scholarly journals How clinically important is the p-value?

2018 ◽  
Vol 26 (1) ◽  
pp. 8-9
Author(s):  
Dhelfeson Willya Douglas-de-Oliveira
Keyword(s):  
Null Hypothesis ◽  
Clinical Effect ◽  
Clinical Decision Making ◽  
Scientific Evidence ◽  
Statistical Significance ◽  
Statistical Parameter ◽  
Clinical Importance ◽  
P Value ◽  
Daily Routine ◽  
Significant Difference

Currently, it has been observed a growing number of publications in all fields of Dentistry. These publications act as scientific evidence, as well as a basis for clinical decision-making in dental care routine. It is important to note that the results and conclusions in articles are based on the p-value that is a purely probabilistic and statistical parameter, and it assists the researcher to accept or reject the null hypothesis being tested. The p-value was proposed by Fisher in 1925, and in Dentistry, it is usual to adopt the p-value stated in 0.05.1 In practical terms, when a statistical test results in p-value less than 0.05, the null hypothesis must be rejected (equality between groups), assuming that there is a difference between the assessed groups.2 In other words, p<0.05 indicates statistically significant difference between groups. Under a critical look, the researcher and reader should keep in mind that a statistical difference is not always reflecting a true clinical importance. In addition, a lack of statistical significance does not necessarily relate to the absence of clinical significance. The clinical importance is far beyond statistical calculations based on the p-value.3 A study presents clinical importance when the one being tested presents clinical effect capable to change the behavior of the dentist in daily routine. This judgment should be done by the researcher based on the results of his/her research, clinical experience and actual  knowledge. In addition, estimates of effect sizes should be presented. This facilitates assessment of how large or small the observed effect could actually be in the population of interest, and hence how clinically important it could be. Kassab et al. (2006)4 compared periodontal parameters in groups with and without chemical biomodifciation of the root prior surgical coverage in cases of gingival recession. The group, that used edetic acid, statistically improved the periodontal parameters in relation to the group without surface biomodification. However, this difference was imperceptible to both dentist and patient. That is, the clinical result of root coverage will be the same when using or not acid biomodification of the root. In other words, there was not an important clinical effect of this step, although there was a significant difference. In the above example, it is clear that just because a statistic test is significant doesn't mean the effect it measures is significant or clinically important. Then, researchers should not draw conclusions based solely on the p-value, they should propose alternatives that really evaluate the clinical effect.   Dhelfeson Willya Douglas-de-Oliveira Federal University of Jequitinhonha and Mucuri Valleys, Diamantina, Brazil. [email protected]

The Effectiveness of Using a Mobile Messenger as an Educational Supporting Tool among Nursing Students

2020 ◽  
Vol 4 (1) ◽  
pp. 67-77
Author(s):  
Rohimah Ismail ◽  
Chong Mei Chan ◽  
Wan Muhammad Azly W. Zulkafli ◽  
Hasnah Zani ◽  
Zainab Mohd Shafie
Keyword(s):  
Nursing Education ◽  
Nursing Students ◽  
Clinical Decision Making ◽  
Intervention Group ◽  
Great Influence ◽  
Control Group ◽  
P Value ◽  
Significant Difference ◽  
Supporting Tool ◽  
Nursing College

                The evolution of information technology has exerted great influence on nursing education via new pedagogy of knowledge delivery without time and place restriction. Mobile technology revolutionises nursing education and clinical practice via empowering skills of critical thinking and clinical decision-making through learning. The aim of this study is to evaluate the effectiveness of using mobile messenger (Whatsapp) as an educational supporting tool among nursing students. The study design used is a Cluster Randomized Control Trail. Two nursing colleges were selected. Sample size was 93 participants, 48 from the Kuala Terengganu Nursing College Kuala Terengganu as the intervention group while the control group were recruited among 45 participants from UniSZA Nursing College. There is a significant difference in the level of knowledge between pre and posttest among intervention group (mean difference was -8.70 with a standard deviation 8.42, p-value< 0.001) and 93.8 percent of the respondents perceived the usefulness of using WhatsApp mobile messenger to enhance learning. This demonstrates that learning through mobile messenger (WhatsApp) enhances learning and is well received as a new method of learning by almost all students.   Keywords: Mobile learning, WhatsApp messenger, Social Interaction

scholarly journals Cataract surgery practice patterns worldwide: a survey

2021 ◽  
Vol 6 (1) ◽  
pp. e000464
Author(s):  
Tommaso Rossi ◽  
Mario R Romano ◽  
Danilo Iannetta ◽  
Vito Romano ◽  
Luca Gualdi ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Practice Patterns ◽  
Scientific Evidence ◽  
Public Hospitals ◽  
P Value ◽  
Evidence Based ◽  
Surgical Volume ◽  
Significant Difference ◽  
Type Of Institution ◽  
Surgical Setting

