. Multivariate monitoring methods have been suggested for dealing with this detection problem. Some of these approaches have shortcomings that have been recently demonstrated in the quality control literature. We discuss these limitations and suggest an alternative multivariate exponentially weighted moving average chart. We compare the average run-length performance of this chart with that of competing methods. We also evaluate the statistical performance of these charts when the actual increase in the disease count rate is different from the one that the chart was optimized to detect quickly. Copyright © 2008 John Wiley & Sons, Ltd. [source] Predictors of injury-related and non-injury-related mortality among veterans with alcohol use disordersADDICTION, Issue 10 2010Sylwia Fudalej ABSTRACT Aims To describe the association between alcohol use disorders (AUDs) and mortality and to examine risk factors for and all-cause, injury-related and non-injury-related mortality among those diagnosed with an AUD. Setting Department of Veterans Affairs, Veterans Health Administration (VHA). Participants A cohort of individuals who received health care in VHA during the fiscal year (FY) 2001 (n = 3 944 778), followed from the beginning of FY02 through the end of FY06. Measurements Demographics and medical diagnoses were obtained from VHA records. Data on mortality were obtained from the National Death Index. Findings Controlling for age, gender and race and compared to those without AUDs, individuals with AUDs were more likely to die by all causes [hazard ratio (HR) = 2.30], by injury-related (HR = 3.29) and by non-injury-related causes (HR = 2.21). Patients with AUDs died 15 years earlier than individuals without AUDs on average. Among those with AUDs, Caucasian ethnicity and all mental illness diagnoses that were assessed were associated more strongly with injury-related than non-injury-related mortality. Also among those with AUDs, individuals with medical comorbidity and older age were at higher risk for non-injury related compared to injury-related mortality. Conclusions In users of a large health-care system, a diagnosis of an AUD is associated significantly with increased likelihood of dying by injury and non-injury causes. Patients with a diagnosis of an AUD who die from injury differ significantly from those who die from other medical conditions. Prevention and intervention programs could focus separately upon selected groups with increased risk for injury or non-injury-related death. [source] Allogeneic bone marrow transplantation with reduced conditioning (RC-BMT)EUROPEAN JOURNAL OF HAEMATOLOGY, Issue 2 2001Lars Vindeløv Abstract: Allogeneic bone marrow transplantation with conventional conditioning (CC-BMT) has the potential of curing various malignant and non-malignant diseases. The curative mechanisms encompass 1) stem cell support for myeloablative radio-chemotherapy, 2) the graft-versus-tumor (GVT) effect, 3) gene replacement for genetic diseases and 4) immunoablation for autoimmune diseases. CC-BMT is characterized by high intensity conditioning, the requirement of prolonged and expensive hospital treatment and a treatment related mortality (TRM) of 10,50% depending on diagnosis, disease stage, patient age and donor type. Recent preclinical and clinical progress has resulted in the emergence of new concepts and procedures that allow replacement of patient bone marrow and immune system with that of the donor by a transplant procedure with markedly reduced conditioning (RC-BMT). This type of transplant, sometimes referred to as mini-BMT, activates curative mechanisms 2,4, which for a number of diseases seems sufficient for cure. It avoids the severe organ toxicity of myeloablative radio-chemotherapy and the complications of profound neutropenia. Patients beyond the age limit of conventional BMT (50,60 yr) may therefore be candidates for this type of transplant as well as patients which because of other medical conditions or the type of disease for which the transplant is needed are poor candidates for CC-BMT. The procedure can be performed in an outpatient setting. The resulting cost reduction should contribute to making allogenic BMT more readily available. This review describes basic concepts and procedures involved in RC-BMT and summarizes preliminary results obtained with RC-BMT in different transplant centers. [source] Evaluation of a computer-adaptive test for the assessment of depression (D-CAT) in clinical applicationINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 1 2009Herbert Fliege Abstract In the past, a German Computerized Adaptive Test, based on Item Response Theory (IRT), was developed for purposes of assessing the construct depression [Computer-adaptive test for depression (D-CAT)]. This study aims at testing the feasibility and validity of the real computer-adaptive application. The D-CAT, supplied by a bank of 64 items, was administered on personal digital assistants (PDAs) to 423 consecutive patients suffering from psychosomatic and other medical conditions (78 with depression). Items were adaptively administered until a predetermined reliability (r , 0.90) was attained. For validation purposes, the Hospital Anxiety and Depression Scale (HADS), the Centre for Epidemiological Studies Depression (CES-D) scale, and the Beck Depression Inventory (BDI) were administered. Another sample of 114 