Low Level Of Concordance Research Articles

Comparación entre el algoritmo de Framingham y el de SCORE en el cálculo del riesgo cardiovascular en sujetos de 40-65 años

The aim of this study was to compare the clinical and treatment implications of 2 cardiovascular risk stratification systems in a population of patients 40-65 years old.929 non diabetic patients (40-65 years old) (51% female) with no evidence of previous cardiovascular disease were included in the study. The risk of cardiovascular death was assessed with the charts of the Systematic Coronary Risk Evaluation (SCORE), and coronary risk by the Framingham function (National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults -NCEP-ATP-III-). Patients were considered of high risk if risk of cardiovascular death was >or= 5% and coronary risk was > 20%, respectively.4.1% of patients were considered as high risk by SCORE and 2.5% by Framingham. Only 0.2% of females were classified as high risk with either system. 8.2% and 4.8% of male population were considered as high risk by SCORE and Framingham, respectively. There was a low level of concordance between both systems. Patients classified as high risk by SCORE but not by Framingham were older, smoke less and had a better lipid profile. According to European Guidelines 28% of male and 23% of female were candidates to hypolipemic treatment, that proportion was higher, 43% of males and 28% of females, by NCEP-ATP-III guidelines.In Spanish patients 40-65 years old, SCORE charts almost duplicate the number of high risk individuals compared to Framingham. although the number of patients candidates to hypolipemic treatment is lower with the European than ATP-III guidelines. Differences were more evident in male.

Concordance with asthma medication: the nurse’s role

Low levels of concordance with asthma medication programmes have negative effects on patients' short and long-term health. Nurses can support patients to develop self-management skills by listening to their individual concerns and tailoring advice accordingly. Simplifying medication routines and choosing the correct inhaler for individual patients can assist with concordance. Causes, triggers and symptoms associated with asthma and variations in patient responses are also discussed.

Effects of chlorpromazine with and without UV irradiation on gene expression of HepG2 cells

Damage to DNA can trigger a variety of stress-related signals that alter the expression of genes associated with numerous biological pathways. In this study, we have used a cDNA microarray representing 1089 genes related to DNA damage and repair, cell cycle, transcription, metabolism and other toxicologically important cell functions to identify genes regulated in response to DNA damage in HepG2 cells induced by UV-activated chlorpromazine (CPZ). CPZ itself is not genotoxic but, upon UV irradiation with a non-genotoxic dose in the UVA range, it produces reactive free radical intermediates with DNA damaging properties. Genotoxicity in HepG2 cells was assessed concomitantly to gene expression profiling using the Comet assay. Kinetic studies were performed at a non-cytotoxic but clearly photogenotoxic concentration of CPZ (1.25 μg/ml) to characterize gene expression profiles at four different time points (3, 7, 15, 23 h) post short-term treatment. The results obtained from repeated experiments display a time-dependent expression pattern of up-regulated and repressed genes with distinct peaks in the number of differentially expressed genes at the 7 and 23 h time points. Most of the genes with altered expression belonged to the functional categories of cell cycle regulation and cell proliferation. A comparison with published expression profiles established in response to other genotoxic compounds showed low levels of concordance, which is most likely caused by the fact that extremely different testing conditions were used.

Show me the genes – I will tell you who/how to treat!

Show me the genes – I will tell you who/how to treat!

Probabilistic linkage in household survey on hospital care usage.

To evaluate the potential advantages and limitations of the use of the Brazilian hospital admission authorization forms database and the probabilistic record linkage methodology for the validation of reported utilization of hospital care services in household surveys. A total of 2,288 households interviews were conducted in the county of Duque de Caxias, Brazil. Information on the occurrence of at least one hospital admission in the year preceding the interview was obtained from a total of 10,733 household members. The 130 records of household members who reported at least one hospital admission in a public hospital were linked to a hospital database with 801,587 records, using an automatic probabilistic approach combined with an extensive clerical review. Seventy-four (57%) of the 130 household members were identified in the hospital database. Yet only 60 subjects (46%) showed a record of hospitalization in the hospital database in the study period. Hospital admissions due to a surgery procedure were significantly more likely to have been identified in the hospital database. The low level of concordance seen in the study can be explained by the following factors: errors in the linkage process; a telescoping effect; and an incomplete record in the hospital database. The use of hospital administrative databases and probabilistic linkage methodology may represent a methodological alternative for the validation of reported utilization of health care services, but some strategies should be employed in order to minimize the problems related to the use of this methodology in non-ideal conditions. Ideally, a single identifier, such as a personal health insurance number, and the universal coverage of the database would be desirable.

Do clinicians understand why individuals stop taking lithium?

