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PubMed1993

The efficacy number as a predictor of morbidity and mortality in peritoneal dialysis patients.

The efficacy number has been proposed as a predictor of clinical outcome in patients on chronic ambulatory peritoneal dialysis (CAPD). The usefulness of this parameter in a large group of CAPD patients was analyzed. Forty-five patients who have received chronic CAPD therapy for at least 1 yr were included in the study. The efficacy number was compared with outcome as defined by mortality and days of hospitalization. Other demographic and laboratory parameters, including gender; race; presence of diabetes; serum albumin, serum creatinine, and BUN levels; and measures of peritoneal transport, including dialysate-to-plasma creatinine and dialysate-to-plasma urea ratios, were also assessed for their role in predicting outcome. Laboratory values were obtained at the initiation of CAPD and at 12 months after the start of CAPD. By univariate analysis, a low 12-month serum albumin level was the best predictor of mortality (P < 0.005), followed by a high 12-month efficacy number (P < 0.05). After adjusting for age and the presence of diabetes, these two variables remained the best predictors of mortality (P < 0.08 and < 0.09, respectively). A low initial serum albumin level was also a strong predictor of mortality (P < 0.09). By univariate analysis, the best predictor of hospitalization was a low serum albumin level obtained either initially or at 12 months (P < 0.005 for both time periods). After adjusting for age and the presence of diabetes, the 12-month serum albumin level remained a significant predictor of hospitalization (P < 0.03), whereas efficacy number was not a strong predictor (P = 0.27).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2000

The impact of multiple predictors on generalist physicians' care of underserved populations.

OBJECTIVES: This study examined the relative and incremental importance of multiple predictors of generalist physicians' care of underserved populations. METHODS: Survey results from a 1993 national random sample of 2955 allopathic and osteopathic generalist physicians who graduated from medical school in 1983 or 1984 were analyzed. RESULTS: Four independent predictors of providing care to underserved populations were (1) being a member of an underserved ethnic/minority group, (2) having participated in the National Health Service Corps, (3) having a strong interest in practicing in an underserved area prior to attending medical school, and (4) growing up in an underserved area. Eighty-six percent of physicians with all 4 predictors were providing substantial care to underserved populations, compared with 65% with 3 predictors, 49% with 2 predictors, 34% with 1 predictor, and 22% with no predictors. Sex, family income when growing up, and curricular exposure to underserved populations during medical school were not independently related to caring for the underserved. CONCLUSIONS: A small number of factors appear to be highly predictive of generalist physicians' care for the underserved, and most of these predictive factors can be identified at the time of admission to medical school.

Career Choice↗

PubMed2005

Absence of lower urinary tract symptoms is an independent predictor for cancer at prostate biopsy, but prostate-specific antigen is not: results from a prospective series of 569 patients.

PURPOSE: Prostate needle biopsy (PNB) is the definitive method for the diagnosis of prostate cancer. Our objective was to evaluate prebiopsy parameters, including lower urinary tract symptoms, that may be predictive of positive biopsy. PATIENTS AND METHODS: We performed a prospective review of 569 consecutive men who underwent transrectal ultrasound (TRUS)-guided PNB. The prebiopsy variables recorded included age, prostate-specific antigen (PSA) levels, prostate volume (PV), percent free PSA levels, suspicious digital rectal examination (DRE) findings, TRUS-detected lesions, race, and American Urologic Association Symptom Score (AUASS). RESULTS: Low AUASS, PV, patient age, and abnormal TRUS findings were independent predictors of positive PNB results (P < 0.05). In patients with PSA levels between 4 and 10 ng/mL, the positive predictive value of a low AUASS (< 8) in predicting a positive PNB result is 68.7%. When race was considered (black vs. white), univariate analysis (UVA) indicated that race was a significant predictor (P = 0.034) of positive PNB. A subgroup analysis was performed for black men undergoing PNB (n = 256). Multivariate analysis (MVA) indicates that abnormal TRUS findings; low AUASS, PV, and PSA levels; and absence of prior biopsy are all independent predictors of PNB in the black patient group. A final subgroup analysis (UVA and MVA) was performed for white men (n = 310). Only patient age and PV demonstrated significance as independent predictors of PNBs in this group. CONCLUSION: This prospective analysis of 569 men demonstrates that traditional indicators for PNB (abnormal DRE findings and PSA levels) are not significant predictors of prostate cancer. Independent predictors for prostate included age, low AUASS, low PV, and abnormal TRUS findings. A low AUASS (indicative of the absence of benign disease) is an important predictor of prostate cancer.

