Percent Of Studies Research Articles

What Is the Quality of the Evidence in the Craniomaxillofacial Surgery Literature?

Evidence-based practice is an important concept for surgeons. The purpose of this study was to assess the quality of evidence in the craniomaxillofacial surgery (CMS) literature. This was a retrospective cohort study of patient-oriented articles published in 9 journals. The primary predictor variable was the year of publication (September 2007 to August 2008 or September 2012 to August 2013). Secondary predictor variables were journal, impact factor, subject (eg, reconstruction, esthetic surgery), and funding. The outcome variable was the level of evidence (levels 1 to 4), evaluated using the Center for Evidence-Based Medicine criteria. Descriptive, bivariate, and regression statistics were computed. The study sample included 2,824 articles. The mean weighted journal impact factor was 1.6 ± 0.6 (range, 0.7 to 2.9). Fifty-two percent of articles were published in the Journal of Craniofacial Surgery or the Journal of Oral and Maxillofacial Surgery. The most frequent subject area was craniomaxillofacial pathology (934 articles; 33.1%). Eight percent of studies were funded. There were 97 (3.4%) level 1, 562 (19.9%) level 2, 228 (8.1%) level 3, and 1,937 (68.6%) level 4 studies. In a multiple regression model, year of publication (odds ratio [OR] = 1.2; P = .05), impact factor (OR = 2.4; P < .001), category (OR = 1.4; P < .001), and funding (OR = 1.6; P < .001) were associated with higher-quality evidence. The quality of evidence in the CMS literature is low. Higher levels of evidence are associated with more recent publications, journal impact factor, topic area, and funding.

The surgical management of scoliosis: a scoping review of the literature.

BackgroundScoping reviews are innovative studies that can map a range of evidence to convey the breadth and depth of a large field. An evidence-based approach to the wide spectrum of surgical interventions for scoliosis is paramount to enhance clinical outcomes. The objectives of this scoping review were to identify critical knowledge gaps and direct future research.MethodsThis study was completed according to the methodology of Arksey and O’Malley. Two reviewers performed duplicate systematic screening of eligibility. Studies were classified according to patient age, scoliosis etiology, outcomes reported, study design, and overall research theme.ResultsThere were 1763 eligible studies published between 1966 and 2013. The literature focused on adolescents (83% of studies) with idiopathic scoliosis (72%). There was a dominance of observational designs (88%), and a paucity of randomized trials (4%) or systematic reviews (1%). Fifty six percent of studies were conducted in North America, followed by 23% in Europe and 18% in Asia. Few high-level studies investigated surgical indications, surgical approaches, surgical techniques, or implant selection. Patient important outcomes including function, health-related quality of life, pain, and rates or re-operation were infrequently reported.ConclusionsCurrent research priorities are to (1) undertake high-quality knowledge synthesis and knowledge translation activities; (2) conduct a series of planning meetings to engage clinicians, patients, and methodologists; and (3) clarify outcome reporting and strategies for methodological improvement. Higher-quality studies are specifically needed to inform surgical indications, surgical approaches, surgical techniques, and implant selection. Engaging global partners may increase generalizability.

Low Elderly Participation in Non-Small Cell Lung Cancer Clinical Trials

Background: Lung cancer, with a median age at diagnosis of 70 years, is the current leading cause of cancer mortality in the United States. A lack of elderly enrollment in lung cancer clinical trials, however, has led to difficulty establishing elderly guidelines for treatment and has been highlighted by the Institute of Medicine and the American Society of Clinical Oncology as a key area for improvement. While there have been few elderly-specific clinical trials investigating chemoradiotherapy in lung cancer, there have been no elderly-specific trials investigating targeted therapy or immunotherapy and little is known about elderly outcomes with these agents. Methods: PubMed was queried for phase I clinical trials involving non-small cell lung cancer (NSCLC) in English in the past five years. Of these 192 studies, 49 investigated targeted therapy and/or immunotherapy without protocolized chemoradiotherapy. These articles were reviewed and assessed based on age demographics and outcomes. Results: Twelve percent of studies had a mean/median age of 65-69 years; no studies had a mean/median age of 70 years or greater. Of the seven studies with published information on age distribution, only four had information regarding the percentage of participants 70 years or older, which ranged from 8-33% and was limited by a total sample size of 15-26. The few studies that published information on age-specific outcomes suggested that targeted therapy and immunotherapy in the elderly may be as well tolerated and have similar treatment outcomes, but were limited by the small number of elderly participants in these trials. Conclusion: Additional research involving elderly enrollment and outcomes in NSCLC clinical trials is warranted. Increased recruitment of the elderly in clinical trials and publication of elderly-specific outcomes in lung cancer research is key to improving treatment guidelines in this field.

