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Biomedical subjects

D Frank

Publications and source records attributed to D Frank.

123 records · Page 7Linked to original sources
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Early anesthesia evaluation of the ambulatory surgical patient: does it really help?

STUDY OBJECTIVE: To evaluate whether early evaluation by the anesthesiologist is more beneficial for the ambulatory surgical patient than a day-of-surgery visit. DESIGN: A randomized study evaluating patients with different surgical procedures. SETTING: Ambulatory surgical outpatients at a university-affiliated integrated ambulatory surgical unit. PATIENTS: Sixty-three ASA physical status I and II women scheduled to undergo elective dilatation and curettage or gynecologic laser surgery. INTERVENTIONS: Approximately half of the patients received an early (1 to 7 days preoperative) anesthesia evaluation, and half received a day-of-surgery evaluation. All patients underwent the surgical procedures with a standardized general anesthetic. MEASUREMENTS AND MAIN RESULTS: The effect of an early versus a day-of-surgery anesthesia visit was evaluated with regard to patient anxiety levels; patient satisfaction with the surgical and anesthetic experience; operating room, recovery room, and ambulatory surgery unit time; anesthetic and analgesic requirements; and frequency of postoperative problems within 72 hours at home. There were no differences between the groups in demographic characteristics, anesthesia or analgesic requirements, degree of satisfaction with the ambulatory surgical experience, time spent in recovery room, or frequency of problems on postoperative follow-up. We were unable to demonstrate any differences between those patients seen early versus those seen on the day of surgery in anxiety levels preoperatively and postoperatively. CONCLUSIONS: Healthy ASA physical status I and II ambulatory surgical patients do not benefit from reducing preoperative anxiety by visiting the anesthesiologist prior to the day of surgery.

Adult↗
PubMedDate not supplied

The product of the imprinted gene IPL marks human villous cytotrophoblast and is lost in complete hydatidiform mole.

The IPL/TSSC3 gene is expressed nearly exclusively from the maternal allele, and its protein product acts to limit placental growth in mice. This protein specifically marks Type II trophoblast in the labyrinthine layer of the mouse placenta. To investigate mouse-human homologies, we carried out immunohistochemistry with antibodies against human IPL. There was strong expression of IPL in villous cytotrophoblast of the human placenta, contrasting with complete lack of expression in syncytiotrophoblast. Staining for IPL was weak in cells of the villous mesenchyme and extravillous trophoblast, including the cytotrophoblast columns in the basal plate and the intervillous trophoblast islands. The IPL and p57(KIP2)/CDKN1C genes are closely linked and coordinately imprinted, and immunostaining showed that their protein products are co-expressed in villous cytotrophoblast. However, other cell types, including extravillous cytotrophoblast and cells in various non-placental tissues, expressed p57(KIP2), but not IPL. IPL protein was absent in both of two cases of androgenetic complete hydatidiform mole examined by immunostaining, and IPL mRNA was absent in an additional three cases of this neoplasm examined by northern blotting. In the mouse, Ipl-expressing cells disappear at mid- to late-gestation when placental growth ceases, but persistent IPL mRNA and protein expression was observed throughout human gestation, correlating with the continuous growth of the human placenta. These findings highlight dosage regulation of human IPL by imprinting and, more generally, suggest homology between Type II labyrinthine trophoblast in the mouse and villous cytotrophoblast in humans, both of which are proliferative stem cell-like compartments.

Amino Acid Sequence↗
PubMedDate not supplied

[Suggestions for implementation of DRG in the fields of Orthopaedics and Trauma Surgery for 2004].

OBJECTIVE: The Implementation of a DRG-Variant in Germany - voluntarily since January 1 st, 2003 and obligatory from January 1 st, 2004 - has been leading to uncertainty, particularly in the hospitals, due to fears that currently practised German diagnostic and therapeutic measures will not be financed properly by a DRG-Variant. The G-DRG-Version 1.0 that was drawn up in connection with an executive order law is to a large degree identical to the Australian AR-DRG-Version 4.1. Adjustments to German requirements were made only marginally. Therefore it is necessary for every medical field to investigate by stock-taking to what extent currently practised German diagnostic and therapeutic measures are considered in the G-DRG-Version 1.0 and whether and where modifications and adaptations need to be made. In order to make qualified statements scientific evaluations of possible problems have to be made based German data. Therefore an evaluation was made of the mapping of the medical fields of orthopaedics and trauma surgery. The German Society of Trauma Surgery (DGU), the German Society of Orthopaedy and Orthopaedic Surgery (DGOOC) in cooperation with the DRG-Research-Group of the University Hospital Muenster, the German Hospital Federation (DKG) and the German Medical Association carried out a DRG evaluation project in order to investigate the medical and economical homogeneity of the case groups. METHOD: 12,645 orthopaedic and trauma surgery cases from 23 hospitals - 11 university hospitals and 12 non-university hospitals - were collected within an period of three months and were scientifically evaluated with regard to their performance homogeneity and length of stay homogeneity. RESULTS: The data formed the basis for the proof of suspected deficiencies of mapping of orthopaedic and trauma surgery cases within the G-DRG-Variant. Based on the data and additionally on conclusions of medical experts when the number of cases were small, 14 suggestions for adaptation were proposed and submitted by the deadline of March 31 st, 2003 to the InEK. CONCLUSION: The results of the DRG-Evaluation Project demonstrate the problems of mapping the very heterogenous and complex medical performances of orthopaedy and trauma surgery to a flat rate financing system that is not adapted properly to German conditions. The G-DRG-Variant Version 1.0 does not offer the sufficient possibilities of differentiation that are needed to map the various orthopaedical and trauma surgical measures in Germany.

