SEARCH · PubMed Health

Results for “list randomization”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,009 records · Page 56Linked to original sources

PubMed2006

The association between domestic violence and self harm in emergency medicine patients.

AIMS: This study compared rates of self harm among victims of domestic assault presenting to an emergency department (ED) with those rates among other ED patients. It also explored the temporal and numeric relation between domestic assaults and self harm. METHODS: A retrospective matched cohort study was conducted using the medical records of a single ED. The cases were patients who had presented to the ED as a consequence of domestic assault. Two control groups matched for age, sex, and Cambridge postcode were randomly generated from the ED patient list. The second control group cases were also matched for postcode sector as a surrogate approximate for socioeconomic status in addition to age and sex. Cases and controls were followed up between November 1996 and 1 October 2004 documenting the number and timing of episodes of self harm reported in the study period. RESULTS: Altogether, 294 cases and 558 controls were followed up. Patients suffering domestic assault were more likely to present with self harm than controls (RR 3.6 95% CI 2.1-6.5). This effect appeared to be independent of deprivation. Patients suffering domestic assault had more ED contacts than controls. There was a moderate correlation between the number of episodes of self harm and number of assaults (Spearman's rho 0.3 p<0.001). Socioeconomic status was a poor predictor of self harm. Emergency physicians should consider asking about suicidal ideation in victims of domestic assault.

Adult↗

PubMed1999

Store tobacco policies: a survey of store managers, California, 1996-1997.

OBJECTIVE: To identify store tobacco policies and retailer perception and beliefs that may have contributed to changes in compliance with youth access laws in California. DESIGN: In the winter of 1996-7, a cross sectional, follow up telephone survey was conducted of California store managers whose stores were anonymously surveyed for illegal tobacco sales in the summer of 1996 (that is, 1996 Youth Tobacco Purchase Survey, YTPS). SETTING: A simple random sample of stores from a list of California stores likely to sell tobacco, used in the 1996 YTPS. PARTICIPANTS: 334 managers (77%) of the 434 stores surveyed in 1996 responded to the survey. After eliminating stores that stopped selling tobacco or were under new management or ownership, 320 responses of store managers were included in the analysis. The stores were analysed by type of ownership: chain, which included corporate managed (n = 61); franchise owned (n = 56); and independent (n = 203). MAIN OUTCOME MEASURES: Responses of store managers were linked with the 1996 YTPS outcomes. Manager responses were compared by chi2 tests. Logistic regression analyses were conducted to identify store factors associated with illegal tobacco sales. RESULTS: A lower likelihood of illegal sales rate was associated with the chain stores when compared with the independent stores (odds ratio (OR) = 0.4, 95% confidence interval (CI) 0.2 to 0.9). A lower likelihood of illegal tobacco sales was found in stores that implemented tobacco related activities in the previous year such as changing tobacco displays (OR = 0.5, 95% CI 0.2 to 0.9) or adding new warning signs (OR = 0.7, 95% CI 0.4 to 1.2). Store managers' beliefs that youth were sent to their stores to do compliance checks also resulted in a lower likelihood of illegal sales (OR = 0.7, 95% CI 0.4 to 1.1). CONCLUSIONS: Store tobacco youth access policies, and managers' beliefs about the extent of youth access enforcement in the community, are important in reducing illegal tobacco sales to minors.

Adolescent↗

PubMed2001

Current practices in left-sided colonic emergencies: a survey of US gastrointestinal surgeons.

