ABSTRACT
To investigate to what extent the use of a three-dimensional (3D) anatomy computer application can improve the acquisition of anatomical knowledge compared with anatomical atlases, junior and advanced medical students participated in an experiment. Participants were asked to answer anatomical questions with the use of a 3D anatomy application (developed at the University Medical Center in Utrecht, the Netherlands) or anatomy atlases. Every student had to complete two assignments, either with an atlas or with the 3D anatomy application. One assignment consisted of 20 questions about the anatomy of the hand, the other one had 20 questions about the anatomy of the foot. The scores on the assignments and time to complete the assignments were registered and investigated. A total of 76 students participated. Students scored significantly higher and were significantly faster when they used the 3D anatomy application. Junior medical students were significantly faster than advanced medical students and particularly, advanced students who worked with an atlas needed most time. These results suggest that the 3D anatomy application is more effective as a studying tool, when compared to the use of paper atlases, for both junior and advanced medical students. The difference in time could indicate an influence of the increased number of mental steps it takes to convert two-dimensional atlas images to a 3D mental representation compared to using the 3D anatomy application, although practical issues explaining this cannot be ruled out. Future studies should establish whether the application leads to better learning/retention and to more time-efficient studying.
Subject(s)
Anatomy , Students, Medical , Anatomy/education , Humans , Imaging, Three-Dimensional , Learning , NetherlandsABSTRACT
OBJECTIVE: To explore associations between physical activity and peak oxygen uptake (VO2peak), age, sex, and Hoffer classification in young wheelchair-users with spina bifida. DESIGN: Exploratory study. SUBJECTS: Fifty-three dutch children (age 5-19 years) with spina bifida who use a manual wheelchair. METHODS: For the dependent variable physical activity, data from 2 physical activity monitors were analysed: VitaMove data for 34 participants and Actiheart data for 36 participants. Time sedentary, time physically active, and time in moderate to vigorous physical activity were analysed. The Wheelchair Shuttle Test was used to measure VO2peak. Univariate and multivariate regression analyses were performed. Independent variables were VO2peak, age, sex, and Hoffer classification. RESULTS: Time sedentary and time physically active during a school day were influenced by age (ß=0.326/ß=-0.320) and Hoffer classification (ß=0.409/ß=-0.534) and during a weekend day by Hoffer classification (ß=0.617/ß=-0.428). Time in moderate to vigorous physical activity was influenced by Hoffer classification (ß=-0.527) during a school day and by age (ß=-0.600) during a weekend day. CONCLUSION: Older age and the inability to walk negatively influence physical activity. Sex and VO2peak were not associated with physical activity. These results imply that increasing cardiorespiratory fitness alone will not improve physical activity in young wheelchair-users with spina bifida.
Subject(s)
Accelerometry/statistics & numerical data , Disabled Persons/statistics & numerical data , Exercise , Spinal Dysraphism/physiopathology , Wheelchairs/statistics & numerical data , Accelerometry/methods , Adolescent , Child , Child, Preschool , Female , Humans , Male , Netherlands , Regression Analysis , Time Factors , Walking , Young AdultABSTRACT
BACKGROUND: The assessment of wheelchair mobility skills (WMS) in youths using a manual wheelchair is important. More information is needed regarding the psychometric properties of the newly developed Utrecht Pediatric Wheelchair Mobility Skills Test (UP-WMST). OBJECTIVE: The purpose of this study was to evaluate the reliability, content validity, construct validity, and responsiveness of the UP-WMST 2.0 in youths using a manual wheelchair. DESIGN: This was a repeated-measurements, cross-sectional study. METHODS: A total of 117 children and adolescents who use a manual wheelchair participated in this study. The UP-WMST 2.0 contains the same 15 WMS items as the original UP-WMST but has an adaptation of the scoring method. Test-retest reliability was estimated in 30 participants. Content validity was assessed through floor and ceiling effect analyses. Construct validity was assessed through hypothesis testing. Preliminary estimates of responsiveness were assessed in 23 participants who participated in a WMS training program. RESULTS: Test-retest reliability analysis showed weighted Cohen kappa coefficients ranging from 0.63 to 0.98 for all but 1 item. The total UP-WMST 2.0 score had an intraclass correlation coefficient of 0.97. No floor or ceiling effects were detected. Independent-sample t test analysis confirmed our hypotheses regarding direction and difference in scores between age and diagnostic groups. Within-group analysis in the responsiveness study showed a positive significant change in UP-WMST 2.0 score (8.3 points). LIMITATIONS: The small sample size used in the responsiveness study was a limitation of this study. CONCLUSIONS: This study provided evidence of the test-retest reliability, content, and construct validity of the UP-WMST 2.0. It also provided initial evidence of the responsiveness of the UP-WMST 2.0 for measuring change in WMS in youths using a manual wheelchair.
