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Biomedical subjects

K Gilbert

Publications and source records attributed to K Gilbert.

At least 19 recordsLinked to original sources

Computed tomography pulmonary angiogram diagnosis of pulmonary embolism.

Over the last decade, contrast-enhanced spiral CT has been established as a non-invasive alternative to catheter angiography and is now regarded as the first-line imaging investigation for the diagnosis of pulmonary embolism (PE). The reported sensitivities for the diagnosis of PE of spiral CT vary from 45 to 100% and the specificities vary from 78 to 100%. Prospective outcome studies have shown a high negative predictive value for a single-detector spiral CT for PE. Patients' outcomes were not adversely affected in these studies when anticoagulation was withheld after a negative CT pulmonary angiogram. The main limitation of single-detector spiral CT has been its limited ability to detect isolated subsegmental PE. However, multidetector spiral CT allows evaluation of pulmonary vessels down to sixth-order branches and significantly increases the rate of detection of PE in segmental and subsegmental levels. The interobserver correlations for diagnosis of subsegmental PE with multidetector spiral CT exceed the reproducibility of selective pulmonary angiography. If appropriate equipment is available (multidetector CT), then CT pulmonary angiogram is safe to be used as the first-line imaging investigation for the diagnosis of PE.

Algorithms↗

Cryptogenic epilepsy: an infectious etiology?

PURPOSE: Cryptogenic epilepsy, the group of epilepsy syndromes for which an etiology is unknown, comprises approximately 20% of all epilepsy syndromes. We selected patients in this subgroup of epilepsy and tested them for evidence of Toxoplasma gondii IgG antibodies by the enzyme-linked immunosorbent assay. T. gondii is found in up to 20% of the U.S. population forming dormant brain cysts in the latent bradyzoite form. We investigated the hypothesis that dormant T. gondii infection might be associated with cryptogenic epilepsy. METHODS: We selected patients with cryptogenic epilepsies and tested them for evidence of T. gondii IgG antibodies by the enzyme-linked immunosorbent assay. A control group was also tested for comparison. RESULTS: We have found a statistically-significant elevation of T. gondii antibodies among cryptogenic epilepsy patients as compared to controls [59% increase in optical density (OD), p = 0.013]. This association persisted after adjustment for subjects' gender and age in a multiple logistic regression model; however, it was no longer as statistically significant. CONCLUSIONS: Our results suggest that chronic T. gondii infection with brain cysts may be a cause of cryptogenic epilepsy.

Adult↗

Health claims data as a strategy and tool in disease management.

A comprehensive definition of disease management provides an opportunity to track a population of patients across the entire continuum of a condition, from wellness through disease and disability, so that improvements in health status and quality of life and efficiencies in the application of health care resources can be demonstrated. The need is great for information systems that can computerize clinical encounter, summarize, and apply the information to help identify opportunities for improvement in the performance of quality and cost control, monitor processes of care, and report outcomes that are meaningful to the organization. By tracking health care charges as a proxy for the application of health care resources, health claim data analyses can identify conditions for disease management, facilitate provider buy-in, develop the disease management program, monitor interventions, and report outcomes.

Continuity of Patient Care↗

Prospective evaluation of cardiac risk indices for patients undergoing noncardiac surgery.

BACKGROUND: Prediction of perioperative cardiac complications is important in the medical management of patients undergoing noncardiac surgery. Several indices have been developed to aid prediction, but their performance has not been systematically compared. OBJECTIVE: To compare four existing methods for predicting perioperative cardiac risk. DESIGN: Prospective cohort study. SETTING: Two teaching hospitals in London, Ontario, Canada. PATIENTS: 2,035 patients referred for medical consultation before elective or urgent noncardiac surgery. MEASUREMENTS: Myocardial infarction, unstable angina, acute pulmonary edema, or death. The indices were compared by examining the areas under their respective receiver-operating characteristic (ROC) curves. RESULTS: Cardiac complications occurred in 6.4% of patients. The area under the ROC curve was 0.625 (95% CI, 0.575 to 0.676) for the American Society of Anesthesiologists index, 0.642 (CI, 0.588 to 0.695) for the Goldman index, 0.601 (CI, 0.544 to 0.657) for the modified Detsky index, and 0.654 (0.601 to 0.708) for the Canadian Cardiovascular Society index. These values did not significantly differ. CONCLUSIONS: Existing indices for prediction of cardiac complications perform better than chance, but no index is significantly superior. There is room for improvement in our ability to predict such complications.

