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Results for “Multivariate response regression”

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PubMed1998

Elevated serum concentrations of hepatocyte growth factor in patients with multiple myeloma. The Nordic Myeloma Study Group.

Serum from 398 myeloma patients at diagnosis and serial samples from 29 patients were analysed for hepatocyte growth factor (HGF). HGF was elevated at diagnosis in 43% of myeloma patients compared with healthy controls (median 1.00 ng/mL and 0.44 ng/mL, respectively; P < .00001). In the group with elevated HGF levels 46% of the patients reached plateau phase, as compared with 60% of the patients with low HGF levels (P = .005), and the median survival time was 21 and 32 months, respectively (P = .002). In a univariate Cox regression analysis, HGF was a significant predictor of mortality (P = .02). In the subgroup of patients with beta 2-microglobulin levels less than or equal to 6 mg/L, high versus low HGF was a prognostic factor when a multivariate Cox regression analysis was performed. In serial samples HGF was higher at the time of diagnosis and relapse (median 0.57 ng/mL and 0.52 ng/mL, respectively; P = .0018) than at response (median 0.24 ng/mL, P = .008). We conclude that HGF may be a useful follow-up parameter in myeloma patients. Measurement of HGF may identify a group of patients with poor response to melphalan-prednisone treatment and short survival. HGF was a prognostic factor in patients with high levels of beta 2-microglobulin.

Adult↗

PubMed2005

Patient-reported medication symptoms in primary care.

BACKGROUND: Little is known about the prevalence and character of medication-related symptoms in primary care and their relationship to adverse drug events (ADEs) or about factors that affect patient-physician communication regarding medication symptoms. METHODS: The study included 661 patients who received prescriptions from physicians at 4 adult primary care practices. We interviewed patients 2 weeks and 3 months after the index visit, reviewed patients' medical records, and surveyed physicians whose patients identified medication-related symptoms. Physician reviewers determined whether medication symptoms constituted true ADEs. We used multivariable regression to examine factors associated with patients' decision to discuss symptoms with a physician and with physicians' decision to alter therapy. RESULTS: A total of 179 patients identified 286 medication-related symptoms but discussed only 196 (69%) with their physicians. Physicians changed therapy in response to 76% of reported symptoms. Patients' failure to discuss 90 medication symptoms resulted in 19 (21%) ameliorable and 2 (2%) preventable ADEs. Physicians' failure to change therapy in 48 cases resulted in 31 (65%) ameliorable ADEs. In multivariable analyses, patients who took more medications (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 1.04-1.08; P<.001) and had multiple medication allergies (OR = 1.07; 95% CI = 1.03-1.11; P = .001) were more likely to discuss symptoms. Male physicians (OR = 1.20, 95% CI = 1.09-1.26; P = .002) and physicians at 2 practices were more likely to change therapy (OR = 1.24; 95% CI = 1.17-1.28; P<.001; and OR = 1.17; 95% CI = 1.08-1.24; P = .002). CONCLUSION: Primary care physicians may be able to reduce the duration and/or the severity of many ADEs by eliciting and addressing patients' medication symptoms.

Adult↗

PubMed1983

A dose and time response analysis of the treatment of Hodgkin's disease with MOPP chemotherapy.

A dose-response analysis of the results of MOPP chemotherapy in 132 patients with Hodgkin's disease was carried out. Complex statistical methods were utilized including 40 different dose-time variables and multivariate logistic analyses of 21 clinical variables, both simply and in stepwise regression. These covariates were not independent, and in stepwise regression analysis only B-symptoms and the mean three-cycle rate of drug delivery significantly influenced complete remission attainment. Two parameters, bone marrow involvement (negative) and lung involvement (positive), significantly influenced the duration of complete remission. Survival was influenced adversely by pleural involvement (effusion), advanced age, and B-symptoms. Analyses indicate that the dose of all three drugs (mustard, vincristine, and procarbazine), and the rate of drug delivery during the first three cycles are important in achieving maximal complete response rates, especially for patients with B-symptoms.