Subject(s)
Disability Evaluation , Pediatrics , Psychometrics , Wheelchairs/standards , Adolescent , Child , Cross-Sectional Studies , Female , Humans , Male , Reproducibility of ResultsABSTRACT
Background: Testing aerobic fitness in youth is important because of expected relationships with health. Objective: The purpose of the study was to estimate the validity and reliability of the Shuttle Ride Test in youth who have spina bifida and use a wheelchair for mobility and sport. Design: Ths study is a validity and reliability study. Methods: The Shuttle Ride Test, Graded Wheelchair Propulsion Test, and skill-related fitness tests were administered to 33 participants for the validity study (age = 14.5 ± 3.1 y) and to 28 participants for the reliability study (age = 14.7 ± 3.3 y). Results: No significant differences were found between the Graded Wheelchair Propulsion Test and the Shuttle Ride Test for most cardiorespiratory responses. Correlations between the Graded Wheelchair Propulsion Test and the Shuttle Ride Test were moderate to high (r = .55-.97). The variance in peak oxygen uptake (VO2peak) could be predicted for 77% of the participants by height, number of shuttles completed, and weight, with large prediction intervals. High correlations were found between number of shuttles completed and skill-related fitness tests (CI = .73 to -.92). Intraclass correlation coefficients were high (.77-.98), with a smallest detectable change of 1.5 for number of shuttles completed and with coefficients of variation of 6.2% and 6.4% for absolute VO2peak and relative VO2peak, respectively. Conclusions: When measuring VO2peak directly by using a mobile gas analysis system, the Shuttle Ride Test is highly valid for testing VO2peak in youth who have spina bifida and use a wheelchair for mobility and sport. The outcome measure of number of shuttles represents aerobic fitness and is also highly correlated with both anaerobic performance and agility. It is not possible to predict VO2peak accurately by using the number of shuttles completed. Moreover, the Shuttle Ride Test is highly reliable in youth with spina bifida, with a good smallest detectable change for the number of shuttles completed.
Subject(s)
Exercise Test/methods , Oxygen Consumption/physiology , Physical Fitness/physiology , Spinal Dysraphism/physiopathology , Wheelchairs , Adolescent , Anaerobic Threshold/physiology , Child , Exercise Test/statistics & numerical data , Female , Humans , Male , Netherlands , Reproducibility of Results , Respiration , Respiratory Rate/physiology , Sports , TransportationABSTRACT
Purpose To investigate knowledge and image interpretation skill development in residency by studying scores on knowledge and image questions on radiology tests, mediated by the training environment. Materials and Methods Ethical approval for the study was obtained from the ethical review board of the Netherlands Association for Medical Education. Longitudinal test data of 577 of 2884 radiology residents who took semiannual progress tests during 5 years were retrospectively analyzed by using a nonlinear mixed-effects model taking training length as input variable. Tests included nonimage and image questions that assessed knowledge and image interpretation skill. Hypothesized predictors were hospital type (academic or nonacademic), training hospital, enrollment age, sex, and test date. Results Scores showed a curvilinear growth during residency. Image scores increased faster during the first 3 years of residency and reached a higher maximum than knowledge scores (55.8% vs 45.1%). The slope of image score development versus knowledge question scores of 1st-year residents was 16.8% versus 12.4%, respectively. Training hospital environment appeared to be an important predictor in both knowledge and image interpretation skill development (maximum score difference between training hospitals was 23.2%; P < .001). Conclusion Expertise developed rapidly in the initial years of radiology residency and leveled off in the 3rd and 4th training year. The shape of the curve was mainly influenced by the specific training hospital. © RSNA, 2017 Online supplemental material is available for this article.