patients was evaluated using standardized diagnostic interviews [Composite International Diagnostic Interview (CIDI)]. The D-CAT was quickly completed (mean 74 seconds), well accepted by the patients and reliable after an average administration of only six items. In 95% of the cases, 10 items or less were needed for a reliable score estimate. Correlations between the D-CAT and the HADS, CES-D, and BDI ranged between r = 0.68 and r = 0.77. The D-CAT distinguished between diagnostic groups as well as established questionnaires do. The D-CAT proved an efficient, well accepted and reliable tool. Discriminative power was comparable to other depression measures, whereby the CAT is shorter and more precise. Item usage raises questions of balancing the item selection for content in the future. Copyright © 2009 John Wiley & Sons, Ltd. [source] Healthcare Utilization of Elderly Persons Hospitalized After a Noninjurious Fall in a Swiss Academic Medical CenterJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2006Laurence Seematter-Bagnoud MD OBJECTIVES: To determine the risk of hospital readmission, nursing home admission, and death, as well as health services utilization over a 6-month follow-up, in community-dwelling elderly persons hospitalized after a noninjurious fall. DESIGN: Prospective cohort study with 6-month follow-up. SETTING: Swiss academic medical center. PARTICIPANTS: Six hundred ninety persons aged 75 and older hospitalized through the emergency department. MEASUREMENTS: Data on demographics and medical, physical, social, and mental status were collected upon admission. Follow-up data were collected from the state centralized billing system (hospital and nursing home admission) and proxies (death). RESULTS: Seventy patients (10%) were hospitalized after a noninjurious fall. Fallers had shorter hospital stays (median 4 vs 8 days, P<.001) and were more frequently discharged to rehabilitation or respite care than nonfallers. During follow-up, fallers were more likely to be institutionalized (adjusted hazard ratio=1.82, 95% confidence interval=1.03,3.19, P=.04) independent of comorbidity and functional and mental status. Overall institutional costs (averaged per day of follow-up) were similar for both groups ($138.5 vs $148.7, P=.66), but fallers had lower hospital costs and significantly higher rehabilitation and long-term care costs ($55.5 vs $24.1, P<.001), even after adjustment for comorbidity, living situation, and functional and cognitive status. CONCLUSION: Elderly patients hospitalized after a noninjurious fall were twice as likely to be institutionalized as those admitted for other medical conditions and had higher intermediate and long-term care services utilization during follow-up, independent of functional and health status. These results provide direction for interventions needed to delay or prevent institutionalization and reduce subsequent costs. [source] Assessing the dietetic needs of different patient groups receiving enteral tube feeding in primary careJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 3 2002S. M. Madigan Abstract Aim To examine the nature of all contacts between adult tube-fed patients and the dietetic service and to refine the current dietetic protocols to reflect the findings of the study with a view to improving patient care. Methods All adult patients referred to the Community Nutrition and Dietetic Service within a 6-month period were included in the study. Using a proforma developed from a retrospective case-note analysis, data were collected on the complications that prompted more frequent contacts than the department protocol. Data were analysed using the Statistical Package for the Social Sciences. Results The most common indication for home enteral feeding in this group of adult patients was a swallowing disorder resulting from a cerebrovascular accident (59.5%) followed by cancer (21.5%). There was a trend for cancer patients to need more intervention compared with those patients with other medical conditions. A significant difference was observed in the total contacts and telephone calls given to those patients in there own homes (P=0.019) and there was a trend towards more domicilary visits with this group. Conclusions The department protocols have been revised to include a planned review within 2,6 weeks of initial dietetic assessment in the community for those patients who were identified to have the greatest need. More intensive dietetic monitoring has clear implications for dietetic services in the community. [source] Integrated Management of Physician-delivered Alcohol Care for Tuberculosis Patients: Design and ImplementationALCOHOLISM, Issue 2 2010Shelly F. Greenfield Background:, While the integration of alcohol screening, treatment, and referral in primary care and other medical settings in the U.S. and worldwide has been recognized as a key health care priority, it is not routinely done. In spite of the high co-occurrence and excess mortality associated with alcohol use disorders (AUDs) among individuals with tuberculosis (TB), there are no studies evaluating effectiveness of integrating alcohol care into routine treatment for this disorder. Methods:, We designed and implemented a randomized controlled trial (RCT) to determine the effectiveness of integrating pharmacotherapy and behavioral treatments for AUDs into routine medical care for TB in