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Biomedical subjects

C H Goldsmith

Publications and source records attributed to C H Goldsmith.

At least 127 records · Page 7Linked to original sources
PubMed1984

The lupus activity criteria count (LACC).

A single clinical and laboratory assessment from each of 50 randomly chosen patients with systemic lupus erythematosus followed in a prospective study were evaluated for disease activity by 3 individual rheumatologists. Of the 50 assessments, 24 were considered to be active, 12 possibly active and 14 inactive. The 38 assessments that were clearly active or inactive were then analyzed. Clusters of variables were chosen for clinical relevance and association with activity, and 7 highly associated variables were combined into the lupus activity criteria count. Analysis of these criteria in the 50 assessments revealed that the presence of any 2 correctly predicted active disease in 100% of cases. This activity criteria count was then validated using a second sample of 50 assessments.

Evaluation Studies as Topic↗
PubMed1983

A clinical approach to the use of predictive values in the prenatal diagnosis of neural tube defects.

The rationale of calculating predictive values to interpret the amniotic fluid alpha-fetoprotein (AFP) test has been examined and applied to amniotic fluid AFP testing from one Canadian center. Such predictive value ccalculations may be misleading if they fail to make use of the actual magnitude of the test result or the results of other investigations. The alculation of predictive values has thus been extended to take into account magnitude of the test results, the clinical history, and the results of other investigations. The interpretation of an abnormal amniotic fluid AFP test that is followed by a normal result of a careful ultrasound scan of the fetal back is that there is a 54.5% chance that the fetus has spina bifida if there is a previous history of spina bifida. There is a 12.5% chance if there is a negative family history. These calculations lead to informed genetic counseling and rational decision making with regard to the continuation of the pregnancy.

Amniocentesis↗
PubMed1982

Steady-state plasma levels of salicylate in patients with rheumatoid arthritis: effects of dosing interval and tablet strength.

Forty patients who were admitted to hospital with rheumatoid arthritis received a total of 3.9 g/d of enteric-coated acetylsalicylic acid (ASA) (Entrophen) according to one of four dosing schedules: group 1 (n = 13), three 325-mg tablets four times daily; group 2 (n = 11), two 650-mg tablets three times daily; group 3 (n = 10), three 650-mg tablets twice daily; and group 4 (n = 6), two 975-mg tablets twice daily. Five to seven days after the start of therapy, when steady-state plasma salicylate levels had been achieved, 10 blood samples, 1 per hour, were collected. Three healthy volunteers who received plain ASA formed a control group. There was little fluctuation in the salicylate levels over the sampling period, regardless of the dosing interval, and no significant difference in the fluctuations between the five groups. Likewise, there was no significant difference in the mean salicylate levels at each sampling time, regardless of the dosing interval or tablet strength. These results suggest that different tablet strengths of enteric-coated ASA and different dosing intervals produce comparable plasma salicylate levels. Less frequent dosing may improve patient acceptance of salicylate therapy in the treatment of arthritis.

Adult↗
PubMed1978

Variation in the disposition of morphine after i.m. administration in surgical patients.

The disposition of morphine when administered by i.m. injection was studied in 36 patients receiving morphine as part of premedication before general anaesthesia, and in five patients who received morphine as a postoperative analgesic after median sternotomy for coronary artery surgery (PCA group). Maximum plasma concentration of morphine (CP max) was 75.3 +/- 6.0 (mean elimination rate constant (k) 4.85 X 10(-3) min-1 and half-life (T1/2) = 143 min for the preanaesthetic group. The corresponding values for PCA group were CPmax = 58.0 +/- 18.0 ng ml-1 (range 30--130 ng ml-1), k = 5.63 X 10(-3) min-1 and T 1/2 = 123 min. Analysis of variance showed no differences between the groups. Within the preanaesthetic group, there was a significant difference in k between males (k = 4.01 X 10(-3) min-1) and females (6.30 X 10(-3) min-1, P less than 0.01). The corresponding T 1/2 for males was 173 min; and 110 min for females. The variation in the disposition of morphine is thought to be the result of variations in resting muscle blood flow and inadvertent injection into adipose tissue. There were no significant differences between males and females in the preanaesthetic group with respect to age, Cpmax or time from injection to Cpmax.

