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PubMed2000

Suburethral sling operations for urinary incontinence in women.

BACKGROUND: Suburethral slings are surgical operations used to treat women with urinary incontinence. They were originally designed for recurrent stress incontinence, but have also been used recently for primary cases. OBJECTIVES: To determine the effects of suburethral slings on stress or mixed urinary incontinence in comparison with other management options. SEARCH STRATEGY: We searched the Cochrane Incontinence Group's trials register, The National Research Register and the reference lists of relevant articles. We hand searched the proceedings of the Brazilian Congress of Urology from 1991 to 1999, inclusive. Date of most recent search: January 2000. SELECTION CRITERIA: Randomised or quasi-randomised trials that included suburethral slings for the treatment of urinary incontinence. DATA COLLECTION AND ANALYSIS: Both reviewers independently extracted data from included trials onto a standard form and assessed trial methodological quality. The data abstracted were relevant to predetermined outcome measures. Where appropriate, a summary statistic was calculated: a relative risk for dichotomous data and a weighted mean difference for continuous data. MAIN RESULTS: Five trials were identified including 206 women - 126 treated with suburethral slings and 80 with other procedures. Three compared suburethral slings with open abdominal retropubic suspensions (Burch/Marshall-Marchetti-Krantz) and one compared suburethral slings with needle suspension (Stamey). In the fifth trial, different types of suburethral sling were compared with each other. Six types of slings were included (Teflon, polytetrafluoroethylene, Goretex, porcine dermis, lyophilized dura mater and rectus fascia). There were no comparisons of suburethral sling with anterior repair, laparoscopic retropubic suspension, peri-urethral injections, artificial sphincters or conservative management. There is one ongoing trial with Tension-free Vaginal Tape (TVT) versus Burch colposuspension, results expected in August 2000. For each outcome data were available only from individual trials. There were no detectable differences in terms of voiding dysfunction, urge incontinence or detrusor instability between suburethral slings and abdominal or needle suspensions, but the data were few and the confidence intervals wide. More peri-operative complications were reported after suburethral slings than after needle suspension (9/10 vs 2/10; RR 4.5, 95% CI 1.3 to 15.8), and length of stay was longer after sling operations than after abdominal or needle suspension. In the trial which compared autologous (rectus fascia) with synthetic (Goretex) slings, 11/32 vs 2/16 women had not improved after a year (RR 2.75, 95% CI 0.69 to 10.95), but fewer had complications (0/32 vs 5/16; RR 0.05, 95% CI 0 to 0.8). Two women in the second group had late sling erosion of the urethra requiring removal of the Goretex, although their incontinence remained cured. REVIEWER'S CONCLUSIONS: There were few data available to compare suburethral sling operations with other surgical management (abdominal and needle suspension, or different types of slings). In general, the quality of trials was poor with no clear method of randomisation, small numbers of women studied, short follow-up and scanty information on outcome measures. There is not enough evidence on which to judge whether suburethral slings are better or worse than other surgical or non surgical managements.

Female↗
PubMedDate not supplied

Charting patients' course: a comparison of statistics used to summarize patient course in longitudinal and repeated measures studies.

Investigators conducting longitudinal studies of psychiatric illnesses often analyze data based on psychiatric symptom scales that were administered at multiple time points. This study examines the statistical properties of seven indices that summarize patient long-term course. These indices can be used to compare differences between two or more groups or to test for changes in symptoms over time. They may also be treated as outcome measures and correlated with other clinical variables.The performance of each of the seven indices was assessed using data from two large ongoing studies of psychiatric patients: a longitudinal study of affective disorders and a longitudinal study of first-episode psychosis. These two datasets were subjected to bootstrapping techniques in order to calculate both type I error rates and statistical power for each summary statistic. Of the seven indices, Kendall's tau performed the best as a measure of patients' symptom course. Kendall's tau appears to offer more statistical power to detect change in course, yet its average type I error rate was comparable to the other indices.

Adult↗
PubMedDate not supplied

Surgical caseload in army general surgery programs: a 10-year retrospective.