What Is the Quality of Reporting of Studies of Interventions to Increase Compliance with Antibiotic Prophylaxis?

Despite studies reporting successful interventions to increase antibiotic prophylaxis compliance, surgical site infections remain a significant problem. The reasons for this lack of improvement are unknown. This review evaluates the internal and external validity of quality improvement studies of interventions to increase surgical antibiotic prophylaxis compliance. Three investigators independently performed systematic literature searches and selected eligible studies that evaluated interventions to improve perioperative antibiotic prophylaxis timing, type, and/or discontinuation. Studies published before the Surgical Infection Prevention project inception in 2002 were excluded. Each study was assessed based on modified criteria for evaluating quality improvement studies (Standards for Quality Improvement Reporting Excellence) and for facilitating implementation of evidence into practice (Reach-Efficacy-Adoption-Implementation-Maintenance). Forty-six articles met inclusion criteria; 93% reported improvement in antibiotic prophylaxis compliance. Surgical site infections were evaluated in 50% of studies and 65% reported an improvement. Less than 5% of studies used randomization, allocation concealment, or blinding. Nine percent of studies described efforts to minimize bias in the design results and analysis and 13% described a sample size calculation. Approximately one-third of studies described participant adoption of the intervention (26%), factors affecting generalizability (33%), or implementation barriers (37%). Most studies (80%) used multiple interventions; no single intervention was associated with change in compliance. Studies with the lowest baseline compliance showed the greatest improvement, regardless of the intervention(s). The methodology and reporting of quality improvement studies on perioperative antibiotic prophylaxis is suboptimal, and factors that would improve generalizability of successful intervention implementation are infrequently reported. Clinicians should use caution in applying the results of these studies to their general practice.

The variation of acute treatment costs of trauma in high-income countries

Background: In order to assist health service planning, understanding factors that influence higher trauma treatment costs is essential. The majority of trauma costing research reports the cost of trauma from the perspective of the receiving hospital. There has been no comprehensive synthesis and little assessment of the drivers of cost variation, such as country, trauma, subgroups and methods. The aim of this review is to provide a synthesis of research reporting the trauma treatment costs and factors associated with higher treatment costs in high income countries. Methods: A systematic search for articles relating to the cost of acute trauma care was performed and included studies reporting injury severity scores (ISS), per patient cost/charge estimates; and costing methods. Cost and charge values were indexed to 2011 cost equivalents and converted to US dollars using purchasing power parities. Results: A total of twenty-seven studies were reviewed. Eighty-one percent of these studies were conducted in high income countries including USA, Australia, Europe and UK. Studies either reported a cost (74.1%) or charge estimate (25.9%) for the acute treatment of trauma. Across studies, the median per patient cost of acute trauma treatment was $22,448 (IQR: $11,819-$33,701). However, there was variability in costing methods used with 18% of studies providing comprehensive cost methods. Sixty-three percent of studies reported cost or charge items incorporated in their cost analysis and 52% reported items excluded in their analysis. In all publications reviewed, predictors of cost included Injury Severity Score (ISS), surgical intervention, hospital and intensive care, length of stay, polytrauma and age. Conclusion: The acute treatment cost of trauma is higher than other disease groups. Research has been largely conducted in high income countries and variability exists in reporting costing methods as well as the actual costs. Patient populations studied and the cost methods employed are the primary drivers for the treatment costs. Targeted research into the costs of trauma care is required to facilitate informed health service planning.

