Matched Comparison Study Research Articles

Returning home after intensive care: A comparison of symptoms of anxiety and depression in ICU and elective cardiac surgery patients and their relatives

This study gathered data on symptoms of anxiety and depression in patients and relatives after discharge from intensive care and examined whether the intensive care population differ from an elective cardiac surgery group with regards to their anxiety and depression symptom reporting. A single measurement point matched group comparison study in an ICU follow-up programme. Twenty ICU patients and their relatives and a matched comparison group of 15 elective cardiac surgery patients and their relatives. Patients and relatives completed the Hospital Anxiety and Depression Scale. Relatives answered an open question to explore the perceived impact of Intensive care/cardiac surgery on their lives. ICU patients' relatives reported significantly higher number of symptoms of anxiety than did ICU patients, higher number of symptoms of depression than cardiac surgery patients' relatives, and more troubling and life-altering experiences than the relatives of cardiac surgery patients. Relatives of ICU patients also suffer anxiety and depression, and services should address this need. Group differences suggest that ICU patients' relatives have "unique" characteristics of depression symptom reporting.

A matched comparison study of medical and psychiatric complications and anesthesia and analgesia requirements in methadone-maintained liver transplant recipients

Approximately 85% of patients receiving methadone maintenance therapy (MMT) for opiate dependence in the United States are infected with hepatitis C virus (HCV). MMT is significantly underrepresented in most liver transplant programs, but the number of patients receiving MMT is increasing and few data are available to guide treatment. We evaluated MMT in our program (27 pretransplant and 10 posttransplant cases) for medical and psychiatric complications and anesthesia and analgesia requirements. After transplant, 10 patients receiving MMT were compared with a matched control group of 19 patients who were not receiving MMT and not dependent on opiates. Fewer patients receiving MMT retained a spot on the transplant waiting list (65%) than patients not receiving MMT (80%); 30% of patients receiving MMT pretransplant used heroin, cocaine, or marijuana, and more than 25% were lost to follow-up. Liver disease according to mean Child-Turcotte-Pugh (CTP) score and transplant waiting times was similar between the 2 groups. Patients receiving MMT required significantly more intraoperative anesthesia and postoperative analgesia (mean fentanyl 3,175 microg/d, SD = 2,832; intravenous morphine 67.86 mg/d, SD = 38.84, respectively) compared with patients not receiving MMT (mean fentanyl 1,324 microg/d, SD = 1,122; intravenous morphine 12.17 mg/d, SD = 10.24, respectively). More patients receiving MMT had severe recurrent HCV infection (60%) and worse survival (60%) versus patients not receiving MMT (21% and 78.9%, respectively). Follow-up times did not differ between groups (MMT: mean 4.19 years, median 1.15 years, SD = 7.6; non-MMT: mean 2.68 years, median 2.19 years, SD = 1.73). Finally, patients receiving MMT required an average methadone dose increase of 60% from pretransplant to posttransplant. Postoperative analgesia guidelines are described. Posttransplant, 20% of patients receiving MMT used alcohol or illicit drugs. Data do not support withholding the provision of liver transplantation to patients receiving MMT, but larger, well-controlled studies are warranted.

Directional atherectomy prior to stenting in bifurcation lesions: A matched comparison study with stenting alone

The ideal catheter-based intervention for treatment of coronary lesions at bifurcation site still has to be defined. The aim of the study was to assess the acute and long-term outcome after treatment of bifurcation lesions with directional atherectomy (DCA) and stenting in comparison with stenting alone. Thirty-one consecutive patients treated for bifurcation coronary lesions (62 lesions) with DCA and stenting in at least one branch (DCA group) were compared with a matched group of 31 patients with bifurcation coronary lesions (62 lesions) treated with stenting alone in at least one branch (non-DCA group). Procedural success was 87.1% in the DCA group compared with 100% in the non-DCA group (P = 0.03). In-hospital major adverse cardiac events (MACE) occurred only in the DCA group (12.9% vs. 0%, P = 0.03), mainly non-Q-wave myocardial infarction. After the procedure, minimum lumen diameter (MLD) and acute gain were significantly greater (P = 0.004 and P = 0.05, respectively) and % diameter stenosis was significantly lower (P = 0.05) in the main branch in the DCA group. At follow-up angiogram, MLD in the main branch was still significantly greater in the DCA group compared to the non-DCA group (2.31 vs. 1.65, respectively, P = 0.04), with no significant difference in late loss and loss index between the two groups. Restenosis rate was 28.8% in the DCA group vs. 43.5% in the non-DCA group (P = 0.13). The incidence of follow-up MACE was 29% in the DCA group compared with 48.4% in the non-DCA group, mainly due to target lesion revascularization. In conclusion, treatment of bifurcation coronary lesions with DCA and stenting was associated with greater acute gain after the procedure and greater MLD at follow-up in the main branch compared with stenting alone. Procedural myocardial infarction was more frequent in the DCA group. Restenosis rates and follow-up MACE were lower following DCA and stenting, without reaching any statistical significance.

