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1.
Practice, efficacy, and costs of thyroid nodule evaluation: a retrospective study in a Dutch university hospital. 总被引:2,自引:0,他引:2
Lotty Hooft Otto S Hoekstra Maarten Boers Maurits W Van Tulder Paul Van Diest Paul Lips 《Thyroid》2004,14(4):287-293
Fine-needle aspiration (FNA) of thyroid nodules has markedly reduced the role of thyroid scintigraphy. This is often limited to nondiagnostic or follicular (tumor) FNA classifications. In this study, we evaluated the efficacy and cost of such a strategy in a university center. From 1992-1998, 995 aspirations were done in 667 patients with palpable nodules. FNA was classified as malignant, suspicious, follicular, benign or inadequate. The Gold standard was surgery or extended follow-up, including physical examination, FNA, and/or ultrasound (US) with a time interval of half a year. Cost analysis was limited to operated patients. The first FNA yielded inadequate results in 28%, decreasing to 6% after 4 aspirations (n = 42). The other final classifications were: 76%, benign; 14%, follicular; 2%, suspicious; 1%, malignant (n = 7). Scintigraphy ((99m)Tc) suggested a hyperfunctioning autonomous nodule (adenoma) in 12% and 3% of the inadequate and follicular subset, respectively. Surgery for diagnostic reasons (n = 105) yielded 24 malignancies (23%): in 47% of suspicious, 12% of the follicular, and in all with malignant FNA. Postoperative morbidity occurred in 14 (5 laryngeal nerve paralyses) with benign histology. Major cost drivers were surgery and hospitalization: mean costs per patient amounting to Euro 3.311 in case of benign histology. We conclude that current work-up is still unable to prevent unnecessary surgery for benign thyroid nodules. Thyroid scintigraphy proved most productive in the inadequate FNA category. Improvement of the diagnostic process using immunohistochemistry and/or imaging is needed from the patient's and society's perspective. 相似文献
2.
Neurogenesis in hippocampal slice cultures 总被引:8,自引:0,他引:8
Raineteau O Rietschin L Gradwohl G Guillemot F Gähwiler BH 《Molecular and cellular neurosciences》2004,26(2):241-250
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How to perform a comprehensive search for FDG-PET literature 总被引:1,自引:0,他引:1
G. Sophie Mijnhout Lotty Hooft Maurits W. van Tulder Walter L.J.M. Devillé Gerrit J.J. Teule Otto S. Hoekstra 《European journal of nuclear medicine and molecular imaging》2000,27(1):91-97
In this study, a comprehensive, unbiassed search strategy for identifying literature on fluorine-18 fluorodeoxyglucose positron
emission tomography (FDG-PET) in Medline, Embase and Current Contents was developed, with specific search strategies for each
database, using MeSH terms as well as free text words for PET and FDG. To examine which text words apply to FDG, we evaluated
the ways of spelling FDG in a random sample of FDG-PET articles (n=100). These words were used as free text words in the two databases and overlap was determined. PET publications were identified
using the text words ”positron emission tomography” and ”pet$” combined with the respective MeSH terms for each database.
To compare the yield of the combined FDG-PET strategy in each database, the retrieved citations were downloaded to Pro-Cite
4.0. Finally, we added search terms for lung cancer, breast cancer, melanoma, head and neck cancer and lymphoma to our strategy
and to a short strategy (consisting of the text words ”positron emission tomography” and ”fdg”). In order to measure the yield
and precision (positive predictive value, PPV) of our search strategy and compare it with the short one, we screened the title
and abstract of the retrieved citations. Reviewing a random sample of the FDG-PET literature yielded 56 different ways of
spelling FDG. We confined the list to 11 text words, without missing articles. Of the publications retrieved by these text
words, only 4% were indexed by the MeSH term ”Fludeoxyglucose F18” in Medline and 29% by the MeSH-term ”Fluorodeoxyglucose
F18” in Embase. Only 51% of PET articles were indexed by the MeSH term ”Tomography, emission-computed” in Medline and 40%
by the MeSH term ”Positron emission tomography” in Embase. The combined search strategy for identifying studies on FDG and
PET resulted in 2865 publications in Medline and 2646 in Embase. Medline identified 1662 publications not found by Embase;
Embase identified 1422 publications not found by Medline. Compared with the short strategy, our search strategy yielded on
average 52% more publications (94%, 41% and 20% more in Medline, Embase and Current Contents, respectively). The PPV of our
strategy (percent of publications that were really on PET, FDG and the specified subject) was 70%, compared with 76% using
the short strategy. Regardless of the strategy used, Embase yielded more publications and was also slightly more specific
than Medline. With the recommended strategy, FDG-PET publications can be identified more efficiently. We have shown the importance
of searching more than one database and emphasize the use of both MeSH terms and text words in a search strategy. Standardization
of the spelling of FDG and indexing of articles on FDG would substantially simplify searching.