PURPOSE: Over the past decade, the Army Medical Department (AMEDD) has been affected by a military-wide drawdown. The volume and acuity of patients appears to be declining, raising questions regarding quantity and quality in Army surgical training programs. The purpose of this study is to examine the caseloads of Army general surgery programs compared with national averages, and to compare the board examination performance of Army residents with national pass rates. METHODS: The program directors of all 6 Army training programs were requested to submit resident caseloads and performance on qualifying and certifying examinations from 1990 to 2000. The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Surgery (ABS) provided resident statistics summaries and board examination statistics, respectively, for the same period. Total caseloads, chief resident cases, performance in defined categories, and board pass rates of military residents were compared with national averages. RESULTS: Four of the 6 programs submitted the requested data. The average caseload for Army residents, both total and chief residents, has been lower than the national average over the past decade. Nationally, total case numbers have gradually increased while military changes have been variable. The number of chief resident cases has trended steadily downward in Army programs at a rate exceeding the national average. The volume of procedures in endoscopy, thoracic, and breast surgery in the Army generally exceeds those recorded outside of the military. Despite the decline in surgical cases in the military, the pass rates in both the certifying and qualifying examinations among Army graduates have been consistently higher than the national average. CONCLUSIONS: Residents who train in Army programs perform fewer operative cases than do their counterparts in civilian programs. The downward trend in the number of chief resident cases over the last 10 years is likely reflective of the changes in military medicine. Despite these trends, Army residency graduates continue to exceed national performance averages on the ABS qualifying and certifying examinations.

Journal Article↗
PubMed2003

Radiation dose is reduced with a single-pass whole-body multi-detector row CT trauma protocol compared with a conventional segmented method: initial experience.

Radiation dose data were collected from a calibrated multi-detector row computed tomographic (CT) scanner during trauma CT. One protocol (used with 10 case subjects) involved a single-pass continuous whole-body acquisition from cranial vertex to symphysis pubis, while the other, conventional protocol (used with 10 control subjects) involved scouting and scanning body segments (head, cervical spine, chest, abdomen, and pelvis) individually. Technical factors were kept constant within each body segment for the single-pass and the segmented protocols. Statistics included univariate analysis, two-tailed t testing to evaluate statistical significance of the summary statistic, and power and subject population contingency tables. The mean dose length product (DLP) with the single-pass protocol was 17% lower than the sum of the DLPs of each of the individual body segment scans (P <.001). Analysis of power and subject population by using a difference in mean of 500 mGy. cm and an alpha of.05 revealed a (1-beta) of higher than 0.90 for a sample of 10 patients. Thus, a whole-body single-pass trauma protocol, compared with a typical segmented acquisition protocol matched for imaging technique, resulted in reduced total radiation dose. The reduction in radiation dose is thought to represent a reduction in redundant imaging at overlap zones between body segments scanned in the segmental protocol but not in the continuous acquisition.

Humans↗
PubMed2006

Survey of the use of quality indicators in academic radiology departments.

OBJECTIVE: Our purpose was to determine whether quality in academic radiology departments in the United States is systematically measured through indicators and evaluated by preset standards. MATERIALS AND METHODS: We performed a cross-sectional study using a validated survey sent to Society of Chairmen of Academic Radiology Departments (SCARD) members and studied type, frequency of monitoring, and use of preset standards for evaluation of quality indicators. Statistical methods were descriptive summary statistics, chi-square test, analysis of variance, and Spearman's rank correlation test. RESULTS: The response rate was 42% (55/132). Most responding hospitals were from the Northeast (20/55, 36.4%) and Midwest (18/55, 32.7%). About 58% (32/55) of the responding hospitals had more than 500 beds in operation; 50.9% (28/55) of the radiology departments performed 200,000-400,000 examinations per year. Among the 80% of departments (44/55) that monitored patient satisfaction, only 49.1% and 45.5% assessed referring physician and employee satisfaction, respectively. The most frequently monitored customer satisfaction indicator, patient satisfaction, was monitored quarterly or less frequently by 70.5% (31/44) of departments; about 45.5% (20/44) had preset standards for this indicator. MRI and CT were monitored for patient appointment access by 80% (44/55) and 72.7% (40/55) of departments, respectively; 59.1% (26/44) and 62.5% (25/40) of departments applied preset standards to these indicators, respectively. The reporting-time indicator monitored most frequently was report turnaround time (45/55, 81.8%). None of the differences in mean numbers and monitoring frequencies of the indicators and the use of preset standards to evaluate them by region and size of departments were significant (p >0.05). CONCLUSION: Use of quality management indicators, particularly customer satisfaction indicators, is not a fully standardized and established process for academic radiology departments in the United States.

Academic Medical Centers↗
PubMed2001

[Systematic reviews in practice. VIII. Searching and assessing systematic reviews].

