Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73).

Objective: To examine the traditional diet-heart hypothesis through recovery and analysis of previously unpublished data from the Minnesota Coronary Experiment (MCE) and to put findings in the context of existing diet-heart randomized controlled trials through a systematic review and meta-analysis.

Design: The MCE (1968-73) is a double blind randomized controlled trial designed to test whether replacement of saturated fat with vegetable oil rich in linoleic acid reduces coronary heart disease and death by lowering serum cholesterol. Recovered MCE unpublished documents and raw data were analyzed according to hypotheses prespecified by original investigators.

Clinical accuracy and safety using the SynchroMed II intrathecal drug infusion pump.

Background And Objectives: We evaluated the infusion accuracy and device-related safety of implantable drug infusion pumps in subjects with chronic pain or severe spasticity.

Methods: Nine centers in the United States enrolled patients receiving intrathecal drug delivery systems to manage chronic pain and/or severe spasticity. Infusion accuracy was assessed at 6 and 12 months by comparing syringe-measured delivered volumes to programmer-predicted volumes.

Randomized trial of a hearing conservation intervention for rural students: long-term outcomes.

Objectives: We had the rare opportunity to conduct a cluster-randomized controlled trial to observe the long-term (16-year) effects of a well-designed hearing conservation intervention for rural high school students. This trial assessed whether the intervention resulted in (1) reduced prevalence of noise-induced hearing loss (NIHL) assessed clinically and/or (2) sustained use of hearing protection devices.

Methods: In 1992-1996, 34 rural Wisconsin schools were recruited and 17 were assigned randomly to receive a comprehensive, 3-year, hearing conservation intervention.

Medical practice perspective: identification and mitigation of risk factors for mortality associated with intrathecal opioids for non-cancer pain.

Objective: The authors recently determined that early and longer term mortality after initiation or reinitiation of intrathecal opioid therapy is higher than previously appreciated: 0.088% within 3 days, 0.39% at 1 month, and 3.

Mortality associated with implantation and management of intrathecal opioid drug infusion systems to treat noncancer pain.

Background: In 2006, the authors observed a cluster of three deaths, which circumstances suggested were opioid-related, within 1 day after placement of intrathecal opioid pumps for noncancer pain. Further investigation suggested that mortality among such patients was higher than previously appreciated. The authors performed investigations to quantify that mortality and compare the results to control populations, including spinal cord stimulation and low back surgery.

Hearing conservation program for agricultural students: short-term outcomes from a cluster-randomized trial with planned long-term follow-up.

Objectives: (1) To conduct a contemporary analysis of historical data on short-term efficacy of a 3-year hearing conservation program conducted from 1992 to 1996 in Wisconsin, USA, with 753 high school students actively involved in farm work; (2) to establish procedures for assessment of hearing loss for use in a recently funded follow-up of this same hearing conservation program cohort.

Methods: We analyzed a pragmatic cluster-randomized controlled trial, with schools as the unit of randomization. Thirty-four rural schools were recruited and randomized to intervention or control.

Estimates of future physical functioning by seriously ill hospitalized patients, their families, and their physicians.

Objectives: To compare prognostic estimates made by seriously ill hospitalized patients, their surrogates, and their physicians about the patients' activities of daily living (ADLs) 2 months after admission; compare the accuracy of their estimates; and identify factors associated with the optimism and accuracy of these estimates.

Design: Prospective cohort study.

Setting: Five teaching hospitals.

Treatment of iron deficiency anemia and associated protein-losing enteropathy in children.

Purpose: The aims of this study were to evaluate the response of oral iron treatment in children with iron deficiency anemia (IDA) fed whole cow's milk (WCM) or soy formula; to compare the incidence of fecal blood loss in infants fed WCM and soy formula; and to evaluate the incidence and relation of protein-losing enteropathy (PLE) and IDA by testing serum albumin, fecal blood loss, and fecal alpha1-antitrypsin (alpha1AT).

Methods: Twenty-four children with nutritional IDA were randomly assigned to receive either 16 oz WCM or soy formula daily. Both groups were treated with daily therapeutic oral iron during 12 weeks.

A hearing conservation program for Wisconsin youth working in agriculture.

Adolescents working in agricultural settings may be exposed to noise levels that result in hearing loss. The article describes the design, implementation, and results of a four-year, hearing conservation program (HCP) conducted at school. Thirty-four schools (753 students) were randomly assigned to either an intervention or control group.

Resuscitation preferences among patients with severe congestive heart failure: results from the SUPPORT project. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments.

Background: We sought to describe the resuscitation preferences of patients hospitalized with an exacerbation of severe congestive heart failure, perceptions of those preferences by their physicians, and the stability of the preferences.

Methods And Results: Of 936 patients in this study, 215 (23%) explicitly stated that they did not want to be resuscitated. Significant correlates of not wanting to be resuscitated included older age, perception of a worse prognosis, poorer functional status, and higher income.

Stimulant use and the potential for abuse in Wisconsin as reported by school administrators and longitudinally followed children.

The purpose of this study was to describe stimulant use and abuse as reported by school administrators and children diagnosed with attention deficit/hyperactivity disorder or attention deficit disorder inattentive. Five years after being identified as Ritalin responders, 161 children were surveyed regarding stimulant use and abuse. School principals in central Wisconsin were also surveyed regarding stimulant use and policies.

Surgery without radiotherapy for primary treatment of endometrial cancer.

Objective: To analyze the role of surgery alone, including pelvic and para-aortic lymphadenectomy, in patients with endometrial cancer who did not receive radiotherapy.

