Statistical analyses for research in arthritis when assessing change.
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Arthritis↗
Biomedical subjects
J E Hewett
Publications and source records attributed to J E Hewett.
Medical students using Grateful Med: analysis of failed searches and a six-month follow-up study.
Medical students at the University of Missouri were taught to search MEDLINE using the Grateful Med software. The traffic files of student searches were analyzed for search behavior. This paper reports on two specific aspects of these analyses: (1) failed searches where retrieval was either too large or too small (zero hits); and (2) a six month follow-up study which focused on error rates and retention of skills. The two major reasons for retrieving too many citations were entering a phrase on a single subject line and a search of only one concept. Of the zero hit searches, the most commonly occurring errors were MeSH (medical subject headings) not used, other MeSH errors, misspelling or keyboard errors, and faulty logic. During the six month follow-up study, the error rates of students declined in spite of the fact that they had not used the software in six months. Furthermore, a larger percentage of the searches showed a more sophisticated use of MeSH than previously employed.
Education, Medical↗
A controlled study of lymphocyte subsets in rheumatoid arthritis.
The purpose of this study was to determine if patients with rheumatoid arthritis (RA) exhibited unique patterns of peripheral blood lymphocyte (PBL) subsets in comparison to patients with osteoarthritis (OA) and, further, if such differences related to disease activity or nondisease factors. Data from 63 RA patients and 47 OA patients revealed that the RA patients had lower absolute numbers of CD2+ and CD4+ lymphocytes. Small differences also were found in selected B-cell subsets and subsets of lymphocytes expressing CD16 and/or CD57 antigens. Further analysis revealed that these differences were due primarily to the effects of cytotoxic medications in the RA group. However, there were also alterations in some subsets independent of medication groups. PBL subsets in RA patients did not relate to chronic low-dose prednisone or measures of disease activity. This study demonstrated the need to control carefully for variables such as age and medication in immunophenotypic investigations of RA.
Aging↗
Spontaneous coping strategies to manage acute pain and anxiety during electrodiagnostic studies.
Electrodiagnostic studies produce both anxiety and pain, which can prevent adequate examination and limit the usefulness of test results. This study examined the spontaneous coping strategies used to manage the pain and anxiety experienced during electrodiagnostic testing. Fifty patients (26 women and 24 men) evaluated in our electrodiagnostic laboratory were administered visual analogue scale (VAS) pain and anxiety measures and the Spielberger State-Trait Anxiety Inventory (STAI) before the procedure. Immediately after the procedure, subjects reported pain, anxiety, and coping strategies used during electrodiagnostic testing using the VAS, the STAI, and a situation-specific version of the Coping Strategies Questionnaire (CSQ-S). The CSQ-S appears to be a valid and reliable measure of spontaneous coping strategies. Multiple-regression analyses revealed that frequent use of catastrophizing, diverting attention, and coping self-statement strategies was significantly and positively correlated with pain, whereas reinterpreting pain was significantly and negatively associated with pain. Judgments of control over pain were also significantly and negatively associated with anxiety experienced during electrodiagnostic studies. Physicians' ratings of pain and anxiety were highly correlated with patients' self-reports. This study suggests that ineffective coping strategies may enhance the pain and anxiety experienced during electromyography. Alternatively, teaching subjects active self-control skills and increasing patients' self-efficacy beliefs may help manage this situation-specific acute anxiety and, possibly, the associated pain.
Adaptation, Psychological↗
Association of immunoglobulin Km and Gm allotypes with specific antinuclear antibodies and disease susceptibility among connective tissue disease patients.
The distribution of the immunoglobulin Km(1) and Gm phenotypes was examined in patients with connective tissue diseases, including systemic lupus erythematosus, mixed connective tissue disease, and scleroderma, whose sera were characterized for antibodies against nuclear antigens and polypeptides of U small nuclear ribonucleoproteins. We found a strong association between Km(1) phenotype and susceptibility to systemic lupus erythematosus (P less than 0.00001, relative risk = 17). We also found a positive association between the Km(1) phenotype and the presence of anti-double-stranded DNA antibodies. The presence of certain immunoglobulin genes or gene families may have a role in susceptibility to the development of autoantibodies and/or of connective tissue disease.
Antibodies, Antinuclear↗
Malignant potential of actinic keratoses and the controversy over treatment. A patient-oriented perspective.
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Carcinoma, Squamous Cell↗
Human autoantibodies against the 70-kd polypeptide of U1 small nuclear RNP are associated with HLA-DR4 among connective tissue disease patients.
Serum samples from patients with connective tissue disease (CTD) were characterized using a recently developed enzyme-linked immunosorbent assay for reactivity with individual specific polypeptides of U1 small nuclear ribonucleoproteins, including the U1-70-kd protein. The distribution of HLA antigens was compared in CTD patients with and in those without anti-U1-70-kd autoantibodies and in normal controls. The frequencies of HLA-DR4 and HLA-DRw53 were increased among the anti-U1-70-kd autoantibody positive CTD group compared with the frequencies in anti-U1-70-kd autoantibody negative systemic lupus erythematosus patients and compared with normal controls. We conclude that the presence of autoantibodies reactive with the anti-U1-70-kd protein antigen is associated with HLA-DR4 and HLA-DRw53.