Aged↗

[Ambulatory/partial inpatient phase II rehabilitation of heart patients in a Rhine-Main district rehabilitation clinic].

According to the guidelines and standards for a comprehensive phase II rehabilitation a new outpatient/part-time outpatient program was developed and started at an existing rehabilitation center in January 1997. All patients of the new program were included in a follow-up study and compared with patients of the same center, who met the inclusion and exclusion criteria for the outpatient mode, but wanted to perform their rehabilitation in the full-time residential mode. Both groups were examined before, at the end and 6 months after the program. Until December 1998 118 patients after an acute cardiac event such as myocardial infarction, PTCA or heart surgery were rehabilitated in the outpatient/part-time outpatient mode. The short- and medium-term results concerning somatic outcomes, e.g. the risk factor profile or the improvement of the maximum work capacity, were equal in both groups. Comparing the direct costs for a 4-week rehabilitation, the part-time outpatient program was 26%, the outpatient program even 52% cheaper than the standard full-time residential program. The new program is as effective as the residential rehabilitation, but it is cheaper. Because of the in- and exclusion criteria it is suitable for only a subgroup of cardiac patients, because of the demands and standards the new program it can be offered only in special rehabilitation centers.

Adult↗

The utility and prediction of allogeneic blood transfusion use in orthopedic surgery.

It is possible to predict the likelihood of postoperative blood transfusion using patient variables. The information could be used to target the high-risk group for intervention(s) that would subsequently reduce the risk of exposure to allogeneic blood. The cost of several of the alternatives to allogeneic blood precludes their use on all surgical patients, and hence the need to identify those patients who are most likely to benefit from such therapy. Further research is needed to assess the impact of predictive models on the use of allogeneic blood and costs. Research is also needed to clarify the impact of blood transfusion on perioperative morbidity and mortality, in patients with and without heart disease. If such an association does indeed exist, then an optimal hemoglobin or transfusion threshold is needed to guide clinicians in caring for their patients.

Blood Transfusion↗

An algorithm for diagnosis and treatment of status epilepticus in adults.

Convulsive or generalized tonic-clonic status epilepticus (SE) is a neurological emergency that can lead to transient or permanent brain damage or even death. A conceptual model was developed to assist nurses and other medical professionals to differentiate between convulsive and nonconvulsive SE. An algorithm was then designed to aid nursing and medical staff in decision making about the type of SE and pharmacological intervention needed to stop prolonged or repetitive seizures occurring in patients undergoing video electroencephalogram (EEG) monitoring. A treatment algorithm for diagnosing and treating SE has clinical benefits in the practice setting of an inpatient comprehensive epilepsy program. Episodes of SE are more accurately classified and faster successful treatment of the episode occurs.

Adult↗

Variations in antimicrobial use and cost in more than 2,000 patients with community-acquired pneumonia.