BACKGROUND: The paradigms in the surgical management of obstruction and perforation of the left colon - once considered absolute contraindications to primary resection and anastomosis - are changing. The aim of this survey was to poll American Gastrointestinal surgeons on their current approach to left colonic emergencies. METHODS: A questionnaire was sent to 500 US-based surgeons, randomly selected members from the membership list of the Society for Surgery of the Alimentary Tract. It surveyed the surgeons on how they would approach 'good-risk' and 'poor-risk' patients with left colonic obstruction or perforation. RESULTS: 215 (43%) surgeons responded to the questionnaire; 180 fully completed questionnaires (36%) were analyzed. Sigmoid obstruction: 96 responders (53%) selected a one-stage procedure in 'good-risk' patients; 78 preferred sigmoid resection with (n = 46) or without (n = 32) 'on-table' colonic lavage and 18 opted for a subtotal colectomy and ileo-rectal anastomosis. Most (94%) responders preferred a staged procedure in 'high-risk' patients: a Hartmann resection (n = 120) or a transverse colostomy (n = 46). Sigmoid diverticular perforation: only one third of the responders recommended a one-stage procedure in 'good-risk' patients: 58 would perform a sigmoidectomy with (n = 19) or without (n = 39) 'on-table' colonic lavage; only two opted for subtotal colectomy with ileo-rectal anastomosis. In 'high-risk' patients most surgeons opted for a Hartmann's (88%) procedure or a diverting colostomy (7%). CONCLUSIONS: This survey suggests that a half and one-third of the responders would perform a one-stage resection and anastomosis in 'good-risk' patients with left colonic obstruction and perforation, respectively. In 'poor-risk' patients most responders would still opt for a staged procedure.

Anastomosis, Surgical↗

PubMed1999

Physical trauma and family history of neurodegenerative diseases in amyotrophic lateral sclerosis: a population-based case-control study.

This population-based case-control study was conducted in three counties in western Washington state (USA) between 1990 and 1994 to assess the association between amyotrophic lateral sclerosis (ALS) and several hypothesized risk factors, including a family history of neurodegenerative diseases, physical trauma (fractures, electrical shocks, and surgeries), rural residence, travel, and medical history. One hundred seventy-four cases with ALS, newly diagnosed by neurologists, were identified through several case-finding methods. Two controls (n = 348), who were matched to each case by gender and age (+/-5 years), were identified through random digit telephone dialing or Medicare lists. Exposure data were collected through structured in-person interviews. A greater proportion of cases (2. 3%) than controls (0.9%) reported a first-degree relative with ALS, resulting in an odds ratio of 3.1 (95% CI, 0.6-15.7). For a positive family history of ALS among second-degree relatives, the odds ratio was 4.0 (95% CI, 1.0-16.6). Overall, reports of first- or second-degree relatives with ALS yielded a significantly elevated odds ratio of 3.3 (95% CI, 1.1-9.9). No association was found with a family history of Alzheimer's disease or Parkinson's disease, or with a family history of the neurodegenerative diseases as a group. No significant associations were demonstrated for any of the other factors analyzed, including a history of fractures, electrical shocks, or surgeries, a history of residence in rural areas, a history of travel to areas in the western Pacific where ALS is endemic, and a medical history of polio, polio immunization, or tetanus immunization.

Adolescent↗

PubMed1999

Previous exposure to trauma and PTSD effects of subsequent trauma: results from the Detroit Area Survey of Trauma.

OBJECTIVE: With the exception of a few reports of higher rates of childhood trauma in Vietnam veterans with posttraumatic stress disorder (PTSD), little is known about the influence of previous exposure to trauma on the PTSD effects of subsequent trauma. The authors examine interrelated questions about the effects of previous exposure to trauma. METHOD: A representative sample of 2,181 individuals in southeast Michigan were interviewed by telephone to record lifetime history of traumatic events specified in DSM-IV as potentially leading to PTSD. PTSD was assessed with respect to a randomly selected index trauma from the list of events reported by each respondent. RESULTS: History of any previous exposure to traumatic events was associated with a greater risk of PTSD from the index trauma. Multiple previous events had a stronger effect than a single previous event. The effect of previous assaultive violence persisted over time with little change. When they examined several features of the previous exposure to trauma, the authors found that subjects who experienced multiple events involving assaultive violence in childhood were more likely to experience PTSD from trauma in adulthood. Furthermore, previous events involving assaultive violence--single or multiple, in childhood or later on--were associated with a higher risk of PTSD in adulthood. CONCLUSIONS: Previous exposure to trauma signals a greater risk of PTSD from subsequent trauma. Although these results are consistent with a sensitization hypothesis, like the results from previous research on PTSD, they do not address the mechanism of increased responsivity to trauma. Long-term observational studies can further elucidate these observations.

Adolescent↗

PubMed1998

Ambulatory blood pressure monitoring for hypertension in general practice.

