Cardiac computed tomography-verified right ventricular lead position and outcomes in cardiac resynchronization therapy

Journal of Interventional Cardiac Electrophysiology - To evaluate the association between different right ventricular (RV) lead positions as assessed by cardiac computed tomography (CT) and...     

Detection of antibodies to tetanus toxoid: comparison of a direct haemagglutination method with a radioimmunoassay.

Two methods of detecting antibodies to tetanus toxoid were compared, a radioimmunoassay (RIA) employing radiolabelled staphylococcal protein A and a direct haemagglutination (HA) method employing sheep erythrocytes coupled to tetanus toxoid with chromic chloride. These were shown to have a similarly high specificity with the HA method showing slightly higher sensitivity. Haemagglutination offers several additional advantages in terms of simplicity, low cost and less requirement for specialised equipment. The assays were also used to demonstrate a transient IgM response after repeated booster injections with absorbed toxin given to seropositive individuals, and these antibodies were found to be protective in biological tests.     

Risk and surveillance of individuals with colorectal polyps. Who Collaborating Centre for the Prevention of Colorectal Cancer

Since colorectal adenomas are very probably the precursors of colorectal cancer, their detection and removal should result in a decrease in the incidence and mortality from colorectal cancer. Individuals who harbour an adenoma have a 30-50% probability of having additional adenomas at that time, and a 30% probability of having additional adenomas later. Adenomas are prevalent in countries where colorectal cancer is prevalent, about two-thirds of them being tubular and the rest tubulovillous or villous. The initial management of patients with an adenoma consists in searching by colonoscopy the entire colon and removing all additional polyps. Surgical resection is required wherever there is invasive cancer with adverse histological factors. Follow-up in most patients can be after 2-4 years, earlier follow-up being reserved for patients with numerous polyps or with a polyp that had been removed piecemeal. The results of ongoing trials should provide firm guidelines for follow-up and could also be used in mathematical modelling to examine alternative strategies and to help understand the evolving patterns of appearance of new polyps. Finally, a deeper understanding of the biology and inherited and acquired genetics will help identify individuals at risk for adenomas initially and at follow-up. Nutritional factors may also provide a basis for prevention of adenomas in high-risk countries. Many of these issues are being addressed in current research.     

Incision and drainage v. incision, curettage and suture under antibiotic cover in anorectal abscess. A randomized study with 3-year follow-up

Conventional incision and drainage was compared with incision plus curettage and primary suture of abscess cavity under antibiotic cover in a prospective, randomized trial of 83 patients with acute anorectal abscess with or without low fistula. All the patients were followed up for three years. The time to healing was on average three weeks less after suture than after incision alone. The difference was statistically significant. Primary healing was obtained in 32 of 42 cases after suture. Recurrence of abscess tended to be more frequent after suture, but the time to healing of initial and recurrent abscesses and fistulas in the three-year observation period continued to be three weeks less after suture than after incision alone, making suture the most attractive treatment.     

What influences the choice of assessment methods in health technology assessments? Statistical analysis of international health technology assessments from 1989 to 2002

OBJECTIVES: Health technology assessment (HTA) has been used as input in decision making worldwide for more than 25 years. However, no uniform definition of HTA or agreement on assessment methods exists, leaving open the question of what influences the choice of assessment methods in HTAs. The objective of this study is to analyze statistically a possible relationship between methods of assessment used in practical HTAs, type of assessed technology, type of assessors, and year of publication. METHODS: A sample of 433 HTAs published by eleven leading institutions or agencies in nine countries was reviewed and analyzed by multiple logistic regression. RESULTS: The study shows that outsourcing of HTA reports to external partners is associated with a higher likelihood of using assessment methods, such as meta-analysis, surveys, economic evaluations, and randomized controlled trials; and with a lower likelihood of using assessment methods, such as literature reviews and "other methods". The year of publication was statistically related to the inclusion of economic evaluations and shows a decreasing likelihood during the year span. The type of assessed technology was related to economic evaluations with a decreasing likelihood, to surveys, and to "other methods" with a decreasing likelihood when pharmaceuticals were the assessed type of technology. CONCLUSIONS: During the period from 1989 to 2002, no major developments in assessment methods used in practical HTAs were shown statistically in a sample of 433 HTAs worldwide. Outsourcing to external assessors has a statistically significant influence on choice of assessment methods.     

High serum levels of alkaline phosphatase are associated with cancer in cholestatic jaundice

In a prospective study of liver function tests in cholestatic jaundice, the median serum level of alkaline phosphatase (ALP) in 129 patients with cancer involving extrahepatic ducts and liver (556 IU/1) was significantly higher (P less than 0.001) than that in 121 patients without cancer (264 IU/1). Of patients with an ALP level of greater than 10 X N, 88% had cancer whereas serum levels of ALP of less than 3 X N were observed in only 9% of patients with cancer but in 45% of those without cancer, most of whom had bile duct stones. A high serum level of ALP is associated with cancer involving extrahepatic ducts and liver.     

Lifestyle and 30-day complications to surgery for colorectal cancer

This study aimed to identify lifestyle factors with impact on 30-day mortality and complications after surgery for a first time colorectal adenocarcinoma. All patients in Denmark within a 20 month period were registered in a nationwide database; 57% were included in the analysis. Logistic regression was used, adjusted for age, sex and disease- or treatment related factors. BMI≥30 kg/m² increased the risk of complications in general (CIG), impaired wound healing (IWH), deep wound infection and mortality. Smoking increased the risk of CIG, IWH and mortality. Alcohol increased the risk of IWH and anastomotic leakage. Self perceived physical fitness at or below average increased the risk of CIG, thrombosis, and mortality. The population attributable risk was 23% for complications and 64% for mortality. The results suggest that lifestyle factors are important for the course of the 30-day postoperative period. Lifestyle factors should be considered in future prediction models for outcome after colorectal cancer surgery.     

Exercise intervention of 65+-year-old men and women: functional ability and health care costs

BACKGROUND AND AIMS: Physical activity has been demonstrated to prevent physical impairment in elderly people. Physical impairment often leads to dependency and the need for help or health services. Therefore, participation in physical activity programs (PAP) may reduce health care costs. The aim of this study was to evaluate: i) the effect of a PAP on functional ability and the use of health care services; ii) the possible association between level of functional ability and public health care costs. METHODS: 185 participants aged 65+ (mean: 74.7 yrs) were recruited. The intervention consisted of a group-based multicomponent PAP, 1.5 hours, once a week, for 5 months. Functional ability was assessed by questionnaire and physical performance tests before and after the PAP. Economic analyses were based on data collected retrospectively from public registers and questionnaires describing the use of health care services (e.g., public home care, GPs, hospitals). RESULTS: Participants revealed a high level of functional ability. Only a few significant differences between pre- and posttests were observed. Many participants incurred no or very low public health care costs. The probability of using health care services decreased with better functional ability scores and lower age. CONCLUSIONS: Participants in this study maintained their level of functional ability in the intervention period with unaltered use of health care resources.