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Biomedical subjects

E A Coleman

Publications and source records attributed to E A Coleman.

At least 19 recordsLinked to original sources
PubMed1998

Breast cancer screening programmes in 22 countries: current policies, administration and guidelines. International Breast Cancer Screening Network (IBSN) and the European Network of Pilot Projects for Breast Cancer Screening.

BACKGROUND: Currently there are at least 22 countries worldwide where national, regional or pilot population-based breast cancer screening programmes have been established. A collaborative effort has been undertaken by the International Breast Cancer Screening Network (IBSN), an international voluntary collaborative effort administered from the National Cancer Institute in the US for the purposes of producing international data on the policies, funding and administration, and results of population-based breast cancer screening. METHODS: Two surveys conducted by the IBSN in 1990 and 1995 describe the status of population-based breast cancer screening in countries which had or planned to establish breast cancer screening programmes in their countries. The 1990 survey was sent to ten countries in the IBSN and was completed by nine countries. The 1995 survey was sent to and completed by the 13 countries in the organization at that time and an additional nine countries in the European Network. RESULTS: The programmes vary in how they have been organized and have changed from 1990 to 1995. The most notable change is the increase in the number of countries that have established or plan to establish organized breast cancer screening programmes. A second major change is in guidelines for the lower age limit for mammography screening and the use of the clinical breast examination and breast self-examination as additional detection methods. CONCLUSION: As high quality population-based breast cancer screening programmes are implemented in more countries, they will offer an unprecedented opportunity to assess the level of coverage of the population for initial and repeat screening, evaluation of performance, and, in the longer term, outcome of screening in terms of reduction in the incidence of late-stage disease and in mortality.

Adult↗
PubMed1998

Predicting hospitalization and functional decline in older health plan enrollees: are administrative data as accurate as self-report?

OBJECTIVE: To compare the predictive accuracy of two validated indices, one that uses self-reported variables and a second that uses variables derived from administrative data sources, to predict future hospitalization. To compare the predictive accuracy of these same two indices for predicting future functional decline. DESIGN: A longitudinal cohort study with 4 years of follow-up. SETTING: A large staff model HMO in western Washington State. PARTICIPANTS: HMO Enrollees 65 years and older (n = 2174) selected at random to participate in a health promotion trial and who completed a baseline questionnaire. MEASUREMENT: Predicted probabilities from the two indices were determined for study participants for each of two outcomes: hospitalization two or more times in 4 years and functional decline in 4 years, measured by Restricted Activity Days. The two indices included similar demographic characteristics, diagnoses, and utilization predictors. The probabilities from each index were entered into a Receiver Operating Characteristic (ROC) curve program to obtain the Area Under the Curve (AUC) for comparison of predictive accuracy. RESULTS: For hospitalization, the AUC of the self-report and administrative indices were .696 and .694, respectively (difference between curves, P = .828). For functional decline, the AUC of the two indices were .714 and .691, respectively (difference between curves, P = .144). CONCLUSIONS: Compared with a self-report index, the administrative index affords wider population coverage, freedom from nonresponse bias, lower cost, and similar predictive accuracy. A screening strategy utilizing administrative data sources may thus prove more valuable for identifying high risk older health plan enrollees for population-based interventions designed to improve their health status.

Activities of Daily Living↗
PubMed1996

Subjective memory complaints prior to and following electroconvulsive therapy.

Using the Squire Subjective Memory Questionnaire (SSMQ), depressed patients rated their memory functioning prior to a course of brief pulse, electroconvulsive therapy (ECT) within the 1 week following the course and 2 months later. Normal controls made similar ratings at comparable intervals. Prior to ECT, patients reported poorer memory functioning than controls. There was marked improvements in the patients' self-reports shortly following ECT, and at 2-month follow-up SSMQ scores were generally comparable in patients and controls. At all time points, the severity of depressive symptoms was strongly associated with patients' reports of memory dysfunction. SSMQ subscales ("depression" and "ECT" items) were not differentially sensitive to effects of ECT or depression. Relations between ECT treatment parameters and changes in patients' self-evaluations only emerged after controlling for clinical state change. Shortly following ECT, there were no relations between SSMQ scores and objective measures of cognitive functioning. However, 2 months following ECT, there was a suggestion that greater retrograde amnesia for autobiographical memories was associated with self-rating of greater memory impairment.

Adult↗
PubMed1996

The relationship of joint symptoms with exercise performance in older adults.