Ambulatory blood pressure monitoring (ABPM) is being increasingly used in general practice. There is at present little published evidence regarding the clinical utility of ABPM in the care of patients with established hypertension in this setting. We examined this issue by undertaking ABPM in a group of patients with established hypertension. 40 patients (aged 33-60 years) currently being treated for hypertension were randomly selected from a general practice list and underwent a single 24-hour ABPM study. ABPM values were compared with clinic blood pressure (CBP) values obtained on the day of monitoring together with previous readings taken by the general practitioner (GP). In the case of mean arterial pressure, 24-hour, awake and asleep ABPM values were found to underestimate CBP values by 14 mmHg (95% confidence interval 11-16 mmHg), 9 mmHg (95% C16-12 mmHg) and 24 mmHg (95% CI 21-27 mmHg), respectively. When used to classify blood pressure control, ABPM values produced equivalent results to CBP except by the criterion of BP load, for which 24-hour ABPM showed a higher rate of unsatisfactory control. 5 patients classified by CBP to have satisfactory BP control according to current international guidelines were found to have unsatisfactory BP control by ABPM. This study demonstrates the potential value of ABPM in patients with essential hypertension in a general practice setting. ABPM provided information over and above that obtained by CBP in a substantial proportion of patients.

Adult↗

PubMedDate not supplied

Optimizing the benefits and minimizing the risks of enteral nutrition in the critically ill: role of small bowel feeding.

BACKGROUND: Strategies that maximize the delivery of enteral nutrition while minimizing the associated risks have the potential to improve the outcomes of critically ill patients. By delivering enteral feeds in the small bowel, beyond the pylorus, the frequency of regurgitation and the risk of aspiration is thought to be decreased while at the same time, nutrient delivery is maximized. The purpose of this paper is to systematically review those studies that compare gastric with small bowel feeding. METHODS: We searched computerized bibliographic databases, personal files, and relevant reference lists to identify eligible studies. Only randomized, clinical trials of critically ill patients that compared small bowel and gastric feedings were included in this review. In an independent fashion, relevant data on the methodology and outcomes of primary studies were abstracted in duplicate. RESULTS: There were 10 studies that met the inclusion criteria for this review. In 1 study, small bowel feeding was associated with a reduction in gastroesophageal regurgitation and a trend toward reduced pulmonary aspiration. Several studies document that small bowel feeding was associated with an increase in protein and calories delivered and a shorter time to target dose of nutrition. Compared with gastric feeding, when the results of 7 randomized trials were aggregated statistically, small bowel feeding was associated with a reduction in pneumonia (relative risk, 0.76; 95% confidence intervals, 0.59, 0.99). There was no difference in mortality rates between the 2 groups. CONCLUSIONS: Small bowel feeding may be associated with a reduction in gastroesophageal regurgitation, an increase in nutrient delivery, a shorter time to achieve desired target nutrition, and a lower rate of ventilator-associated pneumonia.

Critical Illness↗

PubMed1995

Diabetes and related metabolic risk factors among Arab Americans.

OBJECTIVE: To estimate the incidence of noninsulin-dependent diabetes mellitus (NIDDM) and associated metabolic abnormalities such as impaired glucose tolerance, increased blood pressure, hyperinsulinemia, and obesity in the Arab-American community in the Detroit metropolitan area. METHODS: Subjects were selected randomly from a computer-generated list provided by the Arab-American Center for Economic and Social Services. Laboratory studies included a 2-hour, 75-g oral glucose tolerance test with glucose, insulin, and C-peptide determinations. RESULTS: Of the 105 volunteers studied, 57 were women and 48 were men. Mean +/- SD age was 46.0 +/- 13.0 years. Body mass index was 30.4 +/- 6.8 kg/m2, with 68% of subjects having a body mass index of 27 kg/m2 or more. Of the study participants, 33% had NIDDM, 8.6% had impaired glucose tolerance, and 58% had normal glucose tolerance. Subjects with diabetes, compared with subjects who had normal glucose tolerance, exhibited increased fasting insulin (98 +/- 69 vs 55 +/- 31 pmol/L; p = 0.00056); higher cholesterol (6.03 +/- 1.03 vs 5.09 +/- 1.22 mmol/L; p = 0.00073); marginally lower high-density lipoprotein cholesterol (0.98 +/- 0.21 vs 1.14 +/- 0.31 mmol/L; p = 0.054); higher triglycerides (7.84 +/- 5.79 vs 3.83 +/- 2.15 mmol/L; p = 0.00002); and higher diastolic (83.7 +/- 8.9 vs 78.3 +/- 8.0 mm Hg; p = 0.014) as well as systolic (132.5 +/- 16.0 vs 119.0 +/- 10.6 mm Hg; p = 0.00001) blood pressures CONCLUSIONS: This pilot study demonstrates that diabetes may be a frequent medical problem in the Arab-American community. A well-designed epidemiologic study is warranted to validate these results and to elucidate the underlying mechanisms responsible for these findings.