ObjectiveTo report the results of a global survey on cataract practice patterns related to preoperative, intraoperative and postoperative care, surgical setting and personnel allocation.Methods and analysisAn online 28 questions survey was sent to 240 ophthalmologists asking to describe prevailing trends in their institutions across 38 countries and 5 continents. Questions inquired country, institution, surgical volume and setting, anaesthesia, preoperative and intraoperative examination and postsurgical care. Statistical analysis used crosstabs lambda statistics for non-parametric nominal variables. P value less than 0.05 was considered statistically significant.Results209/240 (87%) ophthalmologists responded: 38% representing public hospitals, 36% private practices and 26% academic sites; overall surgical volume was between 241 700 and 410 500 cataracts per year. There was a significant correlation between type of institution and surgical volume. Complete results available in online (https://freeonlinesurveys.com/r/W6BcLLxy).ConclusionCataract surgery related patterns of perioperative care showed significant difference among respondents, regardless to type of institution, surgical volume and country. Many evidence-based procedures are unevenly practiced around the world and some widespread and expensive habits lack solid scientific evidence while consuming enormous amount of resources both monetary and human. There is a need to reach consensus and share evidence-based practice patterns.

617 Who Benefits the Most from Burn Camps?

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S162-S163
Author(s):  
Jennifer B Radics-Johnson ◽  
Daniel W Chacon ◽  
Li Zhang
Keyword(s):  
Retrospective Review ◽  
Burn Injury ◽  
Statistical Significance ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Self Evaluation ◽  
Significant Difference ◽  
Return Home ◽  
The Impact

Abstract Introduction Burn camps provide a unique environment and activities for children that have experienced a burn-injury. Positive outcomes from attending burn camp include increased self-esteem, decreased feelings of isolation and a greater sense of self-confidence. In a 3-year retrospective review of camper evaluations from one of the largest and longest running week-long burn camps in the nation for ages 5–17, we aimed to assess if a child’s gender, age, TBSA or ethnicity affected the impact that burn camp had on a child. Methods A 3-year retrospective review of a Burn Camp’s camper evaluation forms was conducted for campers that attended burn camp between 2017–2019. Camp rosters were reviewed to determine the camper gender, age, TBSA and ethnicity. Camper self-evaluation forms completed at the end of each camp session were reviewed to record camper responses to questions regarding their opinions on the impact camp had on them as well as how camp will impact their lives once they return home. Categorical variables were summarized as frequency and percentage, and continuous variables were described as median and range. To check the relationship between two categorical variables, Chi-square test was used. To compare the continuous variable among groups, Kruskal-Wallis ANOVA was used. Statistical significance was declared based on a p value&lt; 0.5. Results Within 2017–2019, there were 413 camper records. Participants’ demographic characteristics are summarized in Table 1. There were 208 males (50.3%) and 205 females (49.6%). The median age of campers were 11.86, 12.44 and 12.45 for 2017–2019, with the range from 5.16 years to 17.96 years. The median TBSA were 20, 20 and 18 for 2017–2019, with the range from 0.08 to 90. Collectively there were 47.7% Hispanic (n= 197); 24.2% Whites (n=100); 13.1% Black (n= 54); 4.6% Asian (n=19) and 7.7% Other (n=32). There were 395 camper self-evaluation forms submitted. Results of three questions there we were interested in are summarized collectively in Table 2. 57% of campers responded, “Yes, Definitely” to the question “After going to this event, will you feel more comfortable being around your classmates or friends?” 54% responded, “ Yes, Definitely” to the question “Do you feel more confidents in sharing your burn story with others when returning home?” and 51% responded “Yes, Definitely” to “Did you learn anything that will help you when you return home?” Conclusions In analyzing the camper responses, there was no statistically significant difference in responses comparing gender, age, TBSA or ethnicity.

