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Biomedical subjects

K Nanda

Publications and source records attributed to K Nanda.

28 records · Page 2Linked to original sources
PubMed2000

Setting the target for a better cervical screening test: characteristics of a cost-effective test for cervical neoplasia screening.

OBJECTIVE: To determine the potential effects on costs and outcomes of changes in sensitivity and specificity with new screening methods for cervical cancer. METHODS: Using a Markov model of the natural history of cervical cancer, we estimated the effects of sensitivity, specificity, and screening frequency on cost-effectiveness. Our estimates of conventional Papanicolaou test sensitivity of 51% and specificity of 97% were obtained from a meta-analysis. We estimated the effect of reducing false-negative rates from 40-90% and increasing false-positive rates by up to 20%, independently and jointly. We varied the marginal cost of improving sensitivity from $0 to $15. RESULTS: When specificity was held constant, increasing sensitivity of the Papanicolaou test increased life expectancy and costs. When sensitivity was held constant, decreasing specificity of the Papanicolaou test increased costs, an effect that was more dramatic at more frequent intervals. Decreased specificity had a substantial effect on cost-effectiveness estimates of improved Papanicolaou test sensitivity. Most of those effects are related to the cost of evaluation and treatment of low-grade lesions. CONCLUSION: Policies or technologies that increased sensitivity of cervical cytologic screening increased overall costs, even if the cost of the technology was identical to that of conventional Papanicolaou smears. These effects appear to be caused by relatively high prevalence of low-grade lesions and are magnified at frequent screening intervals. Efficient cervical cancer screening requires methods with greater ability to detect lesions that are most likely to become cancerous.

Adolescent↗
PubMed1999

Effect of estrogen replacement therapy on corrected thrombolysis in myocardial infarction frame count.

The effect of chronic estrogen replacement therapy on the corrected Thrombolysis In Myocardial Infarction trial frame count of the left anterior descending coronary artery was assessed in 122 postmenopausal women. With use of multivariate analysis to account for confounding variables likely to affect the corrected Thrombolysis In Myocardial Infarction trial frame count, no chronic effect of estrogen replacement therapy on coronary blood flow was documented.

Aged↗
PubMed1999

Hormone replacement therapy and the risk of colorectal cancer: a meta-analysis.

OBJECTIVE: To review systematically the association between hormone replacement therapy (HRT) and the risk of developing or dying from colorectal cancer. DATA SOURCES: We searched the English-language literature using MEDLINE, Current Contents, CancerLit, and bibliographies of selected studies. METHODS OF STUDY SELECTION: We included studies that specifically addressed the association of HRT with colorectal cancer, had adequate controls, and had retrievable risk estimates. We excluded letters, reviews, and multiple publications of the same data. TABULATION, INTEGRATION, AND RESULTS: Studies were evaluated independently by two of the authors. The exposures of interest were ever, recent, or former use of HRT, and the main outcome measures were colon and rectal cancer incidence and mortality. To reduce the risk of a "healthy estrogen user" bias, we defined recent HRT use as either at time of assessment or within the previous year. The most adjusted risk estimates were extracted. We used a random-effects model to calculate summary relative risks (RRs) and confidence intervals (CIs). Recent use of HRT was associated with a 33% reduction in the risk of colon cancer (RR = 0.67; 95% CI 0.59, 0.77). Protection was limited to recent users; the risk of colon cancer with ever use of HRT was 0.92 (95% CI 0.79, 1.08). Duration of use was not significant. Three studies addressed the risk of fatal colon cancer; the summary RR for death from colon cancer in HRT users was 0.72 (95% CI 0.64, 0.81) compared with nonusers. Rectal cancer incidence was not associated with HRT. CONCLUSION: The risk of colon cancer may be decreased among recent postmenopausal HRT users. Although data are limited, the risk of fatal colon cancer also may be lower in HRT users.

Colorectal Neoplasms↗
PubMed1999

Validation of a Trauma Questionnaire in veteran women.

The Trauma Questionnaire (TQ) assesses a woman's history of childhood and adult sexual trauma, sexual harassment, and domestic violence. The TQ is used widely at Veterans Affairs Medical Centers, but its validity has not been thoroughly examined. In a prospective study of 127 women, we found the TQ to have good to excellent agreement with a semistructured clinician interview and good sensitivity and specificity. The TQ can be used as a valid alternative to the clinician interview in the initial elicitation of trauma history among women veterans in the primary care setting.