Adult↗

PubMed2006

Molar band re-use and decontamination: a survey of specialists.

OBJECTIVE: To determine the pattern of use and re-use of orthodontic molar bands, and examine infection control measures in a sample of UK orthodontists. DESIGN: Questionnaire survey. SUBJECTS AND METHODS: Questionnaires were sent to 204 individuals selected at random from the UK Specialist Orthodontist list. Follow-up questionnaires were sent to those that had not replied within 8 weeks. An overall response rate of 74.5% was achieved. MAIN OUTCOME MEASURES: Orthodontic band use and re-use and cross-infection control. RESULTS: The reported rates of pre-sterilization cleaning and sterilization of orthodontic instruments were 92 and 100%, respectively. Of the respondents, 90% were using bands for molar teeth with the remainder routinely used bonded attachments. Most clinicians (95%) using bands routinely re-used them after being tried-in with 5% discarding them. Pre-sterilization cleaning of re-used molar bands was carried out by 92% of respondents who reclaimed bands. Sterilization of these bands was then carried out by most specialists apart from 2. CONCLUSIONS: The majority of UK specialist orthodontists who responded to the questionnaire are adhering to universal precautions for cross-infection control and are carrying out approved decontamination procedures. The majority are also reusing orthodontic bands that have been tried in the mouth, but found to be the wrong size. The great diversity of reported procedures for decontamination of instruments and bands suggest that more research is required to provide guidelines into the most effective method.

Chi-Square Distribution↗

PubMed2005

Risk for heparin-induced thrombocytopenia with unfractionated and low-molecular-weight heparin thromboprophylaxis: a meta-analysis.

Heparin-induced thrombocytopenia (HIT) is an uncommon but potentially devastating complication of anticoagulation with unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH). Our objective was to determine and compare the incidences of HIT in surgical and medical patients receiving thromboprophylaxis with either UFH or LMWH. All relevant studies identified in the MEDLINE database (1984-2004), not limited by language, and from reference lists of key articles were evaluated. Randomized and nonrandomized controlled trials comparing prophylaxis with UFH and LMWH and measuring HIT or thrombocytopenia as outcomes were included. Two reviewers independently extracted data on thromboprophylaxis (type, dose, frequency, and duration), definition of thrombocytopenia, HIT assay, and rates of the following outcomes: HIT, thrombocytopenia, and thromboembolic events. HIT was defined as a decrease in platelets to less than 50% or to less than 100 x 10(9)/L and positive laboratory HIT assay. Fifteen studies (7287 patients) were eligible: 2 randomized controlled trials (RCTs) measuring HIT (1014 patients), 3 prospective studies (1464 patients) with nonrandomized comparison groups in which HIT was appropriately measured in both groups, and 10 RCTs (4809 patients) measuring thrombocytopenia but not HIT. Three analyses were performed using a random effects model and favored the use of LMWH: (1) RCTs measuring HIT showed an odds ratio (OR) of 0.10 (95% confidence interval [CI], 0.01-0.2; P = .03); (2) prospective studies measuring HIT showed an OR of 0.10 (95% CI, 0.03-0.33; P < .001); (3) all 15 studies measured thrombocytopenia. The OR was 0.47 (95% CI, 0.22-1.02; P = .06). The inverse variance-weighted average that determined the absolute risk for HIT with LMWH was 0.2%, and with UFH the risk was 2.6%. Most studies were of patients after orthopedic surgery.

Controlled Clinical Trials as Topic↗

PubMed2005

Estimating a preference-based index for a menopause specific health quality of life questionnaire.

