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Biomedical subjects

L Ford

Publications and source records attributed to L Ford.

At least 37 records · Page 2Linked to original sources
PubMed1998

The outcome of peripartum cardiac failure in Zaria, Nigeria.

We have studied 227 women who had peripartum cardiac failure (PPCF) in Zaria, Nigeria, since 1969-72. This follow-up and review of survivors in 1993-95 depended chiefly on a Zaria woman (A. Abdullahi) and on her careful reporting. Overall, 31 (13.7%) were completely lost to follow-up, 17 (7.5%) were thought to be alive, and there were data on 179 others (78.8%). Of the 75 known deaths, 55 were cardiovascular--20 due to PPCF, 31 due to cardiac failure unrelated to pregnancy (CF), and four were due to a cerebrovascular accident. PPCF recurred in 13% of 551 subsequent pregnancies. Thirty-two women had a recurrence of PPCF only, and 27 an episode of CF only. Blood pressures rose steadily over the years. An enlarged left ventricle on discharge after the index admission predicted a poor prognosis. In 1993-5, we compared 100 survivors with 100 non-PPCF controls: 96 PPCF women but only 50 control women took extra salt (p = 0.0001). Significantly more PPCF women than controls had a diastolic pressure of 110 mm Hg (p = 0.011). The syndrome is probably provoked in potentially hypertensive women by the traditional practices of eating kanwa, which is rich in Na+, taking additional excess salt and heating the body after delivery. Evidence is presented that PPCF women are potentially hypertensive, and cannot handle the excess ingested sodium which therefore leads to hypervolaemia and thus PPCF.

Adult↗
PubMed1996

Representation of African-Americans, Hispanics, and whites in National Cancer Institute cancer treatment trials.

BACKGROUND: The National Cancer Institute (NCI)-sponsored clinical trials cooperative groups place more than 25 000 American patients in treatment trials every year. Equal access and proportional representation of all races/ethnicities is desired. PURPOSE: Our objectives were to evaluate the inclusion of African-Americans, Hispanics, and non-Hispanic whites in NCI-sponsored treatment trials and to determine if there is proportional racial/ethnic representation. METHODS: During the period of January 1, 1991, through June 30, 1994, 99 495 cancer patients were enrolled in clinical trials and declared themselves as non-Hispanic black, non-Hispanic white, or Hispanic (of any race). In the analysis, participants in NCI treatment trials were subdivided into three age groups: birth to 19 years, 20-49 years, and 50 or more years. The racial/ethnic composition of each of these age groups was compared with the racial/ethnic makeup of the American population with cancer. Estimates of the number of incident cancer cases per year were made for each racial/ethnic group within each age group using data from the Surveillance, Epidemiology, and End Results (SEER) Program and the 1990 Census. The percentage of all cancer patients who were in each racial/ethnic group were compared with the population that entered clinical trials. Comparisons are also made separately for patients with leukemia and breast, colorectal, lung, and prostate cancers. RESULTS: Among patients 0-19 years old, 20-49 years old, and 50 years old or older there is relatively proportional representation of non-Hispanic blacks, Hispanics, and non-Hispanic whites in trials. It is noted that more than 70% of cancer patients aged 0-19 years are estimated to enter cooperative group clinical trials compared with 4.0% of cancer patients aged 20-49 years and 1.5% of patients aged 50 years or older. CONCLUSIONS: Accrual of American cancer patients to NCI-sponsored treatment trials generally parallels the incident burden of disease among non-Hispanic African-Americans, Hispanics, and non-Hispanic whites. IMPLICATIONS: This study shows that the NCI clinical trials are, as a whole, racially/ethnically representative of the American population and suggests that there is equal access to NCI clinical trials.

Black or African American↗
PubMed1996

Learning disabilities and learned helplessness: a heuristic approach.

This study investigated whether students with learning disabilities exhibited learned helpless behavior at a greater rate than their normal achieving peers when confronted with reading failure. Forty-five third grade students from a suburban elementary schools were participants in the study. Thirty of the subjects were classified as having a learning disability (LD) and the remaining 15 subjects were from regular education (RE) classrooms. Fifteen of the students with LD were placed in the treatment group and the remaining fifteen were placed in the control group. All the regular education students were placed in the treatment group. After randomly assigning the students with LD into either a treatment (stressed) group or a control (nonstressed) group, the stressed students were administered a reading instrument in order to measure how they dealt with failure. A one-way ANCOVA was conducted to determine whether significant differences existed between the groups based on their posttest scores. The results indicate that stressed students with LD have a significantly more difficult time recovering from stress than their regular education peers.

Child↗
PubMed1996

Practice setting and physician influences on judgments of colon cancer treatment by community physicians.

