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Biomedical subjects

C Charles

Publications and source records attributed to C Charles.

At least 37 records · Page 2Linked to original sources
PubMed1999

Usefulness of serological IgG antibody determinations for confirming eradication of Helicobacter pylori infection.

OBJECTIVE: Prior studies have suggested that IgG antibody titers may be useful to confirm successful treatment of Helicobacter pylori (H. pylori) infection. However, the diagnostic value of decreasing IgG titers is limited by the necessity to perform pre and posttreatment tests in parallel which requires stored sera. Our objective was to assess the accuracy of IgG antibody titers using the HM-CAP IgG EIA kit (Enteric Products) in monitoring treatment of H. pylori infection and to compare the relative accuracy of parallel versus serial determinations. METHODS: The 14C urea breath test (UBT) was used to confirm H. pylori infection in 83 dyspeptic patients and eradication of the organism at 4 wk and 6 months posttreatment. IgG titers pretherapy and 6 months posttherapy were determined either serially (separate EIA plates) or in parallel (same EIA plate), and the relative percent decline in antibody titer was calculated. RESULTS: When a decline of > or = 25% at 6 months was used as the cut-off for H. pylori eradication, mean sensitivities of serial and parallel determinations were 87.5% and 86.8%, respectively, and mean specificities of both were 100%. In 68 of 75 patients in whom the organism was eradicated, the mean decrease in IgG titer at 6 months was 41.1% for serial determinations and 41.5% for parallel determinations. CONCLUSIONS: Serial or parallel IgG titers offer equivalent diagnostic accuracy for confirming H. pylori eradication after therapy. A > or = 25% decline in titer 6 months after therapy is a sensitive and specific marker for eradication of the infection. Serial evaluation of IgG titers does not require serum storage, and is a cost-effective and accurate alternative to the UBT or endoscopy-based methods.

Adolescent↗
PubMed1999

Adoption of a managerial innovation: a study of physician impact analysis.

This article examines the adoption of physician impact analysis (PIA) among active treatment hospitals in Ontario, Canada. The influence of variables from three different levels of analysis (individual, organizational and contextual) were included as well as measures of key stakeholders' (Chief Executive Officer (CEO) and Medical Chief of Staff) assessments of the attributes of the innovation. A number of conclusions were drawn. First, by adding information about the perceived attributes of the innovation the model was able to account for a larger percentage of explained variance than has been seen in related work. Secondly, the adoption of PIA within a context of written guidelines agreed to by senior management, specifying process and structure concerns, is most likely in organizations which are large and where the CEO positively evaluates the innovation.

Chief Executive Officers, Hospital↗
PubMed1999

Defining morning stiffness in rheumatoid arthritis.

OBJECTIVE: Morning stiffness is a common and clinically important symptom in patients with rheumatoid arthritis (RA); however, it has not performed well as a classification criterion, perhaps due to poor definition. This qualitative study was carried out to identify the characteristics of morning stiffness through the self-reports of patients with RA in order to develop a new patient centered definition. METHODS: Personal interviews with 24 patients with RA were analyzed independently by 2 reviewers using a grounded theory approach. A mail-out questionnaire was used to validate the information summarized from the interviews. RESULTS: These findings resulted in the following definition of morning stiffness in RA: slowness or difficulty moving the joints when getting out of bed or after staying in one position too long, which involves both sides of the body and gets better with movement. CONCLUSION: This new patient centered definition of morning stiffness may allow more precise classification of patients with RA.

Adult↗
PubMed1998

Bonding orthodontic brackets with glass-ionomer cement.

This is a clinical paper outlining the experience of an enthusiastic group of seven individuals in different local orthodontic practices who, over a period of six years, have bonded some 99% of the metal orthodontic brackets to tooth enamel using glass ionomer cement (GIC). Up until recently GIC has been little used within the orthodontic world for the cementing of orthodontic brackets, composite resin being the conventional adhesive. We use GIC as a bracket adhesive because there is a very low incidence of tooth enamel decalcification occurring around the brackets with its use compared with the more universally used composite resin adhesives. This paper details the perceived clinical advantages and disadvantages, and then defines the three critical areas for successful bonding with GIC, followed by a description of the chairside technique.