BACKGROUND: The aim of the study was to develop a menopause-specific, preference-based health-related quality-of-life (HRQoL) index reflecting both menopausal symptoms and potential side-effects of Hormone Replacement Therapy (HRT). METHODS: The study had three phases: the development of a health state classification, a prospective valuation survey and the estimation of a model to interpolate HRQoL indices for all remaining health states as defined by the classification. A menopausal health state classification was developed with seven dimensions: hot flushes, aching joints/muscles, anxious/frightened feelings, breast tenderness, bleeding, vaginal dryness and undesirable androgenic signs. Each dimension contains between three and five levels and defines a total of 6,075 health states. A sample of 96 health states was selected for the valuation survey. These states were valued by a sample of 229 women aged 45 to 60, randomly selected from 6 general practice lists in Sheffield, UK. Respondents were asked to complete a time trade-off (TTO) task for nine health states, resulting in an average of 16.5 values for each health state. RESULTS: Mean health states valued range from 0.48 to 0.98 (where 1.0 is full health and zero is for states regarded as equivalent to death). Symptoms, as described by the classification system, can be rank-ordered in terms of their impact (from high to low) on menopausal HRQoL as follows: aching joints and muscles, bleeding, breast tenderness, anxious or frightened feelings, vaginal dryness, androgenic signs. Hot flushes did not significantly contribute to model fit. The preferred model produced a mean absolute error of 0.053, but suffered from bias at both ends of the scale. CONCLUSION: This article presents an attempt to directly value a condition specific health state classification. The overall fit was disappointing, but the results demonstrate that menopausal symptoms are perceived by patients to have a significant impact on utility. The overall effect is modest compared to the more generic health state descriptions such as the EQ-5D. The resultant algorithm generates a preference-based index that can be used economic evaluation and that reflects the impact of this condition.

Female↗

PubMed2005

Individual cognitive-behavioural anger treatment for people with mild-borderline intellectual disabilities and histories of aggression: a controlled trial.

OBJECTIVES: Anger is a significant predictor and activator of violent behaviour in patients living in institutional settings. There is some evidence for the value of cognitive-behavioural treatments for anger problems with people with intellectual disabilities. In this study, a newly designed treatment targeted at anger disposition, reactivity, and control was provided to intellectually disabled offenders with aggression histories living in secure settings. DESIGN: About forty detained patients with mild-borderline intellectual disabilities and histories of serious aggression were allocated to specially modified cognitive-behavioural anger treatment (AT group) or to routine care waiting-list control (RC group) conditions. METHODS: AT group participants received 18 sessions of individual treatment. The AT and RC groups were assessed simultaneously at 4 time points: screen, pre- and post-treatment, and at 4-month follow-up using a range of self- and staff-rated anger measures. The effectiveness of the treatment was evaluated using ANCOVA linear trend analyses of group differences on the main outcome measures. RESULTS: The AT group's self-reported anger scores on a number of measures were significantly lower following treatment, compared with the RC wait-list condition, and these improvements were maintained at follow-up. Limited evidence for the effectiveness of treatment was provided by staffs' ratings of patient behaviour post-treatment. CONCLUSIONS: Detained men with mild-moderate intellectual disabilities and histories of severe aggression can successfully engage in, and benefit from, an intensive individual cognitive-behavioural anger treatment that also appears to have beneficial systemic effects.

Adult↗

PubMed2000

Identification of vertebral deformities in women: comparison of radiological assessment and quantitative morphometry using morphometric radiography and morphometric X-ray absorptiometry.

Our aim was to compare normal vertebral reference values for morphometric radiography (MRX) and morphometric X-ray absorptiometry (MXA) and to compare these methods for the identification of vertebral deformities. We calculated MXA reference values (Hologic QDR 4500 A) for 327 women (ages 22-88 years) randomly selected from local General Practice lists in Sheffield, U.K. MRX reference values were calculated from spinal radiographs for 123 of these subjects (ages 56-88 years). We used these reference values to identify deformities in the MRX and MXA reference populations and in 83 women with osteoporosis (ages 49-87 years). We observed differences in mean deformity of vertebral height ratios measured by MRX and MXA, especially for the mid-to-posterior ratio. We compared agreement between quantitative methods (MRX and MXA) and qualitative radiological assessment. Severity of deformity was defined by semiquantitative (SQ) assessment. Agreement was moderate for MRX (k = 0.59; 95% CI = 0.43-0.77) and for MXA (k = 0.47; 95% CI = 0.29-0.66) in the reference population. Agreement was good for MRX (k = 0.86; 95% CI = 0.82-0.89) and MXA (k = 0.71; 95% CI = 0.66-0.75) in the osteoporotic population. MRX and MXA correctly identified a greater proportion of moderate or severe deformities compared with mild deformities. Sensitivity, specificity, predictive values, and accuracy were slightly better for MRX than for MXA. Although MXA agrees well with qualitative radiological assessment, the large proportion of vertebrae excluded from analysis because of poor image quality limits the diagnostic value of the technique. Reference intervals should be technique specific.