OBJECTIVES: The objective of this study is to determine if exercise increases joint symptoms in older adults with a history of arthritis or produces symptoms in older adults without such history. In addition, we examine whether joint symptoms explain the large observed variation in strength gain in older adults undergoing vigorous strength training exercise, and report the incidence of musculoskeletal injuries upon initiation of an exercise program. DESIGN: A population-based, single blinded, randomized controlled trial with three exercise groups and one control group. SETTING: A large urban health maintenance organization. PARTICIPANTS: Older men and women (N = 105) aged 68 to 85, with leg strength below the 50th percentile for their age, sex, height, and weight and without neuromuscular disease or active cardiovascular disease. INTERVENTIONS: Supervised exercise in 1-hour sessions, three times each week, for 24 to 26 weeks. One exercise group did strength training (ST) using weight machines (n = 25); another group did endurance training (ET) using stationary cycles (n = 25); and the third group did combined strength training and endurance training (ST+ET) (n = 25). The control group (n = 30) received no intervention. MEASUREMENTS: Strength was measured at the ankle, knee, hip, and elbow using an isokinetic dynamometer. Joint symptoms were rated on a 6-point scale (0 = none, 5 = severe). Arthritis severity was based on self-reported use of arthritis medication. Health status was measured with subscales of the SF-36 and Sickness Impact Profile (SIP). RESULTS: Joint symptoms fluctuated over time in all exercise groups, but they did not improve or worsen significantly in any group. The physical dimension of the SIP and SF-36 subscale scores, including Bodily Pain Scores, did not change over time in any group. Subjects with arthritis and joint symptoms gained as much strength with strength training as did subjects without joint symptoms. Adjustment for age, gender, baseline strength, adherence, and exercise group did not affect this finding. The rate of minor musculoskeletal injuries was 2.2 injuries per 1000 exercise hours. CONCLUSIONS: Moderate intensity stationary cycle exercise and vigorous intensity strength training do not appear to produce or exacerbate joint symptoms in older adults. Joint symptoms did not explain the large variation in gains in strength in older adults participating in a standardized strength training exercise program. Musculoskeletal injuries occurred relatively infrequently, and no major injuries occurred. In evaluating joint pain that occurs in older adults in well regulated exercise programs, clinicians should consider other etiologies before attributing pain to exercise per se.

Aged↗
PubMed1995

Visual fixation and smooth pursuit eye movement abnormalities in patients with schizophrenia and their relatives.

Increasing evidence suggests that smooth pursuit eye movement (SPEM) dysfunction may serve as an endophenotype or genetic marker of schizophrenia. The authors tested SPEM and visual fixation (VF) in 31 patients with schizophrenia, 33 of their first-degree relatives, and 24 patients with major depressive disorder. A high rate of abnormal VF was found in schizophrenic patients and their first-degree relatives, but not in affective disorder patients with or without psychotic features. Rate of VF abnormality distinguished schizophrenic patients from acutely depressed mood disorder patients; SPEM did not. VF and SPEM performance correlated only moderately, suggesting that the pathophysiologies of these two eye movement abnormalities may be partially independent. Implications for identifying a schizophrenia endophenotype are discussed.

Adult↗
PubMed1994

Smooth pursuit eye movement abnormality in severe major depression: effects of ECT and clinical recovery.

Smooth pursuit eye movement (SPEM) dysfunction is a putative genetic marker for schizophrenia, but it has also been described in major depression. The authors longitudinally evaluated effects of clinical state on SPEM quality in patients with depression. Prior to ECT, SPEM abnormality characterized 42% of 24 severely depressed patients, 60% of 30 schizophrenia patients, and 5% of 20 control subjects. SPEM was significantly correlated to Hamilton Rating Scale for Depression scores (r = 0.49, P = 0.02) in the depressed patients. Although SPEM was transiently disrupted by an acute ECT treatment, it improved during the treatment course. This improvement of SPEM quality with clinical recovery suggests that SPEM abnormality may be a state marker in severe major depression, in contrast to its invariable trait nature in schizophrenia.

Adult↗
PubMed1994

Unique features and prognosis of primum ASD presenting in the first year of life.

