bluuebunny/crossref_metadata_2025_split huggingface dataset:
Original Paper: A likelihood ratio approach to meta-analysis of diagnostic studies
Authors: Stengel D , Bauwens K , Sehouli J , Ekkernkamp A , Porzsolt F 
Published: January 2004

Objective: To develop a clinically and methodologically sound approach to diagnostic meta-analysis. Methods: Two-step model was used involving four fictitious sets of 10 studies each with varying sensitivity and specificity; this was followed by the application of the method to data from a published systematic review of emergency ultrasound. Multidimensional test characteristics (relating to the detection or exclusion of the condition of interest) were described by likelihood ratio scatterplots and pooled likelihood ratios. Likelihood ratios summarise the ability of a test to revise the prior probability of disease. They can be summarised by established fixed-effects and random-effects methods. Results: Likelihood ratios precisely describe both directions of test performance. By plotting positive against negative likelihood ratios, together with their 95% confidence intervals, a multidimensional forest plot is obtained that can be interpreted in analogy to therapeutic meta-analyses. There are accepted threshold values of positive and negative likelihood ratios (i.e. 10.0 and 0.1) to recommend a test for clinical use. In the matrix space, distinct test characteristics can even be assessed by eyeballing. With regard to data from the real meta-analysis, the suggested high discriminatory power of ultrasound was only partially qualified by likelihood ratios. The positive value confirms the reliability of a positive scan, whereas the negative value questions a normal sonogram. Conclusions: A full characterisation of test performance requires multidimensional effect measures. Likelihood ratios are recommended descriptors of the two dimensions of diagnostic research evidence and provide a convenient means to visualise and to communicate results as weighted summary estimates of a diagnostic meta-analysis.
Testing for toxoplasmosis in pregnancy: a study of the routines in primary antenatal care
Authors: Eskild Anne , Fallås Dahl Gunn , Melby Kjetil K. , Nesheim Britt-Ingjerd 
Published: January 2004

Objectives: The question of benefit of screening for antibodies against Toxoplasma gondii in pregnancy to prevent impairment in the infant has not been settled. Despite this, it is believed that such testing is common. The aim of this study was to describe the test routines and to identify factors associated with testing in primary antenatal care. Setting: Ulleval University Hospital, Oslo, Norway. Methods: All women who gave birth at Ulleval University Hospital, Oslo, Norway, in May 2000 were included. The number of antibody tests during pregnancy was obtained from the patient registry at the department of microbiology at the same hospital. Results: 81% (361/446) had been tested for antibodies against Toxoplasma gondii during pregnancy. Women attending primary antenatal care at a specialist in obstetrics and gynaecology were most likely to be tested. Among women with no signs of prior toxoplasmosis, 35% (110/317) were tested only once. Discussion: The majority of pregnant women are being tested for toxoplasmosis even though such testing has no documented preventive effect and has not been recommended.
Neonatal birth parameters of positive newborns at PKU screening as predictors of false-positive and positive results at recall-testing
Authors: Zaffanello Marco , Zamboni Giorgio , Maffeis Claudio , Tatò Luciano 
Published: January 2004

Objectives: To investigate the predictive role that neonatal birth parameters of positive newborns at phenylketonuria (PKU) screening have on false-positive and positive results. We reviewed 195 newborns (115 males and 80 females) that had false-positive results between 1998 and 2001. A total of 4386 randomly selected neonates (2191 males and 2195 females) who tested normal at the first investigation in the same period, were used as negative-controls. A total of 38 PKU neonates (17 males and 21 females) diagnosed between 1990 and 2001 were used as positive-controls. Methods: Phenylalanine concentration was measured with a fluorometric multitask plate counter Wallac 1420 VICTOR F (Perkin Elmer, Finland) and the fluorescent ninhydrine method (EG&G Wallac neonatal phenylalanine kit) using a recall cut-off level >120 μmol/l (2 mg/dl) of phenylalanine on dried blood spots. A multivariate logistic regression analysis was performed to evaluate the predictive role that body parameters (sex, gestational age, parity, weight, length and head circumference) of positive newborns at PKU screening had on false-positive and positive results at recall PKU tests. Results: The risk of false-positive results is higher (~48%) in females than in males. Moreover, for each 100g of body weight reduction, the risk of false positive is around 4.2% higher. The risk of confirmation increased by 39% per week of gestational age. Conclusions: In conclusion, our results suggest that preterm or low-birth-weight neonates recalled at the first investigation are more likely to be due to false-positives, whereas the risk of confirmation is higher in at-term neonates. By implication, the phenylalanine cut-off value for premature or low-body-weight infants could be higher.
The burden of prevention: downstream consequences of Pap smear testing in the elderly
Authors: Sirovich B E , Gottlieb D J , Fisher E S 
Published: January 2004

