Meta-analysis of survival models of lung cancer

Lung cancer is a common disease that is difficult to treat successfully. Despite the continuous improvement and development of diagnostic method, the disease is still diagnosed in advanced stages. The present study aimed to calculate the 5-years survival rate of patients with lung cancer, to construct different models of survival rates according to different factors and to perform a meta-analysis involving systematic statistical pooling of eligible studies concerning survival of lung cancer. A longitudinal retrospective study was conducted in the treatment centers of Faculty of Medicine and Gamal Abd-El Nasser Hospital. All available records of patients diagnosed and confirmed pathologically as lung cancer during the years 1992 to 2001,were reviewed, the total number amounted to 1099 patients, these patients were followed up for one year till the end of 2002. Life table revealed that the cumulative probability of survival was 18.7% and 16.7%, respectively at 36 -<42 month and 42 -<48 month. No one survived up to 5 years. The median survival time was 7.97 months.Kaplan-Meier survival curves yielded that the lowest probability of survival throughout the studied period was noticed among those aged 70 years or more, with stage IV and patients who were treated with radiotherapy alone. Cox regression delineated three significant predictors for survival within 5 years, which were age of patients, stage of tumor and grade of differentiation. Results of meta-analysis demonstrated that pooling the results of different studies yielded a trend toward a reduced relative risk of death by 22% among patients with stage I compared to stage II, and reduced relative risk of 33% for patients with stage I compared to stage III. It is essential to improve the strategies for prevention of smoking and health education program for cessation of smoking early for smokers. Diagnosis staging and development of a management plan should be completed quickly as possible. Focuses on the treatment of patients with lung cancer with chemotherapy and radiotherapy

Statistical analysis of referrals by general practitioner at health insurance organization clinics in Alexandria

Referral of patients generates significant economic costs for both physician fees and diagnostic tests. Variation in referral rates between general practices and between individual GPs has long been the focus of attention for policy makers. The present study aimed to analyze the referrals by General Practitioners [GP] at Health Insurance Organization [HIO] clinics in Alexandria. The study was conducted at 18 Health Insurance Organization [HIO] comprehensive clinics in Alexandria, distributed in the 6 districts of Alexandria HIO. Retrospective analysis of records and cross sectional interview to 180 GPs were carried out. Male GPs comprised 82.2% of the sample. On the average, GPs received 6.6 +/- 4.5 patients per working hour. Over the year 2002, 8.4% of consultations were referred to specialists, 5.4% referred to laboratory and only 0.09% were referred to hospital. The highest percent of referrals from GP to specialist were directed to internal medicine followed by orthopedics, general surgery, E.N.T, dermatology, neuropsychiatry, chest then urology clinics. Referral rate from GPs to specialists was found to have a 6.6-fold variation among clinics, and a 54.8-fold variation among individual GPs. Moreover, there was no homogeneity in variations in referral rates of clinics within 3 of the 6 districts. Using multiple regression analysis, the only significant factor was the indirect relation with workload. Comparison of referral rates of GPs with the limits set by HIO [8-17%] revealed that, 48.9% of GPs were within limits, 37.2% were lower and 13.9% were higher than limits. GPs who had diploma or master were average referrers in 51.5%, low referrers in 30.3% and high referrers in 18.2%, compared to 45.6%, 50.6% and only 3.8%, respectively for those with bachelor degree; the difference was statistically significant

Statistical process control for referrals by general practitioner at health insurance organization clinics in Alexandria

Quality control is the application of statistical techniques to a process in an effort to identify and minimize both random and non-random sources of variation. The present study aimed at the application of Statistical Process Control [SPC] to analyze the referrals by General Practitioners [GP] at Health Insurance Organization [HIO] clinics in Alexandria. Retrospective analysis of records and cross sectional interview to 180 GPs were done. Using the control charts [p chart], the present study confirmed the presence of substantial variation in referral rates from GPs to specialists; more than 60% of variation was of the special cause, which revealed that the process of referral in Alexandria [HIO] was completely out of statistical control. Control charts for referrals by GPs classified by different GP characteristics or organizational factors revealed much variation, which suggested that the variation was at the level of individual GPs. Furthermore, the p chart for each GP separately; which yielded a fewer number of points out of control [outliers], with an average of 4 points. For 26 GPs, there was no points out of control, those GPs were slightly older than those having points out of control. Otherwise, there was no significant difference between them. The revised p chart for those 26 GPs together yielded a centerline of 9.7%, upper control limit of 12.0% and lower control limit of 7.4%. Those limits were in good agreement with the limits specified by HIO; they can be suggested to be the new specification limits after some training programs

Retention of pressure sore knowledge at Tanta HIN

The purpose of the present study was to determine if lectures supplemented with audio-visual aids would significantly increase acquisition and retention of knowledge related to "pressure sore", compared to formal lecture. 94 junior students in the fundamentals of nursing course participated in the study. They were randomly divided into control group [48 students] attending a formal lecture on "pressure sore" subject, and an experimental group [46 students] attending a lecture supplemented with audio-visual aids about the same content material. A pre test was given to evaluate knowledge base prior to lecture. A post test was given immediately after the lecture to evaluate initial knowledge acquisition. Retention test was given three weeks later to evaluate the amount of knowledge retained. Analysis of covariance showed that students attending the lectures supplemented with audio-visual aids demonstrated significantly higher retention test score, although they did not demonstrate a significantly higher score from pre test to post test. In conclusion the "pressure sore" subject material was better taught using lecture supplemented with audio-visual aids because it increases the retention of knowledge

Evaluation of nutrition knowledge and attitude among post graduate students with medical and non medical background