Risk-Taking and Self-Regulation

The purpose of this study was to investigate the juvenile justice intervention literature for the statistical consideration given the impact that age, as a marker of neuropsychosocial development, may have on delinquency outcomes. A systematic review of 117 studies published between 1996 and 2009 was conducted to assess the methods by which curvilinear and moderating effects of age were included in the analysis of delinquency outcomes. Ninety-one percent of studies may have underestimated intervention effects through the misspecification of the effect of age on delinquency outcomes. Of the 10 studies that did test for curvilinear and interaction effects, 80% had findings consistent with neuropsychosocial theories of age on delinquency. To account for age effects on delinquency, the regular use of multiple age groups in analysis may increase both the precision with which intervention effects are measured and the identification of specific age groups with whom individual interventions are most effective.

Prevalence, distribution and determinants of myopia in Owerri, Nigeria

Background: Uncorrected myopia is a significant cause of visual impairment and avoidable blindness. Incidence of open-angle glaucoma has been shown to occur more often in myopia. This cross-sectional analytical study determined the prevalence, distribution and determinants of myopia in the adult population of Imo State, Nigeria with a view to establish a reference data for research purposes and future intervention in this locality. Materials and Method: A total of 3451 adults living in Owerri consisting of 2606 persons as test group and 845 persons as controls were randomly selected using standard optometric methods including subjective refraction. Results: Refractive error (ametropia) was found in 79.5% study and 76.8% control. Myopia was found in 23.4% study and 19.6% control. Highest prevalence of myopia was observed in females aged 40-49 years. Fifty percent of study and 68.1% of control group had myopia of -0.50DS to -3.00DS while 4.0% and 2.4% of study and control group respectively had myopic astigmatism. In all, 27.7% study and 16.2% control had myopia > 5.00DS. The highest degree of myopia found in this study was - 24.00DS. Conclusion: This study provided information on the prevalence, distribution and determinants of myopia in Owerri, Nigeria and the data could be a basis for improved visual health care in the south-eastern sub-region of Nigeria.

Protocol for MRI of the Hips After Spica Cast Placement

In reduction of hip displacement in developmental dysplasia, concentric placement of the femoral head within the acetabulum is key. Magnetic resonance imaging (MRI) is an effective modality to assess the adequacy of the reduction, but sedation may be required due to the length of the examination. MRI is also more expensive than other imaging modalities. Our goal was to provide an MRI protocol that does not require sedation and can be performed in <15 minutes. We retrospectively reviewed 34 consecutive MRI studies performed without sedation after spica cast placement in 24 developmental hip dysplasia patients. The MRI examinations were performed with a variety of techniques. Sequences used were evaluated for contrast, resolution, and motion artifact. Ninety-seven percent of studies were diagnostic, although 18% of examinations had significant motion artifact. Seven sequences were analyzed. T2-weighted fast spin echo sequences had the best overall scores and were performed in <3 minutes. T1 and fat-suppressed T2-weighted fast spin echo sequences did not score as well, and also required <3 minutes. Single-shot fast spin echo sequences scored poorly due to decreased contrast and resolution, despite shorter acquisition times of 20 to 40 seconds. Three-dimensional (3D) gradient recovery imaging scored poorly due to lower contrast and increased motion due to longer acquisition times of approximately 4 minutes. Both coronally and axially oriented sequences satisfactorily assessed femoral head position within the acetabulum. MRI is a useful tool in evaluating the hips without radiation exposure and without sedation in infants and toddlers after spica cast placement. Both axial and coronal T2 fast spin echo MRI sequences provided excellent anatomic definition and required ≤3 minutes per sequence. Orthopaedic surgeons can request these 2 sequences for accurate assessment of concentric reduction with a potential study time of 15 minutes, obviating the need for sedation. Level II.

