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Biomedical subjects

I R Merkatz

Publications and source records attributed to I R Merkatz.

At least 19 recordsLinked to original sources
PubMed2000

Improving preconception care.

OBJECTIVE: To improve the documentation and delivery of preconception care to all women of reproductive age attending an inner city hospital's outpatient gynecology clinic. A secondary goal was to evaluate the knowledge and awareness of providers regarding preconception care. STUDY DESIGN: A preintervention chart review of a convenience sample of non-pregnant women with reproductive potential who attend an inner city hospital gynecology clinic (n = 100) was conducted to evaluate delivery of preconception care. Items screened for included: family planning services, domestic violence, nutrition and medical risk factors, medication use, appropriate counseling and use of referral services. All providers in the clinic were surveyed to assess their knowledge of and attitudes toward preconception care. A two-part intervention was then carried out: (1) a one-hour lecture for all providers, and (2) a standardized preconception care form inserted in all charts. A postintervention chart review of a second convenience sample (n = 100) and repeat provider survey were then conducted to evaluate the effectiveness of the two interventions. RESULTS: Following the two-pronged intervention, there was evidence of improved documentation of the delivery of preconception care. Documentation of screening in almost all categories was significantly improved (P < .05). The greatest improvements were noted in complete screening for medical risk factors (from 15% to 44%), for over-the-counter and prescription medication use (from 10% to 70% and 30% to 77%, respectively), domestic violence (from 10% to 57%) and nutrition (from 9% to 50%). However, provider knowledge of and attitudes toward preconception care were not significantly changed. CONCLUSION: The combination of education about preconception care and insertion of a standardized form into a patient's chart led to a clear improvement in the documentation of preconception care. Given the significance of preconception care, insertion of a standardized form should be considered to help providers complete and appropriate care to their patients.

Adult↗
PubMed1999

Methods to encourage the use of antenatal corticosteroid therapy for fetal maturation: a randomized controlled trial.

CONTEXT: Antenatal corticosteroids for fetal maturation have been underused, despite evidence for their benefits in cases of preterm birth. OBJECTIVE: To evaluate dissemination strategies aimed at increasing appropriate use of this therapy. DESIGN AND SETTING: Twenty-seven tertiary care institutions were randomly assigned to either usual dissemination of practice recommendations (n = 14) or usual dissemination plus an active, focused dissemination effort (n = 13). SUBJECTS: Obstetricians and their preterm delivery cases at participating hospitals. INTERVENTION: Recommendations by a National Institutes of Health (NIH) Consensus Conference held in late February-early March 1994 were disseminated in early May 1994. Usual dissemination was publication of the recommendations and endorsement by the American College of Obstetricians and Gynecologists. Active dissemination was a year-long educational effort led by an influential physician and a nurse coordinator at each facility, consisting of grand rounds, a chart reminder system, group discussion of case scenarios, monitoring, and feedback. MAIN OUTCOME MEASURE: Use or nonuse of antenatal corticosteroids was abstracted from medical records of eligible women delivering at the participating hospitals in the 12 months immediately prior to release of the NIH recommendations (average number of records abstracted, 130) and in the 12 months following their release (average number of records abstracted, 122). RESULTS: Active dissemination significantly increased the odds of corticosteroid use after the conference. Use increased from 33.0% of eligible patients receiving corticosteroids to 57.6%, or by 75% over baseline, in usual dissemination hospitals. Use increased from 32.9% to 68.3%, oran 108% increase, in active dissemination hospitals. Gestational age and maternal diagnosis affected use of the therapy in complex ways. CONCLUSION: An active, focused dissemination effort increased the effectiveness of usual dissemination methods when combined with key principles to change physician practices.

Anti-Inflammatory Agents↗
PubMed1999

Evaluation of the readability of ACOG patient education pamphlets. The American College of Obstetricians and Gynecologists.

OBJECTIVE: To evaluate whether ACOG's patient education pamphlets comply with the recommended readability level for health education materials intended for the general public. METHODS: All 100 English-language pamphlets available during 1997 (created or revised between 1988 and 1997) were evaluated using four standard readability formulas. RESULTS: Mean readability levels of ACOG's pamphlets were between grade 7.0 to grade 9.3, depending on the formula used. Analysis of readability over the 10 years showed a trend toward lower readability levels. Analysis by category of pamphlet found that the lowest readability levels were in "Especially for teens" pamphlets. CONCLUSION: Our data suggested that most of ACOG's patient education pamphlets currently available are written at a higher readability level than recommended for the general public. The readability of those pamphlets improved in the 10 years since the organization published its first pamphlet, but the goal of sixth-grade readability level has not been reached.

Adolescent↗
PubMed1997

Modified open laparoscopy through placement of an optical surgical obturator.