OBJECTIVE: This article compares judgments about the treatment of Dukes' B2 and C colon cancer made by general surgeons to those of internists and family practitioners. Physician and practice variables were specialty, affiliation with a Community Clinical Oncology Program (CCOP) hospital, time in practice, professional centrality (level of participation in cancer information networks), solo practice, and number of colon cancer patients. DATA COLLECTION METHODS: Data are combined from national probability samples of CCOP- and non-CCOP-affiliated physicians. This study focused on 1,138 internists, family physicians, and general surgeons who participated in decision making for patients diagnosed with Dukes' B2 or C stage colon cancer. Judgments were elicited using brief vignettes. METHODS OF ANALYSIS: Judgments of adjuvant therapy are classified as (a) consistent with the National Institutes of Health Consensus Conference recommendations (experimental for Dukes' B2, accepted for Dukes' C); (b) accepted treatment for both stages; or (c) experimental for both stages. Multinomial logit analyses were used to examine the association of practice setting and physician characteristics to judgments of treatment. RESULTS: Surgeons and CCOP-affiliated physicians were more likely to endorse the NIH consensus conference position. Surgeons, younger physicians, and those in group practice were more likely to approve of chemotherapy for both cancer stages. The most common position (chemotherapy experimental) was more likely from nonsurgeons, solo practitioners, and non-CCOP physicians. CONCLUSION: Physician and practice setting characteristics, including organized structures such as the CCOP, are possible mediating structures that can facilitate dissemination of standards of treatment.

Clinical Protocols↗
PubMed1995

Memory impairment induced by intraamygdala beta-endorphin is mediated by noradrenergic influences.

These experiments examined the effects on memory in two tasks, inhibitory avoidance and water-maze spatial learning, of intraamygdala injections of drugs affecting noradrenergic and opiate receptors. Male Sprague-Dawley rats (180 g, 50 days old on arrival) were given either a single training trial in an inhibitory avoidance task or eight trials in a water-maze task in which they were trained to swim to a platform submerged 1 cm below the water surface and located in a constant position. Intra-amygdala injections of beta-endorphin (0.03 or 0.1 ng), clenbuterol (10 or 30 ng), or propranolol (0.3 microgram) were given alone or concurrently: beta-endorphin (0.1 ng) + clenbuterol (10 or 30 ng) or beta-endorphin (0.03 ng) + propranolol (0.3 microgram). The injections (0.5 microliter) were administered immediately after inhibitory avoidance training and 5 min before water-maze training. Inhibitory avoidance retention was tested 48 h after training and water-maze retention was tested 24 h after training. In both tasks, clenbuterol attenuated the retention impairing effect of beta-endorphin. Also, in both tasks, low doses of beta-endorphin (0.03 ng) and propranolol (0.3 microgram), which did not affect retention when administered alone, impaired retention when administered concurrently. These results are consistent with extensive previous evidence suggesting that opioid and noradrenergic systems interact in modulating memory storage and provide additional support for the view that the interaction is due to opioid inhibition of noradrenergic activation within the amygdala.

Amygdala↗
PubMed1995

Patterns of Breast Cancer Treatment: A Comparison of a Rural Population With an Urban Population and a Community Clinical Oncology Program Sample.

This Illinois study shows that rural patients who were postmenopausal and node negative were more likely than urban patients to have a modified radical mastectomy (P=.03) and less likely to have had an oncology consultation (P=.01). Postmenopausal rural patients with positive nodes were more likely than comparable CCOP patients to receive radiation therapy (P=.0001), regardless of surgical choice, and were less likely to get hormone therapy than urban patients with an estrogen receptor-positive tumor (P=.007). After adjustment for confounders, rural patients were less likely than those in either comparison group to have limited surgery (odds ratio [OR] = 2.8, 95% confidence interval [CI] 1.4, 5.6 for urban patients, and OR = 2.9, 95% CI 1.5, 5.7 for CCOP patients) and more likely than CCOP patients to undergo radiation (OR = 0.2, 95% CI 0.1, 0.4). These data can be used to assess the impact that dissemination of state-of-the-art treatment strategies has on breast cancer mortality.

Journal Article↗
PubMed1995

EMG feedback-assisted postoperative rehabilitation of minor arthroscopic knee surgeries.

This study assessed the effectiveness of surface integrated electromyographic (EMG) biofeedback in the rehabilitation of 51 patients undergoing minor arthroscopic knee surgery. Prior to surgery, both control (n = 23) and treatment (n = 28) groups received verbal and written explanations of postoperative isometric exercises; the treatment group received additional instruction in the use of ambulatory biofeedback equipment during exercise. Isokinetic tests of strength at approximately two weeks post-surgery revealed that patients given EMG biofeedback during postoperative exercise demonstrated significantly greater extensor torque and quadriceps muscle fiber recruitment than controls. Implications for the use of EMG biofeedback in long-term postoperative rehabilitation are discussed.