Worldwide Behavioral Research on Major Global Causes of Mortality

Researchers willing to publish their interventional studies' results must register their studies before starting enrollment. This study aimed to describe all "open" (i.e., recruiting or not yet recruiting) behavioral studies in 16 of 20 top worldwide leading causes of death. Search on Clinicaltrials.gov database (March 2010). Of 204 studies, 66% accounted for the following diseases: diabetes (26%), colon and rectum cancers (16%), cerebrovascular diseases (14%), and HIV/AIDS (11%). Less than 3% were on tuberculosis, stomach cancer, cirrhosis of the liver, and lower respiratory infections combined; no study was open on malaria, nephrosis and nephritis, and diarrheal diseases. A total of 81% of the studies were interventional, and 19% were observational. Fifty-nine percent were conducted in the United States. A total of 79%, 35%, and 5% were sponsored by universities, U.S. federal agencies, and industry, respectively. Twenty-one percent of studies were cofunded. A typical interventional study had a two-arm prospective parallel design, lasting approximately 3 years and involving 100 to 400 subjects. Increasing the number of trials and participating countries (including developing ones) is necessary to make available behavioral interventions in different settings in the future.

Short communication: Abstracts of forestry-related postgraduate degrees of relevance to Australia

Summary In 1989 and 1991 abstracts of postgraduate theses relating to forest science and undertaken in Australia and by Australians in overseas institutions were published in Australian Forestry. The Institute of Foresters of Australia (IFA) subsequently commissioned a more complete compilation for publication on the IFA website for access by the forestry community. The details (full name, year, institution, doctorate or masters degree, field of study, genus and species, rainforest or native forest or plantation) and abstract of each thesis recording research into forestry, forest products or forestry-related topics in Australian universities or by Australians in overseas institutions were collated through direct contact with university libraries or individuals. Records of a total of 964 theses are now on the website of the IFA (www.forestry.org.au/publications/forestry/abstracts). These records are from a total of 35 institutions, of which four provided 67% of all the records; the annual number of theses completed at the latter increased sharply after the mid-1960s. The topics studied were diverse; wildlife and ecology became prominent in later years. Fifty-four percent of studies pertained to native forest (excluding rainforest), 38% to plantations and 8% to rainforest.

Patient Simulation: A Literary Synthesis of Assessment Tools in Anesthesiology

High-fidelity patient simulation (HFPS) has been hypothesized as a modality for assessing competency of knowledge and skill in patient simulation, but uniform methods for HFPS performance assessment (PA) have not yet been completely achieved. Anesthesiology as a field founded the HFPS discipline and also leads in its PA. This project reviews the types, quality, and designated purpose of HFPS PA tools in anesthesiology. We used the systematic review method and systematically reviewed anesthesiology literature referenced in PubMed to assess the quality and reliability of available PA tools in HFPS. Of 412 articles identified, 50 met our inclusion criteria. Seventy seven percent of studies have been published since 2000; more recent studies demonstrated higher quality. Investigators reported a variety of test construction and validation methods. The most commonly reported test construction methods included "modified Delphi Techniques" for item selection, reliability measurement using inter-rater agreement, and intra-class correlations between test items or subtests. Modern test theory, in particular generalizability theory, was used in nine (18%) of studies. Test score validity has been addressed in multiple investigations and shown a significant improvement in reporting accuracy. However the assessment of predicative has been low across the majority of studies. Usability and practicality of testing occasions and tools was only anecdotally reported. To more completely comply with the gold standards for PA design, both shared experience of experts and recognition of test construction standards, including reliability and validity measurements, instrument piloting, rater training, and explicit identification of the purpose and proposed use of the assessment tool, are required.