OBJECTIVE: To describe a new technique for open laparoscopy. DESIGN: Prospective case series. SETTING: Ambulatory surgical unit. PATIENT(S): Fifty-six women undergoing laparoscopic sterilization. INTERVENTION(S): Intra-abdominal placement of an optical surgical obturator. MAIN OUTCOME MEASURE(S): Evaluation of surgical technique. RESULT(S): The technique was completed successfully in all cases. CONCLUSION(S): This new surgical approach may assist surgeons in avoiding inadvertent injuries.

Female↗
PubMed1995

Impact of an inner-city, hospital-based preterm prevention program on preterm births in twin gestation.

The objective of this study was to determine the impact of an inner-city, hospital-based preterm-birth prevention program on the outcome of twin pregnancies. A retrospective study of delivery outcomes from 1985 to 1992 of eligible consecutive twin deliveries that were > or = 20 weeks' gestation compared two inner-city hospitals in the Bronx, New York: one with a preterm prevention program for twin births and a comparable site offering conventional prenatal care. A group of patients receiving no prenatal care was also included. Outcomes were evaluated by prenatal-care site, except for those who received no prenatal care and delivered at either site. Data were analyzed by chi-square analysis and analysis of variance. Of the 377 twin pregnancies, 330 pregnancies were eligible deliveries. One hundred thirty-four women received prenatal care from the preterm prevention program, 161 received conventional prenatal care at a comparable site, and 35 received no prenatal care. Maternal age, parity, and mode of delivery were similar in the two delivery sites. There was an increased incidence of complications in the no-prenatal-care group compared with the groups who received the preterm prevention or conventional prenatal care. The percentage of low-birth-weight (< 2500 g) and very-low-birth-weight (< 1000 g) infants was similar in the preterm prevention and the conventional care groups. The percentage of extremely low-birth-weight (< 1000 g) infants was significantly lower in twin births of the preterm prevention site (9.7%) and the conventional site (11.3%) compared with the no-prenatal-care group (28.6%) (P < .01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Comparison of visual and tactile localization of the trocar tip during abdominal entry.

We attempted to determine whether video-aided visual imaging during laparoscopic insertion of the trocar would improve the surgeon's ability to localize the sharp penetrating tip of the instrument. A newly described, visually directed laparoscopic trocar was inserted in 184 subjects to correlate visual localization of the tip with the accuracy of the conventional tactile sensory approach. In 164 of the 184 cases the fascia was recognized visually at the same time that the surgeon acknowledged tactile resistance. However, partial intraabdominal penetration was noted in 102 of these cases just before the anticipated loss of resistance could be felt manually. More important, in 20 women there was no subjective manual confirmation of the tip location by the time intraabdominal placement of the trocar was confirmed visually. In this limited series there were no multiple insertions or complications under visually directed trocar entry. Video-aided direct visualization improves the surgeon's ability to localize the tip of the trocar throughout the insertion. It may help the surgeon to recognize and possibly avoid some inadvertent distant intraabdominal organ injuries.

Abdominal Muscles↗
PubMed1994

Placental histology and placental/fetal weight ratios in pregnant women with sickle cell disease: relationship to pregnancy outcome.

Although the adverse effects of sickle cell disease on pregnancy outcome are well recognized, the contribution of placental pathology to these events remains controversial. Placentas from single, term deliveries of 21 women with sickle cell (SS) disease and 63 low-risk control women with hemoglobin AA, matched for maternal age, gestational age, and parity, were examined and findings correlated with neonatal outcome. Gross and microscopic examinations of these placentas were performed by a pathologist unaware of the pregnancy outcome. All placentas were weighed, and the relative placental weight was calculated and examined for the presence of infarction, villous sclerosis, and intervillous fibrin deposits. The mean birth weight of infants of the SS women was significantly lower than that of the low-risk controls (2830 +/- 310 g versus 3415 +/- 250 g, P < .05). The mean placental weight was also lower in the SS group compared with controls (445 +/- 78 g versus 568 +/- 86 g). The mean relative placental weight for the SS women was 12.9 +/- 4% and for the controls, 15.2 +/- 3.4%. Moderate-to-severe villous sclerosis, infarction, and intervillous fibrin deposits were present in 7 of 21 SS placentas but absent in placentas of low-risk controls. These 7 pregnancies with SS disease and abnormal placental findings had small-for-gestational-age infants, and their relative placental weight was less than 10%. We conclude that in SS disease, relative placental weight less than 10% and placental lesions of moderate-to-severe villous sclerosis, intervillous fibrin deposits, and infarction are associated with small-for-gestational-age infants.

Adult↗
PubMed1993

Are there differences in information given to private and public prenatal patients?

