Applying item response theory to enhance health outcomes assessment

Background Health-related quality of life (HRQL) is an accepted outcome measure in patients with mood and anxiety disorders. Yet, surprisingly little attention has been paid to the determinants. In this paper we test the hypothesis that it is associated with personality traits while controlling for mental disorders. Methods A large sample of outpatients (n=640) with mood and anxiety disorders was studied. The empirically supported five factor model of normal personality traits was assessed using the NEO-FFI and includes: neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness. Mental disorders were assessed with the CIDI, and HRQL with the SF-36. Results Regression analyses revealed that the NEO-FFI scores, with the exception of conscientiousness, were significantly associated with SF-36 subscales and summary scores, independently from the mental disorders. The percentage of explained variance due to the personality traits was highest for the subscales Vitality (10.0%), Mental Health (13.3%) and the Mental Health Summary Score (9.5%). Furthermore, specific personality traits were related to specific SF-36 subscales. Conclusions A low HRQL of patients with mood or anxiety disorders is not only determined by the disease or the current health but is also shaped by personality traits that are relatively stable throughout an individual's life time.     

Feasibility of near real-time image-guided sinus surgery using intraoperative fluoroscopic computed axial tomography.

OBJECTIVE: One of the main limitations of image-guided surgery is that navigation relies on the use of a CT scan obtained before surgery and is unable to be updated during the procedure. A software addition has been developed to allow reconstruction of CT-like images from a series of fluoroscopic scans and integrate these into an image-guided system (GE Healthcare Surgical Navigation, Lawrence, MA). We report our initial experience with a series of patients undergoing intraoperative fluoroscopic navigation in sinus surgery. STUDY DESIGN AND SETTINGS: After institutional review board clearance, we prospectively studied 14 consecutive patients undergoing image-guided sinus surgery with the use of intraoperative fluoroscopy. RESULTS: All patients had preoperative and postoperative fluoroscopic images reconstructed into CT-like images. By the conclusion of the study, images were adequate in quality and accurate navigation was achieved. CONCLUSION: Real-time image-guided sinus surgery using fluoroscopy is feasible. Future studies will need to focus on defining the procedures that could benefit, such as tumor resection, to enhance patient safety during these operations.     

Diabetes in sex offenders

Thirteen diabetic male sex offenders were compared to 13 nondiabetic sex offenders matched on age, education and offense type. A standard battery of tests administered in the assessment of sex offenders was used to compare the two groups. The tests examine sexual history and preference, substance abuse, violence, personality, and neuropsychological impairment. Results showed that diabetics more often than controls complained of impotence and were nonresponders during phallometric testing. Diabetics, as adults, tended to have less sexual experience with adults and more with pubescent females. The two groups did not differ in number of sexual or nonsexual offenses. The diabetics reported more problems controlling their emotions and more often than controls presented in assessment with inappropriate and/or aggressive behavior and poor cooperation. MMPI results showed diabetics to have more overall clinical disturbance than controls including anxiety, health concerns, family problems, authority problems, criminality, confused thinking and ruminating. Diabetics and controls did not differ in reported frequency of violent behavior but the diabetics responded more extremely, given the circumstances. Diabetics tended to show more violence to their own children. The role of diabetes in the relapse cycle model of offending is discussed.     

Comparison of FK-506 and cyclosporine regimens in pediatric renal transplantation

Clinical aspects of FK-506 or cyclosporine immunosuppression regimens were evaluated in 48 consecutive pediatric renal transplant recipients. Tapering and discontinuation of prednisone was employed only in children receiving FK-506 who experienced minor or no rejection episodes during the 1st posttransplant month. At 1 year follow-up, 17 of 22 (77%) of all children with functioning allografts were receiving no prednisone (n=13) or a mean dosage of 0.07 mg/kg per day (n=4). During the 1st month, acute cellular rejection was more common in the FK-506 group (0.58 vs. 0.21 rejections per patient,P<0.05) but allograft survival (92%) and renal function at 1 year posttransplant were identical in both groups. Compared with the cyclosporine regimen, FK-506 immunosuppression may be associated with a higher incidence of cytomegalovirus or reversible Epstein-Barr virus-induced lymphoproliferative disease. However, the FK-506 group had less hirsutism and gingival hypertrophy and required fewer antihypertensive medications independent of steroid use. Height standard deviation scores and weight-for-height index improved only in preadolescents receiving FK-506 but no prednisone (P<0.02 andP<0.05, respectively), but did not differ between children on FK-506 plus prednisone and those in the cyclosporine group. We conclude that the major advantages of FK-506 over cyclosporine immunosuppression are a reduced severity of hypertension and an improved cosmetic appearance which may improve long-term medical compliance. When used as monotherapy, FK-506 also shows promise in relieving the growth retardation associated with cyclosporine regimens that include prednisone.     

Colorectal tumor screening in women with a past history of breast, uterine, or ovarian malignancies

Epidemiologic studies have shown that women who have successfully recovered from breast, uterine, or ovarian cancer have about twice the expected risk of developing colorectal cancer. These high-risk women were entered, therefore, into a large bowel screening program based on fecal occult blood detection, flexible sigmoidoscopy, and colonoscopy, when appropriate. The study group consisted of 183 women and the results were compared with 252 comparison subjects of similar age and ethnic origin. Neoplastic lesions, adenomatous polyps, or cancer were 2.5 times more frequent in the study group. However, for the largest group, women with a past history of breast cancer, the relative risk, adjusted for a family history of gastrointestinal cancer, was 3.0 (P = 0.03). This pilot study confirms the value of continuing to screen these patients, especially those with a positive family history of gastrointestinal malignancies. However, for psychological and administrative reasons, it may be better that their colon screening be integrated into a combined colon, breast, and gynecologic tumor follow-up, and not be part of a separate service.