Antibodies, Antinuclear↗
Clinical and clinicopathologic effects of samarium-153-EDTMP administered intravenously to normal beagle dogs.
A study was undertaken to determine the degree of acute bone marrow and vital organs injury sustained when dogs were administered doses of 153Sm-EDTMP calculated to irradiate an acute bone lesion arising from cancer metastasis to a dose considered palliative or even therapeutic (20-160 Gy). The study revealed significant (p less than 0.05) temporary depression of the bone marrow in all doses in the therapeutic (greater than 40 Gy) range. Palliative (20 Gy) doses caused significant leukocyte depression but insignificant (p greater than 0.05) depression of platelet and packed cell volumes when compared to control animals. A mild transient rise in the levels of serum alkaline phosphatase occurred immediately following radioisotope administration. All hematologic parameters had returned to normal by six weeks after the last injection of radioisotope. The study indicates potential for this compound as a safe, therapeutic radiopharmaceutical for treatment of cancer bone metastasis.
Alkaline Phosphatase↗
Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis.
A group of 120 patients with rheumatoid arthritis or osteoarthritis volunteered to be subjects for this study of aerobic versus nonaerobic exercise. Patients were stratified by diagnosis and randomized into an exercise program of aerobic walking, aerobic aquatics, or nonaerobic range of motion (controls). The retention rate for the 12-week program was 83%. Exercise tolerance, disease-related measures, and self-reported health status were assessed. The aquatics and walking exercise groups showed significant improvement over the control group in aerobic capacity, 50-foot walking time, depression, anxiety, and physical activity after the 12-week exercise program. There were no significant between-group group differences in the change scores for flexibility, number of clinically active joints, duration of morning stiffness, or grip strength. Our findings document the feasibility and efficacy of conditioning exercise for people who have rheumatoid arthritis or osteoarthritis.
Adult↗
Multivariate outcome research in arthritis. Implications for sample sizes.
Planning appropriate sample sizes prior to data collection is critical to the overall success of a research project. However, the investigator often encounters practical limitations regarding the number of subjects available. While the literature discusses the various options of analysis of clinical trial data, there is little discussion as to the sample size implications of the statistical method chosen. Since the analysis technique employed affects the required sample size, the investigator should select the analysis that is most appropriate for the data and has the most efficient sample size requirement. This paper addresses the sample size implications of three commonly used methods for comparing two populations when there are two or more outcome measures (multivariate outcome). The concepts and methods are illustrated using a Pain Management Study that was conducted using people with rheumatoid arthritis as subjects.
Arthritis↗
Bone marrow biopsy in the initial staging of Hodgkin's disease.
Results of bone marrow biopsy were retrospectively evaluated in 120 previously untreated patients with Hodgkin's disease. The incidence of bone marrow involvement was 13%. All patients with marrow invasion had B symptoms and/or clinically advanced disease. When patients with bone marrow involvement were compared to those without there were significant differences in the incidence of B symptoms, the clinical stage, hemoglobin levels, leukocyte counts, platelet counts, and serum levels of lactate dehydrogenase and alkaline phosphatase. None of 59 patients with clinical stage IA and IIA had evidence of marrow invasion. This study demonstrates that trephine bone marrow biopsy is of value in detecting marrow involvement in specific subgroups of untreated patients with Hodgkin's disease, i.e., those patients with constitutional symptoms and/or clinical stage III or IV. However, bone marrow biopsy adds little to the initial staging of patients with clinical stage IA and IIA. Routine use of this procedure in such patients may be unnecessary.
Adolescent↗
Risk factors for coronary atherosclerosis in the elderly.
To determine the importance of traditional risk factors for coronary artery disease (CAD) in the elderly, the authors studied 64 consecutive patients with angiographically normal or near-normal coronary arteries and 64 patients with CAD. All patients were greater than or equal to sixty years old. The risk factors studied were male sex, hypertension, diabetes mellitus, hypercholesterolemia, cigarette smoking, sedentary life-style, and family history. The prevalence of these risk factors in the two groups of patients was compared. The results suggest that in persons greater than or equal to 60 years old, male sex and cigarette smoking continue to remain risk factors for CAD. Since most of the patients with diabetes and hypertension were on medical management for their condition, the authors' findings also suggest that diabetes mellitus, even under treatment, remains an important risk factor for CAD in the elderly but controlled hypertension does not. Other traditional risk factors (hypercholesterolemia, sedentary life-style, and family history) do not discriminate individuals with moderate to severe CAD from those with normal or near-normal coronary arteries in persons greater than or equal to sixty years old.
Aged↗
Can patients with chest pain and normal coronary arteries be discriminated from those with coronary artery disease prior to coronary angiography?