Context: Although cervical cancer is an unusual cause of death among women 65 and older, most elderly women in the US report continuing to undergo periodic Pap smear screening. Objective: To describe the incidence of Pap smears and downstream testing among elderly women. Setting: Claims-based analysis of female Medicare enrollees age 65 and older. Methods: Using three years of Medicare Part B 5% Files (1995-1997), we differentiated between women undergoing screening Pap smears and those undergoing Pap smears for surveillance of previous abnormalities or Pap smear follow-up. We determined the proportion of elderly women undergoing Pap smear testing and rates of downstream testing and procedures after an initial Pap smear. Results: Four million female Medicare beneficiaries over 65 years underwent Pap smear testing between 1995 and 1997, representing 25% of the eligible population. After adjusting for underbilling for Pap smears under Medicare, 43% of women over 65 are estimated to have undergone Pap smear testing during the 3-year period. The large majority (90%) of Pap smears were for screening, while 10% were done for surveillance or follow-up. For every 1000 women with a screening Pap smear, 39 had at least one downstream intervention within eight months of the initial Pap smear, including seven women who underwent colposcopy and two women who had other surgical procedures. Rates of downstream interventions were considerably higher for women undergoing Pap smear follow-up (302 per 1000 with at least one downstream intervention), and surveillance of previous abnormalities (209 per 1000 with a downstream intervention). Conclusion: Cervical cancer screening is widespread among elderly American women, and follow-up testing is not uncommon, particularly among the ten percent of women who appear to be in a cycle of repeated testing. This substantial volume of testing occurs despite the rarity of cervical cancer deaths and unknown benefits of screening in this age group.
A Live Baby or Your Money Back: The Marketing of In Vitro Fertilization Procedures
Authors: Schmittlein David C. , Morrison Donald G. 
Published: January 2004

Many clinics that offer in vitro fertilization (IVF) have begun to market the following options to couples: (1) an a la carte program where the couple pays $7,500 per attempt regardless of the outcome; or (2) a money-back-guarantee program where the couple pays a $15,000 fee that covers up to three attempts, however, if after three cycles there is no live-birth delivery, then the full $15,000 is refunded. We assess the a la carte versus the money-back-guarantee programs, and find the surprising result that the money-back-guarantee program appears (for the patients) to be “too good to be true.” That is, the money-back guarantee yields a substantial negative expected profit per couple for the clinics. More importantly from the patients' perspective, the money-back guarantee is the better option for all couples with less than 0.5 success probability per cycle. Virtually all traditional IVF patients have had per-cycle success probabilities below 0.5. A detailed analysis of the key variables—i.e., success rate per attempt, heterogeneity of couples' rates of success, individual couples' “learning” on successive attempts, and cost to the clinic per attempt—shows that these money-back guarantees are unprofitable for the clinics. Since presumably clinics are not in business to lose money, the standard analysis must be missing something major. We suggest that the marketing of money-back guarantees is inducing couples who would previously have used—successfully—other less invasive procedures with fewer side effects and less risk of multiple births to decide to proceed directly to IVF, and that this scenario makes the money-back guarantees profitable for the clinics. The implications of earlier use of IVF are then considered from an overall public policy point of view. Just as mothers everywhere tell their children, “When something looks too good to be true, then it is too good to be true!”
Pro-inflammatory and anti-inflammatory circulating cytokines and periprosthetic osteolysis
Authors: Fiorito S. , Magrini L. , Goalard C. 
Published: January 2004