Science Advances Begin to Reveal Schizophrenia's Early Brain Changes

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessScience Advances Begin to Reveal Schizophrenia's Early Brain ChangesAaron LevinAaron LevinSearch for more papers by this authorPublished Online:18 Dec 2009https://doi.org/10.1176/pn.44.24.psychnews_44_24_020AbstractChildhood-onset schizophrenia is extremely rare, but recent studies demonstrate an association with brain development and circuitry patterns that are helping to define the illness, said speakers at the American Academy of Child and Adolescent Psychiatry's annual meeting in Honolulu in October.“Childhood-onset schizophrenia has clear origins in disruptions during brain development,” said Robert Asarnow, Ph.D., a professor of psychiatry and behavioral science and professor of psychology at the David Geffen School of Medicine at UCLA. Cognitive and imaging studies at UCLA, the National Institute of Mental Health (NIMH), and elsewhere provide insight into what circuits of the brain are disrupted in schizophrenia and thus into possible therapies.Patterns can be seen even before symptoms appear, said Asarnow.“A history of speech, language, and motor development problems before 30 months of age was found in 60 percent to 72 percent in studies at UCLA and NIMH,” he said. Prodromal symptoms at ages 7 to 10 also include inattention, reduced concentration, social isolation, and “attenuated” positive and negative symptoms.However, in adolescents with childhood-onset schizophrenia, expressive language skills are impaired least, so in prodromal individuals, language problems represent a delay but not a failure in acquiring skills that are on the cusp of development.Adding a secondary mental task impairs processing performance in these patients. Asarnow likens the problem to learning to ride a bicycle. At first, the riders' entire attention is concentrated on the mechanics of riding the bike. Once they learn that, they can ride and also hold a conversation or appreciate the scenery.“Less cortical activation is needed for the primary task, which frees up the brain's processing resources,” he said. Cognitively, childhood-onset patients never get out of that first phase. “It's not clear if one cognitive process is impaired or if the abilities of the brain to remold itself are degraded.”Research shows that neurocognitive impairments in childhood-onset schizophrenia reflect liability to schizophrenia and are not just an epiphenomenon of psychiatric symptoms or of medications, said Asarnow. More remains to be learned, however.“There is a lot of leverage to be gained from challenging the underlying neural circuits of the brain to remold [the brain] by studying children and adults with schizophrenia as they're acquiring knowledge and skills.”Childhood-onset schizophrenia appears in only 1 in 30,000 to 50,000 children under age 13, said Nitin Gogtay, M.D., of the Child Psychiatry Branch at NIMH. Children in NIMH studies are diagnosed using unmodified DSM-III/IV criteria, after a complete medication washout. About 30 percent leave without a schizophrenia diagnosis but are followed up to ensure diagnostic consistency.There are advantages to studying children with an average age of 10.4 years, said Gogtay. Probands and their siblings are younger and still developing, so developmental changes can be tracked. There are fewer environmental influences on their brains (like smoking or alcohol), and hence genetic factors are more salient.In a number of imaging studies, Gogtay and others have observed a variety of changes in brain structure, both over time and in comparison with healthy control subjects. Patients' brains show lower cerebral volume, reduced gray matter, and slower annual white matter growth.“Gray matter loss in these young children gets localized in the prefrontal and temporal cortices,” he said.Among patients brought into his clinic who did not develop schizophrenia but who were diagnosed with psychosis NOS, about 40 percent later developed bipolar disorder. Gogtay thus had brain scans on these children both before and after their first manic episode and found no neurobiological overlap between patients with bipolar disorder and those with schizophrenia.Genetic factors likely play a role in childhood-onset schizophrenia. Healthy siblings of the patients had some gray matter deficits at age 8 but had normalized by age 17. Candidate gene studies of the COMT gene found that its Val-Val allele produced a steeper gray matter loss among patients and their siblings.Ultimately, gray matter loss slows over time, merging with the adult-onset pattern, implying a biological continuity between childhood-onset and adult-onset versions of the disorder, said Gogtay. ISSUES NewArchived

Demografischer Wandel in Psychiatrie und Psychotherapie – Relevanz des Altersbezuges

The demographic change will lead to new challenges for the German social and health system in the near future, because it will be accompanied with a large increase of gerontopsychiatric disorders, such as dementia or depression. Age as socio-demographic variable is of high impact in psychiatric and psychotherapeutic research. We aimed to analyze the use of age as sample characteristic or explanatory variable in all publications of the journals "Psychotherapeut" and "Psychiatrische Praxis" in 2007 and 2008. Furthermore, we examined the inclusion of age groups addressed by studies to evaluate the representation of old age studies in German general psychiatric and psychotherapeutic journals. Most studies used age as sample characteristic, but not as explanatory variable in additional analyses. 10 percent of studies addressed old age subjects, especially early detection and diagnosis of dementia. In view of the future population ageing and the associated increasing relevance of mental disorders in old age, more effort in research and publication related to prevention and treatment of mental disorders in old age is required.