Adult↗

PubMed1995

Prognostic value of tumor regression during radiotherapy for head and neck cancer: a prospective study.

OBJECTIVE: Prospective evaluation of tumor regression during external irradiation for head and neck squamous cell carcinomas and its association with long-term local control. METHODS AND MATERIALS: Two hundred twenty-eight patients with histologically confirmed squamous cell carcinoma [oral cavity: 59 (26%), oropharynx: 65 (29%), hypopharynx: 37 (16%), larynx: 67 (29%)] were included between January 1986 and December 1990. Curative intent external irradiation delivered 65-70 Gy over a period of 7 weeks (five 2 Gy fractions per week). Tumor regression was evaluated clinically and endoscopically every week. RESULTS: Tumor regression, assessed at 2 weeks, was as follows: no response: 62 (30%), 25% response: 121 (59%); 50% response: 23 (11%). At 5 weeks, 9 (4%) patients showed 0-25% regression, 75 (33%) showed 50% regression, 115 (50%) showed 75% regression, and 29 (13%) showed complete regression. Median follow-up was 79 months (range: 6-96 months). The local control probability was 68% (62-74%) at 2 years, 65% (59-70%) at 5 years. Univariate analysis showed that, at 2 weeks, local control was significantly different between the nonresponders and the patients with 25% or greater response (p < 0.025) and that, at the fifth week, local control was very different between the major responders (75 and 100%) and the minor responders (0-50%) (p < 0.0001). Multivariate analysis (Cox Proportional Hazards Model) showed that the probability of local relapse was significantly and independently increased for minor regression at 5 weeks [Relative risk (RR) of failure was 2.3 (1.4-3.7)], for nonlaryngeal tumors [RR: 2.4 (1.3-4.5)], and for Stage T3-T4 [RR:2.4 (1.4-4)]. Three prognostic groups can, therefore, be proposed: 1) low risk of recurrence when regression > or = 75% and laryngeal tumor or T1-T2 tumors in other sites: 106 (46.5%) patients, 2-year local control probability: 84% (77-92%); 2) high risk of recurrence: regression < or = 50% and T3-T4 nonlaryngeal tumors: 44 (19%) patients, 2-year local control probability: 27% (13-41%); 3) intermediate risk of recurrence: 78 (34.5%) patients, 2-year local control probability: 69% (58-80%). CONCLUSION: The present study suggests that tumor regression during external radiotherapy is an independent predictive factor of local control in head and neck carcinomas.

Carcinoma, Squamous Cell↗

PubMed1995

Prenatal health behaviors as predictors of breast-feeding, injury, and vaccination.

OBJECTIVE: To identify maternal prenatal preventive health behaviors associated with breast-feeding, early childhood injuries, and vaccination. DESIGN: Secondary analysis of the 1988 National Maternal and Infant Health Survey. SETTING: Questionnaires were mailed to the mother's home. PATIENTS: The response rate to this nationally representative sample was 71%. These analyses include the 10,868 mothers whose infants had ever been at home. INTERVENTIONS: None. MAIN OUTCOME MEASURE(S): Multivariable logistic regression was used to predict the following: (1) having "ever" breast-fed; (2) having breast-fed for at least 6 weeks; (3) "an accident or bad fall" during any of the first 6 months of the child's life ("early" injury) or (4) in the month prior to the interview ("recent" injury); (5) having received "any" vaccinations or (6) having received three diphtheria, pertussis, tetanus immunizations. RESULTS: Children of mothers who reduced alcohol consumption during the pregnancy, had higher incomes, and were white had the best preventive health outcomes. Adequacy of prenatal care was predictive of vaccination, but not of breast-feeding or injury. CONCLUSIONS: These data suggest that prenatal sociodemographic characteristics and maternal health behaviors have significant and continued effects on the preventive health outcomes of infants and children.

Adolescent↗

PubMed2006

A semi-physiological population pharmacokinetic model describing the non-linear disposition of indisulam.

