Biomedical subjects

J A Gaines

Publications and source records attributed to J A Gaines.

At least 19 recordsLinked to original sources

PubMed1997

Plasma lipid and lipoprotein responses to dietary fat and cholesterol: a meta-analysis.

Quantitative relations between dietary fat and cholesterol and plasma lipid concentrations have been the subject of much study and some controversy during the past 40 y. Previous meta-analyses have focused on the most tightly controlled, highest-quality experiments. To test whether the findings of these investigations are generalizable to broader experimental settings and to the design of practical dietary education interventions, data from 224 published studies on 8143 subjects in 366 independent groups including 878 diet-blood lipid comparisons were subjected to weighted multiple-regression analysis. Inclusion criteria specified intervention studies published in English between 1966 and 1994 reporting quantitative data on changes in dietary cholesterol and fat and corresponding changes in serum cholesterol, triacylglycerol, and lipoprotein cholesterol concentrations. Regression models are reported for serum total cholesterol, triacylglycerol, and low-density-high-density-, and very-low-density-lipoprotein cholesterol, with multiple correlations of 0.74, 0.65, 0.41, 0.14, and 0.34, respectively. Interactions of dietary factors, initial dietary intakes and serum concentrations, and study and subject characteristics had little effect on these models. Predictions indicated that compliance with current dietary recommendations (30% of energy from fat, < 10% from saturated fat, and < 300 mg cholesterol/d) will reduce plasma total and low-density-lipoprotein-cholesterol concentrations by approximately 5% compared with amounts associated with the average American diet.

Adolescent↗

PubMed1996

Order writing for parenteral nutrition by registered dietitians.

OBJECTIVES: The purpose of the study was to describe the involvement of registered dietitians in parenteral nutrition (PN) orders, to identify characteristics of those who write orders; and to rank education, training, and support elements that dietitians believe facilitate PN order-writing skills. DESIGN: Mail survey method. SUBJECTS: Usable returned questionnaires (n = 266) represented randomly sampled membership of the Dietitians in Nutrition Support (a dietetic practice group of The American Dietetic Association) and registered dietitian membership of the American Society of Parenteral and Enteral Nutrition. STATISTICAL ANALYSIS: Data were analyzed using basic frequency displays on all questionnaire items, Pearson correlations between the quantitative variables, and one-way analysis of variance with each of the categorical variables and the quantitative variables. Detail exploration among variables was done by chi(2) analyses and two-tailed t tests. RESULTS: "Recommend" was the most frequent response to a query about participation in PN orders. An average of 37% of respondents sometimes or always wrote orders for nutrients. Specialists were more likely to write orders than clinicians and managers. No relationship was found between those who wrote orders and educational level, and writers had been registered for a shorter length of time. Agreement on the training and support needed for order-writing skills was nearly unanimous. APPLICATIONS: The PN skills of respondents who were specialists distinguished them from managers and clinicians. Specialists did not fit criteria for advanced practice, and specialty practice in metabolic nutrition care may be too broad to define their practice. Educators must recognize the importance of including PN training in didactic and clinical training programs. Registered dietitians with PN skills will be well positioned to play an active role in the evolving health care system.

Analysis of Variance↗

PubMed1996

Influence of a statewide trauma system on location of hospitalization and outcome of injured patients.

OBJECTIVE: Evaluate the influence of implementing the Oregon statewide trauma system on admission distribution and risk of death. DESIGN: Retrospective pre- and posttrauma system analyses of hospital discharge data regarding injured patients with one or more of the following injuries: head, chest, spleen/liver, pelvic fracture, and femur/tibia fracture. MATERIALS AND METHODS: Risk-adjusted odds ratio of admission to Level I or II (tertiary care) trauma centers, and odds ratio of death were determined using hospital discharge abstract data on 27,633 patients. Patients treated in 1985-1987, before trauma system establishment, were compared to patients treated in 1991-1993 after the trauma system was functioning. MEASUREMENTS AND MAIN RESULTS: After trauma system implementation, the odds ratio of admission to Level I or II trauma centers increased (odds ratio 2.36, 95% confidence interval 2.24-2.49). In addition, the odds ratio of death for injured patients declined after trauma system establishment (odds ratio 0.82, confidence interval 0.73-0.92). CONCLUSIONS: The Oregon trauma system was successfully implemented with more patients with index injuries admitted to hospitals judged most capable of managing trauma patients. The Oregon trauma system also appears beneficial since trauma system establishment is associated with a statewide reduction in risk of death.