We investigated the circulating levels of the main cytokines involved in bone resorption (IL-1β, IL-6, TNF-α), prostaglandins (PGE2) and metalloproteases (MMP-1), as possible early markers of osteolysis, in the serum of eight patients with periprosthetic osteolysis and ten patients without osteolysis. All had received a cementless hip prosthesis (ABG-1). We also assessed the serum levels of IL-11 and TGF-β anti-inflammatory cytokines exerting protective effect on bone resorption. The mean serum levels of IL-1β, IL-6, TNF-α, TGF-β, MMP-1, and PGE2 in patients with periprosthetic osteolysis did not differ significantly from those of patients without osteolysis or from those of normal controls. IL-11 serum levels were not detectable at all in any of the patients, while they were detected within normal reference values in the control subjects (significant inverse correlation). We believe that circulating cytokines cannot be regarded as markers of osteolysis, a condition characterised by a local inflammation without systemic signs of inflammation. On the contrary, the undetectable levels of IL-11 in implanted patients could provide evidence for a lack of balance between pro- and anti-inflammatory cytokines in these patients.
Acetabular revision in total hip replacement with a press-fit cup
Authors: Elke R. , Berli B. , Wagner A. , Morscher E. W. 
Published: January 2004

The need for supplementary screw fixation in acetabular revisions is still widely debated. We carried out 439 acetabular revisions over an eight-year period. In 171 hips with contained or small segmental defects, the Morscher press-fit cup was used. These revisions were followed prospectively. No screws were used for additional fixation. A total of 123 hips with a mean follow-up of 7.4 years (5 to 10.5) were available for clinical and radiological review. There was no further revision of a press-fit cup for aseptic loosening. Radiological assessment revealed osteolysis in three hips. Of the original 171 hips there was cranial and medial migration of up to 6 mm at two years in 44 (26%). No further migration was seen after the second post-operative year. Acetabular revision without screws is possible with excellent medium-term results in well selected patients.
Closed reduction and percutaneous fixation of supracondylar fracture of the humerus and ipsilateral fracture of the forearm in children
Authors: Tabak Y. , Çelebi L. , Murath H. H. , Yağmurlu M. F. , Aktekin C. N. , Biçimoglu A. 
Published: January 2004

We treated 22 children with a supracondylar fracture of the humerus and an ipsilateral fracture of the forearm by closed reduction and percutaneous fixation. There were four Gartland type-II and 18 Gartland type-III supracondylar fractures of the humerus. There were fractures of both bones of the forearm in 16 and of the radius in six. Both the supracondylar and the distal forearm fractures were treated by closed reduction and percutaneous fixation. The mean follow-up time was 38.6 months. At the latest follow-up there were 21 excellent or good results and one fair result. There were no cases of delayed union, nonunion or malunion. Five nerve injuries were diagnosed on admission and all recovered spontaneously within eight weeks. No patient developed a compartment syndrome.
Surgical treatment of symptomatic osteochondroma
Authors: Bottner F. , Rodl R. , Kordish I. , Winkelmann W. , Gosheger G. , Lindner N. 
Published: January 2004

Our aim was to investigate the outcome of excision of osteochondromas. Between 1994 and 1998, 92 symptomatic osteochondromas in 86 patients were excised. There were 40 women and 46 men with a mean age of 20 years (3 to 62). Of these, 56 had a solitary osteochondroma and 30 had multiple hereditary tumours. The presenting symptoms were pain (79.1%), swelling (23.3%), reduced range of movement (19.8%), cosmetic abnormalities (17.4%), and bursitis (12.8%). The most common site (37.6%) was around the knee. Four patients had major complications (4.7%) including one intra-operative fracture of the femoral neck and three nerve palsies which resolved after decompression. Six patients had minor complications. Overall, 93.4% of the preoperative symptoms resolved after excision of the tumours. Excision is a successful form of treatment for symptomatic osteochondromas with a low morbidity.
Separate vertical wiring for the fixation of comminuted fractures of the inferior pole of the patella
Authors: Yang K. H. , Byun Y. S. 
Published: January 2004