scholarly journals Comparative study between bone patellar tendon bone and quadrupled hamstring autografts in arthroscopic anterior cruciate ligament reconstruction with aperture fixation

2017 ◽  
Vol 3 (2) ◽  
pp. 185 ◽  
Author(s):  
Dilip S. Shaktawat ◽  
Anil Kumar Mishra ◽  
Manoj R. Kashid ◽  
Amit Chaudhry ◽  
Rajshekhar . ◽  
...  
Keyword(s):  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Statistical Significance ◽  
Symptomatic Improvement ◽  
Fixation Method ◽  
P Value ◽  
Significant Difference ◽  
Aperture Fixation ◽  
Anterior Cruciate ◽  
Bone Patellar Tendon

<p class="abstract"><strong>Background:</strong> Bone patellar tendon bone <strong>(</strong>BPTB) and hamstring (HT) auto grafts have been used routinely in reconstruction of ACL over past two decades. Controversy still remains as to which graft is superior over other. Many studies have compared these graft options using different implants and different methods of fixation. Continuation of efforts in the same direction; purpose of the study is to compare these two graft options utilizing identical implants and similar method of fixation.</p><p class="abstract"><strong>Methods:</strong> 40 patients of clinically and radiologically diagnosed ACL tear fulfilling the inclusion and exclusion criteria were randomized into two groups to undergo arthroscopic ACL reconstruction using quadrupled hamstring graft (n=20) and bone patellar tendon bone auto graft (n=20) utilizing bioscrew by aperture fixation method in both the groups. They were compared post operatively for symptomatic improvement, clinical and rolimeter laxity tests and Lysholm functional knee scoring at 02 year.<strong></strong></p><p class="abstract"><strong>Results:</strong> At the end of 02 years laxity measurement by rolimeter showed slightly better results in BPTB group; however it was not statistically significant (p value= 0.362). Knee pain at the end of 02 year was slightly more in HT groups (45%) as compared to BPTB group (35%) but not significant (p value =0.748). Instability symptoms are comparable in both the groups (sense of giving away on exertion). Manual laxity testing by Lachman and Pivot shift tests were comparable in both the groups with p value of 0.695 and 0.999 respectively. Lysholm functional knee score also showed no statistical significance (p value =0.957).</p><p><strong>Conclusions:</strong> There is no significant difference between HT and BPTB auto grafts in terms of clinical and functional outcome at the end of 02 years. </p>

scholarly journals Performance of the BD FACSPresto near to patient Analyzer in comparison with representative conventional CD4 instruments in Cameroon.

2020 ◽  
Author(s):  
Bertrand Sagnia ◽  
Fabrice MBAKOP Ghomsi ◽  
Ana Gutierrez ◽  
Samuel SOSSO ◽  
Rachel KAMGAING ◽  
...  
Keyword(s):  
T Lymphocytes ◽  
T Lymphocyte ◽  
Statistical Significance ◽  
P Value ◽  
Resource Constrained ◽  
Inform Consent ◽  
Remote Areas ◽  
Significant Difference ◽  
Sensitivity Specificity ◽  
Cd4 Testing