Subject(s)
Clinical Competence/statistics & numerical data , Internship and Residency/statistics & numerical data , Radiologists/statistics & numerical data , Radiology/education , Adult , Educational Measurement/statistics & numerical data , Female , Humans , Male , Netherlands , Radiologists/standards , Retrospective StudiesABSTRACT
BACKGROUND: Arterial pressure waveform analysis enables continuous, minimally invasive measurement of cardiac output. Haemodynamic instability compromises the reliability of the technique and a means of maintaining accurate measurement in this circumstance would be useful. OBJECTIVES: To investigate the accuracy, precision and trending ability of arterial pressure waveform cardiac output obtained with FloTrac/Vigileo, versus pulmonary artery thermodilution in patients undergoing elective open abdominal aortic aneurysm repair. DESIGN: A prospective observational study. SETTING: Operating room in a university hospital. PATIENTS: Twenty-two patients scheduled for elective, open abdominal aortic aneurysm repair. MAIN OUTCOME MEASURES: Bias, limits of agreement and mean error as determined with Bland-Altman analysis between arterial waveform and thermodilution cardiac output assessment at four time points: after induction of anaesthesia (t1); after aortic cross-clamping (t2); after clamp release (t3); and after skin closure (t4). Trending ability from t1 to t2, t2 to t3 and t3 to t4, determined with four-quadrant and polar plot methodology. Clinically acceptable boundaries were defined in advance. RESULTS: Bland-Altman analysis revealed a bias of 0.54âlâmin (thermodilution minus arterial waveform cardiac output) for pooled data, and 0.51 (t1), -0.42 (t2), 0.98 (t3) and 0.98 (t4)âlâmin at the different time points. Limits of agreement (LOA) were [-3.0 to 4.0] (pooled), [-2.0 to 3.0] (t1), [-3.1 to 2.3] (t2), [-2.5 to 4.4] (t3) and [-1.7 to 3.7] (t4)âlâmin, resulting in mean errors of 58% (pooled), 45% (t1), 53% (t2), 52% (t3) and 41% (t4). Four-quadrant concordance was 65%. Polar plot analysis resulted in an angular bias of -12°, with radial LOA of -60° to 36°. CONCLUSION: Bias between arterial waveform and thermodilution cardiac output was within a predefined acceptable range, but the mean error was above the accepted range of 30%. Trending ability was poor. Arterial waveform and thermodilution cardiac outputs are, therefore, not interchangeable in patients undergoing open abdominal aortic aneurysm repair.
Subject(s)
Aortic Aneurysm, Abdominal/physiopathology , Aortic Aneurysm, Abdominal/surgery , Arterial Pressure/physiology , Cardiac Output/physiology , Monitoring, Intraoperative/methods , Aged , Aged, 80 and over , Aortic Aneurysm, Abdominal/diagnosis , Female , Humans , Male , Middle Aged , Prospective Studies , Thermodilution/methodsABSTRACT
BACKGROUND: Although various studies have shown high prevalence of malnutrition in hospitalized patients with stroke, recent studies on how the nutritional status of patients with acute stroke develops during the first weeks of hospital stay are scarce. Information is lacking concerning the identification of patients with stroke who are at risk of malnutrition during an acute hospital stay, because these patients may have a significant chance to improve their nutritional status. PURPOSE: This study aimed to investigate the prevalence of malnutrition and risk of malnutrition of patients with acute stroke during the first 10 days of hospitalization. METHODS: A prospective, descriptive study was conducted in a neurological department of a university hospital in The Netherlands. Seventy-three patients with acute stroke were included, of which 23 patients could be followed up after 10 days. The nutritional status was determined with the Mini Nutritional Assessment at admission and after 10 days. RESULTS: At admission, 5% of the patients (n = 73) were malnourished, 14% were at risk of malnutrition, and 81% were well nourished. Of the patients who could be followed up (n = 23), at admission, no patients were malnourished, 9% were at risk of malnutrition, and 91% were well nourished; whereas 10 days later, 26% of these patients were malnourished, 39% were at risk of malnutrition, and 35% were well nourished. This means that, within the followed-up group, the proportion of patients with malnutrition or risk of malnutrition increased significantly during hospital stay from 9% to 65%. CONCLUSIONS: Our study shows that the prevalence of malnutrition and risk of malnutrition in patients with acute stroke increases strongly during the first 10 days of admission. Therefore, screening of the nutritional status of these patients throughout this period is highly recommended to enable timely nutritional intervention and nutritional management of these patients.
Subject(s)
Malnutrition/epidemiology , Malnutrition/nursing , Stroke/epidemiology , Stroke/nursing , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Hospitalization , Humans , Male , Malnutrition/diet therapy , Middle Aged , Nutrition Assessment , Prevalence , Prospective Studies , Risk FactorsABSTRACT
The prediction of progression of individual tumours, prognosis, and survival in squamous cell carcinoma (SCC) of the head and neck is difficult. Cannabinoid-1 (CB1) and cannabinoid-2 (CB2) receptor expression is related to survival in several types of cancer, and the aim of this study was to find out whether the expression of CB1 and CB2 receptors is associated with survival in primary SCC of the head and neck. We made immunohistochemical analyses of the cannabinoid receptors on tissue arrays from 240 patients with the disease. Receptor immunoreactivity was classified as none, weak, moderate, or strong staining. Overall survival and disease-specific survival were plotted using Kaplan-Meier survival curves. A multivariate Cox proportional hazard model was created with all the relevant clinical and pathological features. Strong immunoreactivity of the CB2 receptor was significantly associated with reduced disease-specific survival (p=0.007). Cox-proportional hazard ratio (HR) showed that CB2 receptor immunoreactivity contributed to the prediction of survival (HR 3.6, 95% CI 1.5-8.7, p=0.004). Depth of invasion (HR 2.2, 95% CI 1.2-4.2, p=0.01) and vascular invasion (HR 2.5, 95% CI 1.4-4.5, p=0.001) were also associated with survival.
