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Biomedical subjects

A Ross

Publications and source records attributed to A Ross.

At least 109 records · Page 6Linked to original sources
PubMed1996

A comparative study of laparoscopy and colpotomy for the removal of ovarian dermoid cysts.

OBJECTIVE: To compare laparoscope-assisted transvaginal removal of dermoid cysts to more standard laparoscopic cystectomy techniques. METHODS: We conducted a retrospective review of 44 laparoscopic dermoid removals performed at Olive View-UCLA Medical Center between 1992 and 1995. Cases were divided into three groups based on surgical approach: 1) conventional laparoscopic ovarian cystectomy, 2) laparoscopic ovarian cystectomy and removal of the freed mass via colpotomy, and 3) laparoscopic inspection, then transvaginal cystectomy via colpotomy. Surgical time, estimated blood loss, cyst spillage, and complications were compared. RESULTS: There were 11-19 patients in each group. The groups were similar in patient age, parity, and weight. Larger cysts tended to be removed by the laparoscopy-colpotomy techniques (mean diameter 10 cm) rather than by the purely laparoscopic approach (mean diameter 7 cm, P < .05). Cyst spillage occurred less often (43%, P < .05) and surgical time was shortest (mean 81 minutes, P < .05) with laparoscope-assisted transvaginal ovarian cystectomy compared with conventional laparoscopic techniques. Disposable laparoscopic instruments were used less often with transvaginal cystectomy (7%) than with conventional laparoscopic cystectomy (77%, P < .01). The difference in mean estimated blood loss in the cases using colpotomy (89 mL) compared with cases that did not (65 mL) was not statistically significant. Among the three groups, there were four major operative complications related to blood loss and infection. CONCLUSION: Laparoscope-assisted transvaginal ovarian cystectomy allows the removal of larger dermoid cysts, with less cyst spillage and savings in operative time and equipment compared with conventional laparoscopic cystectomy.

Adult↗
PubMed1996

A menopause-specific quality of life questionnaire: development and psychometric properties.

OBJECTIVE: To develop a condition-specific quality of life questionnaire for the menopause with documented psychometric properties, based on women's experience. METHODS SUBJECTS: Women 2-7 years post-menopause with a uterus and not currently on hormone replacement therapy. Questionnaire development: A list of 106 menopause symptoms was reduced using the importance score method. Replies to the item-reduction questionnaire from 88 women resulted in a 30-item questionnaire with four domains, vasomotor, physical, psychosocial and sexual, and a global quality of life question. Psychometric properties: A separate sample of 20 women was used to determine face validity, and a panel of experts was used to confirm content validity. Reliability, responsiveness and construct validity were determined within the context of a randomized controlled trial. Construct validation involved comparison with the Neugarten and Kraines'Somatic, Psychosomatic and Psychologic subscales, the reported intensity of hot flushes, the General Well-Being Schedule, Channon and Ballinger's Vaginal Symptoms Score and Libido Index, and the Life Satisfaction Index. RESULTS: The face validity score was 4.7 out of a possible 5. Content validity was confirmed. Test-retest reliability measures, using intraclass correlation coefficients were 0.81, 0.79, 0.70 and 0.55 for the physical, psychosocial, sexual domains and the quality of life question. The intraclass correlation coefficient for the vasomotor domain was 0.37 but there is evidence of systematic change. Discriminative construct validity showed correlation coefficients of 0.69 for the physical domain, 0.66 and 0.40 for the vasomotor domain, 0.65 and -0.71 for the psychosocial domain, 0.48 and 0.38 for the sexual domain, and 0.57 for the quality of life question. Evaluative construct validity showed correlation coefficients of 0.60 for the physical domain, 0.28 for the vasomotor domain, 0.55 and -0.54 for the psychosocial domain, 0.54 and 0.32 for the sexual domain, and 0.12 for the quality of life question. Responsiveness scores ranged from 0.78 to 1.34. CONCLUSIONS: The MENQOL (Menopause-Specific Quality of Life) questionnaire is a self-administered instrument which functions well in differentiating between women according to their quality of life and in measuring changes in their quality of life.

Attitude to Health↗
PubMed1996

Physician compensation models in medical group practice.

This article examines physician compensation models in medical groups and the factors affecting physician compensation and their impact on individual physician behavior and group practice performance. Four categories of physician compensation models are identified: (1) production-based compensation, (2) salary, (3) group-based compensation unrelated to individual physician productivity, and (4) capitation-based compensation. The statistics and the economic incentives of different compensation methods are presented. Finally, the impacts on health resources consumption, charges in medical group procedures for utilization and care management, and quality of care are discussed.