Methods: Between August 1987 and January 1997, 225 women with disease clinically confined to the uterus were staged surgically by a standard protocol that included pelvic and para-aortic lymphadenectomy in women with high risk factors. No radiation was administered before or after surgery.

Infections with nonthoracotomy implantable cardioverter defibrillators: can these be prevented? Endotak Lead Clinical Investigators.

Nonthoracotomy ICDs are believed to be the best therapeutic modality for treatment of life-threatening ventricular arrhythmias. Little is known about the risk of infection with initial implantation of these devices. We studied the incidence, clinical characteristics, and risk factors associated with infections in 1,831 patients with nonthoracotomy ICD from the Endotak-C nonthoracotomy lead registry of Cardiac Pacemakers, Inc.

Quality of data regarding diagnoses of spinal disorders in administrative databases. A multicenter study.

The purpose of the present study was to evaluate the accuracy of data regarding diagnoses of spinal disorders in administrative databases at eight different institutions. The records of 189 patients who had been managed for a disorder of the lumbar spine were independently reviewed by a physician who assigned the appropriate diagnostic codes according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The age range of the 189 patients was seventeen to eighty-four years.

Optic nerve contact and compression by the carotid artery in asymptomatic patients.

Purpose: To estimate the frequency and clinical correlates of contact and compression of the intracranial optic nerve by the supraclinoid carotid artery in asymptomatic patients.

Methods: In a retrospective study, we identified asymptomatic patients who had undergone magnetic resonance imaging with sequences that could be used to evaluate the relation between the intracranial optic nerve and the carotid artery. These patients underwent neuroimaging evaluations for reasons unrelated to loss of vision, optic neuropathy, or carotid artery disorders.

Lack of overlap in genetic risks for Alzheimer's disease and Parkinson's disease.

We explored the question of genetic overlap between Alzheimer's disease (AD) and Parkinson's disease (PD) because evidence suggests clinical, pathologic, and epidemiologic overlap between the two disorders. We compared the frequency of AD and PD between the first-degree relatives of probands with AD and PD and first-degree relatives of spouse control subjects. Using life-table methods, we found increased risk of AD in first-degree relatives of patients with AD and an increased risk of PD in first-degree relatives of patients with PD.

The changing radiographic presentation of bronchogenic carcinoma with reference to cell types.

Objective: To analyze chest radiographic patterns of lung cancer at presentation by cell type. This current series is compared with historic published data.

Design: Retrospective, using a tumor registry.

Pain and satisfaction with pain control in seriously ill hospitalized adults: findings from the SUPPORT research investigations. For the SUPPORT investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatmentm.

Objectives: To evaluate the pain experience of seriously ill hospitalized patients and their satisfaction with control of pain during hospitalization. To understand the relationship of level of pain and dissatisfaction with pain control to demographic, psychological, and illness-related variables.

Design: Prospective, cohort study.

The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators.

Objective: To examine the association between the use of right heart catheterization (RHC) during the first 24 hours of care in the intensive care unit (ICU) and subsequent survival, length of stay, intensity of care, and cost of care.

Design: Prospective cohort study.

Setting: Five US teaching hospitals between 1989 and 1994.

Prognostic significance of gross myometrial invasion with endometrial cancer.

Objective: To determine if intraoperative estimation of gross myometrial invasion is sufficiently precise to guide surgical aggressiveness in staging patients with endometrial cancer.

Methods: Between September 1987 and September 1995, 236 women with endometrial cancer had visual estimation of gross myometrial invasion during surgical staging which included pelvic and para-aortic lymphadenectomy.

Results: In 213 patients (90.

Generalizability of clinical studies conducted at tertiary care medical centers: a population-based analysis.

The Marshfield Epidemiologic Study Area (MESA), a geographically defined population registry at one of the participating sites in SUPPORT (a multicenter study of the care of seriously ill hospitalized patients) permitted assessment of generalizability in that study. On the basis of age- and sex-specific rates of enrollment of SUPPORT patients in MESA, we estimate that about 400,000 patients per year would fulfill SUPPORT eligibility criteria in the United States. However, an estimated 925,000 patients, particularly the elderly and those with impairments in their activities of daily living (ADLs), have SUPPORT-like illnesses annually, but do not receive the aggressive care required for study enrollment.

Race, resource use, and survival in seriously ill hospitalized adults. The SUPPORT Investigators.

Objective: To examine the association between patient race and hospital resource use.

Design: Prospective cohort study.

Setting: Five geographically diverse teaching hospitals.

Epidemiologic research in an integrated regional medical care system: the Marshfield Epidemiologic Study Area.

To capitalize on Marshfield Clinic's advantages for population-based health research, we developed the Marshfield Epidemiologic Study Area (MESA). Marshfield Clinic is an integrated system consisting of a large multispecialty clinic and 23 affiliated clinics. Clinic physicians provide virtually all of the medical care, both inpatient and outpatient, for residents of the area.

Early progression of ophthalmoplegia in patients with ischemic oculomotor nerve palsies.

Objective: To describe the frequency and clinical correlates of early progression of ophthalmoplegia in patients with ischemic oculomotor nerve palsies.

Design: Cohort survey, case series.

Setting: Multispecialty clinic providing primary, secondary, and tertiary care in central and northern Wisconsin.

Comparison of D&C and office endometrial biopsy in predicting final histopathologic grade in endometrial cancer.

Objective: To compare the accuracy of D&C and office Z-sampler endometrial biopsy in predicting hysterectomy tumor grade in women with endometrial cancer.

Methods: Between September 1987 and July 1994, 183 women with endometrial cancer had D&C or office Z-sampler endometrial biopsy before hysterectomy.

Results: One hundred thirty-one patients (72%) had Z-sampler biopsies and 52 (28%) had D&C.