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21.
Mapping scores onto stages: mini-mental state examination and clinical dementia rating. 总被引:6,自引:0,他引:6
Robert Perneczky Stefan Wagenpfeil Katja Komossa Timo Grimmer Janine Diehl Alexander Kurz 《The American journal of geriatric psychiatry》2006,14(2):139-144
OBJECTIVE: Although the clinical course of Alzheimer disease (AD) is gradual, it is useful for a number of reasons to distinguish between different levels of severity. The Clinical Dementia Rating (CDR) has demonstrated high validity and reliability for this purpose, but it requires a considerable amount of data to be collected both from the patient and from an informant. In the present study, the authors mapped Mini-Mental State Examination (MMSE) scores onto CDR categories to determine how well the MMSE performs as a surrogate of the CDR as a timesaving method of staging dementia. METHOD: Eight hundred sixty-three probands, including 524 patients with probable AD, 92 patients with questionable dementia, and 247 with memory complaints but no objective cognitive impairment, were included. Cutoff scores were identified on one-half of the sample using a receiver operating characteristic analysis. The cutoff values were then applied to the other half of the sample, and the agreement between MMSE score ranges and CDR stages was determined by calculating Cohen's kappa. RESULTS: The MMSE discriminated well between CDR stages 0.5, 1, 2, and 3 but performed poorly in the separation between CDR stages zero and 0.5. The MMSE ranges were 30 for no, 26-29 for questionable, 21-25 for mild, 11-20 for moderate, and 0-10 for severe dementia. Substantial agreement between the two instruments was obtained for the categories mild (kappa=0.62, p<0.001, N=115), moderate (kappa=0.69, p<0.001, N=114), and severe dementia (kappa=0.76, p<0.001, N=39), whereas the agreement was moderate for no (kappa=0.44, p<0.001, N=120) and only fair for questionable dementia (kappa=0.28, p<0.001, N=42). CONCLUSION: The MMSE can be used as a surrogate measure for the CDR for the staging of dementia in AD. 相似文献
22.
Toshifumi Ozaki Axel Hillmann Christiane Hoffmann Christian Rü be Barbara Dockhorn-Dworniczak Sebastian Blasius Jü rgen Dunst J rn Treuner Herbert Jü rgens Winfried Winkelmann 《Acta orthopaedica》1997,68(1):20-24
We reviewed the treatment outcome of 69 patients with Ewing's sarcoma of the femur. The patients received chemotherapy according to the CESS 81 (n 14), CESS 86 (n 43), and CESS 91P (n 12) protocols. The 10-year relapse-free survival rates were 36%, 65%, and 65% (p = 0.01). 68 patients received local treatment. The primary tumor was treated by surgery without radiotherapy in 28 patients; 1 developed a local recurrence and 7 metastases. 10 patients received radiotherapy alone; 4 developed metastases and 4 local recurrences and metastases. 30 cases had a combination of surgery and radiotherapy; 7 developed metastases and 1 a local recurrence and metastasis. The survival of patients after radiotherapy alone was worse than that of patients after surgery with/without radiotherapy (p = 0.005). Pathological fractures (n 16) did not influence the prognosis. 相似文献
23.
A method to study the proliferation of human brain tumors, is presented. Non radioactive 5-Iododeoxyuridine (2.4 gr) infused over a 24 hours period is detected in situ on histologic section by an immunological technique (peroxidase-anti-peroxidase) using a specific anti-Iododeoxyuridine antibody. This exploration utilised in 45 patients is easy, reliable and harmless. All cells which enter in S phase of cellular cycle during the infusion are labelled. So the cellular kinetics of all the brain tumor cells (malignant cells, inflammatory stroma reaction cells, reactive astrocytes, endothelial and muscular cells of the vessels) are detected on the same histological section, as well as all the others proliferative cells of the body (leukocytes, primitive tumor of the metastatic brain localisation...) if multiples biopsies are done. 8 of 9 gliomas of low histological malignancy (grade I and II) have a slow cellular kinetic. The 23 astrocytomas of different histological malignancy (grade III and IV) have variable proliferative speed (7 very fast, 8 fast and 8 slow). Only the large cells of the pinealoma are very proliferative, the lymphoid stroma is quiescent. The 5 metastasis have a slow to very fast kinetic without correlation with the cellular differentiation except in one case (important differentiation and slow cellular proliferation). The 5 lymphoma cells kinetics are well correlated with the histologic differentiation (3 large cells poor differentiated lymphomas and very fast kinetic, 2 better differentiated and slower proliferation). The 2 meningiomas proliferate slowly. The biochemical and histopathological grounds of the presented method and the limits of quantification are discussed. This method is compared with this using Bromodeoxyuridine. The correlation between proliferation and histologic malignancy is analysed. The use of cytokinetic results for therapeutic and prognosis need further statistical anatomoclinical studies. 相似文献
24.