Economic Competition↗
PubMed1996

A review of eclampsia in Melbourne: 1978-1992.

A retrospective review of all cases of eclampsia diagnosed at 3 obstetric teaching hospitals in Melbourne from January, 1978 to December, 1992 was undertaken. Ninety cases were identified; there were 5 maternal deaths and 17 perinatal deaths. Severe maternal morbidity such as pulmonary oedema, acute renal failure or HELLP syndrome was found in 26%. Significant maternal thrombocytopenia (< 100 x 10(9)/L) was found in 50% and 35% had abnormal maternal liver function tests. Forty six women received magnesium sulphate for treatment of eclampsia and of these 3 had further seizures compared to 4 of 18 who received phenytoin (odds ratio 0.24 (0.04-1.52) X2, p = 0.09). Eclampsia remains a significant complication of pregnancy with high maternal and perinatal mortality and morbidity. Results of this study show a trend that is in agreement with recent randomized controlled trials which demonstrate a reduced incidence of seizures and maternal and fetal complications with the use of magnesium sulphate. The results of these recent trials suggest that magnesium sulphate should be the drug of choice in the prevention and treatment of eclampsia.

Anticonvulsants↗
PubMed1996

Helicobacter pylori and socioeconomic factors in Russia.

BACKGROUND: The factors influencing the acquisition and prevalence of Helicobacter pylori infection remain incompletely understood. In Russia, the demographic and socioeconomic factors are relatively similar, allowing investigation of risk factors that might not be identifiable in a more diverse population. MATERIALS AND METHODS: Sero-prevalence of H. pylori infection was studied in 520 asymptomatic individuals between the ages of 1 and 75 years, residing in St. Petersburg, Russia. Forty-four children lived in orphanages or communal apartments. Demographic information and socioeconomic factors were evaluated, including educational level, income, and living conditions. Helicobacter pylori status was evaluated by using an enzyme-linked immunosorbent assay for anti-H. pylori IgG. RESULTS: The prevalence of H. pylori infection was 44% in children and 88% in adults (P < .001). In adults, H. pylori prevalence was independent of socioeconomic factors. The crude and the age-adjusted odds ratios (ORs) in children showed an inverse correlation between the mother's educational level and H. pylori seropositivity [e.g., OR, 1.8; (95% confidence interval (CI) = 1-3.2] for children whose mothers completed only 8 to 10 years of school compared to children whose mothers completed university. Overcrowding in childhood also was associated with increased H. pylori prevalence. Children from orphanages and communal apartments had the highest crowding index and also were at the greatest risk for H. pylori acquisition (age-adjusted OR, 2.1; 95% CI = 1.2-2.5). CONCLUSIONS: The prevalence of H. pylori infection in Russia correlated with socioeconomic factors, suggesting there are differences sufficient to affect H. pylori transmission. The prevalence of H. pylori infection during childhood forms the basis for the variances in prevalence among populations.

Adolescent↗
PubMed1996

Longitudinal studies of Giardia contamination in two community drinking water supplies: cyst levels, parasite viability, and health impact.

Giardia cyst concentrations were determined in an inventory of 153 raw and 91 chlorinated drinking water samples collected at 86 sites from throughout the western Canadian province of British Columbia. Sixty-four percent of raw water samples were cyst positive (69% of sites). Cyst concentrations were lower in chlorinated than in raw water. The viability of cysts in drinking water samples assessed by infectivity in Mongolian gerbils (Meriones unguiculatus) was decreased in chlorinated water. Two rural communities using Giardia-contaminated surface drinking water sources were selected for longitudinal studies including drinking water testing and serological studies of residents. Three hundred thirty-six raw and treated samples from these communities were collected over 24 months. Cyst concentrations and viability were assessed in a 12-month study of each community. Parasite concentrations were lower in chlorinated water than in raw water in both communities. Cyst concentrations were lower in reservoir-settled water than in raw water. Viability, assessed by animal infectivity and corrected for inoculum, decreased following reservoir settling as well as after chlorination. A bolus or spiking phenomenon of cysts was observed in both community drinking water systems and deserves further study. A striking seasonal pattern was seen in one community but not in the second. The seroprevalence data and number of laboratory-confirmed cases identified in each year-long community study are consistent with the possibility that low-level endemic transmission is occurring.

Adult↗
PubMed1996

Studies of Giardia spp. and Cryptosporidium spp. in two adjacent watersheds.

