Prospective evaluation of p53 as a prognostic marker in T1 transitional cell carcinoma of the bladder

OBJECTIVE: To prospectively evaluate p53 overexpression as a predictor of survival in patients with a first diagnosis of T1 transitional cell carcinoma (TCC) of the bladder, as several reports implicate p53 as an important prognostic marker for progression and survival, but all previous studies were retrospective, giving conflicting and irreproducible results, rendering inappropriate any attempt at integrating p53 into clinical decision-making. PATIENTS AND METHODS: Patients with a first diagnosis of T1 TCC of the bladder were enrolled; p53 overexpression was assessed by immunohistochemistry (IHC) using both monoclonal antibody 1801 and DO7. The pathological stage and IHC score were assigned by one pathologist, and the markers were scored categorically. RESULTS: Of the 89 patients who were evaluable, 53 had p53-positive tumours. The median follow-up for the survivors was 52 months. Eighty-two patients had high-grade tumours, using the World Health Organisation/International Society of Urological Pathology 1998 grading system. Fifty-eight patients had unifocal tumours and 34 had associated carcinoma in situ. The 3 year and 5 year overall survival rates were 81% (95% Cl: 73%, 90%) and 68% (95% Cl: 56%, 80%) respectively. The 3 year and 5 year disease specific survival rates were 87% (95% Cl: 79%, 94%) and 79% (95% Cl: 70%, 89%) respectively. There was no difference in disease-specific survival between patients with and without p53 over expression (p=0.56) [corrected] CONCLUSIONS: p53 tissue typing by IHC in a prospective cohort of patients with T1 bladder cancer was not clinically useful as a prognostic marker in a contemporary series of T1 tumours.     

Relationship between apathy and sleep disturbance in mild and moderate Alzheimer's disease: an actigraphic study

Apathy is the most frequently reported neuropsychiatric symptom across all stages of Alzheimer's disease (AD). Both apathy and sleep disorders are known to have independent negative effects on the quality of life in individuals with AD. The aim of this study was to assess the relationship between apathy and sleep/wake patterns in individuals with AD using ambulatory actigraphy. One hundred and three non-institutionalized individuals with AD wore a wrist actigraph continuously over seven consecutive 24-h periods. Apathy was assessed using the Neuropsychiatric Inventory. Daytime mean motor activity (dMMA) was calculated from daytime wrist actigraphy data. Actigraphic parameters of sleep included total sleep time (TST), wake after sleep onset (WASO), time in bed (TIB), WASO normalized by TIB, sleep latency, and nighttime mean motor activity (nMMA). Among the 103 individuals with AD (aged 76.9 ± 7.2 years; MMSE = 21.4 ± 4.3), those with apathy had significantly lower dMMA, higher WASO (both raw and normalized), and spent more time in bed during the night than those without apathy. Sleep latency, nMMA and TST did not differ significantly between the two subgroups. To our knowledge, this study is the first to identify a relationship between apathy and sleep disturbance in those with mild or moderate AD: apathy was associated with increased TIB during the night and more WASO. These results suggest that AD patients with apathy have less consolidated nocturnal sleep than those without apathy.     

Measuring the Dose of Nursing Intervention

PURPOSE: To increase awareness of the many issues involved in measuring the dose of nursing intervention in nursing interventions effectiveness research. METHODS: Identify critical issues in measurement of the dose of nursing intervention and discuss decisions regarding dosage measurement made in a study of the effectiveness of nursing interventions. FINDINGS: A single method can be applied to resolve two critical issues in intervention dosage measurement. CONCLUSIONS: Those conducting nursing interventions effectiveness research must think explicitly about how intervention dosage will be measured and reported so that dosage can be replicated in research and practice. PRACTICE IMPLICATIONS: Measuring and reporting the dose of nursing intervention in research is essential to the development of an evidence base adequate to support practice.     

