The minimal clinically important difference in the Gastrointestinal Quality-of-Life Index after cholecystectomy

Background  

The minimal clinically important difference (MCID) for the Gastrointestinal Quality of Life Index (GIQLI) is unknown, which limits its application and interpretation. This study aimed to estimate MCIDs for the GIQLI scores of patients after they had undergone cholecystectomy.     

Cost-utility analysis of adjuvant goserelin (Zoladex) and adjuvant chemotherapy in premenopausal women with breast cancer

Background  

Increased health care costs have made it incumbent on health-care facilities and physicians to demonstrate both clinical and cost efficacy when recommending treatments. Though studies have examined the cost-effectiveness of adjuvant goserelin with radiotherapy for locally advanced prostate cancer, few have compared the cost-effectiveness of adjuvant goserelin to adjuvant chemotherapy alone in premenopausal breast cancer.     

Early Morning Surge and Dipping Status of Blood Pressure: Are These of Predictive Value for Silent Myocardial Ischemia?

To investigate the predictive value of morning surge (MS) and dipping status of blood pressure (BP) for ST-segment depression (ST depression) in hypertensive persons, the combined 24-hour ambulatory BP measurement and Holter electrocardiographic recordings of 344 patients (132 women and 212 men, 60±12 years) were analyzed. The morning BP surge was calculated as mean systolic BP during the 2 hours after awaking minus the mean systolic BP during the 1 hour that included the lowest sleep BP. Depending on the percentage decrease in systolic BP at night, patients were subdivided into extreme dippers, dippers, nondippers, and risers. ST depression was defined as horizontal or descending ST depression of 1 mm of 1 minute duration and a 1-minute interval after the previous episode or 24-hour mean ST-segment value <−0.1 mV. ST depression was observed in 76 (22.1%) of 344 patients. The mean MS in patients with ST depression was with 25±15 mm Hg and not significantly different when compared with patients without ST depression (26±15 mm Hg). The prevalence of ST depression was not significantly different in dippers, extreme dippers, nondippers, and risers (20%, 23.5%, 23%, and 25.5%, respectively). Systolic and diastolic BP values during ST depression were significantly higher in the morning as compared with ST depression in the evening (149/84 mm Hg vs 138/78 mm Hg, P <.05). In the present study, MS and dipping status of BP were not associated with ST depression. ST depression was, however, characterized by significantly higher BP peaks in the early morning hours.     

Telemonitoring of blood pressure self measurement in the OLMETEL study

OBJECTIVE: To investigate the feasibility of blood pressure (BP) telemonitoring in previous uncontrolled hypertensives treated with olmesartan medoxomil in a clinical practice setting. METHODS: Patients (n = 53) with untreated, uncontrolled or insufficiently treated hypertension were selected by physicians to receive olmesartan medoxomil 10-40 mg/day for 12 weeks. Office BP values were determined by a physician at baseline and after 12 weeks' treatment; BP self-measurement (BPSM) was conducted throughout the 12-week treatment period using a TensioPhone TP2 telemonitoring device; BP values were stored and automatically downloaded to a remote service centre via standard telephone lines. RESULTS: Olmesartan medoxomil produced statistically significant reductions from baseline in both systolic and diastolic office BP and BPSM values. In contrast to office BP, telemonitoring of BPSM allowed the early identification of responders (e.g., after 2-3 weeks' treatment). Blood pressure reduction with olmesartan medoxomil was greater for office BP than for BPSM values. Normalization of BP was achieved in 64.2% of the patients using office BP measurement compared with 36.4% using BPSM. Blood pressure self-measurement showed no significant difference between morning and evening BP measurements or between the morning : evening BP ratio at baseline and after nine weeks of olmesartan medoxomil treatment. Compliance and tolerability were good or very good in most patients. CONCLUSION: In a 'real-life' clinical practice setting, telemonitoring of BPSM was an effective technique that was partially affected by patient non-compliance. Olmesartan medoxomil provided effective and reliable BP-lowering, which was maintained throughout the 24-hour period.     

The misplacement of external ventricular drain by freehand method in emergent neurosurgery

External ventricular drain (EVD) placement is one of the most basic and common neurosurgical procedure which most was performed by young neurosurgical trainees. This study is conducted to determinate the safe and accuracy of EVD placement by freehand method. About 129 EVD placements were evaluated in this study. Eighty-three catheters (64.3%) were located in the ipsilateral frontal horn or third ventricle. The functional accuracy was 86%. Of eighteen misplaced catheters, only 4 (3.1%) catheters were nonfunctional, requiring a replacement or reposition. The higher misplaced rate was significantly observed in patients whose head CT scans revealed the lower hydrocephalus ratio (28.85%) and the smaller ventricular size (5.6 mm). Twenty-one (16.2%) new hemorrhages associated with EVD placements were observed. Using the freehand method, EVD placement is a safe and effective procedure in management of these emergent neurosurgical diseases.