Two adjacent British Columbia, Canada, watersheds with similar topographical features were studied. Both the Black Mountain Irrigation District (BMID) and the Vernon Irrigation District (VID) serve rural agricultural communities which are active in cattle ranching. The present study was carried out in five phases, during which a total of 249 surface water samples were tested in the study watersheds. The aims of these phases were to determine levels of parasite contamination in raw water samples collected from the intakes as well as from other sites in each watershed and to investigate cattle in the watersheds as potential sources of parasite contamination of surface drinking water supplies. Giardia cysts were not detected in the raw water samples collected from lake sources at the headwaters of both watersheds but were found in 100% (70 or 70) of water samples collected at the BMID intake and 97% (68 of 70) of water samples collected at the VID intake. Significantly higher levels (P < 0.05) of Giardia cysts were found at the BMID intake (phase 1, 7 to 2,215 cysts per 100 liters; phase 3, 4.6 to 1,880 cysts per 100 liters) when compared with that of the VID intake (2 to 114 cysts per 100 liters). The BMID watershed has a more complex system of surface water sources than the VID watershed. Cattle have access to creeks in the BMID watershed, whereas access is restricted in the VID watershed. Collection of raw water samples from a creek upstream and downstream of a cattle ranch in the BMID watershed showed that the downstream location had significantly higher (P < 0.05) levels (0.6 to 42.9 cysts per 100 liters and 1.4 to 300.0 oocysts per 100 liters) of both Giardia cysts and Cryptosporidium oocysts than those of the upstream location (0.5 to 34.4 cysts per 100 liters and 0.5 to 34.4 oocysts per 100 liters). Peak concentrations of both parasites coincided with calving activity. Fecal samples, collected from cattle in both watersheds, showed 10% (3 of 30) in the BMID and 50% (5 of 10) in the VID watersheds to be Giardia positive. No Cryptosporidium-positive fecal samples were found. Giardia cysts isolated from the BMID watershed were repeatedly infective to gerbils in contrast to those from the VID watershed. The 10 BMID drinking water Giardia isolates retrieved into culture and biotyped showed zymodeme and karyotype heterogeneity. The differences in patterns of parasite contamination and cattle management practices contribute to the unique watershed characteristics observed between two areas which are topographically similar and geographically adjacent.

Animals↗
PubMed1996

Maternal HIV and drug use: effect on health and social morbidity.

A retrospective analysis of routine child health surveillance information was performed on health visitor records of 459 children, to examine the independent effects of maternal HIV infection and drug use during pregnancy on morbidity in the first 3 years of life. No significant differences were observed in the developmental progress of children born to HIV infected or drug using women when compared to community controls. The pattern of medical consultations in the first 18 months of life was significantly different, maternal drug use exerting a negative influence on outpatient visits (odds ratio 0.6, 95% confidence interval 0.4 to 1.0). At 6 weeks, the majority of children lived with their birth parent(s), and no differences were observed between the groups. By 10 months of age, only 81% of children born to HIV infected drug using women lived with their parent(s). While maternal drug use and HIV did not have adverse effects on child health and development, these findings highlight the social implications for children affected by the heterosexual spread of HIV.

Adult↗
PubMed1996

The contribution of missed opportunities to childhood underimmunization in Baltimore.

OBJECTIVE: To determine the community-wide incidence of missed opportunities to vaccinate, to describe the clinical settings in which they occur, and to estimate the impact of missed opportunities on immunization coverage. DESIGN AND METHODS: We abstracted outpatient medical records from a random, community-based sample of 2-year-old children whose residence was inner-city Baltimore. The date of each vaccine and the date, diagnoses, and temperature at each visit were collected for 502 children at 98 different provider sites. MAIN OUTCOME MEASURES: Missed opportunities to vaccinate and up-to-date vaccination status. RESULTS: By 24 months of age, 75% of the children had at least one missed opportunity and only 55% were up-to-date for the 4:3:1 series. Missed opportunities occurred at more than one third of eligible visits for each vaccine, including > 20% of preventative care visits. Diagnoses commonly associated with missed opportunities were "well child," otitis media, upper respiratory infection, gastroenteritis, skin infection, and resolving illness. If no missed opportunities had occurred, 73% of the children would have been up-to-date by 24 months. CONCLUSIONS: Missed opportunities occurred commonly at providers serving inner-city children in Baltimore and represent a major factor in underimmunization. Reduction of missed opportunities by accurate screening at all visits and adherence to the contraindication guidelines is a provider-based, low-cost method to increase immunization coverage.

