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Biomedical subjects

B W Brown

Publications and source records attributed to B W Brown.

At least 109 records · Page 6Linked to original sources
PubMed1985

Chronic disease and health system performance. Care of osteoarthritis across three health services.

Care of patients with osteoarthritis is compared for three different types of health service: fee-for-service, prepayment (Kaiser Health Plan), and an experimental service (Midpeninsula Health Service--MHS). While charging fees-for-service, MHS modifies medical practice in defined ways and seeks to involve patients through supervised self-care. Volunteer panels of patients provide the data at 6-month intervals through self-administered questionnaires. This report covers the first 18 months. Health status has not changed. Annualized utilization data, adjusted for age, income, education, pain, disability, disease duration, and prescription drug use, indicate that MHS members have fewer physician visits, fewer diagnostic tests, and lower antiinflammatory drug use than the other two services. MHS members express satisfaction equal to or greater than other participants. The results suggest that, in addition to modified financial incentives, there is another strategy that is relevant to achieving effective, efficient, and satisfying health care.

Aged↗
PubMed1985

A workplace health education program that reduces outpatient visits.

A workplace health education program aimed at reducing unnecessary outpatient visits was offered through 22 California employers. A total of 5,200 employees attended a presentation, received self-help books, and completed self-administered questionnaires. All visits for their households were monitored for up to 15 months. The study utilized a quasi-experimental staggered intervention design involving eight different cohorts, before/after comparisons, with statistical adjustment for seasonality and other intervening variables. Visit rates for households insured only by Blue Cross of California were reduced by 17% (P = 0.001), or 2.0 visits per household per year. For all participants, the reduction was 7.2% (P = 0.06), or 0.8 visits. Reductions were seen for all age and educational strata. The program was most effective among households with first dollar fee-for-service insurance coverage. Households with insurance requiring co-payments had less reduction. No reduction was seen among health maintenance organization (HMO) members. The study concludes that a minimal cost, self-care workplace intervention can reduce outpatient visits by important magnitudes.

Adult↗
PubMed1985

Occupational exposure to mercury in dentistry and pregnancy outcome.

A questionnaire was mailed to dentists and dental assistants requesting information about work, health, and reproductive history. Statistical analysis of the data indicated that there were no increased rates of spontaneous abortions or congenital abnormalities in the children of men and women who were exposed to low versus high levels of mercury in a dental environment.

Abnormalities, Drug-Induced↗
PubMed1985

Efficacy of total lymphoid irradiation in intractable rheumatoid arthritis. A double-blind, randomized trial.

Twenty-six patients participated in a randomized, double-blind study of the efficacy of total lymphoid irradiation in the treatment of intractable rheumatoid arthritis. All 26 patients, for whom therapy with gold compounds and penicillamine had failed, would ordinarily have been considered candidates for cytotoxic or antimetabolite drug therapy. Thirteen patients randomly assigned to receive full-dose total lymphoid irradiation (2000 rad) and 11 patients assigned to receive control low-dose total lymphoid irradiation (200 rad) completed radiotherapy. Alleviation of joint disease activity was significantly greater in the high-dose group as judged by morning stiffness, joint tenderness, and functional assessment (global composite score) at 3 and 6 months after radiotherapy. The high-dose group had a marked reduction in both T-lymphocyte function and numbers, but this finding was not observed in the low-dose group. Complications seen in the high-dose but not low-dose group included transient neutropenia, thrombocytopenia, pericarditis, and pleurisy.

Adult↗
PubMed1985

Capillary blood flow in the endometrium and myometrium of conscious sheep: effect of catheterization of uterine arteries.

Measures of capillary blood flow in the uterine tissues of conscious ewes were obtained by the use of microspheres. Total uterine capillary blood flow was significantly greater (P less than 0.01) at oestrus than at day 8 of the oestrous cycle [69.5 +/- (s.e.m.) 11.9, cf. 15.3 +/- 1.2 ml min-1, n = 7], reflecting increases of a similar order in both the endometrium and the myometrium. At these stages of the oestrous cycle, endometrial capillary blood flow constituted 83.6 and 80.5%, respectively, of the total uterine capillary flow. Following the placement of indwelling catheters in each middle uterine artery there was a decrease in the ratio of endometrial to myometrial capillary blood flow for 3-5 days.

Animals↗
PubMed1985

Confidence limits for probability of response in multistage phase II clinical trials.

Herson (1979, Biometrics 35, 775-783) has given a method for designing one-arm k-stage phase II clinical trials, which permits early termination of the trial if the treatment is apparently ineffective, while retaining acceptable levels of power and significance. This paper gives a method for calculating the confidence limits on the response proportion, conditional on a particular study design.

Drug Evaluation↗
PubMed1984

Effects of ovarian hormones on ovarian capillary blood flow in anoestrous ewes.

