Can we predict a high risk group in stage I epithelial ovarian cancer?

A retrospective review of 373 patients with stage I invasive epithelial ovarian cancer was undertaken over a 5 year period to develop a model to characterize the patient at high risk. Actuarial 5-year survival was 70%. To identify factors with an independent effect on 5-year survival, a logistic regression analysis was performed. Adjuvant chemotherapy, histologic grade and peritoneal washings, were identified as independent variables. A model to determine the predictivity of survival was created using a learning sample (2/3 of the cases) and the model was then used to reclassify a validation sample (1/3 of the cases). Using all the independent variables, outcome was predicted correctly in 78% of cases. However the model failed to improve identification of those at risk of recurrence (specificity of 53%).     

Cerebellar infarction: comparison of computed tomography and magnetic resonance imaging

We correlated clinical, computed tomographic (CT), and magnetic resonance imaging (MRI) findings in 14 patients with cerebellar infarctions. Before MRI, the diagnosis of cerebellar infarction was made in only 7 patients on the basis of clinical and CT evidence. Cerebellar infarction was bilateral in 3 patients and was associated with brainstem infarction in 6. Infarction occurred in the territory of the posterior inferior cerebellar artery (PICA) in 12 patients. The territory of the superior cerebellar artery (SCA) was involved in 1 patient, and 1 infarction encompassed the watershed between the PICA and the SCA. In patients with infarction of the PICA territory, the medial and intermediate hemispheric segments were most frequently involved. Involvement of the lateral hemispheric segment was infrequent and was independent of brainstem involvement. Because of its fine demonstration of anatomical detail, its lack of bony artifact, and its ability to visualize infarctions readily within the first 24 hours, MRI is an excellent method for demonstrating cerebellar infarction.     

Health problems encountered by three levels of providers in a remote setting

A study conducted in the Sioux Lookout Health Zone in northwestern Ontario, Canada analyzed the diagnoses and managements for 139,618 patient visits to three levels of practitioners: physicians, nurse practitioners, and minimally trained health aides. There were major differences between providers in their diagnostic and management patterns. Some of these differences were the result of administrative policy (e.g., physicians and nurses do preventive medicine) but even when adjustment had been made for these differences there was still considerable variation. The minimally trained practitioners made many more signs and symptoms diagnoses and asked for help more frequently. The nurses did much of the preventive measures and made more diagnoses in the supplementary diagnostic class. Physicians diagnosed medically sophisticated conditions more frequently. The physicians did considerable reassuring, suggesting that many cases referred to them were adequately handled. They were also more likely to order investigations.     

Ratio and group size in day care programs

Literature on the influences of ratio and group size on children's development in day care is reviewed. Relatively few studies are responsible for the widely held beliefs about the influence of ratio and group size on children's development. When measured separately, ratio and group size are sometimes, but not always related to children's development. Some significant relationships are not in the expected direction. When included as variables in quality clusters, ratio and group size are more likely to be related to developmental outcomes. Group size more consistantly influences development in the expected direction than ratio. This suggests the need for increased attention to group size in the policy arena. Regardless of methodology, ratio and group size explain a relatively small protion of the variance in children's development. Ratio and group size have been found to have both direct and indirect effects on development, indicating that they are potentially valuable as proxy measures of children's experience in day care programs.Appreciation is expressed to David Caruso, Michael Langenbach, and theAppreciation is expressed to David Caruso, Michael Langenbach, and the