Dental Bonding↗
PubMed1998

The physician-patient encounter: the physician as a perfect agent for the patient versus the informed treatment decision-making model.

Assuming a goal of arriving at a treatment decision which is based on the physician's knowledge and the patient's preferences, we discuss the feasibility of implementing two treatment decision-making models: (1) the physician as a perfect agent for the patient, and (2) the informed treatment decision-making models. Both models fall under the rubric of agency models, however, the requirements from the physician and the patient are different. An important distinction between the two models is that in the former the patient delegates authority to her doctor to make medical decisions and thus the challenge is to encourage the physician to find out the patient's preferences. In the latter, the patient retains the authority to make medical decisions and the physician role is that of information transfer. The challenge here is to encourage the physician to transfer the knowledge in a clear and nonbiased way. We argue that the choice of model depends among other things on the ease of implementation (e.g., is it simpler to transfer patient's preferences to doctors or to transfer technical knowledge to patients?). Also the choice of treatment decision-making model is likely to have an impact on the type of incentives or regulations (i.e., contracts) needed to promote the chosen model. We show that in theory both models result in the same outcome. We argue that the approach of transferring information to the patient is easier (but not easy) and, hence, more feasible than transferring each patient's preferences to the physician in each medical encounter. We also argue that because better "technology" exists to transfer medical information to patients and time costs are involved in both tasks (i.e. transferring preferences or information), it is more feasible to design contracts to motivate physicians to transfer information to patients than to design contracts to motivate physicians to find out their patients' utility functions. We illustrate our arguments using a clinical example of the choice of adjuvant chemotherapy versus no adjuvant chemotherapy for women with early stage breast cancer. We also discuss issues relating to the current realities of clinical practice and their potential implications for the way that economists model physician-patient clinical encounters.

Breast Neoplasms↗
PubMed1998

The meaning of playing-related musculoskeletal disorders to classical musicians.

In creating and performing music, musicians can experience health problems from the high physical and psychological demands of their profession. Musculoskeletal disorders related to playing are painful, chronic and disabling conditions which are prevalent among classical musicians. The widespread study of the prevalence, etiology, and management of playing-related musculoskeletal disorders (PRMDs) is a recent development known as performing arts medicine. Despite the rapid development of this new field, it is unclear how musicians identify themselves as injured, and how they make decisions about what, if anything, to do about these disabling injuries. The aims of our study were two-fold. First, we aimed to provide musicians with the opportunity to define a PRMD in their own words. Second, we sought to understand the subjective meaning of the PRMD experience to musicians. Two key informants identified 30 study participants in Ontario and Quebec, Canada. As a form of data triangulation, participants included 27 musicians and three health professionals. Data were collected in semi-structured interviews which lasted, on average, 40 min. Data were transcribed, and were manually coded and analyzed. Participants defined a PRMD as pain and other symptoms which are chronic, are beyond their control, and which interfere with their ability to play their instrument at their usual level. Participants distinguished between "normal", mild everyday aches and pains, and a PRMD. Although a PRMD is not a medically serious or life-threatening illness, it is devastating to musicians physically, emotionally, socially, and financially. The overall theme of suffering captures the meaning of these problems which threaten the identity of the musician. The findings of this study are consistent with other studies of the experience of work-related musculoskeletal disorders, and other illnesses.

Adaptation, Psychological↗
PubMed1998

Clinical applications of neuroimaging in psychiatry.

New techniques are dramatically expanding current clinical applications of neuroimaging in neuropsychiatry. Neuroimaging research that examines brain structure and function relationships in neuropsychiatric disorders is also enhancing our understanding of the pathophysiology of neuropsychiatric illnesses such as dementia, focal CNS insult, schizophrenia, affective disorders, and neurodevelopmental disorders.

Brain↗
PubMed1997

Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango).