The pharmacokinetic profile of the anti-cancer agent indisulam is non-linear. In addition to non-linear clearance, this may partially be explained by saturable distribution to red blood cells and saturable plasma protein binding. The aims of this study were to develop a semi-physiological population pharmacokinetic model of indisulam and to examine the impact of protein binding and distribution to red blood cells. Indisulam concentrations in plasma, plasma ultrafiltrate and in red blood cells from multiple phase I studies in Caucasian and Japanese patients were used to develop a pharmacokinetic model using NONMEM. This model comprised four physiological compartments: plasma, red blood cells, interstitial fluid and tissue. A simulation study was performed to examine the contribution of physiological processes in indisulam pharmacokinetics. Plasma albumin concentrations were predictive for the maximal protein binding capacity and considerably influenced total plasma concentrations of indisulam, whereas free plasma concentrations remained relatively unaffected. The maximal specific red blood cell binding capacity was 64.0 ( +/-5.9) mg/L and corresponded to the typical red blood cell carbonic anhydrase concentration. Simulation studies demonstrated that the hematocrit does not have a clinically relevant impact on indisulam disposition. This semi-physiological model allowed adequate prediction of the time profiles of indisulam concentrations in all monitored compartments for a large range of dose levels and several treatment regimens. The model has elucidated the mechanism and the role of saturable plasma protein binding and saturable distribution to red blood cells in indisulam pharmacokinetics and provides a basis for rationale PK-PD relationships.

Algorithms↗

PubMed2005

The Preterm Prediction Study: association between maternal body mass index and spontaneous and indicated preterm birth.

OBJECTIVE: The purpose of this study was to evaluate the relationship between prepregnancy maternal body mass index and spontaneous preterm birth and indicated preterm birth. STUDY DESIGN: This was a secondary analysis of the Maternal-Fetal Medicine Units Network, Preterm Prediction study. Patients were classified into categories that were based on their body mass index. Rates of indicated and spontaneous preterm birth were compared. RESULTS: Five hundred ninety-seven (20.5%) of 2910 women were obese. Obese women had fewer spontaneous preterm births at < 37 weeks of gestation (6.2% vs 11.2%; P < .001) and at < 34 weeks of gestation (1.5% vs 3.5%; P = .012). Women with a body mass index of < 19 kg/m2 had 16.6% spontaneous preterm birth, with a body mass index of 19 to 24.9 kg/m 2 had 11.3% spontaneous preterm birth, with a body mass index of 25 to 29.9 kg/m2 had 8.1% spontaneous preterm birth, with a body mass index of 30 to 34.9 kg/m2 had 7.1% spontaneous preterm birth, and with a body mass index of > or = 35 kg/m2 had 5.2% spontaneous preterm birth (P < .0001). Indicated delivery was responsible for an increasing proportion of preterm births with increasing body mass index (P = .001). Obese women had lower rates of cervical length < 25 mm (5% vs 8%; P = .012). Multivariable regression analysis confirmed a lower rate of spontaneous preterm birth in obese gravid women (odds ratio, 0.57; 95% CI, 0.39-0.83; P = .003). CONCLUSION: Obesity before pregnancy is associated with a lower rate of spontaneous preterm birth.

Adult↗

PubMed2005

Influence of timing and dose of thyroid hormone replacement on mental, psychomotor, and behavioral development in children with congenital hypothyroidism.

OBJECTIVES: To evaluate the influence of initial and postinitial treatment factors on cognitive, psychomotor, and psychological outcome in schoolchildren with congenital hypothyroidism (CH). STUDY DESIGN: We studied 45 patients (19 with severe CH and 26 with mild CH) and 37 control children by correlating initial and postinitial treatment factors (free thyroxine and thyroid-stimulating hormone [TSH] concentrations, and the percentage of overtreatment and undertreatment periods) with the results of neuropsychological tests and behavior (as reported on the Teacher Report Form [TRF]). RESULTS: The global IQ of the children with CH was comparable to that of the controls; visuomotor and verbal scores were lower, and total TRF scores were higher. Ethnic group, previous development, and overtreatment predicted IQ and verbal scores, with higher scores seen for the overtreated patients than for the control children and those patients who had not been overtreated. As initial treatment was less satisfactory, total TRF scores were higher. CONCLUSIONS: Our study suggests that initial and postinitial suboptimal treatment of CH leads to abnormalities in IQ and specific fields. Overtreatment may advance cognitive development in 5-1/2- to 7-year-olds. Suboptimal initial treatment may lead to behavioral problems. We recommend that TSH concentrations be maintained within the normal range in patients with CH.