Adolescent↗
PubMed1994

Preferences of community physicians for cancer screening guidelines.

OBJECTIVE: To assess factors related to consensus among community physicians regarding appropriate screening intervals for eight cancer screening procedures for which guidelines have been published. DESIGN: Interviews were conducted with a national random sample of 3436 physicians in family practice, internal medicine, general surgery, and gynecology by mail or telephone or both. The overall response rate was 67%. MEASUREMENTS: Consensus by specialization and by physician and practice characteristics on the appropriate screening intervals for early detection of cancers of the breast, cervix, colon and rectum, and lung for asymptomatic adults at normal risk. RESULTS: More than 60% of the physicians surveyed agreed on the length of the screening intervals for six of eight procedures. Consensus most closely followed American Cancer Society- and National Cancer Institute-recommended screening intervals for all procedures except chest roentgenogram. Acceptance of screening intervals was not related to the extent of agreement among published guidelines. Surgeons tended to favor more aggressive screening than family physicians and internists; gynecologists most consistently favored aggressive screening for cancers occurring in women. Older physicians and those in solo practice tended to favor outmoded procedures such as routine chest roentgenograms and to be more conservative about screening intervals. CONCLUSIONS: Physicians stated that they follow the American Cancer Society and National Cancer Institute guidelines for cancer screening more than the guidelines published by their own specialty societies, but they also reported procedures not recommended in any guidelines. These findings suggest that changing physician screening practices will be difficult.

American Cancer Society↗
PubMed1994

Accrual of patients to randomized clinical trials. Factors affecting cancer prevention and control research.

Clinical judgment is increasingly being challenged by the need for randomized clinical trials. The 1987 National Cancer Institute mandate--that the Community Clinical Oncology Program (CCOP) accrue patients to cancer control protocols--provided an opportunity to examine the factors that affect accrual performance. An analysis of 52 CCOPs and their research bases participating in the program found that the availability of protocols, involvement with research base activities, a demonstrated link to community physicians (particularly those physicians, such as surgeons, who had access to patients), and the use of personal contacts to inform non-CCOP physicians about CCOP activities were important facilitating factors for accruing patients to cancer prevention and control trials.

Humans↗
PubMed1994

Physician and practice characteristics associated with judgments about breast cancer treatment.

Since most cancer is treated in the local community, the judgments of primary care physicians about treatment of breast cancer are important. This study examined physician and practice characteristics associated with physician judgments about the treatment of Stage I and Stage II breast cancer. Data are combined from samples of 3,436 physicians: physicians affiliated with hospitals participating in the Community Clinical Oncology Program (CCOP) and a national sample of non-CCOP physicians. This study focused on 1,460 physicians who had seen breast cancer patients and participated in treatment decision-making. Judgments were elicited using brief vignettes. Judgments were more variable for Stage I than for Stage II treatments. Judgments consistent with the NIH Consensus Conferences on breast cancer were more likely from surgeons, physicians who participated in information networks focused on cancer, and those with more breast cancer patients. Concurrence with the consensus conference positions was less likely in older physicians and those in solo practice. These findings point to structures that reinforce quality of care, particularly those that enhance communication, such as group practice or the activities of hospital staffs, information networks, and organized continuing education.

Breast Neoplasms↗
PubMed1994

Effect of a National Cancer Institute Clinical Alert on breast cancer practice patterns.

PURPOSE: This study evaluates the effect of the 1988 National Cancer Institute Clinical Alert regarding treatment of early-stage breast cancer on the patterns of treatment provided to patients. PATIENTS AND METHODS: Data analyzed were collected from the hospital and outpatient records of 12,534 female patients with a primary diagnosis of breast cancer (stages I and II) initially diagnosed during the years 1983 through 1989. RESULTS: Analyses revealed that the proportions of patients with a negative lymph node status diagnosed after the May 1988 Clinical Alert who received adjuvant treatment (tamoxifen and/or multidrug chemotherapy) were significantly greater than predicted from treatment trends established before the Alert's release. Proportions of patients with positive lymph node status receiving adjuvant therapy subsequent to the Alert's release, in contrast, did not fall outside the projected confidence intervals for that group. Additional analyses showed a significant effect of the Clinical Alert among several subgroups of node-negative patients. CONCLUSION: Findings suggest that the Clinical Alert mechanism, followed by publication in the peer-reviewed scientific literature, is an effective way to communicate important research findings to practitioners in the community. However, the Alert mechanism is controversial and should be used judiciously to ensure its credibility.