Subject(s)
Carcinoma, Squamous Cell/immunology , Head and Neck Neoplasms/immunology , Receptor, Cannabinoid, CB2/immunology , Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/pathology , Female , Head and Neck Neoplasms/mortality , Head and Neck Neoplasms/pathology , Human papillomavirus 16/isolation & purification , Humans , Immunohistochemistry , Kaplan-Meier Estimate , Male , Middle Aged , Polymerase Chain Reaction , Prognosis , Proportional Hazards ModelsABSTRACT
PURPOSE: We aimed to study the association between lung function decline and quantitative computed tomography (CT) air trapping. MATERIALS AND METHODS: Current and former heavy smokers in a lung cancer screening trial underwent volumetric low-dose CT in inspiration and expiration. Spirometry was obtained at baseline and after 3 years. The expiratory to inspiratory ratio of mean lung density (E/I-ratioMLD) was used to quantify air trapping. CT emphysema was defined as voxels in inspiratory CT below -950 Hounsfield Unit. Linear mixed modeling was used to determine the association between CT air trapping and lung function. RESULTS: We included 985 subjects with a mean age of 61.3 years. Independent of CT emphysema, CT air trapping was significantly associated with a reduction in forced expiratory volume in one second (FEV1) and the ratio of FEV1 over the forced vital capacity (FEV1/FVC); FEV1 declines with 33 mL per percent increase in CT air trapping, while FEV1/FVC declines 0.58% per percent increase (both p<0.001). CT air trapping further elicits accelerated loss of FEV1/FVC (additional 0.24% reduction per percent increase; pâ=â0.014). CONCLUSION: In a lung cancer screening cohort, quantitatively assessed air trapping on low-dose CT is independently associated with reduced lung function and accelerated decline of FEV1/FVC.
Subject(s)
Lung/physiopathology , Tomography, X-Ray Computed/methods , Female , Forced Expiratory Volume/physiology , Humans , Male , Middle Aged , Respiratory Function Tests , Smoking/adverse effects , Spirometry , Vital Capacity/physiologyABSTRACT
BACKGROUND: Emphysema and small airway disease both contribute to chronic obstructive pulmonary disease (COPD), a disease characterised by accelerated decline in lung function. The association between the extent of emphysema in male current and former smokers and lung function decline was investigated. METHODS: Current and former heavy smokers participating in a lung cancer screening trial were recruited to the study and all underwent CT. Spirometry was performed at baseline and at 3-year follow-up. The 15th percentile (Perc15) was used to assess the severity of emphysema. RESULTS: 2085 men of mean age 59.8 years participated in the study. Mean (SD) baseline Perc15 was -934.9 (19.5) HU. A lower Perc15 value correlated with a lower forced expiratory volume in 1 s (FEV(1)) at baseline (r=0.12, p<0.001). Linear mixed model analysis showed that a lower Perc15 was significantly related to a greater decline in FEV(1) after follow-up (p<0.001). Participants without baseline airway obstruction who developed it after follow-up had significantly lower mean (SD) Perc15 values at baseline than those who did not develop obstruction (-934.2 (17.1) HU vs -930.2 (19.7) HU, p<0.001). CONCLUSION: Greater baseline severity of CT-detected emphysema is related to lower baseline lung function and greater rates of lung function decline, even in those without airway obstruction. CT-detected emphysema aids in identifying non-obstructed male smokers who will develop airflow obstruction.