Adult↗
PubMed1977

The development and application of indices of health: general methods and a summary of results.

A multidisciplinary group has developed a health index questionnaire designed to measure the social, emotional, and physical function of free-living populations. The strategy has been found to be generally applicable, capable of application by lay interviewers, acceptable to interviewees, and amenable to index construction. Furthermore, initial evaluations of the resulting health indices suggest that they are biologically and clinically valid. These health indices have been successfully applied in a randomized trial of innovative primary care services. The comceptualization of individual sections of the health index questionnaire for each of these three functional areas, the generation of the instrument, and the evaluation of questionnaire responses for their biologic and clinical validity are summarized here.

Adolescent↗
PubMed1977

"Independent assessor" and "pooled index" as techniques for measuring treatment effects in rheumatoid arthritis.

To conduct studies of therapy of rheumatoid patients at the primary care level two new assessment techniques were developed. The "independent assessor" (IA) was a nonmedical person trained to gather information using a questionnaire, a guided count of tender joints, grip strength, and blood tests. The "polled index" was a statistical device for summarizing all abailable information, constructed by transformation of various clinical measures of treatment effects to a common scale, based on standard deviation units. A validation study is reported, which involved 33 rheumatoid patients, each studied by four trained observers plus the IA, before and after 10 days of hospital therapy. Major gains in sensitivity and reliability were achieved by the pooled index. The IAs total assessment provided 84% of the information available in the pooled index, and was more sensitive and reliable than any other single clinical measure. The efficacy of a brief period of hospital therapy for rheumatoid patients was also strikingly demonstrated.

Analysis of Variance↗
PubMed1976

Recovery of ventilatory response to carbon dioxide after thiopentone, morphine and fentanyl in man.

Ventilatory responses to CO2 (delta VI/delta PCO2) were measured half, one, two and four hours after infusions of thiopentone, morphine, fentanyl and saline in healthy men in order to test the idea that variation in clinical recovery and control of breathing after anaesthetic drugs are associated with interindividual differences in control measurements of delta VI/delta PCO2. Ventilatory response to CO2 was profoundly reduced one half hour after each drug, in contrast to the observation during air breathing that ventilation and end tidal PCO2 had returned to within 10 per cent of control. Mean delta VI/delta PCO2 increased progressively at one, two, and four hours, returning to near control after thiopentone, but remaining less than 80 per cent of control four hours after morphine and fentanyl. From the regression equations of each ventilatory response, ventilation at PCO2 of 58 and 70 mmHg (VI58 and VI70) were computed to estimate displacement of the response curves by the drugs. Following thiopentone there was no significant change of V158. In contrast ther was a highly siginificant fall of VI58 one half hour after fentanyl (p less than 0.01), with progressive return towards control at one, two, and four hours; similar changes were observed after morphine. For each drug, changes of VI70 were substantially greater than corresponding changes of V158. At all times during these recovery measurements, subjects were conscious and co-operative and, by traditional clinical criteria, were judged to have recovered from the effects of the drugs. Differences between high and low responding subjects were assessed by plotting control measurements against values obtained half and one hour after drugs. No systematic differences were found. These findings suggest that delta VI/delta PCO2 is a sensitive indicator of central nervous activity, but do not support the concepts that individuals with low delta VI/delta PCO2 might be more susceptible to the ventilatory depressant effects of anaesthetic drugs, or that low delta VI/delta PCO2 might be associated with delayed return of spontaneous breathing after general anaesthesia. Plasma thiopentone levels at half, one, and four hours were highly reproducible, in contrast to the wide variation of delta VI/delta PCO2 among subjects in this study. These findings together support the notion that wide variation in clinical recovery from anaesthesia may have a primary physiological basis in addition to variation caused by interindividual differences in drug dosage, biotransformation and excretion.

Adult↗
PubMed1976

Development and application of an index of social function.