Age Factors↗

PubMedDate not supplied

Predictors of type and site of first acute myocardial infarction in men and women.

BACKGROUND: The importance of pathophysiological mechanisms involved in onset of acute myocardial infarction (AMI) differs with age, gender, and risk profiles. Diversity in the triggering of cardiovascular events has been observed, particularly between men and women. Therefore, we investigated the relationship between age, gender, and risk factors and location of AMI and the presence of Q waves in ECG. PATIENTS AND METHODS: Data was obtained from a chart review of 2958 patients with first AMI: 770 (26%) patients with non-Q-wave AMI and 2188 (74%) patients with Q-wave AMI. Four clinical groups were formed by predetermined criteria (anterior Q-wave, anterior non-Q-wave, inferior Q-wave, inferior non-Q-wave). A logistic regression was performed to assess independent predictors of AMI type and site. RESULTS: Key findings were: 1) inferior non-Q-wave AMI was more frequent in young women (P<0.001); 2) inferior Q-wave AMI was more common in young men (P<0.001); 3) anterior non-Q-wave AMI was more common in older men (P<0.001). Multivariate analysis revealed that independent predictors of anterior non-Q-wave AMI were age over 65 (P=0.002), male gender (P=0.04) and hypercholesterolemia (P=0.0003), and that predictors of inferior Q-wave AMI were male gender (P<0.0001), smoking (P=0.04) and diabetes (P=0.049). In the gender-subgroup analyses, age <45 years (P=0.04), hypecholesterolemia (P=0.02) and smoking (P=0.01) were independent predictors of inferior Q-wave AMI whereas age >65 years (P<0.0001) and smoking (P=0.0003) were predictors of anterior non-Q-wave AMI in men. In women, age <45 years (P<0.0001) and smoking (P=0.02) were independent predictors of non-Q-wave AMI and hypercholesterolemia (P=0.02) was a predictor of inferior Q-wave AMI. CONCLUSION: The link between particular types and the site of AMI and age, gender and risk factors suggest that the importance of pathophysiological mechanisms for onset of AMI differs according to sex and age subgroup.

Adult↗

PubMed2006

Emerging sociodemographic and lifestyle predictors of intention to use condom in human immunodeficiency virus intervention among uniformed services personnel.

Appropriate and consistent use of condom remains an effective approach to human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) intervention. We analyzed the baseline data gathered for a situationally based HIV/AIDS intervention to assess the potential predictors of condom use among the Uniformed Services Personnel in Nigeria. Using condom purchase as a proxy for intention to use condom, we examined the distribution of the demographic and lifestyle characteristics, knowledge of HIV transmission mode, and knowledge of how to correctly use a condom. A univariable logistic regression was used to identify the potential predictors, followed by multivariable logistic regression modeling. The knowledge of how to correctly wear a condom was the most significant positive predictor of the intention to use a condom (adjusted prevalence odds ratio (APOR), 5.99 (95% confidence interval (CI), 1.26, 19.79). The other main positive predictors of intent to use a condom were the knowledge of the mode of HIV transmission via blood, APOR 2.43 (95% CI, 1.01, 5.82), saliva (5. 87, 95% CI, 3.15, 10.94), and pre-ejaculatory fluid (APOR, 3.58, 95% CI, 1.67, 7.48). Male gender was also a significant positive predictor of the intent to use a condom (APOR, 2.55, (95% CI, 1.10, 5.97)). The results further indicated alcohol use (APOR, 0.32, 95%CI, 0.16, 0.61), marijuana use (APOR, 0.24, 95% CI, 0.11, 0.56), and the frequency of oral sexual behavior (APOR, 0.006, 95%CI, 0.002, 0.019) as negative predictors of the intent to use a condom. Therefore, these findings suggest that for an HIV/AIDS intervention to be effective in this population, it must incorporate these predictor variables into its design and conduct.

Adolescent↗

PubMed2001

Children with macrocrania: clinical and imaging predictors of disorders requiring surgery.