Subject(s)
Forced Expiratory Volume/physiology , Pulmonary Emphysema/diagnostic imaging , Respiratory Insufficiency/diagnostic imaging , Smoking/adverse effects , Tomography, X-Ray Computed , Disease Progression , Follow-Up Studies , Humans , Male , Middle Aged , Pulmonary Emphysema/complications , Pulmonary Emphysema/physiopathology , Reproducibility of Results , Respiratory Insufficiency/etiology , Respiratory Insufficiency/physiopathology , Spirometry , Time FactorsABSTRACT
BACKGROUND: Since populations evolve, measurement protocols and equipment improve and analysis techniques progress, there is an ongoing need to reassess reference data for pulmonary function tests. Furthermore, reference values for total lung capacity and carbon monoxide diffusion capacity are scarcely available in children. We aimed to provide updated reference equations for most commonly used pulmonary function indices in Caucasian children. METHODS: In the 'Utrecht Pulmonary Function Reference Data Study' we collected data in Caucasian children aged 2-18 years. We analyzed them using the 'Generalized Additive Models for Location Scale and Shape' (GAMLSS) statistical method. RESULTS: Measurements of interrupter resistance (R(int)) (n = 877), spirometry (n = 1042), body plethysmography (n = 723) and carbon monoxide diffusion/helium dilution (n = 543) were obtained in healthy children. Height (or the natural logarithm of height) and age (or the natural logarithm of age) were both significantly related to most outcome measures. Also sex was a significant determinant, except for RV, RV/TLC, FRC(pleth), Raw(0,5), Raw(tot), R(int) and FEF values. The application of previously published reference equations on the study population resulted in misinterpretation of pulmonary function. CONCLUSION: These new paediatric reference equations provide accurate estimates of the range of normality for most commonly used pulmonary function indices, resulting in less underdiagnosis and overdiagnosis of pulmonary diseases.
Subject(s)
Lung Diseases/physiopathology , Pulmonary Diffusing Capacity/physiology , Respiratory Function Tests/methods , Adolescent , Anthropometry , Child , Child, Preschool , Data Interpretation, Statistical , Female , Humans , Lung Diseases/diagnosis , Male , Reference Values , Respiratory Function Tests/standards , White PeopleABSTRACT
BACKGROUND: Health care for cancer patients is primarily shaped by health care professionals. This raises the question to what extent health care professionals are aware of patients' preferences, needs and values.The aim of this study was to explore to what extent there is concordance between patients' preferences in cancer care and patients' preferences as estimated by health care professionals. We also examined whether there were gender differences between health care professionals with regard to the degree in which they can estimate patients' preferences correctly. METHODS: To obtain unbiased insight into the specific preferences of cancer patients, we developed the 'Cancer patients' health care preferences' questionnaire'. With this questionnaire we assessed a large sample of cancer patients (n = 386). Next, we asked health care professionals (medical oncologists, nurses and policymakers, n = 60) to fill out this questionnaire and to indicate preferences they thought cancer patients would have. Mean scores between groups were compared using Mann-Whitney tests. Effect sizes (ESs) were calculated for statistically significant differences. RESULTS: We found significant differences (ESs 0.31 to 0.90) between patients and professionals for eight out of twenty-one scales and two out of eight single items. Patients valued care aspects related to expertise and attitude of health care providers and accessibility of services as more important than the professionals thought they would do. Health care professionals overestimated the value that patients set on particularly organisational and environmental aspects.We found significant gender-related differences between the professionals (ESs 0.69 to 1.39 ) for eight out of twenty-one scales and two out of eight single items. When there were significant differences between male and female healthcare professionals in their estimation of patients health care preferences, female health care professionals invariably had higher scores. Generally, female health care professionals did not estimate patients' preferences and needs better than their male colleagues. CONCLUSIONS: Health care professionals are reasonably well able to make a correct estimation of patients preferences, but they should be aware of their own bias and use additional resources to gain a better understanding of patients' specific preferences for each patient is different and ultimately the care needs and preferences will also be unique to the person.
Subject(s)
Health Personnel/psychology , Neoplasms , Patient Preference , Adolescent , Adult , Aged , Cross-Sectional Studies , Female , Forecasting , Humans , Male , Middle Aged , Professional-Patient Relations , Young AdultABSTRACT
AIMS AND OBJECTIVES: To measure the nutritional status of neurological patients during admission and after 10 days, with a special focus on those with malnutrition and those at risk of malnutrition, and to measure the association of clinical variables and nutritional status, which may be important for the early detection of patients at risk of malnutrition. BACKGROUND: Studies have shown high prevalence of malnutrition in hospitalised patients and recommend structured screening and nutritional intervention for these patients. There is a lack of information concerning the nutritional status of neurological patients. DESIGN: A prospective descriptive study. METHOD: Neurological patients (n = 196) were included from departments of neurology and neurosurgery in Dutch university hospital. Nutritional status was measured with the Mini Nutritional Assessment and functional status with the Barthel Index and the Rankin Scale at admission to the hospital and after 10 days. RESULT: Of the patients, 34% were at risk of malnutrition, 7% were malnourished, whereas 59% of the patients were well nourished according to the MNA. After 10 days, 57% were at risk of malnutrition, 22% were malnourished and 21% were well nourished. The total group of patients malnourished and at risk of malnutrition was 41% at admission, which had grown to 79% in 10 days. Significant association was found between various clinical variables and nutritional status. CONCLUSIONS: A large group of neurological patients is malnourished and at risk of malnutrition during hospital admission, and the nutritional status of most patients worsens in 10 days. Various clinical variables may be of importance in detecting malnourished patients. RELEVANCE TO CLINICAL PRACTICE: Nurses need to observe the symptoms of malnutrition and provide evidence-based nutritional interventions to these patients. Improved education of nurses and good collaboration between the professionals and the facilitation of hospital management is essential to improve nutritional care of neurological patients.