Shared decision-making is increasingly advocated as an ideal model of treatment decision-making in the medical encounter. To date, the concept has been rather poorly and loosely defined. This paper attempts to provide greater conceptual clarity about shared treatment decision-making, identify some key characteristics of this model, and discuss measurement issues. The particular decision-making context that we focus on is potentially life threatening illnesses, where there are important decisions to be made at key points in the disease process, and several treatment options exist with different possible outcomes and substantial uncertainty. We suggest as key characteristics of shared decision-making (1) that at least two participants-physician and patient be involved; (2) that both parties share information; (3) that both parties take steps to build a consensus about the preferred treatment; and (4) that an agreement is reached on the treatment to implement. Some challenges to measuring shared decision-making are discussed as well as potential benefits of a shared decision-making model for both physicians and patients.

Decision Making↗
PubMed1997

Medical necessity in Canadian health policy: four meanings and ... a funeral?

Four meanings of medical necessity have emerged, evolved, and dominated past and current health policy debates about the appropriate level of service coverage under Canada's health insurance program. To explore the shift in definition, provincial government and national health care association position papers responding to federal legislative and policy reviews of Canada's health insurance program from 1957 to 1984 were examined, as were more current reports on medical necessity. Four meanings of medical necessity predominated: "what doctors and hospitals do"; "the maximum we can afford"; "what is scientifically justified"; and "what is consistently funded across all provinces." These meanings changed with time as different stakeholder associations and governments redefined the concept of medical necessity to achieve different policy objectives for health service coverage under Canada's health insurance program.

Attitude to Health↗
PubMed1997

Physician relations in Canada: shooting inward as the circle closes.

As economic disputes between physicians become more frequent, discussions between physicians are becoming increasingly important. Those seeking insight into how physician organizations might mediate these disputes may be able to learn from others who have had negotiating responsibilities for over a quarter of a century--the provincial medical associations in Canada. In this article we examine the structure, process, and outcomes of negotiations between physicians, with a focus on responses to new physician expenditure caps in Ontario, Alberta, and British Columbia. Early negotiations between physicians over changes in relative fees favored general practitioners because they were the dominant voting block within the associations. Despite fewer gains in the fee arena, specialists were willing to remain in the associations because all physicians generally enjoyed similar income growth. Under new physician expenditure caps, however, physicians have been unable to resolve conflicts over how to allocate income limits across specialties. Negotiations between physicians face expanding economic issues and diverging interests as expenditure caps force physicians to concentrate on total costs.

Alberta↗
PubMed1997

Hyperthermic treatment of malignant diseases: current status and a view toward the future.

New studies in hyperthermia at the basic science, engineering, and clinical level have stimulated renewed enthusiasm for re-investigating its potential as an anticancer therapy. This article reviews the salient features of these recent results and points out areas for additional investigation. Highlighting these new results is the publication of several positive phase III trials for thermoradiotherapy compared to radiotherapy alone. Important highlights are the encouraging results using magnetic resonance imaging for noninvasive thermometry. If this technology is successfully implemented with real time power control it will revolutionize the clinical application of hyperthermia.

Animals↗
PubMed1996

Physician impact analysis predictions in Ontario hospitals: does the emperor have clothes?

Physician impact analysis (PIA) is a human resource planning tool used to predict the impact on hospital resources of adding a new or replacement physician to a hospital's medical staff. This article describes the findings of a study which examined the extent to which PIAs are used in Ontario acute care hospitals and the accuracy of PIA predictions. The results suggest that although PIA appears to be widely used, there is no evidence that it meets the intended policy objective of accurately predicting physician hospital resource use.

Cross-Sectional Studies↗
PubMed1996

Variation between centers in technique and guidelines for liver biopsy.

Hospitals have few published guidelines to follow when performing a liver biopsy. In 1992, we began revising our protocol in an effort to institute new guidelines for our teaching hospitals. To assess the current practice of liver biopsy, we sent 500 multilingual questionnaires to international academic centers, and 85 U.S. centers were surveyed by telephone. The survey assessed: 1) patient preparation, 2) technical aspects of the biopsy, and 3) post-procedural care. One hundred and eighty international centers and 85 U.S. centers responded (total = 265). We found a wide variation in the practice of this surgical procedure at both national and international centers. Many Asian centers (73%) performed a bleeding time prior to liver biopsy. This practice was seen in only 36% of the U.S. centers. Most centers preferred platelet counts of 50,000/mm3 and above. The aspiration needle was more widely used in the U.S. (74%) and in many international centers, but Asian centers (61%) preferred a cutting needle. Thirty percent of Japanese centers performed more than 50% of their liver biopsies laparoscopically. Few laparoscopies were done at other centers. While about a quarter of the reported U.S., European, Asian, and South American centers observed patients for 4-6 hours after a biopsy, the majority of centers observed patients 10 hours or more. In addition to the wide variation seen, this survey provided us with an academic view of the contemporary practice of liver biopsy and an insight into how to redefine our present guidelines.