BACKGROUND AND PURPOSE: Macrocrania is a common pediatric clinical condition affecting up to 5% of the population. The purpose of this study was to determine clinical and imaging predictors that are useful in the differentiation of disorders requiring surgical treatment from those that can be treated medically in children with macrocrania. METHODS: In a 3-year 7-month retrospective study, 88 patients (median age, 8 months; interquartile range, 5--13 months) with macrocrania and no known underlying neurologic disorder underwent imaging of the brain (sonography, n = 36; CT, n = 31; MR imaging = 21). The study was conducted in a pediatric tertiary care referral center. Clinical and imaging data were correlated to final diagnosis by means of logistic regression and receiver operating characteristic curves. RESULTS: Sixteen (18%) of the patients had disorders requiring surgery: communicating hydrocephalus, n = 7; noncommunicating hydrocephalus, n = 3; hemorrhagic subdural collections, n = 3; neoplasm, n = 1; encysted cavum septi pellucidi, n = 1; and vein of Galen malformation, n = 1. Clinical predictors of disorders requiring surgery included vomiting (P =.007), labor instrumentation (P =.026), developmental delay (P =.008), and abnormal neurologic findings (P =.028). Imaging predictors of disorders requiring surgery included a focal space-occupying lesion (P <.0001) and moderate-to-severe ventriculomegaly (P <.0001). The diagnostic sensitivity of the combination of independent clinical and imaging predictors was higher than that of independent clinical predictors alone, being 100% (95% confidence interval = 96.9%, 100%) and 93.8% (95% confidence interval = 88.7%, 98.8%), respectively. A trend indicated that the area under the receiver operating characteristic curve for clinical plus imaging findings (0.95) was greater than that for clinical findings alone (0.85) (P =.09). An increase in the number of clinical and imaging predictors was highly correlated with an increased risk of a disorder requiring surgery (P <.0001). CONCLUSION: Baseline neuroimaging is indicated for children with macrocrania because the combination of clinical and imaging predictors has the best diagnostic performance in determining the need for surgical versus nonsurgical management.

Brain Diseases↗

PubMed2002

Physically demanding situations as predictors of disability pensioning with soft tissue rheumatism among persons 30-39 years old in Norway, 1981-90.

OBJECTIVE: Physically demanding work is a predictor of disability pensioning with musculoskeletal diseases. Being a parent is probably also physically demanding. Having manual work and being a parent will be analyzed as possible predictors of becoming a disability pensioner with soft tissue rheumatism (DPSTR) after controlling for level of education, employment, number of hours worked, income, age, sex, and marital status. METHODS: In this prospective study based on census data of persons 30-39 years old in 1980, predictors of becoming DPSTR during the followup period 1981-90 were identified by logistic regression analysis. RESULTS: Manual work was a predictor for becoming DPSTR for both men and women, while being a parent was neither a risk factor nor a protective factor for becoming DPSTR. Being employed was a predictor of becoming DPSTR for married women, but a protective factor for unmarried women and all men. Low level of education and being married or divorced were predictors of becoming DPSTR for both men and women. Working part time and having low income were predictors of becoming DPSTR among men. CONCLUSION: Physically demanding employment, but not a physically demanding private life, predicts becoming DPSTR. This may reflect that factors concerning a patient's private life are not taken into account when evaluating whether or not a disability pension should be granted, at least not for patients with uncertain medical conditions.

Adult↗

PubMed2002

[Predictors for diabetic neuropathy according to applied criteria of its diagnosis].

It is difficult to establish predictors for diabetic neuropathy because no generally accepted criteria of its diagnosis exist. In previous investigations risk factors profiles for neuropathy differ markedly. The aim of this study was to assess risk predictors for diabetic neuropathy in relation to different criteria of its diagnosis. Ninety-five diabetic patients entered the study. The exclusion criteria included uremia, alcohol abuse and radiculopathy. Control group consisted of 43 healthy volunteers. All patients underwent the clinical assessment, instrumental evaluation of superficial and deep sensation, tests of cardiovascular autonomic function and nerve conduction studies. According to the performed assessment patients were classified into following groups: without neuropathy, suspicion of neuropathy, neuropathy confirmed in clinical examination, neuropathy confirmed in electrophysiological testing, autonomic neuropathy. Analysis showed that the most important predictors in patients with subjective symptoms were type 2 diabetes mellitus, diabetes duration and age of patients. When neuropathy was diagnosed according to the clinical examination, predictors included type 2 diabetesmellitus and duration of the disease. In the cases of neuropathy confirmed by electrophysiological studies and autonomic neuropathy, only diabetes duration appeared to be a significant predictor. Our study demonstrated that predictors for diabetic neuropathy varied in relation to different diagnostic criteria and where the most important predictor for all forms of neuropathy is duration of diabetes. This result indicates the need for frequent screening tests in patients with long duration of the disease, irrespective of its metabolic control, patients' age or type of diabetes.