The indicator fractionation technique with [86Rb]rubidium chloride as the indicator was used to determine the relative blood flow (RBF) as a measure of capillary blood flow in the ovaries of conscious, hormonally treated, anoestrous ewes. Treatment of ewes with either progesterone only or oestradiol only had no effect on ovarian RBF, but treatment with oestradiol subsequent to progesterone caused a significant increase (P less than 0.001). Consequently, it appears that progesterone-induced sensitivity of the ovarian vasculature to the vasodilatory effects of oestradiol may be responsible for increased ovarian blood flow around oestrus in cyclic ewes.

Anestrus↗
PubMed1984

Estimation of human tumor growth rate from distribution of tumor size at detection.

Methods are presented for estimating the growth curve of a tumor (up to an unknown scale factor of time) from the distribution of volumes at detection on the basis of two assumptions: 1) the existence of a common growth curve and 2) the assumption that the probability of detecting a tumor in a period of time is proportional to the tumor volume. These methods can accommodate variation between individuals in speed of traversal of the growth curve. The methods are applied to volumes of tumor at detection of a large series of breast cancers. The simplest, adequate description is exponential growth with great individual-to-individual variation in tumor doubling time. The data are consistent with bounded growth (Gompertzian or logistic form) as well as exponential growth. However, there is no evidence that the bound on growth is within the range of the data. The shape of the distribution of volumes does not yield an effective lower limit on such a bound.

Breast Neoplasms↗
PubMed1984

Immunologic responsiveness and safety associated with the Coccidioides immitis spherule vaccine in volunteers of white, black, and Filipino ancestry.

A trial of the killed Coccidioides immitis spherule vaccine was undertaken with 151 healthy skin test negative adult volunteers and controls to evaluate the safety of selected regimens, the induction of humoral and cell-mediated immune responses, and to determine if there were immunogenetic differences in these responses. The vaccine was given as three intra-deltoid doses over 8 weeks. No severe systemic symptoms were noted, although 3% of 3.5 mg doses (but no 1.75 mg doses) were associated with severe local reactions. Half the vaccinees had skin test conversions, which generally persisted greater than or equal to 6 months, two-thirds showed boosting of lymphocyte transformation in vitro, and 16% given three 3.5 mg doses developed antibody. There was an association between degree of local adverse vaccine reaction and immunostimulation, and a trend to immune response in persons of O blood type and with some HLA phenotypes. There was no evidence of deficient response to vaccination in subpopulations known to respond to coccidioidal infection poorly. A regimen of three 1.75 mg doses appears to be safe and without reduced immunogenicity, and there is no evidence dosage modification for certain subpopulations would be necessary in efficacy studies.

Adolescent↗
PubMed1983

Can patients with breast cancer be cured of their disease? A sample of the M. D. anderson Hospital experience.

Theories concerning cures for breast cancer vary from the concept that no patients are cured, to the idea that the hazard to patients who have survived eight years is no greater than that for the population as a whole. To test these concepts as well as our modification of the concept of cure, we assumed that a proportion (P) of the population of patients is cured and have the same mortality experience as that for the population as a whole. The remaining proportion Q = 1 - P experience mortality as do the population and also that due to cancer. The hazard rate due to cancer is assumed to be constant. When survival experience for the 804 female patients with breast cancer admitted during 1958 through 1960 and that predicted from our model are plotted, the fit is excellent, particularly for survivals up to 15 years. As to whether some patients with breast cancer are cured of their disease, the answer is yes, using our definition of cure.

Adult↗
PubMed1983

Treatment of acne vulgaris by biofeedback relaxation and cognitive imagery.

A multielement intervention involving biofeedback-assisted relaxation and cognitive imagery treatment of acne vulgaris was investigated in this study with 30 patients receiving medical dermatological treatment. Patients were matched on age, sex, and pre-treatment acne severity and randomly assigned to groups. Treatment consisted of 12 sessions over six weeks and resulted in a significant reduction in acne severity as compared to the attention-comparison and medical control groups. Treatment group patients continuing home practice until follow-up maintained their gains, whereas those who discontinued failed to maintain gains.

Acne Vulgaris↗
PubMed1983

The association of blood pressure and dietary alcohol: differences by age, sex, and estrogen use.

This paper presents the results of an analysis of dietary alcohol use and blood pressure in representative population samples from four northern California cities surveyed in 1979-1980 as part of the Stanford Five City Project. The pooled samples included 883 men and 959 women aged 20-74 who were not taking blood pressure medications. Blood pressure was obtained while seated using a standard manometer. Alcohol was assessed by self-report of usual intake. In men, age-specific analysis revealed a positive association between dietary alcohol and both systolic (SBP) and diastolic blood pressure (DBP). The association was linear in men aged 20-34 and 50-74 and was stronger in the oldest men. Both linear and quadratic terms were significant for men aged 35-49. This association remained significant in a linear regression model that included age, relative weight, income, education, physical activity, cigarette use, and untimed urinary sodium/creatinine; for alcohol in ml/day in men aged 50-74, beta = 0.21, p = 0.0001, R2 = 0.32 for SBP; beta = 0.09, p = 0.0002, R2 = 0.18 for DBP. In women, alcohol use was significantly associated with blood pressure only in those above age 49 and was more striking in those not taking estrogens; this association was also independent of the same variables listed above for men (beta = 0.43, p = 0.0001, R2 = 0.23 for SBP; beta = 0.17, p = 0.001, R2 = 0.13 for DBP). Multiple logistic analyses with hypertension as a dichotomous dependent variable and including all subjects showed similar results. These results could be due to any one or more of the following hypotheses: 1) a biologic response to alcohol in older men and in older women that is different from the response in younger persons; 2) a delayed effect of alcohol use on blood pressure; 3) effects of a different pattern of alcohol use in the different age groups; or 4) the presence of some unmeasured confounding factor in the older age groups.