A systematic review of cognitive development and child human immunodeficiency virus infection

The objective was to systematically review measures and effects of human immunodeficiency virus (HIV) on neurocognitive outcomes for children. Published studies were identified through the use of electronic databases (Cochrane database, Medline, PubMed, Psychinfo) supplemented by hand searching and coverage of the gray literature. All studies including children with HIV infection, which utilized at least one systematic measure of cognitive functioning, reported on place, sample size, age, and outcome measures, and included a control group were eligible for inclusion. Outcomes were coded for each study and broken down by measures when multiple measures were used. A systematic analysis of all measures used was also undertaken, as was a specific investigation of gender. Meta-analysis was not performed due to the heterogeneity of studies, the noncomparability of measures, and the wide age ranges of children included. Fifty-four studies were identified, of which had control groups. The data are highly North American biased (63%) with European studies accounting for 13% and only two from South America and seven from Africa, where the vast majority of HIV-infected children are found. Eighty-one percent of studies reported a detrimental effect on neurocognitive development, however measured, whilst three reported no differences and four had mixed findings. Thirty-three percent provided data on child gender, but only 8% went on to analyse data according to gender. The numbers are too small for definitive findings, but of note that three quarters found no gender differences. There seems to be some evidence of detrimental effects of HIV infection and exposure on cognitive development, but the lack of systematic measures, controlled trials and age-specific investigations render the literature inadequate. There is an urgent need for internationally agreed and validated measures to be incorporated and for these to record data by age and gender. This will allow for clarity of understanding of the effects, the ability to monitor change as a result of intervention, and to mobilize resources.

UK addiction research 1994–2001: A profile of studies published in Addiction Abstracts

Introduction: In 2002 the National Treatment Agency for Substance Misuse commissioned a consultation exercise to help identify future research priorities. An overview of UK research published in the journal Addiction s contributed to this.Method: Using a Microsoft Access database, two reviewers systematically profiled all 840 UK abstracts published between 1994 and 2001. The database included 72 fields for each abstract and a coding framework of predefined options.Results: Fifty-seven percent (n = 482) of the 840 abstracts reported studies involving licit substances, of which 65% discussed alcohol and 30% covered tobacco/nicotine. Sixty-three percent (n = 530) covered illicit substances, a high proportion of which described non-specific drug use such as ‘general drug use’ (32%) or ‘injecting’ (16%), rather than individual substances. Heroin was the most common substance specified (8%). Few of the 840 abstracts focused upon subjects with predefined demographic characteristics: 8% detailed single gender studies; 2% reported an ethnic focus. Subgroup surveys were the most frequent research method adopted (32%); 15% described literature reviews, and 7% were ‘laboratory experimental’. Two percent of studies were identified as randomized controlled trials.Conclusion: Our research presents a useful profile of published UK research and provides a focus for reflection and debate on future priorities.