Attention Deficit and Disruptive Behavior Disorder↗

PubMed2005

The role of social norms and friends' influences on unhealthy weight-control behaviors among adolescent girls.

Dieting is common among adolescent girls and may place them at risk of using unhealthy weight-control behaviors (UWCBs), such as self-induced vomiting, laxatives, diet pills, or fasting. Research has suggested that social factors, including friends and broader cultural norms, may be associated with UWCBs. The present study examines the relationship between the school-wide prevalence of current weight loss efforts among adolescent girls, friends' dieting behavior, and UWCBs, and investigates differences in these associations across weight categories. Survey data were collected in 31 middle and high schools in ethnically and socio-economically diverse communities in Minnesota, USA. The response rate was 81.5%. Rates of UWCBs were compared across the spectrum of prevalence of trying to lose weight and friends' involvement with dieting, using chi(2) analysis and multivariate logistic regression, controlling for demographic factors and clustering by school. Girls with higher body mass index (BMI) were more likely to engage in UWCBs than those of lower BMI. Multivariate models indicated that friends' dieting behavior was significantly associated with UWCBs for average weight girls (OR = 1.57, CI = 1.40-1.77) and moderately overweight girls (OR = 1.47, CI = 1.19-1.82). The school-wide prevalence of trying to lose weight was significantly, albeit modestly, related to UWCBs for average weight girls (15th-85th percentile; OR = 1.17, CI = 1.01-1.36), and marginally associated for modestly overweight girls (85th-95th percentile; OR = 1.21, CI = .97-1.50), even after controlling for friends' dieting behaviors. The social influences examined here were not associated with UWCBs among underweight ( < 15th percentile) or overweight ( > 95th percentile) girls. Findings suggest that social norms, particularly from within one's peer group, but also at the larger school level may influence UWCBs, particularly for average weight girls. Implications for school-based interventions to reduce UWCBs are discussed.

Adolescent↗

PubMed2004

[Prognostic and predictive factors of patients with cancer of unknown origin treated with a paclitaxel-based chemotherapy].

BACKGROUND AND OBJECTIVE: Taxane-based combinations appear to be promising for the treatment of carcinoma of unknown primary site (CUPS). PATIENTS AND METHOD: Patients with CUPS not corresponding to any favourable subset were treated with paclitaxel, carboplatin and etoposide. Interaction between various factors with survival was analyzed. A regression model was applied to identify factors with independent prognostic significance. RESULTS: 48 patients were included and 15 responses were observed with a median overall survival of 7.4 months. In the multivariate analysis, performance status and hypoalbuminemia were negatively associated with overall survival. CONCLUSIONS: Some patients can achieve complete response and prolonged survival. This treatment cannot be recommended for patients with a regular performance status. A better knowledge of prognostic factors and a definition of more subgroups with favourable outcome are needed.

Adult↗

PubMed2001

Multivariate data analysis of quality parameters in drinking water.

The quality of water destined for human consumption has been treated as a multivariate property. Since most of the quality parameters are obtained by applying analytical methods, the routine analytical laboratory (responsible for the accuracy of analytical data) has been treated as a process system for water quality estimation. Multivariate tools, based on principal component analysis (PCA) and partial least squares (PLS) regression, are used in the present paper to: (i) study the main factors of the latent data structure and (ii) characterize the water samples and the analytical methods in terms of multivariate quality control (MQC). Such tools could warn of both possible health risks related to anomalous sample composition and failures in the analytical methods.