Adolescent↗

PubMed2005

Predictors of in-hospital and 30-day complications of peripheral vascular interventions using bivalirudin as the primary anticoagulant: results from the APPROVE Registry.

BACKGROUND: Predictors of complications in peripheral percutaneous interventions (PPI) with bivalirudin as a base anticoagulant have not yet been defined. The Angiomax Peripheral Procedure Registry of Vascular Events (APPROVE) offers a unique opportunity to analyze predictors of complications with bivalirudin in PPI. METHODS: APPROVE was a prospective, open-label, multi-center clinical trial that assessed the feasibility of bivalirudin in renal, iliac and femoral interventions. Bivalirudin was administered intravenously at a dose of 0.75 mg per kg bolus followed by an infusion of 1.75 mg per kg per hour for the duration of the procedure. Glycoprotein (GP) IIb-IIIa inhibitors were permitted at the discretion of the treating physician. Multiple independent variables were included in a Logistic Regression model to determine predictors of the combined endpoints of ischemic (death, amputation, unplanned urgent revascularization at the treated site, myocardial infarction) and major bleeding or major bleeding alone, assessed during hospitalization and at 30 days. RESULTS: Predictors of in-hospital ischemic and major bleed events were congestive heart failure (p = 0.0173) and exchanges to larger sheath size (ELS) (p = 0.0045). The strongest predictor of major bleeding alone at discharge (p = 0.0041) and at 30 days (p = 0.0016) was the number of ELS. Also, female gender (p = 0.08) and low weight (stratified by gender with < 80 kg versus > 92 kg for males and < 62 kg versus > 77 kg for females) (p = 0.096) showed a trend toward predicting major bleeding at 30 days. Of 505 patients in APPROVE, 26 patients required more than one sheath exchange. Of these, 24 were ELS. Despite this small number, these patients accounted for most of the major bleeding events that occurred (11.5% versus 1.7% in-hospital bleeding for the patients with ELS versus single sheath use respectively, and 15.4% versus 3.1% for 30-day bleeding). GP IIb-IIIa inhibitors (n = 22) use and thrombotic lesions (3%) were not predictors of ischemic and/or bleeding complications. CONCLUSION: ELS during PPI is a strong predictor of bleeding events when bivalirudin is used as a base anticoagulant. Female gender and low weight also tend to contribute to major bleeding.

Aged↗

PubMed1983

Mirror-tracing and Embedded Figures tests as predictors of dental students' performance.

Recent studies of the Embedded Figures and Mirror-Tracing Tests as predictors of first-, second-, and third-year dental students' grades were extended to the fourth year, and the comparative utility of the experimental predictors were examined in groups of recent dental graduates categorized by their predental science GPAs and DAT scores. The experimental predictors proved to very strong in graduates whose grades were below average at admission and were the best overall predictors for students who entered dental school with a predental science GPA below 3.0 or a combined DAT score below 4.0. Neither the DATs nor the predental science GPAs contributed consistently as predictors in these below average students. However, the predental science GPA was the best single overall predictor for all graduates (when not categorized as described). the experimental predictors contributed significantly to the predictive utility of the predental science GPA.

Aptitude Tests↗

PubMed1994

Epidemiologic predictors of hepatitis C virus infection in pregnant women.