OBJECTIVES: In 1989 the United States Public Health Service Expert Panel on the Content of Prenatal Care reported that health education should become a more integral part of prenatal care. Key questions about providing this education have not been examined. Our study compared the type of information provided to women who sought prenatal care in a public clinic and to those who were seen in a private practice and the degree to which the patients were satisfied with the information they received. STUDY DESIGN: One hundred fifty-nine pregnant women (80 seen in a public clinic, 79 seen in a private practice) completed two questionnaires about 38 topics commonly cited as important during pregnancy. At the first prenatal visit, the women reported their level of interest in each of the topics. At 36 to 40 weeks' gestation the women completed a second questionnaire to assess whether information was provided for each topic and whether they had learned as much as desired. RESULTS: Overall, the women in the public sector received more information than did the women who were cared for privately. This was statistically significant at the p < 0.05 level for 25 of the 38 topics. Satisfaction with information learned was highly correlated with information received during prenatal care, but, surprisingly, it was not shown to be associated with the patient's interest level at the first visit. Fewer than 50% of private patients reported having received information about such important topics as acquired immunodeficiency syndrome, sexually transmitted diseases, preterm birth prevention, family planning, and family violence. CONCLUSIONS: The one-on-one approach to health education in pregnancy usually used in the private setting may not facilitate addressing many topics believed to be important components of contemporary prenatal care. Providers of private prenatal care should initiate discussion of prenatal health education topics rather than relying on patient interest in requesting information. Just as public prenatal care programs have devoted significant resources to more comprehensive prenatal education, the providers in the private sector must assure that pregnant women receive the same comprehensive information. In so doing, these providers can help promote an optimal outcome for their patients, their patients' unborn children, and the family unit.

Adolescent↗
PubMed1993

Twin gestation: fetal presentation as a function of gestational age.

OBJECTIVE: Our objective in this study was to evaluate the rate of spontaneous version in twin gestation throughout the third trimester. STUDY DESIGN: Serial ultrasonographic examinations were performed on 119 consecutive patients with twin gestation. The incidence of spontaneous version as a function of gestational age was calculated. RESULTS: The mean birth weight and gestational age at delivery were 2640 gm and 37 weeks, respectively. Nineteen percent had birth weight discordancy, and 37% were delivered by cesarean section. The incidence of spontaneous version decreased from 60% at 28 to 30 weeks' gestation to 25% to 30% at term. The lowest incidence of spontaneous version was observed in pregnancies with a cephalic-cephalic presentation (7%). All other presentations were relatively unstable. Neither the patients' parity nor the presence of birth weight discordancy, the placental location, or the amniotic fluid volume had a significant association with the incidence of spontaneous version. CONCLUSION: These data should be incorporated into the routine antepartum counseling of patients with twin gestation. Their use in this capacity may result in a decreased cesarean delivery rate if clinicians realize that malpresentations may spontaneously resolve before the onset of labor.

Adolescent↗
PubMed1992

Sudden fetal death in women with well-controlled, intensively monitored gestational diabetes.

An intensive antepartum monitoring system for women with gestational diabetes mellitus was evaluated over a 5-year period. Early diagnosis and liberal treatment with insulin was concomitantly followed with non-stress testing: weekly from 28 to 34 weeks' gestation and semi-weekly thereafter. Despite maternal euglycemia and satisfactory antepartum assessment, three fetal deaths occurred within 72 hours of reassuring fetal monitoring. Additionally, 24 (7%) fetuses were delivered on the basis of a low biophysical profile score (less than 6) at term. The stillbirth rate for women with gestational diabetes was 7.7/1000, whereas the stillbirth rate for nondiabetic low-risk patients was 4.8/1000. Women with gestational diabetes continue to be in a high-risk category for antepartum fetal death, requiring intensive monitoring with consideration for timely delivery.

Adult↗
PubMed1992

Clinical usefulness of computerized colposcopy: image analysis and conservative management of mild dysplasia.

OBJECTIVES: The purposes of this study were to evaluate the clinical usefulness of computerized colposcopy and image analysis, to investigate the correlation between lesion size and grade of dysplasia, and to examine and record the colposcopic changes associated with progression or regression of cervical dysplasia. METHODS: Sixty-eight patients with a fully visualized squamocolumnar junction and a histopathologic diagnosis of mild dysplasia were serially monitored for a period of 1 year using computerized colposcopy and image analysis. All patients had baseline computer-assisted measurements of their cervical lesions and repeat measurements at 3-month intervals. RESULTS: The mean age of the patients was 31 years, and the mean size of the colposcopically visualized lesions was 58 mm2. During the 12-month observation, 5.9% of the lesions increased in size, 32.4% decreased in size, 13.2% remained unchanged, 20.6% disappeared, and 27.9% completely changed location. In patients with an increase in lesion size (N = 4), a repeat biopsy was performed, revealing a progression to moderate dysplasia. Treatment was withheld from patients whose lesions disappeared (N = 14), decreased in size (N = 22), or remained unchanged (N = 9). Active therapy was unnecessary in 66% of cases and repeat biopsy was avoided in 94.1%. CONCLUSIONS: Computerized colposcopy provides objective information and may be an adjunct to cytology and histopathology in some cases. Computerized colposcopy replaces subjective colposcopic evaluation with objective computer assessment and may hold promise for conservative management of cervical dysplasia.