Baltimore↗
PubMed1996

Managing care, incentives, and information: an exploratory look inside the "black box" of hospital efficiency.

OBJECTIVE: We sought to estimate the impact of individual dimensions of hospitals' managed care strategies on the cost per hospital discharge. STUDY SETTING/DATA SOURCES: Thirty-seven member hospitals of seven health systems in the Pacific, Rocky Mountain, and Southwest regions of the United States were studied. STUDY DESIGN: Separate cross-sectional regression analyses of 21,135 inpatient discharges were performed in 1991 and 23,262 discharges in 1992. The multivariate model was estimated with hospital cost per discharge as the dependent variable. Model robustness was checked by comparing regression results at the individual discharge level with those at the level of the hospital/clinical condition pair. DATA COLLECTION/EXTRACTION METHODS: Information on hospitals' managed care strategies was provided by mail and phone survey of key informants in 1991 and 1992. Other hospital characteristics were collected from AHA Annual Survey data, and discharge data from hospital abstracting systems. PRINCIPAL FINDINGS: The pooled discharge analysis indicated three dimensions of hospital managed care strategy that consistently related to lower costs per hospital discharge: the proportion of hospital revenues derived from per case or capitation payment, the hospital's mechanisms for sharing information on resource consumption with clinicians, and the use of formalized, systematic care coordination mechanisms. CONCLUSIONS: Three strategies appear to hold promise for enhancing the efficiency of inpatient resource use: (1) "fixed price" hospital payment incentives, (2) hospital approaches to sharing resource use information with clinicians, and (3) the application of formal care management mechanisms for specific clinical conditions.

Aged↗
PubMed1996

Lothian general practitioners, HIV infection and drug misuse: epidemiology, experience and confidence 1988-1993.

BACKGROUND: Lothian has a high prevalence rate of HIV infection associated particularly with injecting drug use in the mid-1980s. During the late 1980s a number of services were introduced to support general practitioners to care for drug users and people with HIV infection. AIM: To ascertain the practice distribution of patients with HIV infection and drug users, and the experience and confidence of Lothian GPs in a number of HIV and drug related tasks, and to see how these changed over a five year period after the introduction of support services. METHOD: Information about practice distribution of patients with HIV infection and drug users and information about GP experience and confidence was obtained from a survey of individual GPs in 1988. Two practice surveys in 1991 and 1993, using a chosen GP for each practice, gave information about practice distribution of people with HIV infection and drug users, while a second survey of individual GPs in 1993, concentrating on GP experience and confidence, acted as a follow up to the 1988 survey. RESULTS: GPs are in touch with an increasing number of people with symptomatic HIV infection. They are increasingly involved and confident in caring for drug users. Offering support and training to GPs appears to have encouraged their involvement. There are a significant number of people with HIV infection in Lothian who are not known to GPs or to hospital services. A combination of practice and individual GP surveys was found to provide the most reliable information. It is planned to repeat the practice survey in 1995.

Attitude of Health Personnel↗
PubMed1996

Y chromosome microdeletions and male subfertility.

Men with azoospermia and severe oligozoospermia have been investigated by molecular probing of the long arm of the Y chromosome. We find microdeletions affecting various parts of the long arm of the Y chromosome in approximately 10% of men with non-obstructive azoospermia and severe oligozoospermia but not in a fertile comparison population. This work needs further confirmation in different countries and different racial groups but it would appear that microdeletions (and presumably genetic defects) are commonly associated with defects of spermatogenesis. These findings have implications for the management of severe male subfertility with in vitro fertilization/intracytoplasmic sperm injection.

Case-Control Studies↗
PubMed1996

Black-white difference in oral hygiene performance test scores. A preliminary finding.

This paper describes OHPT (Oral Hygiene Performance Test) which was used to measure race differences between African-American and European-American elderly 65 years old and above in performance of daily oral hygiene activities. A total of 80 community-dwelling subjects of which 43 were African-American and 37 European-American participated in the study which involved completion of a battery of functional status measurements including the OHPT. The instrument detected differences in performance as recorded by the length of time to complete each of the 17-items of OHPT. The instrument, the Oral Hygiene Performance Test, is a direct observation measure which objectively quantifies the ability to perform oral hygiene and thus reduces subjective evaluation.

Activities of Daily Living↗
PubMed1995

Subnuclear localization of WT1 in splicing or transcription factor domains is regulated by alternative splicing.