OBJECTIVE: To identify sensitive epidemiologic predictors of a positive hepatitis C virus antibody test in asymptomatic persons, and to compare the cost of testing only persons with an epidemiologic predictor to that of universal screening. METHODS: Seventeen hundred consecutive pregnant women were tested by enzyme-linked immunosorbent assay for antibody to hepatitis C virus. Seventy-five subjects tested positive and were compared with 257 pregnant women who tested negative. Cohort and control patients were interviewed and their medical records were reviewed to identify those with chosen predictors of a positive hepatitis C virus antibody test. RESULTS: Seventy-four of 75 cohort patients and 108 of 257 controls had one or more predictors of a positive antibody test. Cohort patients were significantly more likely (P < .001) to have the following: human immunodeficiency virus infection, a sex partner with a risk factor for hepatitis, age greater than 30 years, and a history of drug use, blood transfusion, sexually transmitted disease, hepatitis, or incarceration. The sensitivity and specificity of a single predictor in identifying a person with a positive test were 99 and 58%, respectively. The cost of finding a single individual with a positive antibody test by universal screening was $674, compared to $303 by selectively screening persons with one or more predictors of a positive antibody test. CONCLUSIONS: Most individuals with positive hepatitis C virus antibody tests can be identified on the basis of epidemiologic predictors, reducing the cost of testing by 55%. These patients may receive appropriate medical therapy, and their children may be evaluated for possible infection by vertical transmission of hepatitis C virus.

Adult↗

PubMed2022

Significant variation in the performance of DNA methylation predictors across data preprocessing and normalization strategies.

BACKGROUND: DNA methylation (DNAm)-based predictors hold great promise to serve as clinical tools for health interventions and disease management. While these algorithms often have high prediction accuracy, the consistency of their performance remains to be determined. We therefore conduct a systematic evaluation across 101 different DNAm data preprocessing and normalization strategies and assess how each analytical strategy affects the consistency of 41 DNAm-based predictors. RESULTS: Our analyses are conducted in a large EPIC DNAm array dataset from the Jackson Heart Study (N = 2053) that included 146 pairs of technical replicate samples. By estimating the average absolute agreement between replicate pairs, we show that 32 out of 41 predictors (78%) demonstrate excellent consistency when appropriate data processing and normalization steps are implemented. Across all pairs of predictors, we find a moderate correlation in performance across analytical strategies (mean rho = 0.40, SD = 0.27), highlighting significant heterogeneity in performance across algorithms. Successful or unsuccessful removal of technical variation furthermore significantly impacts downstream phenotypic association analysis, such as all-cause mortality risk associations. CONCLUSIONS: We show that DNAm-based algorithms are sensitive to technical variation. The right choice of data processing strategy is important to achieve reproducible estimates and improve prediction accuracy in downstream phenotypic association analyses. For each of the 41 DNAm predictors, we report its degree of consistency and provide the best performing analytical strategy as a guideline for the research community. As DNAm-based predictors become more and more widely used, our work helps improve their performance and standardize their implementation.

DNA Methylation↗

PubMed2003

The percentage of prostate needle biopsy cores with carcinoma from the more involved side of the biopsy as a predictor of prostate specific antigen recurrence after radical prostatectomy: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database.

BACKGROUND: The authors previously found that, although the total percentage of prostate needle biopsy cores with carcinoma was a significant predictor of prostate specific antigen (PSA) failure among men undergoing radical prostatectomy (RP), there was a trend toward a lower risk of recurrence in patients with positive bilateral biopsies, suggesting that high-volume, unilateral disease was a worse predictor of outcome than an equivalent number of positive cores distributed over two lobes. In the current study, the authors sought to compare the total percentage of cores with carcinoma directly with the percentage of cores from the more involved or dominant side of the prostate with carcinoma for their ability to predict outcome among men who underwent RP. METHODS: A retrospective survey of 535 patients from the Shared Equal Access Regional Cancer Hospital database who underwent RP at 4 different equal-access medical centers between 1988 and 2002 was undertaken. The total percentage of cores positive was compared with the percentage of cores positive from the dominant and nondominant sides for their ability to predict biochemical recurrence after RP. The best predictor then was compared with the standard clinical variables PSA, biopsy Gleason score, and clinical stage in terms of ability to predict time to PSA recurrence after RP using multivariate analysis. RESULTS: The adverse pathologic features of positive surgical margins and extracapsular extension were significantly more likely to be ipsilateral to the dominant side on the prostate biopsy. The percentage of cores positive from the dominant side provided slightly better prediction (concordance index [C] = 0.636) for PSA failure than the total percentage of cores positive (C = 0.596) and markedly better than the percentage of cores from the nondominant side (C = 0.509). Cutoff points for percentage of cores positive from the dominant side were identified (< 34%, 34-67%, and > 67%) that provided significant risk stratification for PSA failure (P < 0.001). On multivariate analysis, the percentage of cores positive from the dominant side was the strongest independent predictor of PSA recurrence (P < 0.001). Biopsy Gleason score (P = 0.017) also was a significant, independent predictor of recurrence. There was a trend, which did not reach statistical significance, toward an association between greater PSA values and biochemical failure (P = 0.052). Combining the PSA level, biopsy Gleason score, and percentage of cores positive from the dominant side of the prostate resulted in a model that provided a high degree of prediction for PSA failure (C = 0.671). CONCLUSIONS: The percentage of cores positive from the dominant side of the prostate was a slightly better predictor of PSA recurrence than was the total percentage of cores positive. Using the percentage of cores from the dominant side along with the PSA level and the biopsy Gleason score provided significant risk stratification for PSA failure.