Abstract Background In the context of scaling the viral load in resource limited settings, following HIV infected patient’s adults and children with CD4+ T-lymphocyte count still very important in settings where the decentralization of treatment still has some challenges. Effective HIV monitoring in these resource-constrained settings needs affordable and reliable CD4+ T lymphocytes enumeration methods. We investigated the validity of a BD FACSPresto POC which is a dedicated system for enumeration that uses immunofluorescent technologies. In this study, we have assessed the sensitivity, specificity and correlation between most representative flow cytometry instruments present in Cameroon with more than 5000 CD4 T cells tests per year including FACSCalibur, FACSCount, and PIMA POC from Becton dinkinson and ALERE respectively. Methods 268 patients aged from 1 to 72 years old were enrolled and included in the study after inform consent. The BD FACSPresto POC CD4+ T cell technology was placed at CIRCB and operated by technician staff. HIV infected patients were from Chantal BIYA international reference Center (CIRCB), Centre de Sante Catholique de NKOLODOM, Centre de Sante Catholique de BIKOP and CASS de Nkolndongo – Yaounde We compared the accuracy of the BD FACSPresto and three existing reference technologies with more than 5000 tests per year like FACSCalibur, FACSCount and PIMA according to the number of CD4 test done per year and their repartition in the country. Bland – Altman method and correlation analysis were used to estimate mean bias and 95% limits of agreement and to compare the methods, including analysis by subgroup of participant gestational age. In addition sensitivity and specificity were determined. Statistical significance was set at p-value < 0.05 Results The BD FACSPresto POC system has excellent precision, accuracy and linearity for CD4+ T lymphocytes enumeration. Good correlations were obtained between the BD FACSPresto poc system and other single platform methods. Bland–Altman plots showed interchangeability between two machines mean bias BD-FACSPresto vs PIMA= -126,522(-161,221 to -91,822) BD-FACSPresto vs FACSCount= -38,708 (-58,935 to -18,482) and FACSPresto vs FACSCALIBUR= 0,791(-11,908 to 13,491). Mean difference with Absolute CD4+ T-lymphocyte values obtained from the BD FACSPresto system correlated well with PIMA, FACSCount, and FACSCalibur method with R 2 equal to 0.88, 0.92 and 0.968 respectively with P < 0.001 for all. The mean comparison between values obtained from BD FACSPresto with PIMA, FACSCount, and FACSCalibur using paired T test give P=0.17, P=0.5 and P=0.6 respectively meaning that there is no significant differences between values obtained with BD FACSPresto and PIMA, FACSCount or FACSCalibur CD4 enumeration machines. Further analysis revealed close agreement between all the three instruments with no significant difference between the forth methods (P=0.91) Conclusion This BD-FACSPresto POC system is a simple, robust and reliable system for enumeration of absolute and percentage of CD4+ T-lymphocytes especially suitable for remote areas with limited resources. Having one BD-FACSPresto POC system easy to use, should reduce the cost and thus increase and improved access to CD4 testing for HIV infected patients in resource-constrained countries. BD-FACSPresto POC CD4 will enable reduction in patient time and improve the overall quality of ART service count and may improve test access in remote areas. This technology can allow for greater decentralization and wider access to CD4 testing and ART

scholarly journals Comparison of Blood Gas Analysis between Benchtop and Handheld Device

2020 ◽  
Vol 27 (1) ◽  
Author(s):  
Phey Liana ◽  
Iza Netiasa Haris ◽  
Yan Effendi Hasyim
Keyword(s):  
Clinical Decision Making ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
P Value ◽  
Strong Positive Correlation ◽  
Blood Gas ◽  
Cross Sectional ◽  
Handheld Device ◽  
Arterial Blood ◽  
Significant Difference

The use of blood gas analysis is to determine the Acid-base status required to treat patients with emergency conditionssuch as metabolic disorders and respiratory diseases. Benchtop device is commonly used in hospitals to analyze blood gas;however, handheld devices are recently more often used in emergency settings due to its quick and simple process. Thisstudy was performed to compare blood gas analysis results between the i-STAT handheld device and the Nova pHox Ultrabenchtop device that were currently being used in the central laboratory. This cross-sectional study was conducted by using42 arterial blood patients that were measured with i-STAT handheld device dan Nova pHox Ultra benchtop device. The pH,pCO2, and pO2 parameters were then evaluated. The data were analyzed using Spearman's correlation test, Mann-Whitneytest, and Bland-Altman plots. This study showed a very strong positive correlation for all parameters. Mann-Whitneycomparison test showed that there was no significant difference between the result of the two devices (p-value > 0.05). Allparameters showed that 95% of plots were within the acceptable limit. There was no clinical significance on the mean biasesof blood gas results between both devices. The i-STAT and Nova pHox Ultra devices showed a good agreement for bloodgas measurement. Therefore, both devices can be used interchangeably with minimal effect on clinical decision-making.

