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Biomedical subjects

J A Colliver

Publications and source records attributed to J A Colliver.

At least 73 records · Page 4Linked to original sources
PubMed1989

Present status of obstetrics in family practice and the effects of malpractice issues.

A survey of 800 active members of the American Academy of Family Physicians 1985-1987 membership directory was conducted for the purpose of determining the impact, over time, of malpractice issues upon the practice of obstetrics by family physicians. The survey response rate was 60.4 percent. Almost 20 percent of all respondents reported that they have never provided obstetric care of any type. Another 40 percent have provided obstetric care previously but have now discontinued this care, while the remaining 40 percent currently offer obstetric care to their patients. The proportion of respondents who discontinued the practice of obstetrics because of increased risk of malpractice litigation increased significantly over the years from 1947 to 1986 (P = .0084). The proportion of respondents who discontinued obstetric practice because of increased malpractice insurance costs also increased significantly from 1945 to 1986 (P = .0002). The proportion of those entering practice during the past five years who decided not to offer obstetric services because of malpractice risks was significantly greater than the proportion entering practice earlier (21.0 percent vs 2.0 percent, P = .0090). Although the current patterns of obstetric practice showed regional variation, the accelerating impact of malpractice risk and insurance cost on these patterns was similar throughout the nation.

Family Practice↗
PubMed1988

Prevalence of a history of sexual abuse among female psychiatric patients in a state hospital system.

Fifty-one percent of a sample of 105 female state hospital patients were found to have been sexually abused as children or adolescents. In the majority of cases, hospital staff were unaware that the patients had histories of sexual abuse, and only 20 percent of the abused patients believed they had been adequately treated for sexual abuse. Sixty-six percent of the abused patients met the diagnostic criteria for posttraumatic stress disorder, although none had received that diagnosis. Compared with patients who had not been sexually abused, abused patients were significantly more likely to have 17 of 32 symptoms commonly linked with sexual abuse. Every patient who was positive for six symptoms--compulsive sexual behavior, chemical dependency, sadomasochistic sexual fantasy, sexual identity issues, chronic fatigue, and loss of interest in sex--had been sexually abused.

Adaptation, Psychological↗
PubMed1987

Allogeneic matings and immunization have different effects on nulliparous and multiparous mice.

CBA/J female mice have a high rate of spontaneous fetal loss when mated with DBA/2 males. We have confirmed that this fetal resorption rate can be significantly reduced by immunizing the female with C57BL rather than DBA leukocytes. The current studies have been extended to show the effect of continued immunization into second pregnancies. Three new findings emerge: second pregnancies in unimmunized CBA/J females X DBA/2 males proceed with a low percentage of spontaneous resorptions; continued immunization of multigravid, multiparous mice is associated with a high percentage of late onset fetal resorptions; and comparison of sex ratios between treated and untreated pregnancies showed no significant shift. These results suggest that untreated CBA/J females mated to DBA/2 males can be immunized to trophoblast antigens during first pregnancies, and that such immunization leads to "normal" reproductive outcome in subsequent untreated pregnancies. Persistent immunization with leukocytes appears to increase the percentage of fetal wastage in subsequent pregnancies regardless of whether the mother receives paternal or nonpaternal leukocytes. Intentional chronic immunization with male leukocytes does not influence the sex ratio of viable offspring. These data are discussed with reference to immunotherapy for women who suffer unexplained, recurrent spontaneous abortions.

Abortion, Veterinary↗
PubMed1987

Diabetic pregnancy. The effect of genetic susceptibility for diabetes on fetal weight.

Since macrosomic infants of diabetic mothers tend to remain obese throughout their lives, and obesity and heredity are factors predisposing to Type II diabetes, it can be hypothesized that infants who are going to develop diabetes later in life are more likely to be macrosomic at birth than those who are not going to develop diabetes as adults. This hypothesis was tested, using the c57/KsJdb+/+m mouse animal model of gestational diabetes. This animal is frankly diabetic in the homozygous diabetic form. In the heterozygous form, it develops gestational diabetes, and in the homozygous normal form, it is normal. The pups of heterozygous males and females that were bred were weighed, classified by sex, and identified. At 4 weeks of age, the genetic makeup of the pups was determined. From 37 litters, 140 pups were born and raised to weaning age. Multiple regression analysis of the data revealed that the homozygous diabetic pups weighed most at birth; the heterozygous gestationally diabetic pups weighed less, and the homozygous normal pups weighed the least. All comparisons of these groups were statistically significant. Sex and interlitter variation also were found to be significant factors determining birthweight. Controlling for sex and interlitter variation did not change the significance of the effect of the genetic tendency for diabetes on birthweight. This study indicates that in Type II diabetes, neonatal macrosomia in part may be determined by the genetic or congenital susceptibility to develop diabetes in the future.

Animals↗
PubMed1987

Evaluation and comparison of the distributions of gastric pH and hydrogen ion concentration.