Academic Medical Centers↗
PubMed1994

How was your hospital stay? Patients' reports about their care in Canadian hospitals.

OBJECTIVE: To survey adult medical and surgical patients about their concerns and satisfaction with their care in Canadian hospitals. DESIGN: Cross-sectional telephone survey undertaken from June 1991 to May 1992 with a standardized questionnaire. SETTING: Stratified random sample of public acute care hospitals in six provinces; 57 (79%) of the 72 hospitals approached agreed to participate. PATIENTS: Each participating hospital provided the study team with the names of 150 adult medical and surgical patients discharged home in consecutive order. A total of 4599 patients agreed to be interviewed (69% of eligible patients and 89% of patients contacted). MAIN OUTCOME MEASURES: Satisfaction with (a) provider-patient communication (including information given), (b) provider's respect for patient's preferences, (c) attentiveness to patient's physical care needs, (d) education of patient regarding medication and tests, (e) quality of relationship between patient and physician in charge, (f) education of and communication with patient's family regarding care, (g) pain management and (h) hospital discharge planning. RESULTS: Most (61%) of the patients surveyed reported problems with 5 or fewer of the 39 specific care processes asked about in the study. Forty-one percent of the patients reported that they had not been told about the daily hospital routines. About 20% of the patients receiving medications reported that they had not been told about important side effects in a way they could understand; 20% of the patients who underwent tests reported similar problems with communication of the test results. Thirty-six percent of those having tests had not been told how much pain to expect. In discharge planning, the patients complained that they had not been told what danger signals to watch for at home (reported by 39%), when they could resume normal activities (by 32%) and what activities they could or could not do at home (by 29%). Over 90% of the patients reported that they had had a relationship of confidence and trust with their physician and that they had been involved in decision making as much as they wanted to be. Fifteen percent of the patients whose admissions had been scheduled felt that they should have been admitted sooner. CONCLUSION: The self-reported patient data from this survey suggest that hospital routines, medications, tests, pain management and discharge planning are areas of communication to target in future quality-improvement efforts in Canadian hospitals.

Adult↗
PubMed1994

Overview of a quality assurance/quality control compliance program consistent with FDA regulations and policies for somatic cell and gene therapies: a four year experience.

Somatic cell and gene therapy involve the application of biological technologies to an individual patient through the use of living cells which provide a therapeutic benefit (Aliski, 1991). Various forms of cellular and gene therapies are being developed and evaluated in an increasing number of clinical trials for congenital and acquired disorders. The potential and progress of these therapeutic applications have resulted in an increasing effort by the Food and Drug Administration (FDA) to develop the regulatory framework under which these therapeutic approaches would insure safety and efficacy, the primary mandate of the FDA. Over five years ago Cellcor began to define the parameters, specifications, and conditions relevant to a Quality Assurance/Quality Control (QA/QC) program that has evolved to insure safety and maximize the efficacy of applications of the company's ex vivo technology, autolymphocyte therapy. Autolymphocyte therapy is an outpatient form of somatic cell immunotherapy based upon the infusion of T cells that have been activated ex vivo using a combination of previously generated autologous cytokines and an anti-CD3 monoclonal antibody. We have been able to demonstrate the feasibility for the safe, controlled, and consistent preparation and delivery of a cellular therapy by application of relevant GMP regulations. This presentation reviews aspects of this program and chronicles our experience which at present amounts to over 4400 in fusions for over 700 patients. This program provides a high degree of assurance that a cellular therapy program can be carried out in a multisite mode involving hundreds of patients through the strict adherence to cGMP as set forth in existing regulations.(ABSTRACT TRUNCATED AT 250 WORDS)

Cell Transplantation↗