Subject(s)
Hospitalization , Malnutrition/complications , Nervous System Diseases/complications , Humans , Prospective StudiesABSTRACT
AIM: Improving quality of care for cancer patients requires insight into their specific wishes, needs, and preferences concerning cancer care. The aim of this study was to explore the impact of gender on cancer patients' needs and preferences. PATIENTS AND METHODS: Data were obtained from 386 questionnaires assessing cancer patients' preferences for health care. Multivariate regression analyses were performed with data obtained from medical oncology patients treated in seven Dutch hospitals, using the scales of the questionnaire as dependent variables. RESULTS: Patients rated safety, expertise, performance, and attitude of physicians and nurses highest on their list of preferences. There were significant differences between male and female patients concerning preferences in health care in 15 of the 21 scales and in two of the eight single items. Without exception, women found the care aspects mentioned in these scales and items more important than men. Multivariate regression analysis showed that, of all the patient- and disease-related factors, gender was the most important independent predictor of patient preferences. CONCLUSION: Gender impacts cancer patients' needs and preferences and should be taken into account for optimal cancer care. Cancer care might be tailored toward gender, for example, with regard to the means and extent of communication, manner and extent of support, counseling and rehabilitation, consultation length, and physician assignment. The results of this study may guide health care professionals and organizations to develop a gender-specific health care approach to further improve cancer patient-centered care.
Subject(s)
Neoplasms/psychology , Neoplasms/therapy , Patient Satisfaction , Female , Gender Identity , Humans , Male , Patient Preference , Sex FactorsABSTRACT
AIMS: The short-term effect of coronary artery bypass grafting (CABG) on diastolic function is only moderately investigated. Furthermore, it remains unknown whether avoidance of cardioplegic arrest by an off-pump CABG procedure has advantages over on-pump procedure regarding diastolic relaxation and compliance. We investigated whether components of diastolic function would be improved the day after CABG depending on the type of the surgical procedure. METHODS AND RESULTS: Spontaneously breathing on-pump (n = 20) and off-pump CABG (n = 12) patients underwent a comprehensive transthoracic echocardiography examination the day before and the day after elective CABG, including transmitral and pulmonary vein flow parameters, colour M-mode flow propagation velocity (Vp) and tissue Doppler assessment of the average mitral annulus diastolic velocity (Em). Isovolumic relaxation and E-wave deceleration time were corrected for heart rate (IVRTcHR and DTcHR). Left ventricular (LV) relaxation time (τ) and LV operating stiffness (LVOS) were calculated. Overall and independent from operation type and preload, CABG decreased IVRTcHR (107 ± 20 vs. 93 ± 15 ms) (P < 0.01) and τ (54 ± 10 vs. 45 ± 10 ms) (P < 0.01), increased Vp (49 ± 22 vs. 75 ± 37 cm/s) (P < 0.01), and increased Em (6.6 ± 2.0 vs. 7.3 ± 1.3 cm/s, P = 0.06), indicating improved relaxation. LVOS increased (0.13 ± 0.06 vs. 0.22 ± 0.05 mmHg/mL) (P < 0.01), compatible with an impaired compliance. A similar improvement in relaxation and impairment in compliance were observed in both groups. CONCLUSION: Myocardial relaxation improved the day after CABG irrespective of the use of cardiopulmonary bypass with cardioplegic arrest. Impairment in compliance could not be prevented by the avoidance of cardioplegia.