Comminuted and displaced fractures of the inferior pole of the patella are not easy to reduce and it is difficult to fix the fragments soundly enough to allow early movement of the knee. We have evaluated the clinical effectiveness of the separate vertical wiring technique in acute comminuted fractures of the inferior pole of the patella. A biomechanical study was also performed using ten pairs of embalmed cadaver knees. A four-part fracture was made on the inferior pole of the patella and fixed by two separate vertical wires on one side and two pull-out sutures after partial patellectomy on the other. The ultimate load to failure in the first group was significantly higher than in the second (250.1± 109.7 N v 69.7 ± 18.9 N, p< 0.002), as was the stiffness (279.9 ± 76.4 N/mm v 23.2 ± 11.4 N/mm, p< 0.001). The separate wire technique was used in 25 patients with comminuted fractures of the inferior pole of the patella who were followed up for a mean period of 22 months (10 to 50). All the fractures healed at a mean of seven weeks (6 to 10). No breakage of a wire or infection occurred. The mean grading at the final follow-up was 29.5 points (27 to 30) using the Böstman method. This technique preserved the length of the patella, fixed the comminuted fragments of the inferior pole and avoided long-term immobilisation of the knee.
Levator scapulae and rhomboid transfer for paralysis of trapezius
Authors: Romero J. , Gerber C. 
Published: January 2004

Spinal accessory nerve palsy leads to painful disability of the shoulder, carrying an uncertain prognosis. We reviewed the long-term outcome in 16 patients who were treated for pain, weakness of active elevation and asymmetry of the shoulder and the neck due to chronic paralysis of the trapezius muscle, as a result of nerve palsy. Of four patients who were treated conservatively, none regained satisfactory function, although two became pain-free. The other 12 patients were treated operatively with transfer of the levator scapulae to the acromion and the rhomboid muscles to the infraspinatus fossa (the Eden-Lange procedure). At a mean follow-up of 32 years, the clinical outcome of the operatively treated patients was excellent in nine, fair in two, and poor in one patient, as determined by the Constant score. Pain was adequately relieved in 11 and overhead function was restored in nine patients. Pre-operative electromyography had been carried out in four patients. In two, who eventually had a poor outcome, a concomitant long thoracic and dorsal scapular nerve lesion had been present. The Eden-Lange procedure gives very satisfactory long-term results for the treatment of isolated paralysis of trapezius. In the presence of an additional serratus anterior palsy or weak rhomboid muscles, the procedure is less successful in restoring shoulder function.
The extensile rectus snip exposure in revision of total knee arthroplasty
Authors: Meek R. M. D. , Greidanus N. V. , McGraw R. W. , Masri B. A. 
Published: January 2004

Revision of a total knee arthroplasty may require an extensile approach to permit a satisfactory exposure without compromising the attachment of the patellar tendon. It has been assumed that a rectus snip is a relatively benign form of release, but the effect of using this approach on function, pain and patient satisfaction is not known. From January 1997 to December 1999, 107 patients who underwent revision of total knee arthroplasty were followed up at a minimum of two years (mean 40.5 months) and assessed by the Oxford Hip Score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Short-Form (SF)-12 and patient satisfaction. Co-morbidity, surgical exposure, the Hospital for Special Surgery (HSS) knee scores and the range of movement were also used. A standard medial parapatellar approach was used in 57 patients and the rectus snip in 50. The two groups were equivalent for age, sex and co-morbidity scores. The WOMAC function, pain, stiffness and satisfaction scores demonstrated no statistical difference. The use of a rectus snip as an extensile procedure has no effect on outcome.
Acid-etched microtexture for enhancement of bone growth into porous-coated implants
Authors: Hacking S. A. , Harvey E. J. , Tanzer M. , Krygier J. J. , Bobyn J. D. 
Published: January 2004