PURPOSE: To assess the patterns of antimicrobial use, costs of antimicrobial therapy, and medical outcomes by institution in patients with community-acquired pneumonia. PATIENTS AND METHODS: The route, dose, and frequency of administration of all antimicrobial agents prescribed within 30 days of presentation were recorded for 927 outpatients and 1328 inpatients enrolled in the Pneumonia Patient Outcomes Research Team (PORT) multicenter, prospective cohort study. Total antimicrobial costs were estimated by summing drug costs, using average wholesale price for oral agents and institutional acquisition prices for parenteral agents, plus the costs associated with preparation and administration of parenteral therapy. Thirty-day outcome measures were mortality, subsequent hospitalization for outpatients, and hospital readmission for inpatients. RESULTS: Significant variation (P <0.05) in prescribing practices occurred for 17 of the 23 antimicrobial agents used in outpatients across 5 treatment sites, and for 18 of the 20 parenteral agents used in inpatients across 4 treatment sites. The median duration of antimicrobial therapy for treatment site ranged from 11 to 13 days for outpatients (P=0.01), and from 13 to 15 days for inpatients (P=0.49). The overall median cost of antimicrobial therapy was $12.90 for outpatients, and ranged from $10.80 to $58.90 among treatment sites (P <0.0001). The overall median cost of antimicrobial therapy was $228.70 for inpatients, and ranged from $183.70 to $315.60 among sites (P <0.0001). Mortality and hospital readmission for inpatients were not significantly different across sites after adjusting for baseline differences in patient demographic characteristics, comorbidity, and illness severity. Although subsequent hospitalization for outpatients differed by site, the rate was lowest for the site with the lowest antimicrobial costs. CONCLUSION: Variations in antimicrobial prescribing practices by treatment site exist for outpatients and inpatients with community-acquired pneumonia. Although variation in antimicrobial prescribing practices across institutions results in significant differences in antimicrobial costs, patients treated at institutions with the lowest antimicrobial costs do not demonstrate worse medical outcomes.

Anti-Infective Agents↗

Prospective validation of a point score system for predicting blood transfusion following hip or knee replacement.

BACKGROUND: The purpose of this study was to validate a previously published point score system for predicting the likelihood of a postoperative blood transfusion following hip or knee replacement. STUDY DESIGN AND METHODS: Data were collected prospectively on 460 sequential patients undergoing elective hip and knee replacement at two academic hospitals. Blood transfusion frequency was determined for patients in each of the four risk strata, as defined by the point score system. The accuracy of the system was validated by calculating the area under the receiver operating characteristic (ROC) curve for each site. Data were then combined and inappropriate blood transfusions were eliminated, by using the American College of Physicians guidelines. The frequencies of blood transfusion within each strata were recalculated along with an ROC curve. RESULTS: The point score system accurately predicted the likelihood of blood transfusion at both hospitals, despite marked differences in overall transfusion frequencies. The calculated areas under the ROC curves were 0.78 and 0.79 for the two sites. The point score system also proved valid when only appropriate blood transfusions were considered, with a calculated area under the ROC curve of 0.74. CONCLUSION: The point score system can accurately predict the likelihood of postoperative blood transfusion following hip or knee replacement. Such a system can be used to target high-risk patients for preoperative autologous blood donation.

Aged↗

A code of ethics for the medical dosimetrist--the American Association of Medical Dosimetrists experience.

The Committee on Protocol and Ethics of the American Association of Medical Dosimetrists (AAMD) has developed a Code of Ethics for a radiation oncology society of medical dosimetrists. The purpose of the code of ethics is fourfold: (1) Establish an ideal of professional conduct specific to the medical dosimetry profession; (2) Develop a statement of the moral values and commitment of the AAMD; (3) Recognize professional relationships and obligations; and (4) Define goals to which the medical dosimetrist should aspire. The Code of Ethics was adopted as AAMD policy in October 1995.

Ethics, Medical↗

A code of ethics for the medical dosimetrist--the American Association of Medical Dosimetrists experience.

The Committee on Protocol and Ethics of the American Association of Medical Dosimetrists (AAMD) has developed a Code of Ethics for a radiation oncology society of medical dosimetrists. The purpose of the code of ethics is fourfold: (1) Establish an ideal of professional conduct specific to the medical dosimetry profession; (2) Develop a statement of the moral values and commitment of the AAMD; (3) Recognize professional relationships and obligations; and (4) Define goals to which the medical dosimetrist should aspire. The Code of Ethics was adopted as AAMD policy in October 1995.