Adolescent↗
PubMed1983

Effective participation in cooperative clinical trials by an independent community organization. An NCOG Model.

The NCCP has established a model for community involvement in study group clinical trials, based on the use of independent community groups as participating entities. The structure and operation of the Sacramento, California demonstration project are presented. Evaluation of the NCOG small cell lung cancer study 2061 reveals that the data submitted by the community group equalled or exceeded university-generated and group-wide data for evaluability, response rate, survival, and quality control.

Clinical Trials as Topic↗
PubMed1983

The effect of algorithms on the cost and quality of patient care.

In a Veterans Administration ambulatory care facility staffed by experienced nurse practitioners, we observed the length of visits, time utilization for various activities, and the use of diagnostic tests before and after introducing algorithms for 12 common chief complaints. Charges for diagnostic tests decreased as much as 40 per cent, primarily because of reduced utilization of radiographs such as spine films. Nurse practitioner productivity was unaffected once the nurse practitioners became familiar with the algorithms. Outcome of illness did not change measurably, but the process of care improved as reflected by more complete data collection documented in the medical record.

Ambulatory Care Facilities↗
PubMed1983

Reduced cardiotoxicity of doxorubicin delivered on a weekly schedule. Assessment by endomyocardial biopsy.

Endomyocardial biopsy was done 119 times in 98 patients receiving doxorubicin therapy once every 3 weeks and 41 times in 27 patients receiving doxorubicin therapy weekly. Factors contributing to the degree of anthracycline-induced endomyocardial injury were evaluated. Neither age, sex, type of malignancy, concomitant use of other chemotherapeutic agents including cyclophosphamide, nor history of cardiac disease or hypertension influenced the extent of the endomyocardial injury. The dose of doxorubicin (p = 0.0001) and the schedule (weekly versus 3 weekly) (p = 0.0020) independently predicted the degree of endomyocardial damage in multivariate analyses. Previous cardiac irradiation had borderline significance (p = 0.074) in predicting endomyocardial damage in this analysis. Doxorubicin therapy administered on a weekly schedule is associated with less anthracycline-induced cardiac damage than is doxorubicin therapy delivered in the conventional, 3-weekly schedule.

Adult↗
PubMed1982

The natural history of resectable metastatic melanoma (Stage IVA melanoma).

One-hundred-two patients with malignant melanoma who had distant metastases surgically resected and were judged to be clinically free of disease (M. D. Anderson Stage IVA melanoma) were studied. The median survival for all the patients from time of diagnosis of stage IVA disease was 18 months. The site of the resected metastases did not appear to influence survival, being approximately the same for the brain (15 months), lung (16 months), intraabdominal (18 months), and skin and/or lymph nodes (23 months). The site of the resected metastases also did not influence the median disease-free interval. Patients who had metastases resected from several organs at the same time had a median survival of 15 months, which was similar to that of patients with one resected site. Patients who were rendered Stage IVA on several occasions by surgical excisions had a median survival of 36 months. Thirty-five patients received surgery only and 67 patients received adjuvant chemotherapy, immunotherapy, or combined chemoimmunotherapy after surgery. For the group treated with surgery only, the median disease-free interval and survival from diagnosis of stage IVA disease were 6 months and 16 months, respectively, and for the adjuvant group 6 months and 21 months, respectively. Specifically, by the type of adjuvant therapy, the median disease-free interval and survival from stage IVA for 23 patients receiving Corynebacterium parvum were 6.9 and 19 months; for 39 patients receiving BCG, eight months and 26 months; for 24 patients receiving BCG + DTIC, eight and 17.4 months; and for all 51 DTIC treated patients 6.3 and 17.8 months, respectively. Patients receiving BCG had a median survival superior to the surgery only group (P = 0.02). An increase in survival was seen predominantly in patients who achieved IVA status more than once and received BCG. Patients with recurrent soft-tissue metastases appeared to benefit most from BCG in prolonging the disease-free interval. Only 1/10 treated by surgery alone had a disease-free interval longer than 1 year, compared with 9/16 who received BCG (P = 0.01). Stage IVA melanoma appears to be distinctly different in prognosis from Stage IVB melanoma and should be classified separately. Patients with recurrent soft-tissue disease may benefit significantly from treatment with BCG.

Adolescent↗