Subject(s)
Coronary Artery Bypass, Off-Pump , Coronary Artery Bypass , Echocardiography/methods , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/surgery , Aged , Blood Flow Velocity , Diastole/physiology , Female , Heart Arrest, Induced , Humans , Linear Models , Male , Middle Aged , Prospective Studies , Treatment Outcome , Ventricular Dysfunction, Left/physiopathologyABSTRACT
OBJECTIVE: To identify and compare prognostic classification systems based on basic tumour characteristics that were developed and/or validated for differentiated thyroid carcinoma (DTC). DESIGN: Retrospective chart study. METHODS: Literature was studied using PubMed. Fifteen different prognostic classification systems were identified, of which seven were developed or validated for DTC patients and were based on basic tumour characteristics. These systems were applied to 1225 DTC patients who were treated in our hospital between 1978 and 2002. RESULTS: Log-rank analysis of Kaplan-Meier cancer-specific survival curves showed that the curve of the Tumor, Lymph-Node, Metastasis (TNM) system had the greatest discriminatory power (log-rank test, log P = -84.9). Cox-regression analysis showed that the TNM system was the most powerful determinant of cancer-specific survival curves. Proportion of variance explained (PVE) analysis showed that the TNM system had the highest PVE. CONCLUSION: Of the prognostic classification systems analysed in this study, the TNM system performs best in all the three analyses, and is therefore the most suitable for predicting outcome in DTC-patients.
Subject(s)
Carcinoma/classification , Carcinoma/diagnosis , Diagnostic Techniques, Endocrine , Thyroid Neoplasms/classification , Thyroid Neoplasms/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Carcinoma/pathology , Cell Differentiation , Child , Child, Preschool , Databases, Factual , Female , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Thyroid Neoplasms/pathology , Validation Studies as Topic , Young AdultABSTRACT
OBJECTIVES: The aim of this study was to determine, over time, changes in annual trends of nosocomial bacteraemia (NB) and to quantify pathogen-specific changes and emergence of antibiotic resistance. METHODS: A retrospective cohort study in a 997 bed tertiary care centre in the Netherlands was performed. All adult patients (> or =18 years old) admitted for >48 h between 1 January 1996 and 31 December 2005 were included. RESULTS: A total of 163 525 patients, comprising 1 826 852 patient-days and 1785 episodes of NB, were analysed. The number of admissions per year and length of hospital stay decreased over time. Crude incidence of NB per year remained unchanged, but cumulative incidence (cases/10 000 admissions) and incidence densities (cases/100 000 patient-days at risk) increased, on average, by 2.0% and 4.0% per year, respectively, primarily because of infections caused by Enterococcus spp. and Pseudomonas aeruginosa. The incidence density of NB caused by highly resistant microorganisms increased, on average, by 26.1% [95% confidence interval (CI): 17-37] per year, when compared with an annual increase of 3% (95% CI: 1-5) for NB caused by susceptible pathogens. Ratios of increased incidence densities of resistant and susceptible bacteria were 8.7, 3.5, 2.6 and >37.9 for all pathogens, Enterococcus spp., P. aeruginosa and Enterobacteriaceae, respectively. CONCLUSIONS: Due to changes in the patient population, increased incidences of NB over time are only evident when expressed as cumulative incidence or incidence densities. Despite overall low levels of antibiotic resistance, the incidence of NB caused by multiresistant pathogens rapidly increased, adding to the total burden of NB.
Subject(s)
Bacteremia/epidemiology , Bacteria/drug effects , Cross Infection/epidemiology , Drug Resistance, Bacterial , Adult , Aged , Bacteremia/microbiology , Bacteria/isolation & purification , Cross Infection/microbiology , Female , Gram-Positive Bacterial Infections/epidemiology , Gram-Positive Bacterial Infections/microbiology , Hospitals , Humans , Incidence , Male , Middle Aged , Netherlands/epidemiology , Pseudomonas Infections/microbiology , Retrospective Studies , Young AdultABSTRACT
OBJECTIVE: Dynamic preload indicators like pulse pressure variation (PPV) and stroke volume variation (SVV) are increasingly being used for optimizing cardiac preload since they have been demonstrated to predict fluid responsiveness in a variety of perioperative settings. However, in open-chest conditions, the value of these indices has not been systematically examined yet. We, therefore, evaluated the ability of PPV and SVV to predict fluid responsiveness under open- and closed-chest conditions. DESIGN: Prospective, controlled, clinical study. SETTING: University hospital. PATIENTS: Twenty-two patients scheduled for elective coronary artery bypass graft surgery. INTERVENTIONS: Defined volume loads (VL) (10 mL kg-1 hydroxyethyl starch 6%) intra- and postoperatively. MEASUREMENTS AND MAIN RESULTS: Stroke volume index was measured 1) before and after a VL intraoperatively in open-chest conditions, and 2) under closed-chest conditions within 1 hour after arrival in the intensive care unit. Central venous pressure and global end diastolic volume were assessed as static preload indicators. In addition, PPV and SVV (both obtained with PiCCO system) were recorded. Fluid-responders were defined by an increase in stroke volume index >or=12% subsequent to the VL. Receiver operating characteristic analysis showed that all preload indicators failed to predict fluid responsiveness in open-chest conditions. Under closed-chest conditions, the areas under the receiver operating characteristic curve for PPV and SVV were 0.884 (p = 0.004) and 0.911 (p = 0.003), respectively, whereas the static and volumetric preload parameters failed to predict fluid responsiveness. A PPV of >or=10% identified fluid-responders with a sensitivity of 64% and a specificity of 100%, while a SVV of >8% identified fluid-responders with a sensitivity of 100% and a specificity of 78%. CONCLUSIONS: Our results suggest that the dynamic preload indicators PPV and SVV are able to predict fluid responsiveness under closed-chest conditions, whereas all static and dynamic preload indicators fail to predict fluid responsiveness under open-chest conditions.