Adult↗
PubMed1998

Hormone replacement therapy and the risk of colorectal cancer: a meta-analysis.

Objective: To review systematically the association between hormone replacement therapy and colorectal cancer incidence and mortality.Methods: We conducted a literature search of English-language studies using MEDLINE, Current Contents, CancerLit, and bibliographies of selected studies. The exposures of interest were ever, recent, or former use of hormone replacement therapy (HRT) and the main outcome measures were colon and rectal cancer incidence and mortality. To reduce the risk of a "healthy estrogen user" bias, we defined recent HRT usage as use either at time of assessment or within the previous year. Studies were evaluated independently by two of the authors. We included studies with adequate controls and retrievable risk estimates. We excluded letters, abstracts, and multiple publications of the same data. The most adjusted risk estimates were extracted. We used the empirical Bayes method, a random-effects model, to calculate summary relative risks (RR) and confidence intervals (CI).Results: Recent use of HRT was associated with a significantly decreased risk of colon cancer (RR = 0.69, 95% CI 0.58-0.81). Protection was limited to recent users; the risk of colon cancer with any use of HRT was 0.94 (95% CI 0.79-1.12). Duration of use was not significant. Three studies addressed colon cancer mortality; the summary RR for death from colon cancer in HRT users was 0.72 (95% CI 0.64-0.81). Rectal cancer incidence and mortality were not associated with HRT use.Conclusion: The risk of colon cancer may be decreased among recent postmenopausal HRT users. Although data are limited, the risk of death from colon cancer may also be lower in HRT users.

Journal Article↗
PubMed1998

A study on osmotic resistance of RBC and ESR in stored blood.

The present work was undertaken to study the changes in osmotic resistance of stored blood, used for blood transfusion. Blood samples of 50 cases from Orissa Red Cross Blood Bank, Cuttack, were studied. The blood was collected in acid citrate dextrose solution and stored at 4 degrees C. Storage was done under usual condition followed in blood banks. Osmotic fragility was determined at 3 days interval up to 15 days. In each case ESR was determined and in 20 cases plasma fibrinogen level was determined. In this study there was gradual increase in fragility which was maximum on 9th day and then slowly declined, which was statistically significant. ESR decreased markedly after 6th day, which was also statistically significant.

Adult↗
PubMed1987

Glucose oxidase as an adjunct to penicillin on penicillin resistant staphylococcal isolates.

The study was carried out to find out the efficacy of glucose oxidase as an adjunct to penicillin and its comparison with cloxacillin on fifty penicillin resistant staphylococcal isolates. There is an unequivocal evidence that the combined use of glucose oxidase and penicillin is superior in controlling penicillin resistant coagulase positive staphylococcal infections in comparison to cloxacillin.

Drug Resistance, Microbial↗
PubMedDate not supplied

Diagnostic efficiency of home pregnancy test kits. A meta-analysis.

OBJECTIVE: To assess the diagnostic efficiency of home pregnancy test (HPT) kits. DATA SOURCES: A literature search of English-language studies was performed with MEDLINE and a review of bibliographies. STUDY SELECTION: Studies were included if HPT kits were compared with a criterion standard (laboratory testing), if they used appropriate controls, and if data were available to determine sensitivity and specificity. DATA EXTRACTION: Two investigators independently extracted data, and disagreement was resolved by consensus. Sensitivity, specificity, and an effectiveness score (a measure of the discriminatory power of the test, with higher scores implying greater effectiveness) were calculated. DATA SYNTHESIS: Five studies evaluating 16 HPT kits met the inclusion criteria. The range of sensitivities for HPT kits was 0.52 to 1.0. In studies where urine samples obtained by the investigators were tested by volunteers, sensitivity was 0.91 (95% confidence interval [CI], 0.84-0.96). However, the sensitivity was less in studies where subjects were actual patients who performed the test on their own urine samples (sensitivity, 0.75 [95% CI, 0.64-0.85]). The test effectiveness score was 2.75 (95% CI, 2.3-3.2) for studies where subjects were volunteers but deteriorated to 0.82 (95% CI, 0.4-1.2) for studies with actual patients. CONCLUSIONS: The diagnostic efficiency of HPT kits is greatly affected by characteristics of the users. Despite the popularity of these kits, the relatively low effectiveness scores of these kits when used by actual patients are of concern. We suggest that manufacturers of HPT kits publish results of trials in actual patients before marketing them to the general public.

Female↗