Abbreviated Injury Scale↗

PubMed1995

Comparison of the clinical informativeness of photographs and digital imaging media with multiple-choice receiver operating characteristic analysis.

BACKGROUND AND DESIGN: Electronic medical imaging is important for medical informatics, computerized learning, and especially for the growing field of telemedicine. The image resolution necessary for a clinical application can be determined by use of receiver operating characteristic (ROC) experiments. Completely profiling display systems is a tedious process, requiring multiple ROC experiments. We have developed a multiple-choice ROC analysis technique to compare the relative informativeness of digital image formats for a spectrum of cutaneous lesions simultaneously. The technique makes use of logical competitor sets (LCSs) of clinical conditions to redefine multiple-choice responses into the present/absent framework required for conventional ROC curve construction. The study divided 180 slides and digital images into three LCSs: pigmented lesions, flesh-colored papules, and papulosquamous conditions. Eight dermatologists diagnosed the lesions presented in two randomized viewing sessions. Accuracy profiles, independent of individual observer sensitivities, were derived from the responses. RESULTS: The informativeness of color slides and digital images was statistically similar, even when the conditions were stratified by difficulty of diagnosis. Results for nine specific skin conditions represented in the three LCSs were obtained simultaneously. CONCLUSIONS: Digital images appear to be as informative as slides for specific dermatologic diagnoses in the three LCSs tested. The use of LCSs allows stratification of results by diagnosis with greater efficiency than multiple repeated ROC experiments. Multiple-choice ROC analysis used in conjunction with logical competitor sets is the best currently available method for comparing imaging media for use in visual disciplines such as dermatology, radiology, pathology, and others.

Diagnosis, Computer-Assisted↗

PubMed1992

Variability in physician assessment of lesions in cutaneous images and its implications for skin screening and computer-assisted diagnosis.

BACKGROUND AND DESIGN: The diagnosis of skin lesions is a three-part process of (1) screening for abnormalities, (2) examining lesions closely for the presence of important clinical characteristics, and (3) choosing a diagnosis based on the clinical data gathered. The first step, screening for abnormal areas, is of particular interest for anyone wishing to understand and automate the diagnostic process. As part of ongoing research into lesion detection and measurement, we examined the reproducibility and reliability of dermatologists who were asked to screen sets of cutaneous digital images and high-resolution photographs for the presence of skin lesions. RESULTS: The intraobserver and interobserver variation in this task was considerable. The average reproducibilities and reliabilities were approximately 85%. The photographs did not produce significantly better overall screening results than the moderately low-resolution digital images. CONCLUSIONS: Even highly trained dermatologists appear to differ significantly in their initial interpretations of skin images, both from observer to observer and within observers from session to session. These differences were reflected in all measures of diagnostic sensitivity, reproducibility, and reliability assessed. The magnitude of this variation is relatively insensitive to the means used to measure it, and is not simply due to different individual standards for diagnosis. It is highly unlikely that this variation is attributable to the images themselves, since the overall results were nearly identical for moderately low-resolution digital formats and very high-resolution photographs. These findings have important implications for determining where errors may take place in dermatologic screening and for automating the process of detecting changes in skin lesions over time.

Dermatology↗

PubMed1992

Treatment of infants with acute diarrhea: what's recommended and what's practiced.

In 1985, the American Academy of Pediatrics (AAP) published a policy statement on the treatment of infants with acute diarrhea complicated by mild to moderate dehydration. To determine how closely physicians in the United States follow the AAP's treatment guidelines, a questionnaire was sent to 457 pediatricians and 360 family practitioners. The questionnaire presented a hypothetical infant with acute diarrhea complicated by mild to moderate dehydration and included questions regarding the number of such patients seen yearly, length of time used to rehydrate the infant, and how formula or solids are introduced following rehydration. Complete responses were received from 53% of pediatricians and 40% of family practitioners. The number of patients with acute diarrhea seen per year did not affect physician's treatment. Pediatricians and family practitioners responded similarly to most questions. Contrary to the AAP's guidelines to rehydrate in 4 to 6 hours, 62% of responding physicians extend the rehydration period to 12 to 24 hours. Also contrary to the AAP's recommendations, 62% of pediatricians and family practitioners use a lactose-free formula. The majority of responding physicians do follow the AAP's treatment guidelines to initiate feedings with diluted formula. Significantly more pediatricians than family practitioners advance to a full-strength formula within 1 day (P = .011). Fewer than 50% of physicians polled started solids within 24 hours as suggested by the AAP. Overall, the findings suggest that very few pediatricians and family practitioners follow all aspects of the AAP's treatment guidelines for infants with acute diarrhea complicated by mild to moderate dehydration.

