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Biomedical subjects

D A Axelrod

Publications and source records attributed to D A Axelrod.

12 recordsLinked to original sources
PubMed2006

Transplant center quality assessment using a continuously updatable, risk-adjusted technique (CUSUM).

Access to timely, risk-adjusted measures of transplant center outcomes is crucial for program quality improvement. The cumulative summation technique (CUSUM) has been proposed as a sensitive tool to detect persistent, clinically relevant changes in transplant center performance over time. Scientific Registry of Transplant Recipients data for adult kidney and liver transplants (1/97 to 12/01) were examined using logistic regression models to predict risk of graft failure (kidney) and death (liver) at 1 year. Risk-adjusted CUSUM charts were constructed for each center and compared with results from the semi-annual method of the Organ Procurement and Transplantation Network (OPTN). Transplant centers (N = 258) performed 59 650 kidney transplants, with a 9.2% 1-year graft failure rate. The CUSUM method identified centers with a period of significantly improving (N = 92) or declining (N = 52) performance. Transplant centers (N = 114) performed 18 277 liver transplants, with a 13.9% 1-year mortality rate. The CUSUM method demonstrated improving performance at 48 centers and declining performance at 24 centers. The CUSUM technique also identified the majority of centers flagged by the current OPTN method (20/22 kidney and 8/11 liver). CUSUM monitoring may be a useful technique for quality improvement, allowing center directors to identify clinically important, risk-adjusted changes in transplant center outcome.

Adolescent↗
PubMed2001

Impact of chronic obstructive pulmonary disease on elective and emergency abdominal aortic aneurysm repair.

OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is associated with abdominal aortic aneurysm (AAA) expansion and is considered by some to be a relative contraindication to conventional aortic surgery. This study was undertaken to determine if COPD increases operative death, morbidity, intensive care unit (ICU) length of stay (LOS), and hospital LOS, after AAA repair. METHODS: Data from national administrative records supplemented with laboratory data previously obtained for a system-wide study were analyzed in a retrospective review of 1053 consecutive patients (264 with and 789 without COPD) undergoing operation for intact or ruptured AAAs in Veterans Administration Hospitals from 1997 to 1998. Bivariate comparisons and multivariate regression were used to evaluate the impact of COPD on the number of days of ventilation, ICU LOS, total hospital LOS, and death, while controlling for other known risk factors, including acute myocardial infarction, renal failure, and age. RESULTS: The mortality rate in elective aneurysm patients did not differ (P =.99) between patients with (3.7%) or without COPD (3.7%). However, elective AAA repair was associated with longer hospital LOS (14.4 vs 12.3 days, P =.01), longer ICU LOS (6.5 vs 5.4 days, P =.01), and a higher incidence of requiring 96 hours or more ventilation (6.9% vs 3.6%, P =.02) in patients with COPD. Ruptured AAA affected 4.9% of patients and was strongly associated with COPD (P =.02); however, COPD did not result in a statistically significant increase in death (P =.25). CONCLUSIONS: Although COPD does not appear to increase operative death, it is associated with an increased risk of rupture. Elective repair of AAA should not be deferred in patients with COPD despite their higher LOSs and need for postoperative ventilation.

Aged↗
PubMed2001

Outcomes after surgery for thoracic outlet syndrome.

PURPOSE: This study determined whether there is an association between psychological and socioeconomic characteristics and the long-term outcome of operative treatment for patients with sensory neurogenic thoracic outlet syndrome (N-TOS). METHODS: Clinical records, preoperative psychological testing results, and long-term follow-up questionnaire data were reviewed for consecutive patients who underwent surgery for N-TOS from 1990 to 1999. Multivariate logistic regression models were developed as a means of identifying independent risk factors for postoperative disability. RESULTS: Operative decompression of the brachial plexus via a supraclavicular approach was performed for upper extremity pain and paresthesia with no mortality and minimal morbidity in 170 patients. After an average follow-up period of 47 months, 65% of patients reported improved symptoms, and 64% of patients were satisfied with their operative outcome. However, 35% of patients remained on medication, and 18% of patients were disabled. Preoperative factors associated with persistent disability include major depression (odds ratio [OR], 15.7; P =.02), not being married (OR, 7.9; P =.04), and having less than a high school education (OR, 8.1; P =.09). CONCLUSION: Operative decompression was beneficial for most patients. Psychological and social factors, including depression, marital status, and education, are associated with self-reported disability. The impact of the preoperative treatment of depression on the outcome of TOS decompression should be studied prospectively.

Adult↗
PubMed2000

Maintaining trust in the surgeon-patient relationship: challenges for the new millennium.

Changes in the structure of the health care system have placed unprecedented stress on the surgeon-patient relationship. The essential trust placed in the surgeon by her patients has been weakened by changes in the structure and financing of the health care system. This article considers the historical and ethical foundation of the surgeon-patient relationship and proposes that the primary moral obligation of surgeons is to strengthen and earn patient trust. By improving communication skills, enhancing ethical education, serving as consistent advocates for patients, and conducting patient-focused outcome research, the surgical community can meet its moral obligation by increasing trust in the surgeon-patient relationship.

Conflict of Interest↗
PubMed2000

An economic evaluation of sonographic examination of children with suspected appendicitis.