The shapes of the distributions of gastric pH and hydrogen ion concentration [H+] were determined for each of 68 groups of patients scheduled for elective surgery under general anesthesia. The 68 groups comprised a total of 1,326 patients who had served as subjects in 13 of the authors' previously published studies. In general, the results showed that neither pH nor H+ was normally distributed; most of the pH distributions (47 of 68 = 69%) and most of the H+ distributions (53 of 68 = 78%) showed significant departure from the normal distribution. Moreover, the shapes of the distributions varied, depending upon the conditions under which gastric acidity was assessed. Groups receiving no medication for gastric acidity had positively skewed pH distributions (nonsymmetrical distribution with tail pointing to right and majority of cases in lower range), and groups receiving medications for the reduction of acidity had negatively skewed pH distributions (nonsymmetrical with tail pointing to left and majority of cases in upper range). The medications produced an inverse relationship between mean pH and skewness such that the skewness of the groups decreased from positive to negative as mean pH increased. For H+, all groups had positively skewed distributions, but the distributions were more positively skewed for groups receiving medications for gastric acidity. Again, the medication conditions produced an inverse relationship between mean acidity and skewness such that the groups became more positively skewed as the mean H+ decreased.(ABSTRACT TRUNCATED AT 250 WORDS)

Gastric Acidity Determination↗
PubMed1987

Direct, standardized assessment of clinical competence.

Doctor ratings of clerkship performance are often discounted as not accurately reflecting clinical competence. Such ratings are influenced by the following uncontrolled variables: case difficulty; differing rater focus and standards; lack of agreement on what constitutes acceptable performance; and collective patient care responsibility masks individual contributions. Standardized direct measures of clinical competence were developed to control these factors and allow direct comparisons of student performance. Students saw 18 patients representing frequently occurring and important patient problems. Student actions and decisions were recorded and subsequent responses to questions revealed knowledge of pathophysiology, basis for actions, use and interpretation of laboratory investigations, and management. Actions and responses were graded using a pre-set key. The examination covered 73% of designated clinical competencies. Examinations scores corresponded with independent measures of clinical competence. Reliability studies indicated that new cases can be substituted in subsequent years with confidence that scores will maintain similar meaning. Costs are +6.95 per student per case, which is modest considering the quality and quantity of information acquired. Methods described are practical for evaluation of clerks and residents and for licensing and specialty certification examinations.

Clinical Clerkship↗
PubMed1987

Relationships of five Doppler measures with flow in an in vitro model and clinical findings in newborn infants.

This report compares six Doppler ultrasound measures of blood flow: Pourcelot's pulsatility index, Gosling's pulsatility index, area under the curve, systolic amplitude, diastolic amplitude, and mean amplitude. Recordings from an in vitro arterial model and from the anterior cerebral arteries in 33 newborn infants with asphyxia, intraventricular hemorrhage, or normal state were analyzed. In the model, all measures had excellent correlation with flow. Neonates were correctly classified according to diagnosis by the Doppler measures as follows: Pourcelot's pulsatility index (100%), Gosling's pulsatility index (97%), diastolic amplitude (94%), mean amplitude (76%), area under the curve (70%), and systolic amplitude (58%). The best accuracy was obtained with the pulsatility indices.

Asphyxia Neonatorum↗
PubMed1986

The electrocardiogram in obesity: statistical analysis of 1,029 patients.

The electrocardiogram in 1,029 obese subjects was correlated with the severity of obesity and with age, sex and blood pressure. The heart rate, PR interval, QRS duration, QTc interval and voltage (R + S or Q wave in leads I, II and III) increased, and the QRS vector shifted to the left with increasing obesity. These changes were independent of age, sex and blood pressure. Bradycardia was present in 19% of the patients, but tachycardia in only 0.5%. ST and T wave abnormalities were present in 11%, correlating better with increasing age and blood pressure than with severity of obesity. Conduction abnormalities were infrequent. Low voltage was present in only 3.9% of the patients and QTc prolongation was present in 28.3%. The heart rate and QRS voltage increase with increasing obesity. Conduction is slowed, and the QRS vector shifts toward the left as percent overweight increases. These changes must be considered when evaluating both baseline electrocardiographic studies in obese patients and the changes seen during weight reduction.

Adolescent↗
PubMed1986

Dose-response effects of intravenous ranitidine on gastric pH and volume in outpatients.

The dose-response effects of intravenous ranitidine given 45 min to 5 h earlier on gastric pH and volume were evaluated in six groups of 25 outpatients, each undergoing elective surgery under general anesthesia. Patients in Group 1 received no ranitidine and served as controls. Patients in Groups 2-6 received ranitidine intravenously in incremental doses of 0.5 mg X kg-1 body weight from 0.5 mg to 2.5 mg (Group 2, 0.5 mg; Group 3, 1.0 mg; Group 4, 1.5 mg; Group 5, 2.0 mg; and Group 6, 2.5 mg). Ninety-six per cent of patients in the control group (Group 1) had gastric pH less than or equal to 2.5 while 36% of the patients had gastric content volumes greater than or equal to 25 ml with pH less than or equal to 2.5. Ranitidine, in incremental doses of 05.-2.5 mg X kg-1 body weight, caused a significant reduction of gastric acidity and volume. The ED50 of ranitidine producing a gastric pH greater than 2.5 was 0.36 mg X kg-1, and the ED95 was 0.98 mg X kg-1 body weight. The ED95 of ranitidine producing a gastric volume less than 25 ml was 1.96 mg X kg-1. At the dose of 1.5 mg X kg-1 of ranitidine, 100% of the patients had gastric contents with pH greater than 2.5. The proportion of patients with volume less than 25 ml was 68% with ranitidine, 0.5 mg X kg-1, and gradually increased to 100% with 2.5 mg X kg-1 body weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