Acute Disease↗

PubMed1990

Prospective comparison of plain abdominal radiography with conventional and digital renal tomography in assessing renal extracorporeal shock wave lithotripsy patients.

Most publications citing the effectiveness of renal extracorporeal shock wave lithotripsy have used plain abdominal radiography to assess residual calculi after treatment. We compared radiologist sensitivity and specificity in the detection of calculi on plain abdominal radiographs versus conventional film-screen and digital renal tomograms in extracorporeal shock wave lithotripsy patients. Of the patients 50 were imaged before and within 24 hours after lithotripsy. Six radiologists evaluated the resultant 300 studies for the presence and location of calculi. The mean sensitivity for digital tomograms was 83% for pre-lithotripsy and post-lithotripsy studies, which was significantly higher than for plain abdominal radiography and conventional tomography after lithotripsy. However, there were significantly more false positive stone diagnoses associated with digital tomogram interpretation. Signal detection analysis verified the over-all superiority of digital tomography for post-extracorporeal shock wave lithotripsy imaging. Calculus detection by conventional and digital tomography is superior to detection by plain abdominal radiography. However, because we did not perform delayed imaging, it is not possible to say what impact digital tomography might have on the management of extracorporeal shock wave lithotripsy patients.

Humans↗

PubMed1990

Observations of the posterior tibial nerve SEP of patients requiring extradural spinal surgery.

The cortical potentials evoked by posterior tibial nerve stimulation were examined in a series of 141 hospital patients requiring extradural spinal surgery. One hundred and five patients were neurologically intact, while in 36 some deficit was present. In the intact subjects, the absolute latencies of the main medium-latency peaks (N30, P40, N50, P60) were found to vary with height and age. There were no additional gender-related differences. The latencies of the deficit group were longer than those of the intact group but only marginally useful as a clinical discriminator; their amplitudes were not significantly lower than those of the intact group. A model for variations in SEP latency is suggested.

Age Factors↗

PubMed1989

Serum prostate-specific antigen and prostate pathology in men having simple prostatectomy.

Prostate-specific antigen (PSA) is a sensitive and specific serum marker for monitoring disease activity in men with prostatic carcinoma. Despite reports of elevation of levels of this analyte in men with benign prostatic hyperplasia, no information is available correlating the serum levels with the actual prostatic abnormalities in men having prostatectomy for presumed benign disease. In the present investigation, the authors compared preoperative serum PSA levels with prostate disease in 81 men with bladder outlet obstruction. Five pathologic groups were found: incidental high-grade carcinoma (n = 3), low-grade carcinoma (n = 11), acute inflammation (n = 16) with or without chronic inflammation, Prostatic intraepithelial neoplasia (PIN) (n = 25), and benign hyperplasia (n = 26). Serum PSA levels were significantly elevated in both low- and high-grade carcinoma, acute inflammation, and PIN when compared with the patients with benign hyperplasia with and without chronic inflammation. Within the four groups with elevated levels, use of PSA levels could separate only the high-grade cancer patients who were subsequently shown to have metastatic disease. Only one patient with simple hyperplasia had PSA levels in the abnormal range.

Adenocarcinoma↗

PubMed1989

Relationships between microvascular function and capillary structure in diabetic and nondiabetic human skin.

Despite the commonly held view that abnormalities in capillary morphology, in particular thickening of the capillary basement membrane, are partly responsible for diabetic ischemia, few studies have correlated anatomic and hemodynamic variables in the same diabetic subjects. In a previous study of 24 type II (non-insulin-dependent) diabetic subjects and 24 age-matched control subjects, we showed that a standard finger exercise vasodilated cutaneous forearm vessels nearly equally (51%), but the postarteriolar flow responded differently between groups. Nondiabetic subjects increased flow by recruitment of capillaries, whereas diabetic subjects did so by capillary flow augmentation. Moreover, resting permeability-surface area product (PS) to pentetic acid was 85% higher in diabetic than nondiabetic subjects. In this study, these same subjects had their forearm skin biopsied and examined morphometrically by electron microscopy for capillary radius, basement membrane thickness, endothelial cell density, and a folding index of luminal membrane reduplication. All morphological variables were correlated stepwise in a saturated, analysis of covariance model with the physiological results. The correlations were sparse and specifically excluded basement membrane thickness. The highest r2 value was .432 between resting PS and a ratio of capillary density to endothelial cell number per capillary. These studies show little evidence that diabetic microvascular physiological variables are tightly connected to morphometric changes except for minor permeability changes, which rise with capillary density and decrease with endothelial cell number. Because PS to pentetic acid is increased in diabetic subjects at any level of capillary density, it seems reasonable that permeability may be increased above that of nondiabetic subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Capillaries↗

PubMed1988

An optimal morphometric method for quantitating wound epithelization.