the Tomsk Oblast Tuberculosis Service (TOTBS) in Tomsk, Russia. Eligible patients are diagnosed with alcohol abuse or dependence, are newly diagnosed with TB, and initiating treatment in the TOTBS with Directly Observed Therapy-Short Course (DOTS) for TB. Utilizing a factorial design, the Integrated Management of Physician-delivered Alcohol Care for Tuberculosis Patients (IMPACT) study randomizes eligible patients who sign informed consent into 1 of 4 study arms: (1) Oral Naltrexone + Brief Behavioral Compliance Enhancement Therapy (BBCET) + treatment as usual (TAU), (2) Brief Counseling Intervention (BCI) + TAU, (3) Naltrexone + BBCET + BCI + TAU, or (4) TAU alone. Results:, Utilizing an iterative, collaborative approach, a multi-disciplinary U.S. and Russian team has implemented a model of alcohol management that is culturally appropriate to the patient and TB physician community in Russia. Implementation to date has achieved the integration of routine alcohol screening into TB care in Tomsk; an ethnographic assessment of knowledge, attitudes, and practices of AUD management among TB physicians in Tomsk; translation and cultural adaptation of the BCI to Russia and the TB setting; and training and certification of TB physicians to deliver oral naltrexone and brief counseling interventions for alcohol abuse and dependence as part of routine TB care. The study is successfully enrolling eligible subjects in the RCT to evaluate the relationship of integrating effective pharmacotherapy and brief behavioral intervention on TB and alcohol outcomes, as well as reduction in HIV risk behaviors. Conclusions:, The IMPACT study utilizes an innovative approach to adapt 2 effective therapies for treatment of alcohol use disorders to the TB clinical services setting in the Tomsk Oblast, Siberia, Russia, and to train TB physicians to deliver state of the art alcohol pharmacotherapy and behavioral treatments as an integrated part of routine TB care. The proposed treatment strategy could be applied elsewhere in Russia and in other settings where TB control is jeopardized by AUDs. If demonstrated to be effective, this model of integrating alcohol interventions into routine TB care has the potential for expanded applicability to other chronic co-occurring infectious and other medical conditions seen in medical care settings. [source] The significance of diabetes and disability: referrals made to a disability servicePRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 6 2006MRCP Specialist Registrar in Rehabilitation Medicine, R Singh MA Abstract Diabetes mellitus is an important cause of disability even after correction for complications. It has been suggested that diabetes may be underestimated in referrals to rehabilitation services. We tested this by assessing how often patients with diabetes had this diagnosis mentioned when referred to a wheelchair clinic. Two hundred consecutive referrals to a wheelchair service were assessed to ascertain whether diabetes was mentioned in the referral letter compared to how many actually had a diagnosis of diabetes. This was then compared to other medical conditions to assess whether diabetes was being under-mentioned in referrals. Only 7/29 (24.1%) patients with diabetes in the cohort had diabetes mentioned in their referral. By comparison, 34/42 (81%) of those with stroke/heart failure/chronic obstructive pulmonary disease were mentioned (,2=22.69, df=1, p<0.001) There was no difference between those with diabetes mentioned or not mentioned in terms of age, gender, type of diabetes, HbA1c or complication rate. We conclude that diabetes is under-mentioned in referrals to a rehabilitation service. It may be the case that health services are yet to appreciate the significance of diabetes as a cause of disability compared to other major conditions that cause disability. There seems to be a need to create an awareness of the importance of diabetes in disability. Copyright © 2006 John Wiley & Sons, Ltd. [source] Beyond treatment of individual behavior problems: an effective residential continuum of care for individuals with severe behavior problemsBEHAVIORAL INTERVENTIONS, Issue 1 2007Terry J. Page We report on one component of a residential continuum of care designed to integrate children and adolescents with severe behavior problems into community residential and educational placements. The continuum featured three components: a behavior stabilization unit, campus apartments, and community group homes. Data are reported for a 5-year period, during which 116 children and adolescents were admitted to a behavior stabilization program for treatment of severe self-injury, aggression, and/or property destruction, and non-compliance. Additional problems for some admissions included stereotypy, feeding disorders, sleeping disorders, seizure disorders, and other medical conditions. Archival data were collected retrospectively on age, gender, length of stay, prescribed medications, function of problem behaviors, acuity level of behavioral interventions, and discharge site. Analysis of data indicated (1) the behavior stabilization unit was successful in reducing occurrence of severe behavior problems, and increasing adaptive behaviors, (2) Seventy-three individuals were able to successfully transition to a campus apartment program that had been designed as a step-down program from the behavioral stabilization