BACKGROUND/PURPOSE: Appendicitis is the most common surgical emergency presenting in the pediatric population. Approximately one third of these patients present with equivocal signs and symptoms frequently resulting in inpatient observation or additional diagnostic investigation. Although sonographic examination of patients with suspected appendicitis has been shown to be a highly accurate diagnostic modality, the cost effectiveness of this technology in the pediatric population has not been addressed. The economic value of this examination can be evaluated using a structured decision analysis. METHODS: The authors constructed a decision analysis model of treatment strategies for 2 groups of patients with a suspected diagnosis of acute appendicitis. Patients were categorized as either presenting with a "definitive acute abdomen" or "equivocal examination." Data drawn from published literature reports of the sensitivity and specificity of ultrasound, institution-specific cost data, and expert judgment were used to construct 2 decision trees. These data were used to determine the least costly diagnostic strategy for each group of patients, and sensitivity analysis performed to assess the robustness of the conclusions. RESULTS: The use of ultrasonography in patients with "an acute abdomen" is not cost efficient and results in average additional cost of $234 per patient. In patients with equivocal diagnoses who are discharged from the emergency room after a negative ultrasound examination finding results in an average cost savings of $260 when compared with admission and observation. Patients who are discharged without examination incur an average additional cost of $373 as a result of the high cost of a missed diagnosis resulting in a perforated appendix. CONCLUSION: The use of ultrasonography can be recommended for children with suspected appendicitis and equivocal examinations who are discharged from the emergency room after a negative examination result.

Abdomen, Acute↗
PubMed1985

Polyclonal B-cell activation of rabbit Peyer's patch.

This study delineates the culture conditions and cellular requirements for pokeweed mitogen (PWM)-induced polyclonal B-lymphocyte activation of rabbit Peyer's patch cells for immunoglobulin secretion. This system was optimal with a cell density of 3 X 10(5) cells/ml and a culture duration of 7 days, in round-bottom containers. Although glass-plate-adherent cells did not appear to influence this process, the immunoglobulin responses to PWM were T cell dependent. This study supplies a foundation for further work on the mechanisms of polyclonal activation of B cells in the rabbit Peyer's patch.

Animals↗
PubMed1985

Primary and secondary in vitro immune response of the rabbit Peyer's patch and spleen to RDEC-1 pili.

The culture conditions and cellular requirements for antigen-induced B-cell activation of the rabbit Peyer's patch and spleen using the RDEC-1 pilus antigen were delineated. It was found that optimal conditions for both primary and secondary in vitro immunization are similar except for culture duration. Optimal cell density was 3 X 10(6) cells/ml and optimal antigen dose was 30 to 100 ng/ml. Antibody production was best carried out in flat-bottom culture plates. Both T cells and glass-plate-adherent cells (macrophages) were required for antigen induced antibody production for both the primary and secondary responses. Of note was the inability to induce a primary antibody response in the spleen cell cultures. This study demonstrates the effectiveness of the system in elucidating some of the complex in vitro events associated with primary and secondary, antigen-specific B-cell activation of the rabbit Peyer's patch to RDEC-1 pili and the ability of rabbit spleen cell cultures to respond to RDEC-1 pilus antigen only after in vivo challenge.

Animals↗
PubMedDate not supplied

Cardiologists performing peripheral angioplasties: impact on utilization.

CONTEXT: Angioplasty and stent placement for peripheral arterial occlusive disease has traditionally been performed by radiologists and surgeons. However, cardiologists have recently begun to perform these procedures. It is unknown whether this has affected how often the procedure is done. OBJECTIVE: To assess how the proportion of peripheral angioplastics performed by cardiologists in a geographic area relates to population-based angioplasty rates. DESIGN: Cross-sectional analysis of all U.S. Medicare beneficiaries undergoing peripheral arterial (i.e., renal, iliac, or lower extremity) angioplasty in 1996 using Part B (physician) claims for cardiovascular procedures. Physician specialty was obtained from the American Medical Association's masterfile and Medicare. MEASURES: For each of the 306 U.S. hospital referral regions (HRRs), we calculated the proportion of procedures performed by cardiologists and rates of peripheral arterial angioplasty (adjusted for age, sex, and race). RESULTS: More than 37,000 peripheral arterial angioplastics were performed on Medicare beneficiaries in 1996 (50% for lower extremity, 33% iliac, and 17% renal arterial disease). Cardiologists performed 26% of these procedures overall, including 37% of the renal angioplastics. Few (12%) procedures were done as part of a cardiac catheterization; instead, most were done as a separate procedure. Use of peripheral angioplasty varied more than 14-fold across HRRs (median, 12 procedures per 10,000 beneficiaries; 10th to 90th percentile, 4.1 to 57.9). The mean angioplasty rate in HRRs where cardiologists performed 50% or more of the procedures was almost double that of regions where they performed none (21.9 vs. 12.1 procedures per 10,000 beneficiaries; P < 0.001). CONCLUSIONS: Cardiologists are performing a substantial proportion of peripheral angioplasties. Rates of these procedures are highest in regions where cardiologists do most of the angioplasties.

Aged↗
PubMedDate not supplied

Rheumatoid factor isotypes following immunization.

Serum from 422 healthy subjects prior to and four weeks after multiple immunizations was studied for rheumatoid factors (RF) by an enzyme-linked immunosorbent assay (ELISA). Increase in IgM RF was detected in 22% of subjects by ELISA, but was not detectable by a standard sheep-cell agglutination test. Immunization may be a cause of RF positivity by a sensitive assay such as ELISA; it is not likely to be detected by standard clinical methods.

Adult↗