Ethics, Medical↗

A code of ethics for the medical dosimetrist--the American Association of Medical Dosimetrists experience.

The Committee on Protocol and Ethics of the American Association of Medical Dosimetrists (AAMD) has developed a Code of Ethics for a radiation oncology society of medical dosimetrists. The purpose of the code of ethics is fourfold: (1) Establish an ideal of professional conduct specific to the medical dosimetry profession; (2) Develop a statement of the moral values and commitment of the AAMD; (3) Recognize professional relationships and obligations; and (4) Define goals to which the medical dosimetrist should aspire. The Code of Ethics was adopted as AAMD policy in October 1995.

Ethics, Medical↗

A code of ethics for the medical dosimetrist--the American Association of Medical Dosimetrists experience.

The Committee on Protocol and Ethics of the American Association of Medical Dosimetrists (AAMD) has developed a Code of Ethics for a radiation oncology society of medical dosimetrists. The purpose of the code of ethics is fourfold: (1) Establish an ideal of professional conduct specific to the medical dosimetry profession; (2) Develop a statement of the moral values and commitment of the AAMD; (3) Recognize professional relationships and obligations; and (4) Define goals to which the medical dosimetrist should aspire. The Code of Ethics was adopted as AAMD policy in October 1995.

Ethics, Professional↗

A code of ethics for the medical dosimetrist--the American Association of Medical Dosimetrists experience.

The Committee on Protocol and Ethics of the American Association of Medical Dosimetrists (AAMD) has developed a Code of Ethics for a radiation oncology society of medical dosimetrists. The purpose of the code of ethics is fourfold: (1) Establish an ideal of professional conduct specific to the medical dosimetry profession; (2) Develop a statement of the moral values and commitment of the AAMD; (3) Recognize professional relationships and obligations; and (4) Define goals to which the medical dosimetrist should aspire. The Code of Ethics was adopted as AAMD policy in October 1995.

Ethics, Professional↗

A code of ethics for the medical dosimetrist--the American Association of Medical Dosimetrists experience.

The Committee on Protocol and Ethics of the American Association of Medical Dosimetrists (AAMD) has developed a Code of Ethics for a radiation oncology society of medical dosimetrists. The purpose of the code of ethics is fourfold: (1) Establish an ideal of professional conduct specific to the medical dosimetry profession; (2) Develop a statement of the moral values and commitment of the AAMD; (3) Recognize professional relationships and obligations; and (4) Define goals to which the medical dosimetrist should aspire. The Code of Ethics was adopted as AAMD policy in October 1995.

Ethics, Medical↗

A point score system for predicting the likelihood of blood transfusion after hip or knee arthroplasty.

BACKGROUND: Given the high cost of autologous blood donation for elective surgery, it would be desirable to predict which patients are most likely to benefit from the procedure. The purpose of this study was to develop a point score system for predicting the likelihood of blood transfusion in hip and knee arthroplasty. STUDY DESIGN AND METHODS: A database of 599 patients undergoing elective surgery at a teaching hospital was used for the analysis. Variables were analyzed to determine their univariate association with postoperative blood transfusion. Significant factors were entered into a multiple logistic regression model, and a point score system was developed on the basis of the regression coefficients. Four strata of transfusion risk were constructed. RESULTS: Factors independently associated with blood transfusion included preoperative hemoglobin, type of arthroplasty, primary versus revision surgery, autologous donor status, and patient weight. Four factors were used to create a point score system with four strata. The likelihood of blood transfusion for patients in the four risk strata was 1.7, 11.0, 40.0, and 78.3 percent. The calculated area under the receiver operating characteristic curve was 0.86. CONCLUSION: The likelihood of a postoperative blood transfusion can be predicted by using this simple point score system. Autologous blood donation can subsequently be targeted to the high-risk patients.

Aged↗

Environmental health hazards: the impact on a southern community.