Subject(s)
Coronary Artery Bypass , Fluid Therapy/methods , Hemodynamics , Monitoring, Intraoperative/methods , Aged , Aged, 80 and over , Algorithms , Cardiac Output/physiology , Central Venous Pressure/physiology , Female , Humans , Male , Middle Aged , Prospective Studies , Pulsatile Flow/physiology , Stroke Volume/physiology , ThermodilutionABSTRACT
BACKGROUND: A minority of patients with attention-deficit hyperactivity disorder (ADHD) do not respond favorably to methylphenidate. This has been partially associated with homozygosity for the Dopamine transporter (DAT1) 10-repeat allele and the presence of one or two Dopamine D4 receptor (DRD4) 7-repeat alleles. This study examined the sibling correlation of methylphenidate response rate and the possible association between response rate and these risk alleles. METHODS: A sample of 82 Dutch children with ADHD, from 54 families, (including 30 singletons and 28 sib pairs), who used methylphenidate, was phenotyped according to DSM-IV criteria. Patients were members of affected sib pairs and were genotyped for DAT1 and DRD4. The sibling Intraclass Correlation Coefficient for methylphenidate response rate was calculated. The association between individual response rates and the risk alleles was examined using linear regression techniques. RESULTS: The Intraclass Correlation Coefficient was significant (r=.563, p=.001). No evidence was found establishing an association between methylphenidate response and DAT1-homozygosity. There was a positive trend towards association with the presence of one or two DRD4-7R alleles. CONCLUSIONS: The sibling correlation may indicate a familial clustering of methylphenidate response. This response is possibly associated with the presence of one or two alleles at the DRD4-7R locus, but not with DAT1-10R homozygosity in the Dutch population.
Subject(s)
Attention Deficit Disorder with Hyperactivity/drug therapy , Attention Deficit Disorder with Hyperactivity/genetics , Dopamine Agents/pharmacology , Dopamine Plasma Membrane Transport Proteins/genetics , Homozygote , Methylphenidate/pharmacology , Polymorphism, Genetic , Receptors, Dopamine D4/genetics , Attention Deficit Disorder with Hyperactivity/epidemiology , Child , Comorbidity , Female , Humans , Male , Mental Disorders/epidemiology , Minisatellite Repeats , Netherlands/epidemiology , Regression Analysis , Retrospective Studies , Risk , SiblingsABSTRACT
A randomized, controlled field trial was performed in The Netherlands to determine the therapeutic efficacy of parenteral penethamate hydriodide (Leocillin) against naturally occurring, chronic, streptococcal mastitis during lactation. Quarter milk samples were collected from subclinical cases of Streptococcus uberis or Streptococcus dysgalactiae mastitis to determine the effect of treatment on bacteriological cure and somatic cell count (SCC) at quarter level. A quarter was considered to be cured when the bacterial species, isolated prior to treatment, was not isolated from the quarter milk samples taken on days 10 and 20 post-treatment (bacteriological cure), or when a quarter milk SCC (QMSCC) was <250000 cells/ml on days 10 and 20 post-treatment (SCC cure). Longitudinal data analysis was performed to determine the effect of antibiotic therapy on SCC and milk yield at cow level. Bacteriological cure occurred in 59% of 29 treated quarters, while no cure was observed in any of the 21 untreated control quarters. Treatment resulted in a significant decrease in SCC at cow and quarter level in comparison with untreated controls. There was no significant effect of treatment on milk production. Antibacterial treatment of subclinical streptococcal infections during lactation also prevented clinical mastitis. Furthermore, the treatment may contribute to reduction of bulk milk SCC and to prevention of pathogen spread in dairy herds.