Relationship of Psychological well-being with Depression and Anxiety among Heart Patients

2021 ◽  
Vol 15 (11) ◽  
pp. 3101-3102
Author(s):  
Babar Javaid ◽  
Abrar Ahmed ◽  
Gohar Ali Arshad ◽  
M Shoaib Akhtar ◽  
Shazia Taj ◽  
...  
Keyword(s):  
Null Hypothesis ◽  
Well Being ◽  
Military Hospital ◽  
P Value ◽  
Depression And Anxiety ◽  
Psychological Well Being ◽  
Heart Patients ◽  
Significant Difference ◽  
Relationship Of ◽  
The Relationship

The study was designed to investigate the relationship of psychological well-being with depression and anxiety among heart patients.1 For this purpose, a sample of 200 patients was taken, including 100 men and 100 women, educated uneducated, employed and unemployed volunteers. The sample was taken from Nishtar Hospital, Combined military hospital and other private hospitals in Multan. The age range from 25 to 60 (mean age 43.085).2,3 Objective: To observe the effect of demographic variables (age, education, gender and source of finance) on psychological well-being and depression, anxiety in heart patients. Methods: 1. Low psychological well-being would be positively correlated with depression and anxiety. 2. Older age (above 50) heart patients would have low sense of psychological well-being as compared to younger age (above 35) heart patients. Results: Different statistical procedures were used to determine the relationship of psychological well-being with depression and anxiety among heart patients. Correlation was computed to see the relationship among variables. It was found that there is negative correlation between psychological well-being with depression and anxiety. Since the p-value in less than α (p-value < 0.01), so we reject null hypothesis Ho, and conclude that low psychological well-being is positively correlated with depression and anxiety. Conclusion: This study also finds out important findings on the role of stresses, feeling of worthlessness in depression and anxiety disorder. It is concluded that psychological well-being, depression and anxiety are not significant correlated with each other. Source of income or job and sex of the heart patients have significant effect on psychological well being. However there is no significant difference between men and women regarding the rate of depression and anxiety. Keywords: P-Value, Correlation, Null Hypothesis , Depression

The Relationship between the Type of Milk Consumed and the Risk of Kidney Stones in Children Under Two Years of Age

2021 ◽  
Author(s):  
Hamideh Shajari ◽  
Ahmad Shajari ◽  
Mohammad Golshan Tafti ◽  
Reza Samaninejad
Keyword(s):  
Kidney Stones ◽  
Statistical Significance ◽  
Cow Milk ◽  
Control Group ◽  
P Value ◽  
Case Group ◽  
Growth Disorders ◽  
Formula Milk ◽  
Significant Difference ◽  
Duration Of Breastfeeding

Background: Kidney stones are one of several serious health problems in childhood that cause nutritional and growth disorders, and may finally lead to chronic kidney failure in this group. Methods: In this analytical study conducted through a case-control design, 30 children under the age of two with kidney stones, and 125 children of the same age and sex without stones were studied. Patient information including personal profile and the results of some necessary tests were extracted from patient records and listed in a checklist. The data was analyzed using SPSS (Version 17.0). Statistical significance was considered when p-value was <0.05. Results: In terms of duration of breastfeeding, a significant difference was observed between the patients with stones and patients without stones; the duration of breastfeeding was longer in the control group (p=0.003). In addition, the duration of feeding with formula milk and cow milk was longer in the case group (p=0.038 and p=0.012, respectively). Conclusion: Breastfeeding can serve as a nutritional factor that plays a preventive and protective role against the formation of kidney stones in infants.

scholarly journals Population-based survey of HIV sero-status and vertical transmission among naive pregnant women in Sokoto, Nigeria

2014 ◽  
Vol 6 (3) ◽  
pp. 49-57 ◽  
Author(s):  
Fiekumo Igbida Buseri ◽  
Charity Ngozi Okonkwo
Keyword(s):  
Antiretroviral Therapy ◽  
Pregnant Women ◽  
Vertical Transmission ◽  
Statistical Significance ◽  
Demographic Data ◽  
Age Groups ◽  
P Value ◽  
Full Time ◽  
Cross Sectional ◽  
Significant Difference