Brief indexes of social function were constructed in a project to develop a health index questionnaire designed to measure the social, emotional, and physical function of free-living populations. The social function items have been found to be generally applicable, capable of application by lay interviewers, and acceptable to interviewees. Initial evaluations to form composite scores for social function items have demonstrated their validity against concurrent assessments of a health professional. These social function indexes have been successfully applied in two randomized trials of innovative primary care services. The criteria for inclusion of items in the social function index questionnaire, the generation of the instrument, and the evaluation of questionnaire responses for their validity are summarized here.

Attitude to Health↗
PubMed1976

The arthritic complaint in primary care: prevalence, related disability, and costs.

Surveys conducted in five areas of Southern Ontario obtained clinical and service utilization data from 5,478 adults over 25 years of age. The two week period prevalence rates of arthritic and rheumatic (AR) complaints were 1.72 per cent and 2.14 per cent among two groups of users of primary care. In free-living general populations, the rates ranged from 6.23 per cent to 8.84 per cent. It was shown that only 25 per cent of complainants with AR symptoms sought health services. Of all adults seen by family physicians in one year, 28 per cent presented at least once with an AR complaint. While 20 per cent of all respondents reported some physical impairment, 43 per cent of those with AR complaints had impairment. The excess impairment was two per cent. Complaints with AR symptoms used health services at costs 78 per cent higher than the average expenditures in the same communities. The essential role of the primary care practitioner in the identification and control of AR disorders is strongly supported.

Adult↗
PubMed1975

Career choices of physicians 15 years after entering medical school.

The career status of 149 graduates of the University of Toronto faculty of medicine who entered in 1958 and graduated in 1962 was determined in 1973. The response rate to the mailed questionnaire was 96.6%. Of the graduates 4.7% were not practising medicine, 2.0% stated that medicine was not their primary gainful activity and 4.1% were untraceable or unknown. Of the 24 women in the class 17 (70.8%) were practising at least 76% of their time and 4 (16.7%) were practising 26 to 75% of their time. General practice or family medicine had been chosen by 39.0% of the class and a specialty by 55.7%; 5.4% were unknown or untraceable. The place of longest residence before entrance to university was a good predictor of ultimate location of practice but not of type of practice.

Adult↗
PubMed1973

Nurse practitioners in primary care. 3. The southern Ontario randomized trial.

A group of nurses who formerly had performed office functions received a special university-based educational program designed to prepare them to assume much of primary care management as nurse practitioners. The associated family physicians would shift their role to general supervision and attention to difficult clinical problems. To test this new form of practice, two complementary randomized trials have been conducted in south-central Ontario. The particular trial reported here was intended to assess the influence of the educational program on the changing roles of the professional personnel. The nurses of 14 family medical practices, with the physicians' support and commitment to participation, applied for the new training. Seven applicants were randomly selected to receive the training and their corresponding practices became the experimental group, while the remaining nurses and practices were retained as controls. During the subsequent year of investigation important changes occurred in professional roles of the experimental group. Nurse practitioners spent more time in clinical activities than conventional office nurses. The shift was not at the expense of time devoted to clinical work by physicians. Doctors delegated more professional activities to nurse practitioners than to conventional nurses. Except for remuneration (affected by legal constraints) job satisfaction among experimental physicians and nurses remained high after one year of experience with the new method.

Attitude of Health Personnel↗
PubMedDate not supplied

An approach to determine objectively minimum hemoglobin standards for blood donors.

The minimum hemoglobin level for an individual to be accepted as a blood donor in North America is 13.5 g/dl for males and 12.5 g/dl for females. The present study was undertaken to determine the iron status of donors deferred because their hemoglobin did not meet present standards. This was done prospectively by measuring hemoglobin, mean corpuscular volume, ferritin and free erythrocyte protoporphyrin on venous samples of blood. The majority of deferred donors, 85% of males and 83% of females, were found not to be iron deficient. In order to determine objectively minimum hemoglobin standards for blood donors that would include the maximum number of non iron deficient donors while excluding the majority with iron deficiency ROC curves were drawn. This approach demonstrates that minimum hemoglobin levels can be established objectively and from our data indicates that these levels are 12.5 g/dl for males and 12.0 g/dl for females.

Blood Donors↗