Efficacy of Programmes for the Unemployed: Discrete Time Modelling of Duration Data from a Matched-Comparison Study

Summary An evaluation is described of two UK Government programmes for the long-term unemployed in Great Britain, Employment Training and Employment Action, using discrete time hazard modelling of event histories. The study design employed a closely matched comparison group and carefully chosen control variables to minimize the effect of selection bias on conclusions. The effect of unobserved heterogeneity is investigated by using some standard random effect model formulations.

Anthropometrical antecedents of non-insulin dependent diabetes mellitus: An age and sex matched comparison study of anthropometric indices in schoolchildren from a high prevalence Port Moresby community

Anthropometrical indices of 66 school children aged between 7 and 9 years from a community with a very high prevalence of non-insulin dependent diabetes mellitus (NIDDM) were compared with those of age and sex matched school children from two low prevalence communities. Two way analysis of variance indicated that case children of both sexes were significantly lighter ( P < 0.001), shorter ( P < 0.001) and had lower body mass indices (BMI) ( P < 0.001) than their comparisons but had greater triceps skinfold thickness (TSFT) ( P = 0.01). These differences may be a reflection of subtle changes in metabolism in children destined, without intervention, to develop NIDDM. Anthropometrical indices may therefore have a role to play in the prediction of future disease. Although not the prime objective of the study, an analysis of available birth weights indicated a lower mean birth weight for the cases than the controls (difference of means, 0.35 kg; 95% confidence intervals (CI 95%), 0.13–0.57). This finding is consistent with the theory that impaired intrauterine growth may predispose to NIDDM.

Combined iodine-125 plaque irradiation and indirect ophthalmoscope laser therapy of choroidal malignant melanomas: Comparison with iodine-125 and cobalt-60 plaque radiotherapy alone

The authors studied the short-term impact of combined episcleral iodine-125 plaque radiotherapy and argon laser treatment in a series of 24 patients with choroidal malignant melanoma. All patients underwent plaque therapy prior to their initial laser session. All laser treatments were performed with an indirect ophthalmoscope argon green laser, using low-power, long-duration exposures. The endpoint of laser therapy was a well-defined atrophic circumbasal chorioretinal laser scar and complete or nearly complete nonfluorescence of the lesion on fluorescein angiography. In a case-by-case matched comparison study, the authors evaluated the relative local regression of tumors treated by combined plaque-laser therapy, iodine-125 plaque therapy alone, and cobalt-60 plaque therapy alone. The tumors treated with supplemental laser regressed substantially faster and more completely than did those treated by either type of plaque therapy alone. However, the short-term visual loss was greater in eyes treated by the combined therapy.

Planned Combined I-125 Plaque Irradiation and Indirect Ophthalmoscope Laser Therapy for Choroidal Malignant Melanoma

ABSTRACT We studied the short-term impact of planned sequential episcleral I-125 plaque irradiation and indirect ophthalmoscope laser therapy in a series of 25 patients with choroidal or ciliochoroidal malignant melanoma. In a case-by-case matched comparison study, we evaluated the relative local regression of tumors which did and did not receive planned supplemental laser therapy following plaque treatment. The tumors treated with supplemental laser regressed substantially faster and more completely than those treated by plaque alone. Planned sequential I-125 plaque irradiation combined with indirect ophthalmoscope laser therapy appears to be a more effective local-tumor treatment than plaque radiotherapy alone.

Recognition of facial expressions of emotion by persons with mental retardation. A matched comparison study.

Children and adults with mental retardation were tested on their ability to recognize facial expressions of emotion. The sample consisted of 80 children and adults with mental retardation and a control group of 80 nonhandicapped children matched on mental age and gender. Ekman and Friesen's normed photographs of the six basic emotions (anger, disgust, fear, happiness, sadness, and surprise) were used in a recognition task of facial expressions. Subjects were individually read two-sentence stories identifying a specific emotion, presented with a randomized array of the six photographs of the basic facial expressions of emotion, and then asked to select the photograph that depicted the emotion identified in the story. This procedure was repeated with 24 different stories, with each of the six basic emotions being represented four times. Results showed that, as a group, individuals with mental retardation were not as proficient as their mental-age-matched nonhandicapped control subjects at recognizing facial expressions of emotion. Although adults with mild mental retardation were more proficient at this task than those with moderate mental retardation, this finding was not true for children. There was a modest difference between the children with moderate mental retardation and their nonhandicapped matched controls in their ability to recognize facial expression of disgust.

A Matched Comparison Study of Cost-Effectiveness: Institutionalized and Deinstitutionalized People

Seventy people with mental retardation who had moved from a large state institution to small community living arrangements were matched with 70 people who remained at the same institution. They were matched by sex, level of retardation, years institutionalized, self-care skills, age, and IQ. Developmental growth, operationally defined as adaptive behavior change using a research version of the AAMD Adaptive Behavior Scale, was measured for all people; only those people who had been deinstitutionalized demonstrated significant growth. They also received more services. Subsequently, telephone surveys and other procedures were used to identify the inclusive public costs associated with the two groups. Upon comparison, the deinstitutionalized group required less public money than the institutionalized group, although the financial burden shifted substantially from federal sources to state (and local) funding sources when people moved from the institution to community-based facilities. Correlates of costs in the community were explored in a preliminary way.