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Biomedical subjects

C Gray

Publications and source records attributed to C Gray.

At least 145 records · Page 8Linked to original sources
PubMed1996

Can and should level II nurseries care for newborns who require mechanical ventilation?

Perinatal regionalization was conceived roughly 25 years ago to provide centralized care for critically ill newborn infants. As for many 25-year-old concepts, the obligatory centripetal design of many regionalization policies may need to be modified. This article presents the outcomes of 408 surviving patients who required mechanical ventilation (136 born in one community hospital and 272 birthweight-matched infants born in our tertiary center), and were cared for in our perinatal network. Mechanical ventilation of a resident population of newborns at a community NICU appeared to be as effective as ventilatory care at a regionalized tertiary neonatal intensive care unit, when assessed by comparing birthweight-matched populations for length of hospital stay, days on ventilator, and the need for home O2. Some may still claim that every baby who requires mechanical ventilation must be transferred to a tertiary care center. In an era of heightened interest in health services, health outcomes, and cost-effectiveness analysis, however, the authors believe that such claims will be subjected to increasing scrutiny. Our study represents a first attempt at determining the shape such scrutiny might take, and the sort of data analyses that may be required to reformat a perinatal network.

Humans↗
PubMed1995

Is medicine moving to the right?

During the CMA's recent annual meeting in Winnipeg, General Council delegates agreed that as far as Canada's health care system is concerned, maintenance of the status quo is impossible. Some delegates were motivated by the principle of professional autonomy, while others approached the issue from a public-policy perspective. Still others were driven by outrage at what is happening to physicians' incomes. But delegates barely resisted the pull of a vocal group of physicians who favour giving Canadians the right to choose regulated private insurance for all medical services. The compromise position, for now at least, is that delegates want the CMA to lead a public debate on the future of health care.

Canada↗
PubMed1995

CMA-cosponsored conference raises many questions about future of regionalized health care.

Is regionalization better because it's cheaper? Or because it provides better outcomes? Or simply because it's different from whatever went before? Those were some of the questions asked during a recent conference cosponsored by the CMA and Queen's University. With each successive speaker, says Charlotte Gray, the message became clearer: there are more muddled theories behind the trend and more pitfalls ahead than planners ever expected when they embarked on the exercise to decentralize health care in Canada and elsewhere.

Canada↗
PubMed1995

It's 210 transplants and counting at the University of Ottawa Heart Institute.

The Ottawa Heart Institute, the site of more than 200 heart-transplant procedures since 1984, is preparing for the retirement of its founder, Dr. Wilbert Keon, in 2001. The institute has developed a national and international reputation, but also faces the same funding challenges as other Canadian health care facilities. Although the cost of the institute's high-tech procedures is challenged by some, Keon makes no apologies. "I haven't the slightest problem rationalizing what we do here," he says. "There are many areas in our health care system that should be tightened up before we cut services with demonstrable benefits." He also thinks there might be room for private care within Canada's publicly funded system.

Heart Transplantation↗
PubMed1995

Traumatic prepatellar neuralgia.

Fourteen patients with painful knees caused by a direct blow to the front of the knee have been studied. The exact diagnosis was often delayed. Apart from pain, all patients had one common feature which they may not have been aware of, namely, marked tenderness localized towards the middle of the outer border of the patella. Surgical treatment in 11 patients, by excision of the subcutaneous tissue in the tender area and the prepatellar bursa, cured all cases. Histology of the excised specimens confirms the existence of a definite clinico-pathological entity.

Adolescent↗
PubMed1995

Ketorolac versus meperidine-plus-promethazine treatment of migraine headache: evaluations by patients.

This study was designed to compare and contrast the speed and efficacy of meperidine (75 mg)/promethazine (25 mg) intramuscularly to ketorolac (60 mg) intramuscularly, in a double-blind study in reducing the symptoms of migraine headache. Forty-two patients who presented to the emergency department between July 1992 and February 1993, with previous diagnoses of migraine headache, were considered for this study. Patients subjectively evaluated parameters of their migraine headaches (eg, pain and nausea) using a numeric scale and were later asked to reevaluate these same parameters at 30, 60, and 360 minutes after a single intramuscular injection of either ketorolac (60 mg) or meperidine (75 mg)/promethazine (25 mg). Sixty-eight percent of patients given meperidine/promethazine responded whereas 55% of patients given ketorolac responded. The responder group showed a statistically significant reduction in headache within 30 minutes with both drug regimens. There was no statistically significant difference between the number of responders in either group. The responders from both groups had relief that lasted 6 hours after injection. In the nonresponder groups, most of the patients withdrew within 1 hour after treatment. As determined by patient response to treatment of their migraine headaches, there was no statistically significant difference between the ketorolac and the meperidine/promethazine groups.

Adult↗
PubMed1995

Botulinum toxin treatment of essential head tremor.

We examined in a double-blind, placebo-controlled study the effects of botulinum toxin in 10 patients with essential head tremor. Each subject received two treatments approximately 3 months apart, one with botulinum toxin injections and another with normal saline injections into the sternocleidomastoid and splenius capitis muscles. The subjects were assessed before each treatment and at 2, 4, and 8 weeks after injections. There was moderate to marked improvement in clinical ratings in five subjects after botulinum toxin injections and in one subject after placebo. There was moderate to marked subjective improvement in five patients with botulinum toxin as compared with three subjects with placebo. Side effects were mild and transient. We conclude that botulinum toxin may be useful for patients with essential head tremor who have failed to benefit from oral medications.

Aged↗
PubMed1995

Gender differences of reported safer sex behaviors within a random sample of college students.