Adult↗
PubMed1992

A persistent clinical problem: profile of the term infant with significant respiratory complications.

A group of 72 term infants with significant respiratory complications were compared with 11,428 term infants delivered during the same time period and without respiratory morbidity. Compared with controls, the study group had a higher incidence of postdatism (36 versus 7%), intrauterine growth retardation (33 versus 8%), meconium-stained amniotic fluid (AF) (90 versus 9%), fetal heart rate (FHR) abnormalities upon admission to labor and delivery (58 versus 7%), and low 5-minute Apgar scores (46 versus 1.4%). Even in the presence of normal intrapartum FHR and 5-minute Apgar scores, infants with meconium-stained AF had an incidence of respiratory complications 100 times higher than those with clear AF. Of infants with a low 5-minute Apgar score at birth, only 20% went on to develop respiratory complications. The remaining 80% had a significantly lower incidence of postdatism, intrauterine growth retardation, and meconium-stained AF.

Apgar Score↗
PubMed1991

Intrapartum ultrasonographic estimates of fetal weight by the house staff.

In spite of the widespread use of ultrasonographic estimates of fetal weight, a paucity of data exists with regard to its use in patients who are in labor. The purpose of this study was to evaluate the accuracy of ultrasonographic estimates of fetal weight in a busy labor and delivery suite by the house staff. Measurements of biparietal diameter, abdominal circumference, and femur length were prospectively obtained in 109 patients in labor in whom this information was expected to be contributory in making delivery plans. All patients were delivered within 48 hours of ultrasonographic evaluation. Measurements of abdominal circumference were obtained in all cases. Biparietal diameter and femur length were obtained in 85% and 92% of cases, respectively. Overall, the mean absolute errors were 9.3% and 9.2% for estimated fetal weight by biparietal diameter/abdominal circumference and abdominal circumference/femur length ratios, respectively. Estimated fetal weight by biparietal/diameter/abdominal circumference ratio was not significantly different from that by femur length/abdominal circumference ratio. In conclusion, the accuracy of intrapartum estimates of fetal weight performed by the house staff in a busy labor and delivery unit is comparable to that reported for estimates obtained during the antepartum period by professional users of ultrasonography in a controlled setting.

Abdomen↗
PubMed1991

The effect of fetal movement counting on maternal attachment to fetus.

The effect of fetal movement counting on maternal attachment to fetus was investigated in 213 women with uncomplicated singleton pregnancies at 28 to 32 weeks' gestation. Women were randomized into those who counted fetal movements using the Sadovsky (n = 63) or Cardiff (n = 62) charts and controls (n = 88). After 1 month of fetal movement counting, the Cranley 24-item scale with five subscales was used as a measure of maternal-fetal attachment. Univariate analysis revealed a statistically significant increase in total attachment scores and in each of the five attachment subscales among women who counted fetal movements (p less than 0.0001). Turkey's studentized range test confirmed significant differences between each of the Sadovsky and Cardiff groups compared with controls (p less than 0.05). Our study suggests that fetal movement counting may enhance the maternal-fetal attachment process.

Adolescent↗
PubMed1991

Antepartum fetal surveillance tests during sickle cell crisis.

A study was conducted to evaluate the characteristics of antepartum fetal assessment tests for women with sickle cell disease during crisis. A total of 24 women with 39 episodes of crisis after 34 weeks of pregnancy were studied. All subjects were evaluated with nonstress tests, biophysical profile score, and uterine and umbilical artery systolic/diastolic ratios during and after sickle cell crisis. Results revealed that the incidence of nonreactive nonstress tests was significantly higher during crisis compared with the period after crisis (58.9% vs 10.3%, p less than 0.05). The frequency of biophysical profile score less than 8 was significantly higher during crisis compared with after crisis (33.3% vs 7.7%, p less than 0.05). All subjects had an increase in uterine systolic/diastolic ratio during crisis. The average uterine systolic/diastolic ratio was 3.92 (range, 2.16 to 4.24) during crisis and 2.54 (range, 1.98 to 3.23) after crisis (p less than 0.05). In contrast, there was no significant change in the mean umbilical systolic/diastolic ratios during and after crisis (2.58 and 2.62, respectively). We conclude that, although sickle cell disease crisis is associated with a higher incidence of abnormal biophysical test results, in most patients these results will revert to normal after crisis. The increase in uterine vascular resistance without a concordant increase in umbilical vascular resistance suggests that the transient effects of sickling during crisis may not compromise umbilical blood flow.

Adult↗