When is a change a genuine change?: A clinically meaningful interpretation of grip strength measurements in healthy and disabled women

The aim of this study was twofold: 1) to use estimates of random and systematic error to ascertain the test-retest reliability of grip strength measurements obtained with the Jamar hand dynamometer in healthy and disabled women, and 2) to determine the size of the change required to detect a genuine change in grip strength for accurate and meaningful clinical interpretation. Previous research has shown grip strength measurements obtained with a Jamar hand dynamometer from healthy and disabled subjects on different occasions to be reliable. However, the test-retest reliability has been based on correlation coefficients rather than on the actual size of the test-retest differences required to detect a genuine change in grip. The test-retest reliability of maximum grip strength measurements in 32 healthy women and painfree grip in 10 disabled women with nonspecific regional pain (NSRP) was determined. Reliability, based on estimates of systematic and random error, was high in both subject groups. There was no statistically significant systematic error between tests. Test-retest measurement error was +/-5.7 kg (12.5 lb) and +/-5.9 kg (13.0 lb) in healthy and disabled subjects, respectively, 95% of the time. In this population of healthy women and women with NSRP, any change in grip of less than 6 kg (13.2 lb) could have occurred by chance. The results of our study suggest that a change of more than 6 kg (13.2 lb) is necessary to detect a genuine change in grip strength 95% of the time.     

Intensification with intermediate-dose intravenous methotrexate is effective therapy for children with lower-risk B-precursor acute lymphoblastic leukemia: A Pediatric Oncology Group study.

PURPOSE: To determine whether early intensification with 12 courses of intravenous (IV) methotrexate (MTX) and IV mercaptopurine (MP) is superior to 12 courses of IV MTX alone for prevention of relapse in children with lower-risk B-lineage acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS: Six hundred fifty-one eligible patients were entered onto the study. Vincristine, prednisone, and asparaginase were used for remission induction therapy. Patients were randomized to receive intensification with IV MTX 1,000 mg/m(2) plus IV MP 1,000 mg/m(2) (regimen A) or IV MTX 1,000 mg/m(2) alone (regimen C). Twelve courses were administered at 2-week intervals. Triple intrathecal therapy was used for CNS prophylaxis. Continuation therapy included standard oral MP, weekly MTX, and triple intrathecal therapy every 12 weeks for 2 years. RESULTS: Six hundred forty-five patients (99.1%) achieved remission. Three hundred twenty-five were assigned to regimen A and 320 to regimen C. The estimated 4-year overall continuous complete remission for patients treated with regimen A is 82.1% (SE = 2.4%) and for regimen C is 82.2% (SE = 2.6%; P =.5). No significant difference in overall outcome was shown by sex or race. Serious grade 3/4 neurotoxicity, principally characterized by seizures, was observed in 7.6% of patients treated with either regimen. CONCLUSION: Intensification with 12 courses of IV MTX is an effective therapy for prevention of relapse in children with B-precursor ALL who are at lower risk for relapse but may be associated with an increased risk for neurotoxicity. Prolonged infusions of MP combined with IV MTX did not provide apparent advantage.     

Hilft das zahnmedizinische Bonussystem den station?r Pflegebed��rftigen?

Oral health of long-term care (LTC) residents is often poor. From 30?random German LTC facilities, 242?random residents (Berlin n=75, Northrhine-Westfalia (NRW) n=94, Saxony n=73) (median age: 82?years, female: 78.5%) were interviewed as to their use of dental services, possession of a bonus booklet (BB), and completeness of records. Only 18.6% possessed a BB. Significant regional differences were observed (Berlin=5.3%, NRW=18.1%, Saxony=32.9%) (χ(2) test p<0.01). The number of teeth was higher (Mann-Whitney test p=0.01) and the time since last dental visit shorter (p<0.01) for all residents with a BB. Only 18.6% of people possessing a BB declared not having had a dental appointment within the previous 12?months (LTC residents without BB 51.3%). As a means towards improved quality management in nursing, better oral infection control of residents and increased oral health and general quality of life, the introduction of a regular annual preventive dental screening program including the use of a dental bonus system are suggested.     

Forensic-psychiatric assessment of pedophilia

The present paper illustrates the approach of a forensic psychiatric expert witness regarding the assessment of pedophilia. In a first step it is inevitable to differentiate if the defendant is suffering from pedophilia or if the alleged crime might have been committed because of other motivations (antisociality, sexual activity as redirection, impulsivity). A sound diagnostic assessment is indispendable for this task. In a second step the level of severity needs to be gauged in order to clarify whether the requirement of the entry criteria of §§?20, 21 of the German penal code are fulfilled. In a third step, significant impairments of self-control mechanisms need to be elucidated. The present article reviews indicators of such impairments regarding pedophilia. With respect to a mandatory treatment order (§?63 German penal code) or preventive detention (§?66 German penal code) the legal prognosis of the defendant needs to be considered. The present paper gives an overview of the current state of risk assessment research and discusses the transfer to an individual prognosis critically.     

Summary of notifiable diseases--United States, 2006

The Summary of Notifiable Diseases--United States, 2006 contains the official statistics, in tabular and graphic form, for the reported occurrence of nationally notifiable infectious diseases in the United States for 2006. Unless otherwise noted, the data are final totals for 2006 reported as of June 30, 2007. These statistics are collected and compiled from reports sent by state and territorial health departments to the National Notifiable Diseases Surveillance System (NNDSS), which is operated by CDC in collaboration with the Council of State and Territorial Epidemiologists (CSTE). The Summary is available at http://www.cdc.gov/mmwr/summary.html. This site also includes publications from previous years.     

Dose reduction from loss of backscatter in superficial x-ray radiation therapy with the Pantak SXT 150 unit

Loss of backscatter has been measured for a Pantak Therapax SXT 150 superficial x-ray therapy unit. Ionisation chamber measurements at the surface were performed in solid water with and without underlying lead to confirm the applicability of previous published measurements. Measurements of loss of backscatter with and without lead allowed the effect of underlying lead to be separated from the effect of loss of backscatter. It was found that the difference between the effect of lead and that of air on surface dose is minimal for solid water phantom thickness exceeding 3 cm. Differences up to 3% in dose reduction at the surface were found between this work and previous published results with different x-ray units.