This study investigated the frequency of safer sex behaviors with a random sample of sexually active college students (N = 315) at a university in the Northwest. The most frequent safer sex behaviors were discussion of contraceptives (58.6%), being more selective (46.5%), and reducing the number of sexual partners (43.6%). The least frequent safer sex behaviors included discussion of partner's sexual health prior to sexual behavior (26.1%), using condoms or dental dams (24.4%), one sexual partner (22.6%), and abstaining from sex as a safer sex practice (12.3%). The only two behaviors which indicated gender differences were (a) if they were being more selective as a safer sex practice and (b) reducing number of sexual partners as a safer sex practice. Women were more likely to state that they were " almost always" more selective than their male peers. Findings from this study indicated that a substantial number of students reported "risk factors" sexual practices. These findings indicated a need for HIV-prevention efforts.

Adult↗
PubMed1995

Effects of ethanol on bone cells in vitro resulting in increased resorption.

Abuse of alcohol has been found to be an important risk factor for fractures and osteoporosis, and tissue culture experiments have indicated that low concentrations of ethanol can affect bone formation and resorption. This study investigated direct effects of ethanol on bone cells using an in vitro resorption assay. Osteoclasts from long bones of 19-day prehatch chicks were seeded onto slices of dentine and cultured with control medium alone, or medium containing 0.001%, 0.01% or 0.1% ethanol, at 37 degrees C with 5% CO2 for 24 h before being removed. The volumes and areas of resorption pits made in the dentine were measured using confocal laser reflection microscopy (Lasertech 1LM21 system) and the pits counted. An increase in the pit numbers and mean pit areas, volumes and volume/area ratios was observed with 0.001% and 0.01% ethanol, with a dose-related, bell-shaped curve of resorption. Greatest mean volume resorbed per pit (p < 0.05), mean area resorbed per pit (p < 0.01) and number of pits was at 0.01% ethanol. Volume/area (mean depth) per pit was greatest at 0.001% ethanol (p < 0.05). This study has shown that ethanol, even at blood concentrations experienced by the social drinker, has an immediate direct effect on bone cells in vitro, resulting in increased resorption by osteoclasts.

Animals↗
PubMed1995

Changes in adult cigarette smoking in the Minnesota Heart Health Program.

OBJECTIVES: The Minnesota Heart Health Program was a research and demonstration project designed to reduce risk factors for heart disease in whole communities. This paper describes smoking-specific interventions and outcomes. METHODS: Three pairs of matched communities were included in the study. After baseline surveys, one community in each pair received a 5-year education program, while both cross-sectional and cohort surveys continued in all sites. Adult education programs for smoking cessation included Quit and Win contests, classes, self-help materials, telephone support, and home correspondence programs. RESULTS: Encouraging short-term results were obtained for several adult education programs. Overall long-term outcomes were mixed, with evidence of an intervention effect only for women in cross-sectional survey data. Unexpectedly strong secular declines in smoking prevalence were observed in comparison communities. CONCLUSIONS: The findings suggest that community education may be unlikely to exceed dramatic secular reductions in smoking prevalence. The success of several key interventions and the incorporation of Minnesota Heart Health Program interventions by education communities are encouraging, however.

Adult↗
PubMed1994

Assessing intervention effects in the Minnesota Heart Health Program.

The Minnesota Heart Health Program is a 13-year research and demonstration project to reduce morbidity and mortality from coronary heart disease in whole communities in the upper Midwest. Six communities were selected for the study: three intervention and three comparison sites, matched to increase baseline comparability. After 2-4 years of baseline observations, a 5- to 6-year program of intensive intervention was introduced in the three intervention communities. Periodic cross-sectional and cohort surveys provided data on risk factors and related behaviors. Regression adjustments within and between communities reduced the confounding influences of important covariates and the variance inflation associated with the nesting of individuals within communities and surveys. Post hoc stratification allowed exploration of the main and strata-specific effects of the intervention program. Finally, the intervention effect was modeled as a departure from the trend line fit to the nonintervention city-year means. Together, these procedures explicitly acknowledged the component of variance associated with communities, and so avoided a major source of bias created in the usual analysis when that variation is ignored. They also increased the interpretability of the analyses and reduced the mean square errors used to assess the treatment effects.

Cohort Studies↗
PubMed1994

Simulation of bone resorption-repair coupling in vitro.

In the normal adult human skeleton, new bone formation by osteoblasts restores the contours of bone surfaces following osteoclastic bone resorption, but the evidence for resorption-repair coupling remains circumstantial. To investigate whether sites of prior resorption, more than the surrounding unresorbed surface, attract osteoblasts or stimulate them to proliferate or make new matrix, we developed a simple in vitro system in which resorption-repair coupling occurs. Resorption pits were produced in mammalian dentine or bone slabs by culturing chick bone-derived cells on them for 2-3 days. The chick cells were swept off and the substrata reseeded with rat calvarial osteoblastic cells, which make bone nodules in vitro, for periods of up to 8 weeks. Cell positions and new bone formation were investigated by ordinary light microscopy, fluorescence and reflection confocal laser microscopy, and SEM, in stained and unstained samples. There was no evidence that the osteoblasts were especially attracted to, or influenced by, the sites of resorption in dentine or bone before cell confluence was reached. Bone formation was identified by light microscopy by the accumulation of matrix, staining with alizarin and calcein and by von Kossa's method, and confirmed by scanning electron microscopy (SEM) by using backscattered electron (BSE) and transmitted electron imaging of unembedded samples and BSE imaging of micro-milled embedded material. These new bone patches were located initially in the resorption pits. The model in vitro system may throw new light on the factors that control resorption-repair coupling in the mineralised tissues in vivo.

Animals↗