Comparison of transfers to Fallopian tubes or uterus after ICSI

The aim of this study was to compare the implantation rate of tubal-replaced microinjected oocytes (MIFT) versus conventional day 2 intrauterine embryo transfer in patients undergoing intracytoplasmic sperm injection (ICSI). Sixty-three patients in need of ICSI, between 18 and 37 years of age with normal menstrual cycles and fewer than four previous ICSI attempts, were randomized between April 1999 and December 2001. In the MIFT group, up to three micro-injected oocytes were transferred laparoscopically 4 h after microinjection. In the ICSI-embryo transfer group, up to three cleaving embryos were replaced into the uterine cavity 48 h after insemination. Fifty-nine patients reached the stage of oocyte retrieval; 31 patients had a day 2 embryo transfer and 28 patients had MIFT. The ongoing clinical pregnancy and implantation rate (i.e. the total number of gestational sacs with fetal heartbeat divided by the total number of transferred embryos or micro-injected oocytes) was 35 and 24% in the ICSI-embryo transfer group and 29 and 11% in the MIFT group respectively. In conclusion, this study shows a significant decrease in implantation rate in the MIFT group (P < 0.05). In this group of patients there seems to be no advantage to tubal replacement of micro-injected oocytes.     

Validity of the Leg-O-Meter, an instrument to measure leg circumference

The objective of this study was to validate the Leg-O-Meter measure against the clinical assessment of edema made by physicians using data from a 1-year follow-up study of unselected patients with chronic venous disease of the leg (CVDL). The Leg-O-Meter consists of a tape measure fixed to a stand attached to a small board on which the patient is in standing position. Its reliability has been shown to be above 97%. Data from the Venous Insufficiency Epidemiologic and Economic Study (VEINES) were used: 1,521 patients from France, Belgium, Italy, and Quebec (Canada) who spontaneously consulted a physician between 1994 and 1995 with a complaint resulting from venous problems of the legs were included. Baseline variables included leg circumference measurements using the Leg-O-Meter; physicians were also asked to diagnose edema and report it as present or absent on each leg. Clinical edema and leg circumferences were assessed again 3 to 6 months after the baseline visit and 12 months after baseline. The tape measure of the Leg-O-Meter was fixed at 13 cm from the floor. The first and last assessments were used to evaluate the variation in edema during the follow-up period. Clinical variation in edema status was assessed as follows: improved, if edema was diagnosed at baseline but not at the final visit; unchanged, if edema was diagnosed at both visits; and worsened, if there was no diagnosis of edema at baseline but a diagnosis of edema was made at the final visit. Variation in measured edema was classified as improved if there was a decrease in leg circumference of more than 1 cm between baseline and final evaluation; unchanged, if the difference in leg circumference was between plus or minus 1 cm between the 2 assessments; and worsened, if there was an increase in leg circumference greater than 1 cm between the 2 assessments. Data-driven cut-off points were also used: 1.3 cm and 1.5 cm. Sensitivity and specificity of the Leg-O-Meter using physician diagnosis as "gold standard" were calculated. In addition, receiver operating characteristics (ROC) curves were calculated by using the 3 different leg circumference cut-off points in order to determine the accuracy of the Leg-O-Meter to detect changes in edema. The overall accuracy of the Leg-O-Meter was 0.84 (standard error (se) = 0.06). Accuracy was greater when 1.5 cm was used as a cut-point. The Leg-O-Meter is an objective, reliable, and standardized instrument to assess patients over time. A change of 1.5 cm between 2 measurements gives a valid estimate of improvement or worsening of edema, when compared to physicians' diagnosis. The Leg-O-Meter is also sensitive to any changes in leg circumferences, which is an advantage over the clinical evaluation of edema.     

Risk factors for the first-time development of venous ulcers of the lower limbs: the influence of heredity and physical activity

The objective of this prospective case-control study was to identify and quantify demographic and clinical risk factors for venous ulcer disease, with special emphasis on heredity and physical activity. Patients presenting to a participating vascular surgery department between January and December 1997 with a first open venous ulcer served as cases. Controls were sampled among patients with subacute conditions such as skin problems, back pain, cold, headache/migraine, sore throat, and mild ear infections and were matched on referral physician, age (+/-5 years), and gender. Subjects were eligible if they were 18 years or older and were excluded if they had nonpalpable pedal pulse or any chronic active diseases such as cancer or AIDS. Cases' and controls' statuses were ascertained by the participating physicians. Data on risk factors were collected with an interviewer-administered questionnaire and were self-reported by patients. The mean age of participants was 61 years for cases (n = 102) and 59 years for controls (n = 200). Family history of maternal venous insufficiency (odds ratio (OR) = 6.8, 95% confidence interval (CI) = [1.9, 24.3]95%), vigorous exercise (OR = 8.9, CI = [1.1, 72.0]95%), and history of deep vein thrombosis (DVT) (OR = 17.6, CI = [2.9, 106.8]95%) were found to be significant predictors of venous ulcers in matched multivariate logistic regression analysis; number of pregnancies was also a significant risk factor in women (OR = 1.2, Cl = [1.0, 1.5]95%). Our study suggests that knowledge of family history of venous insufficiency and monitoring of physical activity will lead to ulcer prevention. Although physical activity is recommended for patients with venous insufficiency, vigorous exercise increases the likelihood of ulcerations.     

Impact of better adherence to statin agents in the primary prevention of coronary artery disease

Background  

Statins reduce cardiovascular morbidity and mortality after continuous treatment. Studies have shown that less than 50% of patients take 80% or more of prescribed doses 1 year after starting therapy.     

Race, Ethnicity, and Management of Pain from Long-bone Fractures: A Prospective Study of Two Academic Urban Emergency Departments

Objectives:  The objective was to test the hypothesis that African American and Hispanic patients are less likely to receive analgesics than white patients in two academic urban emergency departments (EDs).
Methods:  This was a prospective observational study of a convenience sample of patients with long-bone fractures from April 2002 to November 2006 in two academic urban EDs. Eligibility criteria were age 18–55 years, isolated long-bone fracture, and race and ethnicity (Hispanic, African American, and white). The primary outcome was receipt of analgesics; secondary outcomes included receipt of opioids, dose, route, time to first analgesic, and change in pain. Logistic regression was used to adjust the risk of receiving analgesics for patients' initial rating of pain and demographic characteristics.
Results:  Of 1,239 patients with suspected long-bone fractures, 345 patients were eligible: 177 (51%) were Hispanic, 98 (28%) were African American, and 70 (20%) were white. Administration of analgesics was not associated with race or ethnicity. Sixteen percent (95% confidence interval [CI] = 11% to 22%) of Hispanic, 15% (95% CI = 10% to 24%) of African American, and 14% (95% CI = 8% to 24%) of white patients did not receive any analgesics. Seventy-four percent of Hispanic (95% CI = 67% to 80%), 66% of African American (95% CI = 57% to 75%), and 69% (95% CI = 57% to 78%) of white patients received opioid analgesics. After adjustment for covariates, there was no evidence of an association between receipt of analgesics or opioid analgesics and the race or ethnicity of the patients. There were no significant differences in time to treatment, dose, route, or change in pain.
Conclusions:  Receipt of analgesics for pain from long-bone fractures was not associated with patient race or ethnicity in two academic urban EDs.