Background: This study aims at investigating the seroprevalence of HIV infection among status naive pregnant women and probable vertical transmission in Sokoto, Nigeria.Materials and Methods: This cross-sectional study examined 13,026 apparently healthy pregnant women aged between 14 and 45 years and 312 mother-baby pairs in 4 different hospital settings in Sokoto State, North West, Nigeria between March, 2011 and February, 2013. The babies were aged between 8 and 16 months. HIV screening was performed using qualitative rapid tests and ELISA and HIV-DNA polymerase chain reaction (PCR) techniques. Measurement of CD4+ T-lymphocytes was carried out by the BD FACScount System. All seropositive pregnant women were immediately placed on triple antiretroviral therapy (ART) throughout the duration of the pregnancy and beyond.Results: An overall 2.4% prevalence of HIV-1 infection among the pregnant women and 20.5% incident of mother-to-child transmission were found. Of the seropositive pregnant women, 75.0% were full-time house wives, 13.8% and 11.2% were traders and civil servants respectively; of which, 70.2% were within the ages of 14 and 27 years (youthful predominance). Pearson’s χ2analysis did not show any statistically significant difference in the Mean values in the 4 health facilities (χ2 =2.084, df=3, P-value=0.555). Similarly, no significant difference in HIV seropositivity in the demographic data of the pregnant women were observed (P>0.05). Infection was recorded in all age groups but there was no statistical significance between age groups and infection (P = 0.833). Of the 64 seropositive babies, 62 (92.5%) contracted HIV from antiretroviral therapy non-adherence mothers (χ2 =271.457, df=1, P<0.01), OR=1506.6 (95%CI=285.5-7950.4). Conclusion: This study found high prevalence of vertical transmission due to ART non-adherence. Intervention initiatives should, therefore, focus seriously on ART non-adherence. DOI: http://dx.doi.org/10.3126/ajms.v6i3.11530Asian Journal of Medical Sciences Vol.6(3) 2015 49-57  

scholarly journals Performance and Return to Sport After Hip Arthroscopic Surgery in Major League Baseball Players

2019 ◽  
Vol 7 (2) ◽  
pp. 232596711982583 ◽  
Author(s):  
Robert A. Jack ◽  
Kyle R. Sochacki ◽  
Takashi Hirase ◽  
Justin Vickery ◽  
Patrick C. McCulloch ◽  
...  
Keyword(s):  
Major League Baseball ◽  
Statistical Significance ◽  
Arthroscopic Surgery ◽  
Return To Sport ◽  
Control Group ◽  
P Value ◽  
Postoperative Performance ◽  
Significant Difference ◽  
Major League ◽  
And Performance

Background: Femoroacetabular impingement (FAI) is a common cause of hip pain that may lead to decreased performance in Major League Baseball (MLB) players. Purpose: To determine the (1) return-to-sport (RTS) rate in MLB players after hip arthroscopic surgery for FAI; (2) postoperative career length, innings pitched (IP) (pitchers), and plate appearances (PA) (position players); (3) preoperative and postoperative performance; and (4) postoperative performance compared with control players matched by position, age, years of experience, and performance. Study Design: Cohort study; Level of evidence, 3. Methods: MLB athletes who underwent hip arthroscopic surgery for FAI and matched controls were identified. Demographic and performance data were collected. RTS was defined as playing in at least 1 MLB game after surgery. Continuous variables of each group were compared using a 2-tailed paired-samples Student t test for normally distributed data. The chi-square test was used to analyze categorical data. The Bonferroni correction was used to control for multiple comparisons, with statistical significance defined by a P value of ≤.007. Results: A total of 50 players (57 surgeries) were analyzed (mean age, 30.4 ± 3.9 years; mean MLB experience at the time of surgery, 7.0 ± 4.6 years). Pitchers (31 surgeries; 54.4%) represented the largest proportion of players analyzed. Of these players, 42 (47 surgeries; 82.5%) were able to RTS at a mean of 8.3 ± 4.1 months. The overall 1-year MLB career survival rate of players undergoing FAI surgery was 78.9%. Players in the control group were in MLB a similar number of years (4.0 ± 2.9 years) to players who underwent surgery (3.3 ± 2.4 years) ( P > .007). There was no significant decrease in IP or PA per season after surgery ( P > .007). There was no significant difference in performance for pitchers and nonpitchers compared with matched controls after surgery ( P > .007). Conclusion: The RTS rate for MLB athletes after hip arthroscopic surgery for FAI was high. There were similar IP, PA, and career lengths postoperatively compared with preoperatively and with matched controls. There was no significant difference in performance for pitchers and nonpitchers compared with matched controls after surgery.

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