Ultrasonography use in the emergency department: Six-month prospective analysis

Study objectives: Although emergency department (ED) ultrasonography is embraced officially by the American College of Emergency Physicians and is used at virtually all emergency medicine training sites in the United States, the extent to which it has been incorporated into emergency medicine practice has not been well characterized or quantified. Our objective is to record, quantify, and characterize the use of ultrasonography at an emergency medicine training site where it has been fully implemented. Specifically, we assess the volume and frequency of studies, breadth of applications, experience level of sonographers, and impact on clinical management. Methods: This prospective observational study was conducted during a 6-month period in the high-acuity section of an urban county ED with an emergency medicine residency, an emergency medicine ultrasonography fellowship, and 3 available ultrasonography machines. Basic information about all ED ultrasonographic examinations was handwritten in logbooks located on the ultrasonographic machines. These data were imported into a computerized database for analysis. Results: From October 10, 2003, to March 10, 2004, there were a total of 19,896 patients treated in the high-acuity ED, of whom 1,855 underwent an ultrasonographic examination (9% of patients, or 1 in 11 patients), with a total of 2,467 logged ultrasonographic studies. Thirty-two distinct applications were performed. The top 5 ultrasonographic applications, their percentage of total scans, and the percentage that were positive for pathologic findings were as follows: right upper quadrant 640 (26%; 31%), focused abdominal sonography for trauma 333 (13.5%, 22%), aorta 203 (8%, 8%), renal 198 (8%, 21%), and abscess 182 (7%, 63%). Thirteen percent of studies involved were for procedural assistance (abscess, intravenous line placement, ascites, pleural fluid). Some nonstandard indications included the following: abscess (182), deep venous thrombosis (147), nonpregnant pelvic (45), ascites (42), cardiac resuscitation (42), sinus (33), eye (30), bladder (23), pleural fluid (21), testicular (19), pneumothorax (17), joint (8), late pregnancy (8), fracture (7), arterial blood gas (5), tendon (4), foreign body (4), nerve block (3), thyroid (3), and lumbar puncture (2). ED ultrasonography had an impact on patient management in 73% of cases, the remainder being performed strictly for training purposes. Forty-five percent of all studies were supervised by 1 of 4 "core ultrasonographic" faculty or the ultrasonographic fellow, whereas 29% were followed by a formal study. The ultrasonographic fellow was present for 10% of studies, and 19.5% were performed by a resident or medical student during a dedicated ED ultrasonographic rotation. Conclusion: In this ED, ultrasonography is used extensively and affects clinical management in as much as 6.6% of cases. ED ultrasonographic training appears to drive a significant proportion of examinations.

Eliciting women's preferences in health care: a review of the literature.

The increasing availability of information about health care suggests an expanding role for consumers to exercise their preferences in health-care decision-making. Numerous methods are available to assess consumer preferences in health care. We conducted a systematic review to characterize the study of women's preferences about health care. A MEDLINE search from 1965 to July 1999 was conducted as well as hand searches of the Medical Decision Making Journal (1981-1999) and references from retrieved articles. Only original articles on women's health issues were selected. Information on thirty-one variables related to study characteristics and preferences were extracted by two independent investigators. A third investigator resolved disagreements. Qualitative and quantitative analyses were conducted to synthesize the data. Four hundred eighty-three studies were identified in the initial search. Seventy articles were selected for review based on title, abstract, and inclusion criteria. There was an increase in published articles and number of methods used to elicit preferences. White women were studied more than black women (p < .001). Preferences were mainly studied in outpatient settings (p < .005) and in the United States, United Kingdom, and Canada (83 percent). Preferences related to participation in decision-making were the most common (21 percent). Only 4 percent of the studies were performed to inform the debate for public policy questions. Willingness to pay was the method most used (11 percent), followed by category scaling (10 percent), rating scale (9 percent), standard-gamble (6 percent). Preferences for individual particular (opposed to sequential and health states) outcomes (68 percent), different treatments/tests (47 percent), and related to a treatment episode (31 percent) were addressed. Information regarding diseases, conditions, or procedures was given in 57 percent of studies. Information provided was mainly written (37 percent) and included positive and negative potential outcomes (67 percent). There is no relationship between the method or tool used for delivery information and the choice performed. The literature on preferences in women's health care is limited to a fairly homogeneous population (white women from the United States, United Kingdom, and Canada). Additionally, use of utility-based measures to capture preferences has decreased over time while others methods (e.g., time trade-off [TTO], contingent valuation) have increased. Women's preferences are not necessarily uniform even when asked similar questions using similar tools. Little information on women's preferences exists to inform policy-makers about women's health care.

Age comparisons in acquiring biofeedback control and success in reducing headache pain.