To determine whether the precatheterization clinical data in patients with chest pain could be used to discriminate patients with normal coronary arteries (NCA) from those with coronary artery disease, the authors compared 125 consecutive patients with less than 30% stenosis of all major coronary arteries and 125 patients with greater than 60% stenosis of one or more major coronary arteries. Clinical characteristics that occurred more frequently in patients with NCA were: nonexertional pain, pain to the left of the sternum, sharp pain, associated palpitations, absence of typical relief with sublingual nitroglycerin, pain commencing less than one week or more than ten years prior to coronary angiography, a normal electrocardiogram, and negative results from a treadmill stress test or from thallium scintigraphy. However, none of these clinical features, either singly or in combination, could be used to identify the patients with NCA with certainty.
Adult↗
The electroretinogram in preterm infants.
With the hope that the electroretinogram (ERG) in preterm infants could help clarify their vitamin A requirements, a technique for recording the full-field ERG in the neonate is described. One hundred seventy-seven ERGs were performed in 59 preterm and 52 term infants. An ERG was recorded as soon as 7 hours after birth and as early as 30 weeks after conception. In preterm infants the a-wave latency was longer and the amplitude less than in term infants of the same age. The amplitude of the ERG in preterm infants increased with the duration of light exposure. Longitudinal data on 15 preterm infants showed a reduction in a-wave latency. None of the ERG findings correlated with postconceptional age, which suggests that the duration of light exposure is a major determinant of the ERG pattern in preterm infants. Despite low circulating levels of retinol, no correlations with any of the ERG values were found.
Electroretinography↗
Exercise tolerance and disease related measures in patients with rheumatoid arthritis and osteoarthritis.
One hundred and twenty patients with symptomatic rheumatoid arthritis (RA) or osteoarthritis (OA) in weight bearing joints (RA = 40; OA = 80) performed subjective maximal graded exercise tests on a motor driven treadmill. Disease related measures were also assessed. Findings from this sample indicated that people with arthritis were significantly impaired in exercise tolerance, flexibility and biomechanical efficiency. Significant differences between diagnoses appeared on a number of disease related measures; however, there was little correlation between disease related measures and exercise tolerance. Women demonstrated a greater aerobic impairment than men; and women with RA had a greater aerobic deficit than women with OA.
Arthritis, Rheumatoid↗
Pain in rheumatoid arthritis: relationship to demographic, medical, and psychological factors.
Our purpose was to investigate the relationship among demographic, medical, and psychological factors and self-reported pain in 135 patients with classic or definite rheumatoid arthritis (RA). Patients were examined using the systemic index, articular index, McGill Pain Questionnaire, Symptom Checklist-90-R, and a pain visual analogue scale. Multiple regression analyses found no significant relationships between pain and the medical variables. However, age, income, and selected psychological variables were significantly correlated with pain reports. The greatest pain management challenge occurred in patients who were middle-aged, living on limited incomes, and experiencing major stresses in everyday life. These high risk pain patients were also worry-prone and felt isolated and lacking in social support. Attention to these related psychosocial problems is recommended as an important pain management strategy in RA.
Arthritis, Rheumatoid↗
Vitamin A status of preterm infants: correlation between plasma retinol concentration and retinol dose response.
Retinol dose response tests were performed on 83 preterm infants shortly before discharge by giving orally 5000 IU of an aqueous dispersion of retinol. Predose plasma retinol concentrations were 2.5-20.5 micrograms/dL (0.087-0.72 mumol/L) and the retinol dose responses were 0-59.8%. The regression of retinol dose response on predose retinol was -0.58. There was a parallel increase in both retinol and retinol-binding protein and an increase in the molar ratio of retinol-binding protein to prealbumin. Prealbumin did not increase. These findings suggest that preterm infants have reduced liver stores of vitamin A.
Dose-Response Relationship, Drug↗
Effects of collection time and food consumption on the urine protein/creatinine ratio in the dog.
Effects of collection time and food consumption on the variability of the urine protein/creatinine ratio were determined in 10 healthy dogs. In trial 1, dogs were fasted for 12 hours, and urine specimens were obtained by bladder catheterization every 2 hours over an 8-hour collection period during the day. After a 1-week rest, the dogs were entered into trial 2. Dogs were fed at least 60 kcal of a high protein meal/kg of body weight, and urine specimens were obtained every 2 hours over an 8-hour period during the day. Urine total protein and urine creatinine concentrations and the urine protein/creatinine ratio were determined for each urine specimen obtained. Friedman's 2-way analysis by ranks was used to determine the constancy of this ratio over the 4 periods in the 2 trials (fasted and fed). There was no significant variability (P greater than 0.05) in ratios over the 8-hour collection periods in the fasted or fed trial. Feeding did not significantly alter this ratio, because there was no significant difference (P greater than 0.05) in the urine protein/creatinine ratios of the dogs when they were fasted, compared with those of the dogs when they were fed. Seemingly, urine specimens obtained anytime during the day from dogs in both trials (fasted and fed) reflected the urine protein/creatinine ratio.
Animals↗