unit, and (3) Sixty-seven individuals were able to transition to community group homes. The benefits of a residential continuum of care for individuals with severe behavior problems are discussed. Copyright © 2007 John Wiley & Sons, Ltd. [source] The pharmacokinetics, pharmacodynamics and tolerability of dabigatran etexilate, a new oral direct thrombin inhibitor, in healthy male subjectsBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 3 2007Joachim Stangier Aims The novel direct thrombin inhibitor (DTI), dabigatran etexilate (Boehringer Ingelheim Pharma GmbH & Co. KG), shows potential as an oral antithrombotic agent. Two double-blind, randomized trials were undertaken to investigate the pharmacokinetics (PK), pharmacodynamics (PD) and tolerability of orally administered dabigatran etexilate in healthy male subjects. Methods Dabigatran etexilate or placebo was administered orally at single doses of 10,400 mg (n = 40) or at multiple doses of 50,400 mg three times daily for 6 days (n = 40). Plasma and urine samples were collected over time to determine the PK profile of dabigatran. PD activity was assessed by its effects on blood coagulation parameters: activated partial thromboplastin time (aPTT), prothrombin time (PT), reported as international normalized ratio (INR), thrombin time (TT), and ecarin clotting time (ECT). All adverse events were recorded. Results Dabigatran etexilate was rapidly absorbed with peak plasma concentrations of dabigatran reached within 2 h of administration. This was followed by a rapid distribution/elimination phase and a terminal phase, with associated estimated half-lives of 8,10 h and 14,17 h with single and multiple dose administrations, respectively. Dabigatran exhibited linear PK characteristics with dose-proportional increases observed in maximum plasma concentration and area under the curve. Steady-state conditions were reached within 3 days with multiple dosing. The mean apparent volume of distribution during the terminal phase (Vz/F) of 1860 l (range 1430,2400 l) and the apparent total clearance after oral administration (CLtot/F) of 2031 ml min,1 (range 1480,2430), were dose independent. Time curves for aPTT, INR, TT and ECT paralleled plasma concentration,time curves with values increasing rapidly and in a dose-dependent manner. At the highest dose of 400 mg administered three times daily, maximum prolongations over baseline of 3.1 (aPTT), 3.5 (INR), 29 (TT) and 9.5-fold (ECT) were observed. Dabigatran underwent conjugation with glucuronic acid to form pharmacologically active conjugates that accounted for approximately 20% of total dabigatran in plasma. Overall, variability in PK parameters was low to moderate, with an average interindividual coefficient of variation (CV) of approximately 30% and variability in PD parameters was low, with CV < 10%. Of the four assays, TT and ECT exhibited the greatest sensitivity and precision within the anticipated therapeutic dose range. Bleeding events were few and were mild-to-moderate in intensity, occurring only in the higher, multiple dose groups. Conclusions These data suggest that dabigatran etexilate is a promising novel oral DTI with predictable PK and PD characteristics and good tolerability. Further investigation of dabigatran etexilate for the treatment and prophylaxis of patients with arterial and venous thromboembolic disorders, acute coronary syndromes and other medical conditions is warranted. [source] Use of magnetic enrichment for detection of carcinoma cells in fluid specimensCANCER, Issue 1 2002Eric Kielhorn B.S. BACKGROUND Ascites fluid or a pleural effusion are common events in metastatic carcinoma, but they also can be associated with several other medical conditions. The standard for determination of malignancy in these situations is cytologic evaluation of these fluids. Although this method is frequently successful, there are times when it fails, even when the patient has a malignancy, either because of insufficient cells in the fluid or for other reasons. This study addresses this problem taking advantage of the recent advances in technology for detection of rare epithelial cells in liquid specimens. METHODS The authors examined fluid specimens from 59 patients to determine the frequency of recovery of epithelial cells compared with that achieved by conventional cytopathology. The Dynal CELLection Epithelial Enrich (Dynal AS, Oslo, Norway) method was used. This method is based on immunomagnetic selection of cells binding to EpCAM antibodies. Carcinoma cells were confirmed by morphology and, when there was sufficient material, by E-cadherin staining. RESULTS Grouping the cases by cytologic diagnosis, the authors found malignant cells using the cell enrichment assay in 11 of 12 malignant cases, 2 of 5 atypical cases, and 3 of 42 negative cases. Further investigations were conducted on the five cases that were cytologically negative or atypical but yielded epithelial cells after immunomagnetic enrichment. Four cases ultimately were proven malignant by other methods and one had incomplete follow-up. CONCLUSIONS The new methods available for epithelial cell enrichment in liquids may be used successfully on cytologic fluid specimens and may lead to increased sensitivity for detection of malignancy, and consequently more accurate staging. Cancer 2002;94:205,11. © 2002 American Cancer Society. [source] | ||||||||||