Background: Previous research highlights that, over a 2-year period, up to 50% of individuals receiving lithium prophylaxis are non-adherent with medication against medical advice. The main reasons identified by clinicians only partially reflect the reasons given by patients. Methods: Seventy-two subjects who were identified from biochemistry laboratory data as receiving lithium for an affective disorder and who gave written informed consent, completed the ‘Reasons for Stopping Medication’ questionnaire. Forty-one clinicians involved in treating these 72 patients also completed the same questionnaire. Ratings on the ‘Reasons for Stopping Medication’ questionnaire were compared between adherent and non-adherent patients and between patients and their clinicians. Results: Adherent ( n=39) and previously non-adherent patients ( n=33) showed a high level of concordance in their rank ordering of reasons for considering stopping taking lithium (Kendall’s W=0.059; P=0.001), with ‘bothered by the idea that moods were controlled by medication’, ‘bothered by the idea of a chronic illness’ and ‘felt depressed’ being the most commonly endorsed items. Clinicians and patients views showed low levels of concordance (Kendall’s W=0.019; P=0.32). Clinicians identified ‘missing highs’, and ‘felt well, saw no need to take medication’ as the most likely reasons for non-adherence. The differences in the primary reasons for stopping lithium identified by clinicians and patients were statistically significant ( χ 2=61.1; df 40, P=0.005). Conclusions: Patients’ reasons for stopping lithium appear to be influenced by concerns about what having an affective disorder and taking medication says about them. Clinicians are not fully aware of the main reasons patients would stop prophylactic treatment.

Cosmetic Outcome and Breast Morbidity in Breast-Conserving Treatment

A total of 266 recurrence-free breast cancer patients from the randomized DBCG-82TM breast conservation trial were called in for a follow-up investigation to study the impact of surgical and radiation treatment factors on the cosmetic and functional outcome after breast conservation. The patients were interviewed and examined after a median follow-up time of 6.6 years, and 194 of them (73%) regarded the cosmetic result as excellent or good. M orbidity assessments showed that breast fibrosis, skin telangiectasia, and breast retraction were significantly associated with a less satisfactory cosmetic result. On univariate analysis, it was found that treatment with a direct anterior electron field produced more morbidity and inferior cosmetic outcomes compared with tangential photon treatment, while increasing breast size was associated with increased breast retraction and breast fibrosis. Treatment characteristics that emerged as independent prognostic factors of a poor cosmetic outcome on multivariate analysis were the use of a direct anterior electron field (OR =2.15, CI 1.25-3.70) and adjuvant systemic therapy (OR =2.13, 1.22-3.71). A significant but relatively low level of concordance was found between the patients' and the clinician's evaluations of cosmetic results but self-assessments of breast morbidity and psychological distress were significantly related to the observed treatment-induced side effects after breast-conserving treatment, indicating that subjective perceptions and observations as reported by the patients are relevant for the identification of treatment factors that impact on normal tissue reactions.

Cosmetic and functional outcomes of breast conserving treatment for early stage breast cancer. 1. Comparison of patients' ratings, observers' ratings and objective assessments

The cosmetic and functional results of breast conserving therapy were evaluated in a sample of 76 patients with early stage breast cancer, treated by wide local excision, axillary dissection and postoperative radiotherapy between 1975 and 1985. A comparison was made between patients' ratings, independent ratings by two observers (an oncology nurse and a radiation oncologist) and objective measurements. In approximately 40% of the cases, moderate to large differences in the appearance of the treated versus the untreated breast were reported by patients and clinical observers alike. When evaluated on an individual level, the observers' ratings showed relatively high inter-rater agreement (κ = 0.64), but low levels of concordance were found between the patients' and observers' ratings (κ<0.10). Approximately half of the patients reported limited arm or shoulder function, generally mild in nature. Compared to the patients', the observers' ratings of arm edema were significantly lower, indicating 20% mild and 5% more severe swelling. Objective measures of cosmesis and function correlated moderately with the observers' and patients' ratings. Both cosmetic and functional results were found to be significantly related to time elapsed since treatment, with patients treated longer ago exhibiting more problems. The cosmetic and functional outcomes were not related to the patients' age. The results suggest that the patients' opinion can provide important additional information in the evaluation of cosmetic and functional results of breast conserving treatment.

Determinants of support for group decisions

The effects of three factors on the reactions of group members toward a group decision and the support they subsequently accorded such decisions were examined. These factors were: (a) the decision process used by the group (majority rule with formal voting, discussion to unanimity, discussion to majority agreement, or choice by an experimenter appointed executor); (b) the level of prediscussion agreement among group members (concordance); and (c) the relative extent to which an individual's preferences were congruent with his group's decision (relative individual goal attainment, RIGA). Individual ratings of satisfaction with decisions, anticipated commitment to decisions, and the support accorded to decisions were highest in groups with initially high concordance and among individuals higher on RIGA. Members of groups required to reach unanimity and those run by executive choice exhibited comparable support for their groups' decisions across all levels of concordance. In groups required to discuss to majority agreement, support of the group decisions dropped markedly under low levels of concordance. Individual ratings of the difficulty experienced in reaching a decision were highest in groups required to reach unanimous agreement. However, members of these groups showed the greatest degree of postdecision change in the direction of their groups' decisions.