Aged↗

PubMed2005

Efficient estimation of the risk of a disease by quantile-categories of a key predictor variable using generalized additive models.

Suppose that one wishes to make inference to the risk of a disease by the population quartile-categories of a key continuous predictor variable. When one collects data on a prospective cohort, the standard method is simply to categorize the key predictor variable by the empirical quartiles. One may then include indicator variables for these empirical quartile-categories as predictors, along with other covariates, in a generalized linear model (GLM), with the observed health status of each subject as the response. The standard GLM method, however, is relatively inefficient, because it treats all observations that fall in the same quartile-category of the predictor variable identically, regardless of whether they lie in the centre or near the boundaries of that category. Alternatively, one may include the key predictor variable, along with other covariates, in a generalized additive model (GAM), again with the observed health status of each subject as the response. The alternative GAM method non-parametrically estimates the functional relationship between the key predictor variable and the response. One may then compute statistics of interest, such as proportions and odds ratios, from the fitted GAM equation using the empirical quartile-categories. Simulations show that both the GLM and GAM methods are nearly unbiased, but the latter method produces smaller variances and narrower bootstrap confidence intervals. An example from nutritional epidemiology illustrates the use of these methods.

Adult↗

PubMed1994

Predictors of cancer prevention attitudes and participation in cancer screening examinations.

BACKGROUND: Few current data are available regarding factors associated with participation in cancer screening examinations in the general population. METHODS: To identify factors associated with participation in cancer screening examinations, random population samples of 25- to 74-year-old men and women in six various-sized communities in three upper-Midwestern states (n = 4,915) were surveyed in 1987-1989. Multivariate-adjusted means were calculated and compared using analysis of covariance. RESULTS: Statistically significant (P < 0.05) strong predictors (other than age and sex) of ever having had a specific cancer screening test were as follows (the numbers in parentheses following each listed association are the absolute maximum differences in mean proportions among the levels of the predictors): (1) rectal examination: higher education (14%); (2) fecal occult blood testing: higher education (6%) and never smoker (5%); (3) sigmoidoscopy: higher income (7%) and higher education (6%); and (5) mammography: higher income (25%), higher education (8%), and a positive family history of breast cancer (7%). There were no strong predictors (out of nine) of ever having had a Papanicolaou smear or a breast self-examination. CONCLUSIONS: The largest differences among the population for participation in cancer screening examinations involves income and the two most expensive cancer screening tests: higher income is a strong predictor of having a mammogram and, to a lesser extent, of having a sigmoidoscopy. The most consistent predictor of participation in cancer screening examinations across all cancer screening tests is education: higher education is a predictor of having each kind of cancer screening test.

Adult↗

PubMed2005

Modified Mallampati test, thyromental distance and inter-incisor gap are the best predictors of difficult laryngoscopy in West Africans.