A new, inexpensive method for quantitative evaluation of reepithelization of shallow split thickness wounds in piglets is described. Wounds, 2.2 X 2.2 cm and 0.4 mm depth are inflicted by an electro-keratome knife in domestic piglets. At a specific time after wounding, the wound area is excised and processed for histology. A computer simulation, based on a randomized systematic sectioning of an entire wound, was used to conclude that only eight sections from the 2.2 X 2.2 cm wound are needed for the final evaluation. The results showed that the above method allows for determination of the epithelization magnitude within +/- 5% at a 95% confidence limit. It was found that in 15 kg piglets 50% epithelization of the above wounds was achieved in 65 hr; however, there exists a great interindividual variability. The rate of epithelization is age dependent and significantly faster in 7 kg body weight piglets than in those weighing 40 kg. The epithelization rate was the same at both the wound edge and the center of the wound, stressing the importance of hair follicles as a source of epithelization.

Animals↗

PubMed1988

Risk factors for blood loss from adenomatous polyps of the large bowel: a colonoscopic evaluation with histopathological correlation.

In 27 patients with 74 colonic polyps we prospectively evaluated polyp-related risk factors and specific histopathological characteristics that might result in blood loss from these lesions. Each polyp was endoscopically bathed in saline which was then aspirated back into a syringe through a catheter and tested for presence of blood on a Hemoccult II slide. Forty-nine polyps were excised. We found the following: 1) A relatively small proportion of adenomas (approximately 11%) have a propensity to bleed. 2) Approximately 22% of polyp-bearing patients have a bleeding adenoma. 3) Risk factors for bleeding include polyp size greater than 1.0 cm, presence of a stalk, and cherry-red color; associated histopathological findings include marked vascular congestion and intramucosal lakes of blood. 4) Clinically detectable bleeding occurs after intramucosal hemorrhage in the polyp head and dissection of blood into the bowel lumen through the glandular or surface epithelium. Most polyps are small, sessile and pink, without histopathological features of hemorrhage and are unlikely to bleed. Therefore, patients with Hemoccult-positive stools in whom such neoplasms are found should undergo further study to detect other causes of gastrointestinal blood loss. High-risk polyps in otherwise asymptomatic patients can be held responsible for bleeding; in them colonoscopic polypectomy with follow-up Hemoccult testing is sufficient management. Only if bleeding persists is study of other parts of the gut essential.

Adenoma↗

PubMed1988

Cutaneous vascular spiders in cirrhotic patients: correlation with hemorrhage from esophageal varices.

Ninety-two consecutive male cirrhotic patients had esophagoscopy to determine the presence and size of varices, and a concomitant skin examination for assessment of cutaneous vascular spiders. Thirty-one subjects bled from varices within 10 days of the spider evaluation, and this group was compared to 61 individuals who never bled. Our results show that incidence of spiders (90%) and varices (91%) is nearly identical, that frequency of variceal bleeding is higher among subjects with spiders compared with those who lack these lesions (36% vs 11%, p less than 0.05), and that the spider profile may be useful to identify individuals who are at increased risk for variceal hemorrhage. Frequency of bleeding was 50% (p less than 0.01) when greater than 20 spiders were present and 63% (p less than 0.01) when multiple atypically located lesions were detected. Large spiders (greater than 15 mm) correlate best with large varices and have the strongest association with bleeding (80%, p = 0.0002). If evidence of benefit from prophylactic treatment of esophageal varices can be established, then elements of the spider profile may serve as a discriminating marker to assist in selection of appropriate patients for therapy.

Adult↗

PubMed1986

Inflatable and noninflatable penile prostheses: comparative follow-up evaluation.