A demographic and attitudinal questionnaire and a knowledge test were administered to post graduate students with medical and non medical background upon entry to their first nutrition course at the High Institute of Public Health. Knowledge was assessed regarding basic principles of nutrition and nutrition application [food sources, food functions, requirements and factors affecting requirement and other nutritional information] using t-test for paired observations. results indicated that the students had a relatively low knowledge of nutrition upon entering the course, but there was a significant improvement upon completion of the course. Moreover, stepwise multiple regression analysis applied to determine the effect of different factors on initial knowledge and achievement score indicated that educational background was the most important independent variable affecting significantly students initial knowledge where students with medical background showed a higher score than those with non medical background, while prescore was the most important independent variable affecting significantly students achievement where students with low prescore showed a higher achievement score as compared to those with high prescore. Attitudes were assessed regarding the role of dietitian in the hospital, nutrition education and general nutrition using Wilcoxon matched pairs test. Attitudes were not greatly altered during the nutrition course

Investigation of risk factors associated with lower respiratory tract infection using logistic analysis: a matched case control study

The present case-control study was conducted to estimate the risk of lower respiratory illnesses associated with various biological, socioeconomic and nutritional factors among children aged 6- <24 months in Alexandria. A total of 350 children with history of LRI was selected and matched in age and sex with an equal number of controls having no history of LRI during the past 3 months prior to the study. Using the logistic model in analysis, results revealed excess risk [with varying degrees and statistical significance] of encountering LRI among children possessing the following risk factors: maternal age <20 or 35+ years, artificial feeding, late birth order, low socioeconomic level, illiteracy of parents, low income, large family size [7+], high crowding index and chronic malnutrition

Appendectomy: developing a scoring system to improve diagnostic accuracy

Problems related to the diagnosis of appendicitis are evidenced by the significant negative laparotomy rate. The present study sought to assess the feasibility of decreasing this diagnostic error by studying two groups of patients and identifying and weighing details of history, physical examination and laboratory findings utilizing 20 predictive factors, 100 patients who underwent operation because of suspicion of acute appendicitis constituted the study sample, and were classified into AAp and NAp groups based upon the results of histologic examination. Rates of occurrence for each predictive factor were determined separately for both groups. These were converted into weights which were then added to yield a diagnostic score for each patient. A cutoff point established the score which designated one group for observation and the other for surgery. Scores were assessed at three different points by balancing risks of missed diagnoses against benefits of avoiding unnecessary operations. Seven predictive factors had differentiating weights and reached statistical significance [p

Growth and nutritional status of preschool children attending the well-baby clinics

This study aimed at the assessment of growth and nutritional status of preschool children by comparing it with internationally recognized growth standards, using the anthropometric indices of nutritional status. A cross-sectional study was carried out upon a sample of children [N = 660] aged 0-71 months who attended the well-baby clinics in the MCH centres in Alexandria. Individual measurements of weight and height were done for each child. Anthropometric indices of weight and height were calculated. These indices were related to the US National Centre of Health Statistics [NCHS] reference population by standard deviation scores [Z-scores]. The growth pattern of children was different from that of western reference populations, while it resembled that of most developing countries. Of all children, 10.5% suffered from malnutrition [weight for age <2 S.D. of the reference median], 14.1% were stunted, and 5.5% were wasted. Parents of all children were interviewed, and analysis of specific social risk factors associated with poor attained size was done using stepwise multiple regression analysis. Few of such factors reached statistically significant association such as sex, infant feeding pattern, birth order and parental consanguinity

simplified method of developmental assessment of infants and preschool children and some associated findings

This study aimed at the construction of a modified simple developmental screening test, and the determination of some risk factors for developmental delay using this test. Many developmental screening tests were revised, and the modified test was constructed containing the four areas of development: gross motor, fine motor-adaptive, personal social, and language. According to this test, the child is assessed 4 times in the first year of life [every 3 months], 2 times in the second year [every 6 months], and once a year afterwards. The test was applied upon 220 children who attended the well-baby clinics in 4 MCH centers in Alexandria within 2 weeks. Out of those children, 7.7% were classified by the test as developmentally delayed in gross motor. 12.7% in fine motor. 7.7% in social and 14.5% in language development. Parents of all children were interviewed by a questionnaire including some risk factors for developmental delay. Relative risk was estimated using the odds ratio for statistical determination of risk factors. Hospitalization was a significant risk factor for delay in all areas of development. Frequent attacks of cough and diarrhea were risk factors for delay in social and language development. Close child spacing was a risk factor for delay in gross motor development, while consanguinity of parents was a risk factor for delay in social development. The use of this modified test in the assessment of children in MCH centers was recommended

multivariate analysis of determinants of clinic utilization by the elderly

The present study is designed to assess the importance of selected health and sociodemographic factors in explaining and predicting the use of the specialized geriatric clinic at Main University Hospital in Alexandria. Two multivariate analysis techniques were applied. Discriminant analysis was used to determine the extent to which the clinic contact by the elderly could be predicted by the selected factors. Then, stepwise multiple regression analysis was used to identify the factors most important in explaining the number of contact with the clinic. The results suggest the following conclusions: First, the clinic users are a diverse group with respect to clinic utilization. Second, the most single powerful predictor of utilization of the clinic was income [the most discriminating variable of presence or absence of clinic contact, as well as the most powerful predictor of number of contacts a patient will have with the clinic]. This reflects the need for maintaining adequate medical care at non paying hospital outpatient facilities and ambulatory care clinics which are the primary source of medical care for a significant segment of the aged population whose ability to pay for private care is limited. Third, in planning future health services for older people, care should be given to incorporate demographic and economic characteristics as well as the health status of the target population