Absorptiometry, Photon↗

PubMed2002

Maryland adults' perspectives on oral cancer prevention and early detection.

OVERVIEW: In any given 12-month period, Maryland ranks 27th among all states and the District of Columbia in estimated new cases of oral cancer. The state also has the seventh highest overall mortality rate for oral cancer. Because of earlier research indicating that Maryland adults had little knowledge and many misconceptions about oral cancer, the authors undertook a study to obtain in-depth information from Maryland adults 40 years of age or older on oral cancer, oral cancer examinations and factors associated with having an oral cancer examination. METHODS: The authors conducted a qualitative descriptive study using information gathered from three focus groups consisting of nine, 10 and seven adults respectively, and which met at two locations. The authors hired a private focus group research firm, which randomly selected participants from a telephone list of local residents. A professionally trained moderator conducted all focus groups using a semistructured interview guide. RESULTS: Participants were struck by the fact that they rarely hear about this type of cancer. Many said that they never had had an oral cancer examination and did not know there was such a thing. Many participants also reported that they likely would be more comfortable discussing oral cancer with their physicians than with their dentists. CONCLUSIONS: These findings provide additional in-depth insights to earlier work about Maryland adults' oral cancer knowledge, opinions and practices. The state plans to use this information to develop educational materials and interventions for the public to promote oral cancer prevention and early detection in Maryland. CLINICAL IMPLICATIONS: Extensive public education about oral and pharyngeal cancers should be provided in dental offices and clinics, as well as in mass media of all types. More clinicians should include comprehensive oral cancer screenings in their oral examinations, and they should explain to patients what they are doing when they provide these screenings.

Adult↗

PubMed2003

Sustained breastfeeding rates at a US baby-friendly hospital.

OBJECTIVE: Boston Medical Center (BMC) became the 22nd US Baby-Friendly hospital in 1999. Previous research found that breastfeeding initiation rates increased significantly from 58% in 1995 to 86.5% in 1999. The objective of this study was to establish whether Baby-Friendly status would sustain elevated breastfeeding initiation rates at this US hospital beyond the year of designation. Breastfeeding rates in 1999 were compared with rates in 2000 and 2001. METHODS: A total of 200 medical records of full-term, healthy infants who were born at BMC in 2000 and 2001 were reviewed using the same criteria as the study conducted for 1999. Records were selected randomly by a computer-generated list. All infant feedings during the hospital postpartum stay were tallied, and each infant was categorized into 1 of 4 groups: 1) exclusive breast milk, 2) mostly breast milk, 3) mostly formula, and 4) exclusive formula. RESULTS: Maternal and infant demographics for all 3 years were comparable. The breastfeeding initiation rates, defined as an infant's receiving any amount of breast milk, remained at high levels: 87% (1999), 82% (2000), and 87% (2001). Infants who received more breast milk than formula also was sustained: 73% (1999), 67% (2000), and 67% (2001). Infants who were breastfed exclusively across the 4 years did not differ significantly: 34% (1999), 26% (2000), and 25% (2001). CONCLUSIONS: Full implementation and continued application of the "Ten Steps to Successful Breastfeeding," the framework of the Baby-Friendly Hospital Initiative, has an extended positive impact on breastfeeding rates in a US hospital setting.

Academic Medical Centers↗

PubMed2006

Management of the patient who smokes and the diabetic patient in the dental office.