Received 5 July and in revised form 25 September 1999 相似文献
4.
Selective publication of complete studies or outcomes within studies hampers unbiased medical decision making. If the available body of evidence does not offer a fair representation of all existing evidence, the true effect of an intervention cannot be judged, possible harmful effects cannot be identified and unnecessary costs for healthcare may be invoked. Prospective registration of studies at their inception and public disclosure of all study results via result databases should be enforced on a worldwide scale in accordance with the fundamental and ethical obligations of the investigators towards study participants who were subjected to potential harm in the belief that they contributed to medical progress. These regulations will ensure a solid basis for fully evidence-based decision making in health care. 相似文献
5.
Reversible loss of dendritic spines and altered excitability after chronic epilepsy in hippocampal slice cultures. 总被引:4,自引:0,他引:4
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M Müller B H G?hwiler L Rietschin S M Thompson 《Proceedings of the National Academy of Sciences of the United States of America》1993,90(1):257-261
The morphological and functional consequences of epileptic activity were investigated by applying the convulsants bicuculline and/or picrotoxin to mature rat hippocampal slice cultures. After 3 days, some cells in all hippocampal subfields showed signs of degeneration, including swollen somata, vacuolation, and dendritic deformities, whereas others displayed only a massive reduction in the number of their dendritic spines. Intracellular recordings from CA3 pyramidal cells revealed a decrease in the amplitude of evoked excitatory synaptic potentials. gamma-Aminobutyric acid-releasing interneurons and inhibitory synaptic potentials were unaffected. Seven days after withdrawal of convulsants, remaining cells possessed a normal number of dendritic spines, thus demonstrating a considerable capacity for recovery. The pathological changes induced by convulsants are similar to those found in the hippocampi of human epileptics, suggesting that they are a consequence, rather than a cause, of epilepsy. 相似文献
6.
Michael Müller Lotty Rietschin Franziska Grogg Peter Streit Beat H. Ghwiler 《Hippocampus》1994,4(2):204-209
The heavy metal bismuth induces a new type of selective neuronal degeneration that shares some common aspects with that seen following hypoxia and ischemia. Continuous application of 3 μm bismuth to organotypic cultures of rat hippocampus resulted after 2–3 weeks in selective degeneration of CA1 pyramidal cells, while CA3 pyramidal cells, dentate granule cells, and subicular neurons were resistant. With 10 μm MK-801, a noncompetitive NMDA-antagonist, during the entire culturing period failed to prevent neuronal degeneration induced by 3 μm bismuth. GABA-immunoreactive interneurons were also affected by bismuth, but were generally less sensitive than CA1 pyramidal cells. Acute application of up to 100 μm bismuth did not change the electrophysiological properties of CA1 pyramidal cells. © 1994 Wiley-Liss, Inc. 相似文献
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Increasing numbers of children and adolescents of foreign descent are currently being admitted to residential homes in the
Netherlands. Based on research carried out in the Netherlands, this article deals with the immigrant youngster’s problems,
the placement process, diagnostics, treatment, the involvement of parents, and the impact of cultural differences. The authors
conclude that, compared to indigenous Dutch adolescents, immigrant youths in residential care more often show externalized
behavioral problems. A second conclusion is that it appears to take more effort and time to find a suitable residential setting
for these youngsters, mainly because they seem to be more often unmotivated for treatment and more frequently engaged in antisocial
or delinquent activities than indigenous Dutch adolescents. A third conclusion is that there are several impediments to the
full involvement of immigrant parents in their children’s treatment. The treatment itself almost completely remains a “black
box.” The impact of culture-related differences between immigrant families and care institutions on communication and treatment
needs more attention in practice and research. 相似文献