Cost-Benefit Analysis↗
PubMedDate not supplied

Sore nipples.

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Breast Feeding↗
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Health promoting behaviors of urban African American female heads of household.

Nurse practitioners' understanding of the health status and health promoting behavior of African American women is only in its infancy. This study utilized the Health Promoting Lifestyle Profile to examine these behaviors in 198 females (73% African American) in an urban setting who were heads of household. The purpose was to identify their health promoting lifestyles. Such knowledge could be the basis for health promotion programs to meet the needs of these women. Findings revealed that being head of household had no significant relationship to health promoting behavior. Religiosity and education were positively associated with health promoting behavior, while smoking and ethnic background were inversely correlated. Age and marital status also influenced specific health promoting behaviors. Implications for development of programs to foster involvement of African American women in health promotion programs were presented.

Adolescent↗
PubMedDate not supplied

Congenital syphilis at Goroka Base Hospital: incidence, clinical features and risk factors for mortality.

A prospective study of all cases of congenitally acquired syphilis diagnosed at Goroka Base Hospital was conducted between January 1998 and December 1999. 67 affected neonates and children were seen, of whom 19 died during the first admission and 3 died during the period of follow-up. Congenital syphilis caused 5.5% of 994 neonatal admissions, but 22% of all neonatal deaths. The major risk factor for death in affected babies was low birthweight. A birthweight of less than 2 kg had an odds ratio for death of 30.0 (95% confidence interval 6.90-131.1). During the time of the study 5385 women attended antenatal care at Goroka Base Hospital, of whom 382 had both positive VDRL and TPHA tests. The incidence of syphilis in women attending antenatal care was 7.1%. Syphilis is a major cause of neonatal mortality and morbidity and a major cause of morbidity among women of childbearing age in the Eastern Highlands Province. Current antenatal screening is inadequate, covering less than 30% of pregnant women. New ways to extend syphilis screening and treatment to all affected pregnant women are urgently required and must be formally assessed.

Birth Weight↗
PubMedDate not supplied

Control measures and the outcome of the measles epidemic of 1999 in the Eastern Highlands Province.

In the Eastern Highlands Province (EHP) of Papua New Guinea (PNG) measles outbreaks have occurred regularly every 3 to 4 years since 1980. The latest was between September 1998 and March 2000. Between July 1999 and March 2000 314 children with measles were reviewed at Goroka Base Hospital. The majority of these children were very young: 55% were under 1 year and 27% under 6 months. The median age of the measles cases was 11 months (range 10 days to 13 years). 40% of the children had a verifiable history of having received at least one dose of measles vaccine. The majority were vaccinated during the epidemic and included many children who either were below 6 months of age or who developed measles within 2 weeks of vaccination. Measles complications occurred in 82% of the children, the most common being pneumonia. Serious complications, particularly severe pneumonia, were more common among the unvaccinated children than in those who had received at least a single dose of the measles vaccine. No deaths occurred among 82 children who had received measles vaccine more than 2 weeks before the onset of clinical measles, compared with 10 deaths in 206 children who had never been vaccinated against measles or were vaccinated in the 2 weeks before presentation (p=0.067). The overall case fatality was 4%: 14% among the hospital-acquired and 2.5% in community-acquired measles. Improvement in the measles vaccination coverage and supplementary vaccination campaigns are required to prevent measles outbreaks in PNG. Intensified measles vaccination campaigns, such as the one conducted in EHP in 1999, are recommended during epidemics to minimize deaths due to measles and to rapidly control outbreaks. The efficacy of measles vaccination can only be measured in total mortality, not in the prevention of clinical measles.

Adolescent↗
PubMedDate not supplied

A comparison of sexual behavior and self-esteem in young adult females with positive and negative tests for sexually transmitted diseases.

Contracting sexually transmitted diseases is a serious health problem faced by young women, in part, because they may routinely engage in risky sexual behaviors. This study describes the sexual behaviors of eighty-one young adult females who had positive and negative tests for STDs. The STD-negative group consisted of forty-nine African American females and the STD-positive group was thirty African American and two Caucasian females. The women completed the Safe Sex Behavior Questionnaire and the Rosenberg Self Esteem Scale. Demographic factors were also examined. The findings revealed that STD-negative females had higher self esteem and practiced safe sex more frequently. Also, women with higher education and incomes above $10,000 a year, plus a higher self-esteem level scored higher on the SSBQ, indicating the practice of safer sex. Age was not related to self esteem or the practice of safe sexual behavior. Implications for nurse practitioner practice are discussed.

Adult↗