WT1 is a tumor suppressor gene with a key role in urogenital development and the pathogenesis of Wilms' tumor. Two alternative splice sites in the WT1 transcript allow the gene to encode four proteins. These carry four Krüppel-type zinc fingers and to date have primarily been implicated in transcriptional control of genes involved in growth regulation. However, here we demonstrate colocalization of WT1 with splicing factors in the fetal kidney and testis and in expressing cell lines. Using immunoprecipitation, we show that two WT1 isoforms directly associate with one or a limited number of components in the spliceosomes and coiled bodies. Moreover, COS cell expression studies suggest that alternative splicing within the WT1 zinc finger region determines whether the protein localizes mainly with splicing factors or with DNA in transcription factor domains in the nucleus. We propose that WT1 plays roles in posttranscriptional processing of RNA as well as in transcription.

Alternative Splicing↗
PubMed1995

Surface-associated proteins from Staphylococcus aureus demonstrate potent bone resorbing activity.

Staphylococcus aureus infections are associated with rapid bone destruction in conditions such as osteomyelitis, bacterial arthritis, and infected orthopedic implant failure. How this bacterium induces bone destruction has not been defined. In studies of the role of oral Gram-negative bacteria in periodontal pathology, we have established that cell surface-associated proteins (SAPs) are potent stimulators of bone resorption. The surface-associated components from S. aureus have now been isolated and demonstrated to be extremely potent stimulators of bone resorption in the murine calvarial bone resorption assay. Bone resorption appears to be due to proteins, is not the result of contamination with lipoteichoic acid or muramyl dipeptide, and is potently inhibited by indomethacin and can be completely blocked by high concentrations of interleukin-1 receptor antagonist or TN3-19.12, a neutralizing monoclonal antibody to murine TNF. The SAP fraction can stimulate fibroblasts or monocytes to release osteolytic cytokines, but only at high concentrations. Fractionation of the SAPs by high performance liquid chromatography demonstrated that a number of fractions were osteolytically active. The most active contained a heterodimeric protein of molecular weight 32-36 kD. The presence of this osteolytically active surface-associated fraction may account for the bone resorption associated with local infection with S. aureus.

Animals↗
PubMed1995

Treatment with thyrotropin-releasing hormone (TRH) in patients with traumatic spinal cord injuries.

Numerous preclinical studies have demonstrated that posttraumatic treatment of spinal cord injury (SCI) with thyrotropin-releasing hormone (TRH) or TRH analogs improves long-term behavioral recovery. The purpose of the present study is to provide preliminary data regarding the safety and potential efficacy of TRH in patients with acute SCI. A total of 20 patients with SCI were classified by clinical examination into complete and incomplete injury groups within 12 h of trauma and randomly assigned in double-blinded fashion to treatment with either TRH (0.2 mg/kg intravenous bolus followed by 0.2 mg/kg/h infusion over 6 h) or vehicle (equal volume physiological saline) placebo. A variety of physiological variables were followed during treatment. Clinical examination included motor and sensory testing, as well as assigning a Sunnybrook score based upon level of function. Patients were examined at 24 h, 72 h, 1 week, 1 month, 4 months, and 12 months after injury. TRH infusions were well tolerated. There appeared to be no discernible treatment effect in patients with complete injuries although data were available from only six such patients at 4 months. For the incomplete injury group, a total of 6 treated and 5 placebo patients had 4-month evaluations. TRH treatment was associated with significantly higher motor, sensory, and Sunnybrook scores than placebo treatment. Because of patients lost to subsequent follow-up, 12-month data were not highly informative. These observations must be interpreted with considerable caution because of the small patient numbers, but together with extensive animal studies they support the need for a larger multicenter clinical trial of TRH.

Adult↗
PubMed1995

Management of sharps injuries and contamination incidents in health care workers: an audit in the Wessex and Oxford regions.

Fifteen NHS occupational health departments from the Wessex and Oxford regions took part in an audit of the management of sharps injuries and contamination incidents. Data were collected prospectively for a series of 1102 incidents notified over a nine-month period. The rates of notified incidents for each department ranged from 9 to 44 incidents per 1000 staff members per year. The proportion of injured employees who were naturally immune to hepatitis B or had completed a full course of vaccination against the infection ranged from 57 to 83%, with the main shortfall occurring in ancillary workers. Some departments rarely stored source serum, while others did so in the majority of cases. The proportion of cases where the injured person was known to have had hepatitis B antibody levels > 100 IU/l within the past 12 months, or underwent immediate antibody assessment or had an immediate vaccination against hepatitis B varied from 26 to 97%, with a median of 68%. On the basis of these findings, the audit group has set targets against which performance will be re-assessed in a follow-up exercise.

Accidents, Occupational↗