BACKGROUND: Primum atrial septal defect (ASD) is a defect that is usually associated with few symptoms and can be electively repaired with good results. A review of our experience with primum ASD identified a subset of patients characterized by presentation with congestive heart failure (CHF) in the first months of life and a requirement for early operation. Echocardiograms, catheterizations, operative reports, and clinical data were reviewed and compared with that on all other patients with primum ASD. Patients with transitional or complete atrioventricular (AV) canal defects were excluded. METHODS AND RESULTS: From January 1984 to December 1992, significant CHF was present in the first year of life in 11 patients (10.5%) with primum ASD who were managed surgically among 105 total patients undergoing repair of primum ASD. This early CHF group had a higher incidence of hypoplastic left-sided cardiac structures (9 of 11 patients) compared with other primum ASD patients (5 of 94, P < .001), including patients with coarctation (CoA) (n = 9), abnormal mitral valve (n = 7), left ventricular hypoplasia (n = 5), and subaortic stenosis (subAS) (n = 7). Other differentiators from patients without early CHF included incidence of Downs syndrome (0% versus 19%), elevated pulmonary artery pressures (72% versus 33% systemic, P < .001), earlier mean age at operation (8 months versus 5.4 years), greater incidence of reoperation after initial ASD closure (5 of 8 patients, 12 operations [5 subAS, 3 mitral valve, 3 CoA, 1 pacemaker] versus 4 of 93 patients, P < .001), and higher mortality (36% versus 1%, P < .001). CONCLUSIONS: Left-sided obstructive lesions must be sought in children with primum ASD presenting with CHF in the first year of life. The presence of these lesions alters prognosis and surgical management and mandates close follow-up, with particular attention to late appearance or progression of subaortic stenosis or deterioration of mitral valve function.

Child, Preschool↗
PubMed1993

Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy.

BACKGROUND: The efficacy of electroconvulsive therapy in major depression is established, but the importance of the electrical dosage and electrode placement in relation to efficacy and side effects is uncertain. METHODS: In a double-blind study, we randomly assigned 96 depressed patients to receive right unilateral or bilateral electroconvulsive therapy at either a low electrical dose (just above the seizure threshold) or a high dose (2.5 times the threshold). Symptoms of depression and cognitive functioning were assessed before, during, immediately after, and two months after therapy. Patients who responded to treatment were followed for one year to assess the rate of relapse. RESULTS: The response rate for low-dose unilateral electroconvulsive therapy was 17 percent, as compared with 43 percent for high-dose unilateral therapy (P = 0.054), 65 percent for low-dose bilateral therapy (P = 0.001), and 63 percent for high-dose bilateral therapy (P = 0.001). Regardless of electrode placement, high dosage resulted in more rapid improvement (P < 0.05). Compared with the low-dose unilateral group, the high-dose unilateral group took 83 percent longer (P < 0.001) to recover orientation after seizure induction, whereas the combined bilateral groups took 252 percent longer (P < 0.001). During the week after treatment, there was three times more retrograde amnesia about personal information with bilateral therapy (P < 0.001). There were no differences between treatment groups in cognitive effects two months after treatment. Forty-one of the 70 patients who responded to therapy (59 percent) relapsed, and there were no differences between treatment groups. CONCLUSIONS: Increasing the electrical dosage increases the efficacy of right unilateral electroconvulsive therapy, although not to the level of bilateral therapy. High electrical dosage is associated with a more rapid response, and unilateral treatment is associated with less severe cognitive side effects after treatment.

Amnesia, Retrograde↗
PubMed1993

Individual pulmonary vein size and survival in infants with totally anomalous pulmonary venous connection.

OBJECTIVES: We investigated whether mortality in totally anomalous pulmonary venous connection could be predicted from preoperative individual pulmonary vein size. BACKGROUND: Some infants with this anomaly die with or without surgical repair because of stenosis of individual pulmonary veins. METHODS: Individual pulmonary vein, vertical vein and pulmonary venous confluence diameters were retrospectively measured from preoperative echocardiograms in 32 infants with totally anomalous pulmonary venous connection presenting to Children's Hospital, Boston over a 4 1/2-year period. Data on body surface area, other cardiac anomalies, presence of initial pulmonary venous obstruction and early surgery and outcome were also recorded. RESULTS: Of 32 patients, 6 (18.8%) died before hospital discharge, and 8 (25.0%) died subsequently. Six (75.0%) of the eight patients who died late had individual pulmonary vein stenosis at sites remote from the surgical anastomosis to the left atrium. The remaining 18 patients (56.3%) are alive at a mean follow-up period of 9.7 months. A Cox proportional hazards model revealed that small sum of individual pulmonary vein diameters (p = 0.0004), small confluence size (p = 0.02) and presence of heterotaxy syndrome (p = 0.008) were each significant univariate predictors of survival. Multivariate analysis showed that small pulmonary vein sum was a strong predictor of survival (p = 0.008), independent of the presence of heterotaxy syndrome. An analysis stratified by the presence of heterotaxy syndrome showed that the predictive effect of small pulmonary vein sum on survival was strongest in patients without heterotaxy syndrome. CONCLUSIONS: These data show that individual pulmonary vein size at diagnosis is a strong, independent predictor of survival in patients with totally anomalous pulmonary venous connection. In patients with this anomaly and small individual pulmonary veins, the anomaly may not be correctable by surgical creation of an anastomosis between the pulmonary venous confluence and the left atrium.

Echocardiography↗
PubMed1993

A statewide breast cancer screening project.