This article presents a review and archival analysis to assess age differences in acquiring biofeedback control and success in treating recurrent headache by using data from 56 studies with either adult (total N = 503) or child (total N = 98) subjects. All studies focused on treating headache with temperature biofeedback (TBF) or electromyographic (EMG) biofeedback. To standardize the varied measures across studies, we calculated each study's percent change scores for biofeedback performance and headache activity. All headache activity scores included assessments of pain intensity. We then calculated subject-weighted means of percent change for biofeedback performance and for headache activity by summing the products of each relevant percent change score and N and then dividing by the total number of subjects contributing to those sums. Results showed that both children and adults reported substantial improvements in headache activity with TBF and EMG biofeedback treatment (Ms ranged from 34% to 81%), but children showed significantly greater improvement than adults. No age differences were found in the acquisition of biofeedback control. Further analyses revealed two additional findings. First, biofeedback control and headache improvement were strongly correlated. Second, headache activity continued to decrease in the weeks following treatment, and this decrease was significantly greater for children than adults.

Pregnancy Outcomes in a Prospective Matched Control Study of Pregnancy and Renal Disease

Objective : Assessment and comparison of pregnancy outcomes in women with renal disease and women with high risk pregnacies due to medical illness without renal disease. Design : A prospective, matched controlled study. Setting : The High Risk Obstetrical Clinics of Magee Women's Hospital, a primary and referral center where approximately 9,500 deliveries occur per year. Patients : Two groups of pregnant women, all identified in the first trimester. The study group included 43 pregnancies in 40 women with renal disease as defined by : 1) known renal disease antedating pregnancy, 2) prepregnant proteinuria ≥150 mg/24 hours, or 3) first trimester serum creatinine ≥0.8 mg/dl or proteinuria ≥300 mg/24 hours. The 43 controls included women with medical problems other than renal disease that placed them at high obstetrical risk. Control women were matched to study women for parity, advanced maternal age, race, and insulin-dependent diabetes mellitus. Measurements : For all patients, blood pressure was recorded once at approximately 10, 20, and 30 weeks gestation. For study patients, serum creatinine, 24-hour urinary protein, and creatinine clearance were obtained at least once in each trimester. Pregnancy outcomes were recorded as favorable if gestation was ≥36 weeks and without evidence of intrauterine growth retardation. Adverse pregnancy outcomes included prematurity, intrauterine growth retardation, intrauterine fetal death, spontaneous abortion, or neonatal death. Results : Forty-two percent of study and control patients were diabetic. First trimester renal function was normal (creatinine <0.8 mg/dl) in 12 study patients, mildly impaired in 24 (creatinine 0.8-1.4 mg/dl) and moderately impaired in 5 (creatinine ≥1,4 mg/dl). Compared with controls, first and third trimester hypertension was more prevalent in the study patients (p = 0.003, p = 0.012) ; overall mean blood pressure was also higher in study patients (92 ± 11 mmHg vs 85 ± 8 mmHg, p = 0.002). The mean gestational age was shorter in the study patients (33.4 ± 6.9 weeks vs 37.2 ± 4 weeks, p = 0.001). Overall pregnancy loss was more common in the study patients (14/43 vs 3/43, p = 0.003) with spontaneous abortion contributing half of those pregnancy losses (7/14). Hypertension in any trimester was associated with adverse pregnancy outcome in study but not control patients. In the subset of study patients, adverse fetal outcome was directly associated with degree of renal dysfunction and proteinuria. Conclusions : Pregnancy outcome in women with renal disease was significantly worse than in the control group and showed no improvement over retrospective reports from the 1970's and 1980's. Specifically, fetal deaths were more common in women with renal disease and were predicted by proteinuria and the degree of renal dysfunction. The uncommonly low number of spontaneous abortions in the control group may have contributed to the worse fetal outcome in the study patients compared with controls. Women with diabetes mellitus and hypertension are at particularly high risk for relatively poor pregnancy outcome. These higher risks should be discussed when counseling women with renal disease who contemplate pregnancy.