Multivariate Analysis↗

PubMed2000

Thymidilate synthase and p53 primary tumour expression as predictive factors for advanced colorectal cancer patients.

The purpose of this work was to analyse the ability of p53 and thymidilate synthase (TS) primary tumour expression to retrospectively predict clinical response to chemotherapy and long-term prognosis in patients with advanced colorectal cancers homogeneously treated by methotrexate (MTX)-modulated-5-fluorouracil (5-FU-FA). A total of 108 advanced colorectal cancer patients entered the present retrospective study. Immunohistochemical p53 (pAb 1801 mAb) and TS (TS106 mAb) expression on formalin-fixed paraffin-embedded primary tumour specimens was related to probability of clinical response to chemotherapy, time to progression and overall survival. p53 was expressed in 53/108 (49%) tumours, while 54/108 (50%) showed TS immunostaining. No relationship was demonstrated between p53 positivity and clinical response to chemotherapy (objective response (OR): 20% vs 23%, in p53+ and p53- cases respectively) or overall survival. Percent of OR was significantly higher in TS-negative with respect to TS-positive tumours (30% vs 15% respectively; P < 0.04); simultaneous analysis of TS and p53 indicated 7% OR for p53-positive/TS-positive tumours vs 46% for p53-positive/TS-negative tumours (P < 0.03). Logistic regression analysis confirmed a significant association between TS tumour status and clinical response to chemotherapy (hazard ratio (HR): 2.91; 95% confidence interval (CI) 8.34-1.01; two-sided P < 0.05). A multivariate analysis of overall survival showed that only a small number of metastatic sites was statistically relevant (HR 1.89; 95% CI 2.85-1.26; two-sided P < 0.03). Our study suggests that immunohistochemical expression of p53 and TS could assist the clinician in predicting response of colorectal cancer patients to modulated MTX-5-FU therapy.

Adult↗

PubMed2002

Insecure attachment as a risk factor for future depressive symptoms in early adolescence.

OBJECTIVE: To investigate whether insecure attachment is a predictor of subsequent depressive symptoms among adolescents 12-14 years of age, when controlled for depressive levels the preceding year, various demographic and psychosocial factors, and stressful life events. METHOD: A representative sample of 2,360 young adolescents was assessed at two time points 1 year apart. Measures included were depressive symptoms measured by the Mood and Feelings Questionnaire (MFQ), attachment to parents and friends measured by the Inventory of Parent and Peer Attachment, stressful events, and various sociodemographic factors. The initial response rate was 88.3% and the attrition rate was 4.3%. RESULTS: The proportions of high scorers (MFQ > 33) increased threefold from T1 to T2 (3.4% to 10.9%). Results of multivariate logistic regression analyses showed that the following variables at T1 were predictive of depressive symptoms at T2 : severe depressive symptoms (odds ratio [OR] = 5.30), gender (OR = 4.08), attachment to parents (OR = 1.36), and stressful life events (OR = 1.12). No interactions between attachment and severe depressive symptoms and gender and stressful life events, respectively, were found. CONCLUSIONS: Insecure attachment to parents may contribute to the development of severe depressive symptoms among young adolescents. Improving the adolescent-parent relationship could be a focus for interventions both in community services and in clinical work.

Adolescent↗

PubMed2005

Low back pain and pelvic pain during pregnancy: prevalence and risk factors.