PURPOSE: To determine the ability to predict difficult visualization of the larynx (DVL) from the following preoperative airway predictive indices, in isolation and combination: modified Mallampati test (MMT), thyromental distance (TMD), sternomental distance (SMD), horizontal length of the mandible (HLM) and inter-incisor gap (IIG). METHODS: Three hundred and eighty consecutive patients undergoing general anesthesia were evaluated using the MMT, TMD, SMD, HLM and IIG and the cut-off points for the airway predictors were Mallampati III and IV; < or = 6.5 cm, < or = 13.5 cm, < or = 9.0 cm and < or = 4.0 cm respectively. During direct laryngoscopy, the laryngeal view was graded using the Cormack and Lehane (CL) classification. CL grades III and IV were considered difficult visualization. Sensitivity, specificity and positive predictive value for each airway predictor in isolation and in combination were determined. Logistic regression analysis was used to determine independent predictors of DVL. RESULTS: Difficulty to visualize the larynx was found in 13 (3.4%) patients. The sensitivity, specificity and the positive predictive value for the five airway predictors were: MMT (61.5%; 98.4%; 57.1%), TMD (15.4%; 98.1%; 22.2%), SMD (0%; 100%; 0%), HLM (30.8%, 76.0%; 4.3%) and IIG (30.8%; 97.3%; 28.6%). The best combination of predictors was MMT/TMD/IIG with a sensitivity, specificity and positive predictive value of 84.6%; 94.6%; 35.5% respectively. Logistic regression analysis showed that weight, MMT, IIG and TMD were independent predictors of DVL. CONCLUSION: MMT, TMD and IIG appear to provide the optimal combination in prediction of DVL in a West African population.

Adult↗

PubMed1997

Predictors of outcome following cricopharyngeal disruption for pharyngeal dysphagia.

The indications for, and predictors of outcome following cricopharyngeal disruption in pharyngeal dysphagia are not clearly defined. Our purpose was to examine the symptomatic response to cricopharyngeal disruption, by either myotomy or dilatation, in patients with oral-pharyngeal dysphagia and to determine pre-treatment manometric or radiographic predictors of outcome. Using simultaneous pharyngeal videoradiography and manometry, we studied 20 patients with pharyngeal dysphagia prior to cricopharyngeal dilatation (n = 11) or myotomy (n = 8), and 23 healthy controls. We measured peak pharyngeal pressure, hypopharyngeal intrabolus pressure, upper esophageal sphincter diameter, and coordination. Response rate to sphincter disruption was 65%. The extent of sphincter opening was significantly reduced in patients compared with controls (p = 0.004), but impaired sphincter opening was not a predictor of outcome. Increased hypopharyngeal intrabolus pressures (> 19 mmHg for 10 ml bolus; > 31 mmHg for 20 ml bolus) was a significant predictor of outcome (p = 0.01). Neither peak pharyngeal pressure nor incoordination were predictors of outcome. In pharyngeal dysphagia, hypopharyngeal intrabolus pressure, and not peak pharyngeal pressure, is a predictor of response to cricopharyngeal disruption. The relationship between intrabolus pressure and impaired sphincter opening is an indirect measure of sphincter compliance which helps predict therapeutic response.

Aged↗

PubMed1997

Not all postmenopausal women on chronic steroid and estrogen treatment are osteoporotic: predictors of bone mineral density.

Chronic steroid use results in osteoporosis, and postmenopausal women are believed to be at a high risk for steroid-induced bone loss. The purpose of this study was to determine predictors of bone mineral density (BMD) in postmenopausal women on both chronic steroid and hormone replacement therapy. Seventy-six postmenopausal women (> or = 3 years postmenopausal, > or = 2 years of steroid treatment of > or = 5 mg/day of prednisone, and > or 1 year of hormone replacement therapy) were recruited into this study. Measurements of BMD of the lumbar spine and femoral neck were obtained in all subjects. Risk factors for osteoporosis were obtained by questionnaire. Discriminant analysis was performed to determine predictors of BMD. Osteoporosis, defined by a T score of < -2.5, was present in the lumbar spine or femoral neck in 34 of the 76 subjects. Based on these criteria, women with osteoporosis were significantly older, were more years postmenopausal, and had a lower body mass index (BMI) than women who did not have osteoporosis. Predictors of osteoporosis for both the femoral neck and spine included a low BMI (P < 0.05), more years postmenopausal (P < 0.01), and more years on steroids (P < 0.01). Low BMI was the only significant predictor of osteoporosis in the lumbar spine (P < 0.05), whereas for the femoral neck both years on steroids (P < 0.05) and BMI (P < 0.05) were significant predictors of low BMD. In summary, not all postmenopausal women on chronic steroid and hormone replacement therapy are osteoporotic but a low BMI, more years on steroids, and more years postmenopausal were significant predictors of osteoporosis in these subjects.

Absorptiometry, Photon↗