BACKGROUND: Approaches to patient care consistent with a greater emphasis on the importance of risk factors associated with periodontal disease should include measures to reduce risk. In this article, we investigate the extent to which periodontists' and general practice dentists' (GPs) behaviors and attitudes reflect current understanding of the most important environmental risk factor for periodontitis (smoking) and the most important systemic disease risk factor for periodontitis (diabetes mellitus). METHODS: A mail survey of active periodontists and GPs in the Northeastern United States was conducted during the fall of 2002. Random samples of periodontists and GPs listed in the designated Northeastern states were drawn from the 2002 American Academy of Periodontology Directory and the 2001 American Dental Directory, respectively. Responses were received from 103 periodontists (for a response rate of 73%) and from 105 GPs (for a response rate of 80%). RESULTS: Although periodontists generally perform risk identification and management behaviors for patients who smoke or who have diabetes more frequently than GPs, both groups tend to engage in activities that inquire, discuss, and inform more than they tend to undertake measures to control or manage these risk factors. Rates of proactive patient management activities are quite low in both clinician groups. CONCLUSIONS: There is a need to increase periodontists' and GPs' involvement in the active management of the patient who smokes and in the diabetic patient. Such actions can be expected to result in improved periodontal and general health outcomes.

Adult↗

PubMed2005

A comparison of pain, strength, range of motion, and functional outcomes after hemiarthroplasty and total shoulder arthroplasty in patients with osteoarthritis of the shoulder. A systematic review and meta-analysis.

BACKGROUND: A systematic review of the literature was performed to estimate the impact of hemiarthroplasty compared with total shoulder arthroplasty on function and range of motion in patients suffering from osteoarthritis of the shoulder. METHODS: We conducted an electronic search for relevant studies published in any language from 1966 to 2004, a manual search of the proceedings from five major orthopaedic meetings from 1995 to 2003, and a review of the reference lists from potentially relevant studies. Four randomized clinical trials, with similar eligibility criteria and surgical techniques, that compared hemiarthroplasty and total shoulder arthroplasty for the treatment of primary osteoarthritis of the shoulder were found to be eligible. Authors from three of the four studies provided original patient data. Analysis of covariance focused on the two-year outcome and included a comparison of the aggregate University of California at Los Angeles shoulder score, four University of California at Los Angeles domain scores, and range of motion. RESULTS: A total of 112 patients (fifty managed with hemiarthroplasty and sixty-two managed with total shoulder arthroplasty), who had a mean age of sixty-eight years, were included in this analysis. A significant moderate effect was detected in the function domain of the University of California at Los Angeles shoulder score (p < 0.001) in favor of total shoulder arthroplasty (mean [and standard deviation], 8.1 +/- 0.3) compared with hemiarthroplasty (mean, 6.6 +/- 0.3). A significant difference in the pain score was found in favor of the total shoulder arthroplasty group (p < 0.0001). However, the large degree of heterogeneity (p = 0.006, I(2) = 80.2%) among the studies decreased our confidence that total shoulder arthroplasty provides a true, consistent benefit with regard to pain. There was a significant difference in the overall change in forward elevation of 13 degrees (95% confidence interval, 0.5 degrees to 26 degrees ) in favor of the total shoulder arthroplasty group (p = 0.008). CONCLUSIONS: At a minimum of two years of follow-up, total shoulder arthroplasty provided better functional outcome than hemiarthroplasty for patients with osteoarthritis of the shoulder. Since continuous degeneration of the glenoid after hemiarthroplasty or glenoid loosening after total shoulder arthroplasty may affect the eventual outcome, longer-term (five to ten-year) results are necessary to determine whether these findings remain consistent over time.

Activities of Daily Living↗

PubMed1975

The influence of social factors in expectations of pain associated with osteoarthritis.

A survey was conducted on a sample of 113 individuals who might not be under medical care at the time of the study. A stratified random sample was drawn from two lists; one from a population of college teaching faculty who for purposes of the study were defined as upper class, and a second from individuals interviewed in various lower class neighbourhoods in a large metropolitan area. Among other questions the respondents were asked about the amount of pain they would expect to have with arthritis. Lower class, Blacks, and women respondents expect greater amounts of pain than do upper class, Whites, and men. Age, religion, and whether or not a person is married and living with a spouse do not appear to be important factors in an individual's expectations of the amount of pain associated with arthritis.

Adult↗