STUDY DESIGN: Cross-sectional study. Women giving birth at one of two hospitals of northern Sweden from 1 January 2002 until 30 April 2002 were invited to fill in a questionnaire on their obstetric and gynecological history, actual pregnancy, and delivery. OBJECTIVE: The aim of this study was to investigate prevalence and risk factors for low back pain and pelvic pain (LBPP) during pregnancy. SUMMARY OF BACKGROUND DATA: Although low back pain and pelvic pain during pregnancy is a most common complication of pregnancy, its etiology is unknown and the pathophysiology is poorly understood. METHODS: The sample was analyzed by calculating the prevalence of LBPP during pregnancy. Univariate and multivariate logistic regression was performed to calculate odds ratio (OR) and its 95% confidence intervals (CI) where applicable. Parametric and nonparametric testing was used to establish differences between groups. RESULTS: The response rate was 83.2% (N = 891). The prevalence of LBPP during pregnancy was 72%. Most cases reported both anterior and posterior pain. Increasing parity, history of hypermobility, and reported periods of amenorrhea were risk factors for LBPP. Women with LBPP had significantly higher prepregnancy weight, end-pregnancy weight, and prepregnancy and end-pregnancy body mass index. Age at menarche and use of oral contraceptives were not associated with LBPP. Nonrespondents were of the same age and parity as respondents. CONCLUSIONS: A majority of pregnant women report LBPP. Parity, LBPP during a previous pregnancy, body mass index, a history of hypermobility, and amenorrhea are factors influencing the risk of developing LBPP during pregnancy.

Adult↗

PubMed2002

Iron plus folate is more effective than iron alone in the treatment of iron deficiency anaemia in pregnancy: a randomised, double blind clinical trial.

OBJECTIVE: To evaluate whether folate supplementation to iron is able to accelerate solving of iron deficiency anaemia in pregnancy. DESIGN: Multicentre, double blind, randomised clinical trial. SETTING: Nine hospital gynaecologic units located in Mexico. POPULATION: Three hundred seventy-one women with iron deficiency anaemia between 14 and 27 weeks of pregnancy. METHODS: Random allocation of the study population to receive 80 mg iron proteinsuccinylate, with or without 0.370 mg folinic acid daily for 60 days. MAIN OUTCOME MEASURE: Haemoglobin concentration increase. RESULTS: Combined iron and folate therapy showed a better therapeutic response: the increase in haemoglobin levels from baseline was 1.42 (0.14) g/dL for women treated with both compounds vs 0.80 (0.125) g/dL for those given iron only (P < 0.001). A multivariable regression analysis showed that this effect was independent of basal levels of blood iron, ferritine and serum folate and was more evident in women with more severe anaemia. In the 64 women belonging to the subgroup defined by the per-protocol (PP) population and the lowest quartile of baseline haemoglobin values (mean 8.96, range 5.9-9.8 g/dL), the increase at day 60 was estimated 2.3 (0.53) g/dL for the combined therapy vs 0.5 (0.5) g/dL for iron only (P = 0.07). No significant differences in tolerability were observed between the two groups. CONCLUSION: Folate supplementation is recommendedin pregnant women with iron deficiency anaemia irrespective of the serum levels of folate.

Adult↗

PubMedDate not supplied

Once-daily use of ofloxacin for prophylaxis in breast cancer surgery.

The 150 consecutive patients who were hospitalized for breast cancer at our department between September 1992 and November 1995 were enrolled in this open study after having given their informed consent. Patients were assigned randomly to receive ofloxacin in daily doses of 200 mg to be taken in a single dose or a total dose of 600 mg divided into three doses postoperatively for 5 days. Ten patients (8 found to be without malignancies) were excluded from evaluation. Wound infections developed in 8 (12%) of the 69 patients in the 200-mg group and 12 (17%) of the 71 patients in the 600-mg group. Postoperative wound care lasted a median of 19 days (25th and 75th percentiles, 15 and 29 days) for patients given 200 mg and 16 days (13 and 25 days) for those given 600 mg; the difference was not statistically significant (Wilcoxon's U test). Signs or symptoms suggesting ofloxacin toxicity were not observed, and several significant differences were found in laboratory test results between the two groups both before and after treatment. Abnormal changes after treatment were found in many individuals, but the rate of occurrence was similar in the two groups (U test). When ofloxacin is used for prophylaxis after breast surgery, we recommend a once-daily administration of 200 mg orally for financial reasons and increased patient compliance.

Adult↗

PubMed2002

[Acute hepatitis C].