The cause of breast cancer remains unknown. Because prevention is not an option, early detection is the most viable alternative for decreasing the mortality rates from breast cancer. To promote early detection, the Arkansas Division of the American Cancer Society implemented a project aimed at increasing public awareness. The project used a three-pronged approach: the life-saving benefits of mammography, regular breast examination by a health-care professional, and the importance of regular breast self-examination (BSE). This article focuses on the third prong, BSE. Project members recruited and trained 408 BSE instructors in the MammaCare method of BSE and contacted a total of 87,141 Arkansas women about breast cancer and the importance of early detection. In a follow-up survey of 1,300 women, of the 198 (15%) who returned the surveys, two women reported finding lumps that were diagnosed as cancer.

Adult↗
PubMed1992

Breast cancer screening among women from 65 to 74 years of age in 1987-88 and 1991. NCI Breast Cancer Screening Consortium.

OBJECTIVE: To compare breast cancer screening rates from the 1991 survey with data from 1987-88 for women aged 65 to 74. DESIGN: Surveys of women from five communities. SETTINGS: Five control communities of the National Cancer Institute's Breast Cancer Screening Consortium. PARTICIPANTS: White, non-Hispanic women, ages 65 to 74; 499 in 1987-88 and 2156 in 1991. Response rates for the first survey wave ranged by area from 65% to 77% and for the second survey wave, from 62% to 85%. MAIN OUTCOME MEASURE: Mammogram and clinical breast examination during the past year and performance of monthly breast self examination, with the screening rates in wave 2 directly standardized to the income and education distribution of wave 1 in each area. RESULTS: Mammography use between waves increased significantly (P < 0.05 after adjusting for education, income, and age) in all but one area (from 19% to 33% in wave 1 to 35% to 59% in wave 2). Among women who had a mammogram, the percent who also had a clinical breast examination decreased between waves from 95% to 85% (P = 0.001). CONCLUSIONS: Mammography in older women increased dramatically over 3 years, although the use of clinical breast examination may be decreasing.

Aged↗
PubMed1991

Practice and effectiveness of breast self examination: a selective review of the literature (1977-1989).

From a review of the literature on studies on breast self examination (BSE), it is evident that BSE functions as an effective preventive health behavior. Only 19% to 40% of women practice BSE on a monthly basis, and there is no strong evidence that women who practice monthly BSE perform the procedure correctly. Confidence in BSE performance, prior BSE instruction, and finding some way to remember to do BSE were the factors most positively associated with frequent BSE practice. Women need to be given the facts about breast cancer and information about early detection methods and also need to be taught BSE in such a way that they feel confident in their BSE skills. The most effective way to teach BSE is to teach the woman on her own breasts. Since BSE is a skill, an accurate assessment of the learners' BSE techniques is necessary to adequately evaluate BSE teaching methods.

Breast Self-Examination↗
PubMed1991

Chemotherapy for glioblastoma multiforme.

Treatment for the patient with a glioblastoma multiforme often includes chemotherapy with many specific nursing implications directly associated with this form of treatment. While the four agents described share some common adverse effects such as nausea and vomiting, even with this relatively common adverse effect, the onset, duration and severity varies. Multiple other adverse effects like nephrotoxicity, ototoxicity, thrombocytopenia and leukocytopenia vary greatly from agent to agent in occurrence and severity. Knowing the mode of action for each agent, which adverse effects to expect, when to expect them and appropriate treatment measures will help the nurse, patient and family to better manage these effects and improve quality of life.

Antineoplastic Agents↗
PubMed1991

Measuring breast self-examination proficiency. A scoring system developed from a paired comparison study.

A continuous scoring strategy yielding a proficiency score on breast self-examination (BSE) performance was developed and validated. The method of paired comparisons was used to provide a rank ordering on an interval scale of the eight components of the evaluation tool. Twenty-one experts in teaching the MammaCare method of breast self-examination participated in the survey to help in developing the composite measure of proficiency in BSE performance. Data on each component of BSE were collected quantitatively, and performance scores were computed using a formula incorporating the weighting schema derived from the paired comparisons procedure. A comparison of preteaching versus postteaching mean performance scores on BSE indicated that the scoring system worked even when the teaching method varied. The scoring system presented here is a start on the development of a tool that can be useful to researchers using relative performance as a measure in BSE studies. The components of the scoring system can be used by nurses in the practice setting as a checklist for evaluating BSE performance.

Breast Self-Examination↗
PubMed1991

Graded versus pass/fail evaluation for clinical courses.

Grades vs. pass/fail for clinical courses-Thompson et. at. look at an old problem. Neither a literature review nor a survey were adequate to favor one approach over the other, but both systems' pitfalls are made clear here.

Clinical Competence↗