In a systematic review (SR) the information from the original studies is searched, selected, extracted, appraised and summarised in a transparent, valid and reproducible manner. SRs are therefore an efficient and reliable source of information for the clinician, health policy maker and researcher. SRs can be identified in various sources. The search strategy is determined by the desired comprehensiveness, the availability of various sources and the need for additional comments on the SR by a referee. In Medline a sensitive filter is available for searching SRs. An SR should be based on a carefully formulated clinical question that can be answered on the basis of data from the original studies. SRs should be thoroughly assessed as they can differ substantially in terms of quality. In such an appraisal the following aspects should be considered: question, search strategy, selection of studies, quality assessment, data extraction and data presentation, (statistical) summary of the data, statistical and clinical heterogeneity, results and conclusion. Various assessment lists are available. Differences in conclusions between SRs on the same subject can be analysed in a systematic manner and can often be resolved.

Data Interpretation, Statistical↗
PubMed2002

Summary health statistics for U.S. children: National Health Interview Survey, 1997.

OBJECTIVE: This report presents statistics from the 1997 National Health Interview Survey on selected health measures for sample children under 18 years of age, classified by sex, age, race/ethnicity, family structure, parent's education, family income, poverty status, health insurance coverage, place of residence, region, and current health status. The topics covered are asthma, allergies, learning disability, Attention Deficit Disorder, use of medication, respondent- assessed health status, school-loss days, usual source of medical care, time since last contact with a health care professional, selected health care risk factors, and time since last dental contact. SOURCE OF DATA: The NHIS is a multistage probability sample survey conducted annually by interviewers of the U. S. Census Bureau for the National Center for Health Statistics, Centers for Disease Control and Prevention, and is representative of the civilian noninstitutionalized population of the United States. Data are collected during face-to-face interviews with adults present at the time of interview. Information about children is collected for one sample child per family in face-to-face interviews with an adult proxy respondent familiar with the child's health. HIGHLIGHTS: In 1997, most U.S. children under 18 years of age enjoyed excellent or very good health (82%). However, 13% of children had no health insurance coverage, and 6% of children had no usual place of medical care. The percent of children with unmet medical need was twice as high in single-mother families (4%) as in two-parent families (2%). Eleven percent of children had ever been diagnosed with asthma. An estimated 8% of children 3-17 years of age had a learning disability, and an estimated 6% of children had Attention Deficit Disorder.

Absenteeism↗
PubMed2002

Summary health statistics for U.S. adults: National Health Interview Survey, 1997.

This report presents health statistics from the 1997 National Health Interview Survey for the civilian noninstitutionalized adult population, classified by sex, age, race and Hispanic origin, poverty status, region of residence, and where appropriate, education, income, health insurance coverage, marital status, and place of residence. The topics covered are health status and limitations in activity, health care access and utilization, health behaviors and lifestyle, chronic condition prevalence, and knowledge and attitudes toward the Acquired Immunodeficiency Syndrome (AIDS). Source of Data The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the National Center for Health Statistics, Centers for Disease Control and Prevention, and is representative of the civilian noninstitutionalized U.S. population. Data are collected during face-to-face interviews. Highlights Among adults 18 years of age or over, 12% had ever been told by a doctor or health professional that they had heart disease, 6% had ever been told they had coronary heart disease, and 19% had been told on two visits or more that they had hypertension. Nearly a quarter of adults were current smokers, 23% were former smokers, and 52% had never smoked. Sixty-one percent did not engage in any leisure-time vigorous physical activity, while approximately 24% engaged in such activity three times or more per week. Based on estimates of body mass index, 4% of adults were underweight, 42% were at a healthy weight, 35% were overweight, and 19% were obese.

Adolescent↗
PubMed2002

Summary health statistics for the U.S. population: National Health Interview Survey, 1997.

OBJECTIVES: This report presents health statistics from the 1997 National Health Interview Survey for the civilian noninstitutionalized population of the United States, classified by age, gender, race and Hispanic origin, poverty status, income, education, place of residence, region of residence, and, where appropriate, health insurance coverage. The topics covered are health status and limitations of activity, injuries and poisonings, health care access and utilization, and health insurance coverage. SOURCE OF DATA: The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the National Center for Health Statistics, Centers for Disease Control and Prevention, and is representative of the civilian noninstitutionalized U.S. population. Data are collected during face-to-face interviews with adults present at the time of interview. Information about children and absent adults is obtained from an adult proxy respondent. HIGHLIGHTS: Nearly 40% of Americans reported having excellent health in 1997, while almost 10% reported having either fair or poor health. Regarding health insurance coverage, 16% of the U.S. population did not have any health insurance coverage in 1997. Nineteen percent of non-Hispanic black persons and 33% of Hispanics were uninsured in 1997 as opposed to 12% of non-Hispanic white persons. Further, 45% of poor Hispanics and 43% of near poor Hispanics under age 65 years were uninsured, while among persons ages 65 years and over, 7% of poor Hispanics were uninsured. Lastly, 78% of non-Hispanic white persons under age 65 years had private health insurance coverage as opposed to 55% non-Hispanic black persons and 46% of Hispanics in this same age category.