OBJECTIVE: The aim of the study was both to evaluate the natural outcome of acute hepatitis C (AHC), in this factors influencing chronicity of HCV, and to assess results of antiviral therapy in acute phase of disease. PATIENTS AND METHODS: Seventy-seven pts with diagnosis of AHC (all HCVRNA-positive, in this 44 anti-HCV-positive at entry) were seen. Sixty-four of them (F/M: 33/31; mean age: 45.4y +/- 16.0) were non-treated (NT pts) with IFN during 6-months follow-up and thirteen patients (F/M: 5/8; mean age: 36.6ys +/- 11.9) were treated (T pts) with IFN. Antiviral therapy was started within 2 to 18 (median 10) weeks after the onset of AHC including seven pts with IFN alpha-2b at 5MU thrice weekly (TIW) and one pt with IFN-alpha-2a at 6MU TIW for 24 weeks, three pts with combined (Rebetron) therapy according to HCV genotype (1F/3a for 24 weeks and 2M/1b for 48 weeks) and two pts with PEG-Intron for one month followed by Intron at 3MU TIW for 20 weeks. RESULTS: 64.1% of NT pts developed chronic hepatitis. In multivariate logistic regression analysis age > 40y, nonicteric course and medical procedures as route of infection were independently and significantly associated with chronicity. Ten of the thirteen (77%) treated pts presented sustained response (SR) at the end of follow-up. Only one seronegative pt no responded to the therapy. The others 12 pts (all seropositive) presented rapid normalisation of ALT levels. However, 3 of them developed breakthrough between 12 and 20 week of therapy and ribavirin was added with beneficial effect. At the end of treatment point, all seropositive patients showed biochemical and virological response but two (with breakthrough history) of them relapsed. CONCLUSIONS: Seropositive, nonicteric patients with acute hepatitis C should be treated as soon as possible and pegylated-IFN for 24 weeks seems to be currently the best choice. Combination therapy with PEG and ribavirin could be proposed to the patients who failed to monotherapy. The beneficial effect of AHC therapy is indicative for necessity of creating conditions for diagnosed AHC more frequent than hitherto.

Acute Disease↗

PubMedDate not supplied

International survey of peritoneal dialysis training programs.

OBJECTIVE: To survey nurses around the world about current practices for peritoneal dialysis (PD) home training programs. DESIGN: Random sampling of nurses to complete a written survey from the International Society for Peritoneal Dialysis Nursing Liaison Committee. SETTINGS: United States, Canada, South America (Brazil, Columbia), The Netherlands, Hong Kong. METHODS: Surveys and responses were sent by fax whenever possible, or by regular mail, or hand carried, or conducted by telephone. Results were stratified by geographic areas as well as by cumulative responses and were expressed as medians with ranges. Kruskal-Wallis was used to evaluate differences in responses. Associations between variables were tested with Pearson correlation. Univariate regression analysis was used to evaluate the impact of variables on peritonitis rates. Variables with p < 0.10 were included in a multivariate analysis. RESULTS: A total of 317 nurses responded: 88 in the United States, 46 in Canada, 58 in South America, 58 in Hong Kong, and 67 in The Netherlands. This represented 37% of all surveys distributed. Respondents had a median of 12 years' experience in nephrology (range 1-35 years), but only 31% had a formal background in adult education. Nearly half received their guidance to patient training from a nurse colleague, 11% were guided by a corporate colleague, and 8% were simply self-taught. Clinics responding had a median of 30 PD patients (range 1-400) and reported they trained a median of 8 patients per year (range 0-86). Reported peritonitis rates were a median 0.46 per year or 1 episode every 26 months. Peritonitis rates, however, were not known by 53% of respondents. Total training time per patient had a very wide range of hours, from 6 to 96. There was no correlation between training time and peritonitis rates among the study respondents (p = 0.38), nor with any other variables. CONCLUSIONS: There is wide variation in practices for PD patient training programs within countries and around the world. Training time did not appear to be related to peritonitis rates. Randomized trials of training practices are needed to determine which approaches produce the best outcomes for patients.

Hemodialysis, Home↗