The impact of environment on health is a growing area of concern for nurses. The purpose of this study is to describe and characterize residents living near an abandoned hazardous waste site, assess their past and present exposure risk, and describe health concerns and psychosocial effects. Data were obtained by a door-to-door outreach effort. Networking was also used to identify residents with health concerns. Extensive field notes were taken to record the responses of residents. A preliminary windshield survey was conducted to approximate the number of residents living in the geographic area, assess the residential community, analyze drainage pathways away from the site, and observe outdoor activity patterns. Community concerns from the residential population were collected and analyzed for recurrent themes. Significant off-site activity patterns included use of drainage ditches as play areas for children. Foraging on-site activities included picking berries, crawfishing, geophagy (clay eating), and rabbit hunting. Common health problems described by residents included skin rashes, respiratory-related complaints, reproductive difficulties, and headaches. The majority of residents were concerned about the incidence of cancer in the area. Identifying the concerns of residents and indicators of health problems helps nurses begin to understand the relationship between the environment and health.

Adolescent↗

Complete genome sequence of Methanobacterium thermoautotrophicum deltaH: functional analysis and comparative genomics.

The complete 1,751,377-bp sequence of the genome of the thermophilic archaeon Methanobacterium thermoautotrophicum deltaH has been determined by a whole-genome shotgun sequencing approach. A total of 1,855 open reading frames (ORFs) have been identified that appear to encode polypeptides, 844 (46%) of which have been assigned putative functions based on their similarities to database sequences with assigned functions. A total of 514 (28%) of the ORF-encoded polypeptides are related to sequences with unknown functions, and 496 (27%) have little or no homology to sequences in public databases. Comparisons with Eucarya-, Bacteria-, and Archaea-specific databases reveal that 1,013 of the putative gene products (54%) are most similar to polypeptide sequences described previously for other organisms in the domain Archaea. Comparisons with the Methanococcus jannaschii genome data underline the extensive divergence that has occurred between these two methanogens; only 352 (19%) of M. thermoautotrophicum ORFs encode sequences that are >50% identical to M. jannaschii polypeptides, and there is little conservation in the relative locations of orthologous genes. When the M. thermoautotrophicum ORFs are compared to sequences from only the eucaryal and bacterial domains, 786 (42%) are more similar to bacterial sequences and 241 (13%) are more similar to eucaryal sequences. The bacterial domain-like gene products include the majority of those predicted to be involved in cofactor and small molecule biosyntheses, intermediary metabolism, transport, nitrogen fixation, regulatory functions, and interactions with the environment. Most proteins predicted to be involved in DNA metabolism, transcription, and translation are more similar to eucaryal sequences. Gene structure and organization have features that are typical of the Bacteria, including genes that encode polypeptides closely related to eucaryal proteins. There are 24 polypeptides that could form two-component sensor kinase-response regulator systems and homologs of the bacterial Hsp70-response proteins DnaK and DnaJ, which are notably absent in M. jannaschii. DNA replication initiation and chromosome packaging in M. thermoautotrophicum are predicted to have eucaryal features, based on the presence of two Cdc6 homologs and three histones; however, the presence of an ftsZ gene indicates a bacterial type of cell division initiation. The DNA polymerases include an X-family repair type and an unusual archaeal B type formed by two separate polypeptides. The DNA-dependent RNA polymerase (RNAP) subunits A', A", B', B" and H are encoded in a typical archaeal RNAP operon, although a second A' subunit-encoding gene is present at a remote location. There are two rRNA operons, and 39 tRNA genes are dispersed around the genome, although most of these occur in clusters. Three of the tRNA genes have introns, including the tRNAPro (GGG) gene, which contains a second intron at an unprecedented location. There is no selenocysteinyl-tRNA gene nor evidence for classically organized IS elements, prophages, or plasmids. The genome contains one intein and two extended repeats (3.6 and 8.6 kb) that are members of a family with 18 representatives in the M. jannaschii genome.

Anaerobiosis↗