We designed an in vivo study to determine if the superimposition of a microtexture on the surface of sintered titanium beads affected the extent of bone ingrowth. Cylindrical titanium intramedullary implants were coated with titanium beads to form a porous finish using commercial sintering techniques. A control group of implants was left in the as-sintered condition. The test group was etched in a boiling acidic solution to create an irregular surface over the entire porous coating. Six experimental dogs underwent simultaneous bilateral femoral intramedullary implantation of a control implant and an acid etched implant. At 12 weeks, the implants were harvested in situ and the femora processed for undecalcified, histological examination. Eight transverse serial sections for each implant were analysed by backscattered electron microscopy and the extent of bone ingrowth was quantified by computer-aided image analysis. The extent of bone ingrowth into the control implants was 15.8% while the extent of bone ingrowth into the etched implants was 25.3%, a difference of 60% that was statistically significant. These results are consistent with other research that documents the positive effect of microtextured surfaces on bone formation at an implant surface. The acid etching process developed for this study represents a simple method for enhancing the potential of commonly available porous coatings for biological fixation.
The Provision of Occlusal Splints in Primary Dental Care
Authors: Patel Kalpesh , Hemmings Kenneth W , Vaughan Simon 
Published: January 2004

Occlusal splints (Michigan splints, night/bite guards or bite-raising appliances) can be an effective, inexpensive and reversible treatment for a wide range of dental problems. Objective The aim of this study was to analyse retrospectively the provision of occlusal splint (‘Michigan’ type) in general dental practice, following a prescription by a restorative dental consultant. Method One hundred patients were recruited from consultant clinics in a department of conservative dentistry during 1995 and 1996. All patients were prescribed a maxillary, full-coverage, heat-cured, acrylic-resin splint (Michigan splint) as part of a treatment plan. An explanatory letter and questionnaire were sent to all patients and to their referring general dental practitioner in 1997 and 1998. Results A response rate of 79% was achieved in obtaining completed questionnaires from both patients and general dental practitioners. Of respondents 43% (34/79) received an occlusal splint of some form. A small proportion of the respondents (16.5% [13/79]) received a Michigan splint as prescribed. Irrespective of the type of appliance provided, most patients (82% [28/34]) found them helpful. Of those who did not receive an occlusal splint, 38% (17/45) of patients felt financial implications deterred them from obtaining an appliance. Other common reasons for non-provision included: patients felt that symptoms had improved (18% [8/45]) and patients did not agree with treatment (18% [8/45]). The general dental practitioners had similar opinions to their patients. Discussion These findings raise some serious doubts on the efficacy of consultant clinic advice in the prescription of occlusal splints in general dental practice. The financial and educational issues raised by this study will need to be addressed to improve service provision. Conclusion The results of this study indicate that 16.5% of patient respondents prescribed a Michigan splint at a consultant clinic received such an appliance in general dental practice.
An Evaluation of Powder-free Gloves in General Dental Practice
Authors: Brunton Paul A , Abidia Randa , Macfarlane Tatiana V , Wilson Nairn HF 
Published: January 2004

Purpose of study To evaluate the suitability of two non-sterile, powder-free gloves for routine use in general dental practice. Basic procedures Randomly allocated blind evaluation of two powder-free gloves by five dentists and five dental nurses in general dental practice. Each dentist and dental nurse were allocated a four-day supply of two unnamed powder-free gloves. Following glove usage a questionnaire sought their views regarding ease of donning, operator comfort, puncture and tear resistance, and tactile sensitivity. Details of procedure undertaken, time of wear and puncture and tear formation for the dentists’ gloves were also recorded. The dentists’ gloves were retained and subsequently tested for punctures and tears. Main findings In terms of ease of donning, operator discomfort, tear resistance and tactile sensitivity neither glove was ideal, however one glove was rated higher than the other. Overall, the dentists noticed only half of the punctures and tears detected in the laboratory. One glove was more prone to punctures with the other glove more liable to tear. Time worn in excess of 20 minutes and endodontic procedures were associated with a higher incidence of punctures. Principal conclusions The two powder-free gloves evaluated in this study would appear not to be suitable for routine use in general dental practice. Further developments are required before powder-free gloves of the type evaluated can be expected to receive widespread acceptance for routine use by dentists and dental nurses in general dental practice.