Activities of Daily Living↗
PubMed2003

Summary health statistics for the U.S. population: National Health Interview Survey, 2000.

OBJECTIVES: This report presents health statistics from the 2000 National Health Interview Survey for the civilian noninstitutionalized population of the United States, classified by age, sex, race and Hispanic or Latino origin, family income, poverty status, education, place of residence, region of residence, and, where appropriate, health insurance coverage. The topics covered are health status and limitations in activities, special education or early intervention services, injuries and poisonings, health care access and utilization, and health insurance coverage. SOURCE OF DATA: The NHIS is a household, multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention, National Center for Health Statistics. Household interviews were completed for 100,618 persons living in 38,633 households, reflecting a household response rate of 89%. SELECTED HIGHLIGHTS: Nearly 7 in 10 persons were in excellent or very good health in 2000, and fewer than 1 in 10 were in fair or poor health. About 31 million people (11%) were limited in their usual activities due to one or more chronic health conditions, and about 3 million people (2%) required the help of another person with activities of daily living such as bathing and dressing. Persons with the least education and the lowest incomes were the most likely to be limited in their ability to work. About 5% of children received special education or early intervention services. The three leading causes of medically attended injury and poisoning episodes were falls, being struck by a person or an object, and transportation. Among people under age 65 years, about 40 million (17%) did not have any health insurance coverage.

Adolescent↗
PubMed2003

Summary health statistics for U.S. adults: National Health Interview Survey, 1999.

OBJECTIVES: This report presents health statistics from the 1999 National Health Interview Survey (NHIS) for the civilian, noninstitutionalized adult population, classified by sex, age, race and Hispanic origin, poverty status, and region of residence for chronic condition prevalence, health status and limitations in activity, health care access and utilization, health behaviors, and attitudes toward Acquired Immune Deficiency Syndrome (AIDS). Also, health statistics by education, income, health insurance coverage, marital status, and place of residence are presented for health status and limitations in activity, health care access and utilization, health behaviors, and knowledge and attitudes toward AIDS. SOURCE OF DATA: The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the National Center for Health Statistics, Centers for Disease Control and Prevention, and is representative of the civilian noninstitutionalized U.S. population. Data are collected during face-to-face interviews with adults present at the time of the interview. The self-reported health information for adults in this report was obtained from one randomly-selected adult per family. HIGHLIGHTS: In 1999, 65% of adults 18 years of age or over reported excellent or very good health. However, 17% of adults less than 65 years of age had no health insurance coverage, and 16% of adults did not have a usual place of medical care. Eleven percent of adults had ever been told by a doctor or health professional that they had heart disease and 19% had been told on two or more visits that they had hypertension. Nearly a quarter of adults were current smokers, while 23% were former smokers. Sixty-one percent did not engage in any leisure-time vigorous physical activity, and, based on estimates of body mass index, 35% were overweight and 21% were obese.

Adolescent↗
PubMed2003

Summary health statistics for U.S. children: National Health Interview Survey, 2000.

OBJECTIVES: This report presents statistics from the 2000 National Health Interview Survey on selected health measures for children under 18 years of age, classified by sex, age, race, Hispanic origin, family structure, parent's education, family income, poverty status, health insurance coverage, residence, region, and health status. The topics covered are asthma, allergies, learning disability, Attention Deficit Hyperactivity Disorder (ADHD), prescription medication, respondent-assessed health status, school-loss days, usual place of health care, time since last contact with a health care professional, unmet dental need, time since last dental contact, and selected measures of health care access. SOURCE OF DATA: The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the National Center for Health Statistics, Centers for Disease Control and Prevention, and is representative of the civilian noninstitutionalized population of the United States. Data are collected during face-to-face interviews with adults present at the interview. Information about children is collected for one randomly selected child per family in face-to-face interviews with an adult proxy respondent familiar with the child's health. SELECTED HIGHLIGHTS: In 2000 most U.S. children under 18 years of age enjoyed excellent or very good health (83%). However, 12% had no health insurance coverage, and 6% had no usual place of health care. Twelve percent of children had ever been diagnosed with asthma. Eight percent of children 3-17 years of age had a learning disability, and 7% of children in this age group had ADHD. Lastly, 11% of children in single-mother families had two or more visits to an emergency room in the past year compared with 6% in two-parent families.