The dorsomedial visual area of owl monkeys: Connections,myeloarchitecture, and homologies in other primates

Cortical connections of the dorsomedial visual area (DM) of owl monkeys were revealed with injections of the bidirectional tracer, wheatgerm agglutinin conjugated with horseradish peroxidase (WGA-HRP), or the retrograde fluorescent tracer, diamidino yellow. Microelectrode recordings in two cases identified DM as a systematic representation of the visual hemifield in a densely myelinated rectangle of cortex just rostral to the dorsomedial portion of the second visual area (V–II, or area 18). Cortex was flattened and cut parallel to the surface in all cases so that the myeloarchitectonic borders of DM and other areas such as the primary visual area (V-I or area 17), V-II or area 18, and the middle temporal visual area (MT) could be readily determined, and the surface view patterns of connections could be directly appreciated. The ipsilateral pattern of connections of DM were dense and visuotopically congruent with area 17, area 18, and MT, and moderate to dense connections were with the medial visual area (M), the rostral division of the dorsolateral visual area, the dorsointermediate area, the ventral posterior area, the caudal division of inferotemporal cortex (ITc), the ventral posterior parietal area, and visuomotor cortex of the frontal lobe. The connections of DM were concentrated in the cytochrome oxidase (CO)-dense blobs of area 17, the CO-dense bands of area 18, and the CO-dense regions of MT. Callosal connections of DM were with matched locations in DM in the opposite hemisphere, and with VPP. The ipsilateral connections of DM with area 17 were confirmed by injecting WGA-HRP into area 17 in one owl monkey. In addition to labelled cells and terminals in area 18 and MT, bidirectionally transported tracer was also apparent in DM. Evidence for the existence of DM in other primates was obtained by injecting area 17 and examining the areal patterns of connections and myeloarchitecture in three species of Old World monkeys, two additional species of New World monkeys, and prosimian galagos. In all of these primates, one of three major targets of area 17 was a densely myelinated zone of cortex just rostral to dorsomedial area 18, in the location of DM in owl monkeys. Thus, it seems likely that DM is a visual area common to all primates. © 1993 Wiley-Liss, Inc.     

Accuracy of Leopold Maneuvers in Screening for Malpresentation: A Prospective Study

This study describes the accuracy of Leopold maneuvers as a screening procedure for fetal malpresentation. The frequency of fetal malpresentation ranges from 15 percent at 32 weeks to 4 percent at term. We prospectively determined fetal presentation by performing Leopold maneuvers on 150 women, followed by a fetal ultrasound examination for comparison. Experienced certified nurse-midwives performed the maneuvers with high sensitivity (88%), specificity (94%), positive predictive value (74%), and negative predictive value (97%) in a population with a 17 percent frequency of fetal malpresentation. We conclude that the maneuvers used by experienced clinicians can be effective as a screening tool for fetal malpresentation, particularly in settings where ultrasound may not be readily available. (BIRTH 20:3, September 1993)     

Measuring the effect of a large reduction in welfare payments on mental health service use in welfare-dependent neighborhoods

BACKGROUND: Major social policy changes were implemented in Canada in the last decade with few efforts to examine their potential health effects. OBJECTIVES: We sought to determine the impact of a large reduction in welfare benefits on use of ambulatory physician mental health services in areas with high levels of welfare dependency relative to areas with low levels of welfare dependency. METHODS: The setting was Toronto, Canada. Data sources included census, provincial health insurance, and municipal welfare data. We used generalized estimating equations to compare ambulatory mental health service rates by neighborhood level of welfare dependency before and after a 21.6% reduction in welfare payments. RESULTS: There were no long-term relative differences by welfare dependency in mental health service use before compared with after the policy change. There was a very small short-term increase in mental health visits to generalists in the 6 months after the policy change. We demonstrated a marked gradient in psychiatric service use with low welfare dependency areas having significantly higher rates of use than high welfare dependency areas. CONCLUSIONS: We demonstrated a mismatch between known levels of need for care and levels of psychiatric use. We conclude that where use of services is not tightly linked to need for services, utilization data may be unsuitable for evaluating programs or policies. Social policy changes with potential health effects should have integrated evaluations planned at the time of policy implementation.