This evaluation was conducted with 63 men who were organically impotent and subsequently received either an inflatable penile prosthesis (n = 43), a noninflatable penile prosthesis (n = 14), or both in succession (n = 6). The patient groups were compared for sexual satisfaction, sexual activity, mental status, complications, satisfaction with prosthesis, and relationship changes. The methods of evaluation were the Derogatis Sexual Functioning Inventory and two unstandardized questionnaires. Significant differences were found between the two patient groups: inflatable prosthesis recipients report being more sexually satisfied, more satisfied with their implant, experiencing less psychiatric distress, having a more rapid postsurgical recovery, more sexually active, and experiencing more positive changes in relationships with their partners than do recipients of a noninflatable prosthesis. The data suggest that the inflatable prosthesis may be a more favorable choice for most individuals than noninflatable devices.

Adaptation, Psychological↗

PubMed1985

Persistent fetal circulation. Neurodevelopmental outcome.

Forty children who had persistent fetal circulation (PFC) were followed up for one to four years. At the most recent examination, 16 (40%) were normal, eight (20%) had neurosensory hearing loss, three (7.5%) were profoundly impaired, six (15.0%) had suspect or abnormal results of neurologic examinations exclusive of hearing loss, three (7.5%) had speech impairment and normal hearing, and one had a delay in motor development. The remaining three had clinically suspect speech. Neurosensory hearing loss correlated only with having a mother with insulin-dependent diabetes, hand-to-mouth facility on the Brazelton scale, and eight-month neurologic status. Earlier diagnosis of hearing loss may be facilitated by testing of neonatal auditory behavioral responses, neurologic status at eight months, and by attention to parental concern about abnormal speech development. Neonatal and infancy auditory screening are recommended in children who have PFC in the neonatal period.

Child Development↗

PubMed1985

Early identification of learning problems in neonatal intensive care graduates.

Most investigators have documented a notable frequency of educational problems in children who received treatment in the neonatal intensive care unit (NICU). Seventy-four children born between 1972 and 1976 and in NICUs were followed up prospectively. At ages 3 to 6 years, preschool development was within the normal range on the McCarthy scales. A school problem, defined as grade repetition and/or special help in school, occurred in 32 (48.8%). Those with school problems had significantly lower scores on the McCarthy scales at 4 to 6 years and on the Woodcock Johnson test than the group without school problems. Children with school problems were classified correctly 60.3% of the time by duration of neonatal hospitalization, and 72% to 80.9% of the time by preschool development. If replicable, the data indicate that potential school problems can be identified sufficiently early in NICU nursery graduates that intervention could be started before they enter school.

Child, Preschool↗

PubMed1985

Prediction of growth and development in intensive care nursery graduates at 12 months of age.

Although many perinatal events have been linked with the outcome status of neonatal intensive care unit (NICU) graduates, few studies have evaluated the cumulative longitudinal prediction of outcome. This study followed up 65 term and 139 premature NICU graduates to 12 months' chronologic age. Variables that were utilized in predicting 12-month growth and the neurologic and developmental outcome were maternal and neonatal medical factors, prior growth measurements, and neonatal behavior, which was measured with the Brazelton Scale for term infants and with a modified version for premature infants. The neurologic status was normal in 141 (71.9%) of 204 infants. The average Bayley Scale Mental Developmental Index was 112.7, and the average Psychomotor Developmental Index was 97.5, which was corrected for early gestation. Predictions of 12-month neurologic and developmental status were weak and had been derived only by variables from the neonatal behavioral examination; endurance predicted neurologic status and the motor cluster predicted cognitive and motor development. The prediction of growth at 12 months was high and was derived from prior growth parameters. Thus, although predictions of neurodevelopmental status at 12 months' chronologic age were low, the variables that aided in predicting were from the neonatal behavioral evaluation. This finding provides support for recommending that the functional status of the NICU graduate as well as the more traditional list of perinatal problems be considered when contemplating the infants' short-term outcome.

Child Development↗

PubMed1985

Computer-aided rhinometry: analysis of inspiratory and expiratory nasal pressure-flow curves in subjects with rhinitis.

Airflow through the nose was measured by posterior rhinometry with the aid of a microcomputer to study reproducibility of pressure-flow curves, the ease of detection of nasal congestion and decongestion, and mathematical modelling of P-V curves. In twelve subjects with rhinitis, the median coefficient of variation of nasal airway resistance was between 4.9% and 14.4% and was not significantly affected by inspiration and expiration, congestion and decongestion, or the flow rate at which it was measured. Fitting of 630 P-V curves to a quadratic equation was usually excellent, particularly during expiration.

Adult↗