Absenteeism↗
PubMed2003

Summary health statistics for the U.S. population: National Health Interview Survey, 1999.

OBJECTIVES: This report presents health statistics from the 1999 National Health Interview Survey (NHIS) for the civilian noninstitutionalized population of the United States, classified by age, sex, race and Hispanic origin, poverty status, family income, education, place of residence, region of residence, and, where appropriate, health insurance coverage. The topics covered are health status and limitations of activity, injuries and poisonings, health care access and utilization, and health insurance coverage. SOURCE OF DATA: The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC), and is representative of the civilian noninstitutionalized U.S. population. Data are collected during face-to-face interviews with adults present at the time of interview. Information about children and absent adults is obtained from an adult proxy respondent. SELECTED HIGHLIGHTS: Nearly 40% of Americans reported having excellent health in 1999, while almost 9% reported having either fair or poor health. Fourteen percent of the U.S. population did not have any health insurance coverage in 1999. Eighteen percent of single race non-Hispanic black persons and 32% of Hispanics were uninsured in 1999, compared with 11% of single race non-Hispanic white persons. Further, 47% of poor Hispanics and 43% of near poor Hispanics under age 65 years were uninsured; percents of uninsurance among poor and near poor single race non-Hispanic white and black persons under age 65 years were much lower. Eighty percent of single race non-Hispanic white persons under age 65 years had private health insurance coverage, compared with 57% of single race non-Hispanic blacks and 49% of Hispanics in this same age category.

Absenteeism↗
PubMed2002

Summary health statistics for the U.S. population: National Health Interview Survey, 1998.

OBJECTIVES: This report presents health statistics from the 1998 National Health Interview Survey (NHIS) for the civilian, noninstitutionalized population of the United States, classified by age, sex, race and Hispanic origin, poverty status, family income, education, place of residence, region of residence, and, where appropriate, health insurance coverage. The topics covered are health status and limitations of activity, injuries and poisonings, health care access and utilization, and health insurance coverage. SOURCE OF DATA: The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the National Center for Health Statistics, Centers for Disease Control and Prevention, and is representative of the civilian noninstitutionalized U.S. population. Data are collected during face-to-face interviews with adults present at the time of interview. Information about children and absent adults is obtained from an adult proxy respondent. HIGHLIGHTS: Nearly 40% of Americans reported having excellent health in 1998, while almost 9% reported having either fair or poor health. Fifteen percent of the U.S. population did not have any health insurance coverage in 1998. Nineteen percent of non-Hispanic black persons and 33% of Hispanics were uninsured in 1998, as opposed to 11% of non-Hispanic white persons. Further, 46% of poor Hispanics and 44% of near-poor Hispanics under age 65 years were uninsured; percents of uninsurance among poor and near poor non-Hispanic white and black persons under age 65 years were much lower. Lastly, 80% of non-Hispanic white persons under age 65 years had private health insurance coverage, as opposed to 55% of non-Hispanic black persons and 49% of Hispanics in this same age category.

Activities of Daily Living↗
PubMed2002

Summary health statistics for U.S. children: National Health Interview Survey, 1998.

OBJECTIVES: This report presents statistics from the 1998 National Health Interview Survey (NHIS) on selected health measures for children under 18 years of age, classified by sex, age, race/ethnicity, family structure, parent's education, family income, poverty status, health insurance coverage, place of residence, region, and current health status. The topics covered are asthma, allergies, learning disabilities, Attention Deficit Disorder, use of medication, respondent-assessed health status, school-loss days, usual place of medical care, time since last contact with a health care professional, selected health care risk factors, and time since last dental contact. SOURCE OF DATA: The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the National Center for Health Statistics, Centers for Disease Control and Prevention, and is representative of the civilian noninstitutionalized population of the United States. Data are collected during face-to-face interviews with adults present at the time of interview. Information about children is collected for one randomly selected child per family in face-to-face interviews with an adult proxy respondent familiar with the child's health. HIGHLIGHTS: In 1998 most U.S. children under 18 years of age enjoyed excellent or very good health (84%). However, 12% of children had no health insurance coverage, and 6% of children had no usual place of medical care. Twelve percent of children had ever been diagnosed with asthma. An estimated 8% of children 3-17 years of age had a learning disability, and an estimated 6% of children had Attention Deficit Disorder (ADD). Lastly, 11% of children in single mother families had two or more visits to an emergency room in the past year compared with 6% of children in two-parent or single-father families.

Absenteeism↗