Concurrent Validation of Substance Abusers Self-Reports Against Collateral Information: Percentage Agreement VS. k Vs. Yule's Y 总被引:1,自引:0,他引:1
Norman G. Hoffmann Fred G. Ninonuevo 《Alcoholism, clinical and experimental research》1994,18(2):231-237
The ability for chemical users to give an accurate self-report of (ubrbnce use vs. abstinence has been questioned. This study hatlgated its concurrent validity, against collateral ratings. The results indicated that validity of reports of chemical use must be evaluated in the context of the validity of other types of information. Chemical use items were corroborated about as often as such nonchemical use items as reports of emergency room visits, arrests, md hospitalizations, thus arguing against the presence of a specific denlal syndrome or overarching tendency toward self-misrepresenletion. Relative concurrent validities seemed more a function of such factors as item salience and specificity. No consistent trend in patient over-or underreporting of chemical use was found. The choice of concurrent validation statistic is important and can influence interpretation of results. Current standards such as percentage agreement and K were seen as flawed; comparisons of results based on these two measures, as well as Yule's Y led to the conclusion that Yule's Y is the statistic of choice. 相似文献
25.
26.
H. Dienemann C. Trainer H. Hoffmann H. Bülzebruck T. Muley K. Kayser I. Vogt-Moykopf 《Der Chirurg》1997,68(10):1014-1019
Zusammenfassung. Nach Lungenresektion und ipsilateraler Lymphknotendissektion wegen Bronchialcarcinoms verblieb in 88 von 2464 F?llen (3,6
%) mikroskopisch Residualtumor (R1) am zentralen Bronchusresektionsrand. Sieben Patienten entwickelten eine Insuffizienz der
Bronchusnaht, 2 weitere eine Nachblutung bzw. eine Herzluxation (Morbidit?t 8,0 %). Die Hospitalletalit?t betrug 16,6 %. Todesursachen
waren Bronchusnahtinsuffizienz (n = 7), Arrosionsblutung (n = 4), respiratorische Insuffizienz (n = 1) und Pleuraempyem (n = 1). Eine postoperative Bestrahlung wurde bei 43 Patienten durchgeführt. Die mediane überlebenszeit aller Patienten nach
R1-Resektion war 16 Monate gegenüber 37 Monaten nach R0-Resektion (p < 0,001). Die überlebenszeit war unabh?ngig von Tumorstadium und -histologie, Lokalisation des Residualtumors in der Bronchuswand
und einer Nachbestrahlung. Inkomplette Resektionen sind durch intraoperativen Schnellschnitt zu verifizieren. Sofern funktionell
vertretbar, sollte in den Stadien I und II eine Nachresektion (R0) angestrebt werden; auch in den Stadien III a und III b
ist bei R0-Resektion ein statistisch signifikanter überlebensvorteil gegenüber R1-Resektion zu verzeichnen, jedoch weniger
deutlich als in niedrigeren Stadien.
相似文献
27.
S Bauer I Wolff N Werner P Hoffmann R Herzschuh K Oemus F W Rath R Voigt 《Toxicology and industrial health》1992,8(3):141-156
In dry etching processes--one of the sources of potential exposure to toxic wastes in the semiconductor industry--complex mixtures of inorganic and organic compounds arise from reactions between feed stock gases (BCl3/Cl2), top layers (aluminium photoresist), and the carrier gas (N2). Two different fractions of the complex mixture--one an ethanolic solution (ES) and the other an insoluble liquid residue (LR)--were examined for acute oral toxicity in rats. Analytical data showed that the ethanol soluble fraction contained mainly inorganic compounds, whereas the residue contained various halogenated hydrocarbons. Neither death nor behavioral changes occurred after oral administration and observation up to 23 days. ES caused a lower mean arterial blood pressure in both sexes, increased P-R-intervals in male rats, and caused some mild biochemical and hematological alterations and changes in relative organ weights compared to the control groups. Exposure to LR influenced food and water intake, and caused a significant decrease in body weights, signs of polyurie, as well as changes in various relative organ weights and biochemical and hematological parameters. The blood pressure of the male animals fell and the heart rates of both sexes decreased. 相似文献
28.
In premature neonates a patent ductus arteriosus causes often other complications thus the immediate closure of the patent ductus arteriosus should be preferred or recommended. Performing the surgical closure of the ductus within the incubator can avoid complications during transportation from the premature neonates intensive care unit to the operating room. 25 very small premature neonates or those with another burden in addition were operated upon in the incubator on the premature infants intensive care unit of our hospital during the period from January 1987 to April 1989. No complications occurred during the operation, especially not caused by the strange circumstances for the operating team. Wound infections because of possible bacterial contamination of the incubator or the room were not observed during the postoperative period. 相似文献
29.
30.
Dr. Flemming Moesgaard M.D. Mogens Lykkegaard Nielsen M.D. Ph.D. Allan Hjortrup M.D. Peter Kjersgaard M.D. Carsten Sørensen M.D. Peter Nørgaard Larsen M.D. Steen Hoffmann M.D. 《Diseases of the colon and rectum》1989,32(1):36-38
One hundred ninety patients with peritonitis at the time of abdominal surgery were allocated at random to systemic antibiotic
treatment alone or systemic antibiotic treatment combined with topical application of antibiotics in the wound at the time
of wound closure. The overall wound infection rate was 17 percent without significant difference between the two treatment
groups (P>0.80). 相似文献