Adult↗
PubMed1994

Comparative three-factor solutions of the WISC-III and WISR-R at 11 age levels between 6-1/2 and 16-1/2 years.

The Wechsler Intelligence Scale for Children, Third Edition (WISC-III) was factor analyzed at ages 6 12 through 16 12 years of age (n = 200 per age group). The study replicated analyses conducted by Kaufman (1975) with the WISC-R using comparable subtests across the two scales. As in the WISC-R study, a three-factor structure emerged as consistent across the age range of the WISC-III: Verbal Comprehension, Perceptual Organization, and Freedom from Distractibility. The results of the study are discussed in terms of their clinical utility with useful statistics for the interpretation of the WISC-III presented.

Journal Article↗
PubMed1993

Assuring access to state-of-the-art care for U.S. minority populations: the first 2 years of the Minority-Based Community Clinical Oncology Program.

BACKGROUND: The Minority-Based Community Clinical Oncology Program (MBCCOP) was initiated in September 1990 to expand the National Cancer Institute's (NCI's) clinical trials network to minority populations. Institutions, organizations, and/or physician groups that had more than 50% of new cancer patients from minority groups were eligible to participate. There has been no previous evaluation of the MBCCOP. PURPOSE: This study was designed to describe the early implementation of the MBCCOP and identify the challenges that have emerged in developing a network aimed at increasing the participation of minority populations in clinical trials. METHODS: Data were taken from primary and secondary sources, including site visits and patient log data, that described performance of 12 MBCCOP centers initially funded in September 1990. Accrual was measured by the number of credits earned per MBCCOP for patients enrolled in research protocols for cancer treatment or for prevention and control, which includes activities such as early detection, pain control, and rehabilitation. These accrual credits, assigned by the NCI, were based on the complexity of the protocol and the amount of resources expected to be required for accrual of patients by the MBCCOP. RESULTS: Data for the first 2 years of the MBCCOP showed that 344 patients were accrued to trials of treatment protocols from June 1, 1990, to May 31, 1991, and this number increased to 470 during the second accrual year, June 1, 1991, to May 31, 1992. Similarly, accrual of patients to cancer prevention and control studies increased from 256 in 1990-1991 to 423 in 1991-1992. More than 70% of the MBCCOP patients entered in studies were from minority populations. The proportion of eligible MBCCOP patients entered into treatment protocols was identical with that experienced by the initial Community Clinical Oncology Program (CCOP). Results also demonstrated that MBCCOP centers operate in an environment characterized by socio-economic decline and limited resources, both having substantial effects on the implementation of clinical trials among minorities. While minority patients are willing to participate in clinical trials, there are profound barriers involving language, logistics, and the appropriateness of available protocols. Participating physicians, nurses, and support personnel report a high level of agreement with program goals and have developed unique approaches to meeting the challenges faced in the implementation of this program. CONCLUSIONS: The MBCCOPs have demonstrated their ability to participate in clinical trials. Evaluation reveals, however, that they are emerging organizations influenced by factors endemic to the community they serve and their own structure. The MBCCOPs are confronting substantial challenges, yet they provide an important link to the overall NCI clinical trials network.

Aged↗
PubMed1993

Predicting the performance of a strategic alliance: an analysis of the Community Clinical Oncology Program.

OBJECTIVE: This study is designed to examine the effects of environment and structure of the Community Clinical Oncology Program (CCOP) on performance as measured by patient accrual to National Cancer Institute (NCI)-approved treatment protocols. DATA SOURCES/STUDY SETTING: Data and analysis are part of a larger evaluation of the NCI Community Clinical Oncology Program during its second funding cycle, June 1987-May 1990. Data, taken from primary and secondary sources, included a survey of selected informants in CCOPs and research bases, CCOP grant applications, CCOP annual progress reports, and site visits to a subsample of CCOPs (N = 20) and research bases (N = 5). Accrual data were obtained from NCI records. STUDY DESIGN: Analysis involved three complementary sets of factors: the local health care resources environment available to the CCOP, the larger policy environment as reflected by the relationship of the CCOP to selected research bases and the NCI, and the operational structure of the CCOP itself. A hierarchical model examined the separate and cumulative effects of local and policy environment and structure on performance. PRINCIPAL FINDINGS: Other things equal, the primary predictors of treatment accrual were: (1) the larger policy environment, as measured by the attendance of nurses at research base meetings; and (2) operational structure, as measured by the number and character of components within participating CCOPs and the number of hours per week worked by data managers. These factors explained 73 percent of the total variance in accrual performance. CONCLUSIONS: Findings suggest criteria for selecting the types of organizations to participate in the alliance, as well as for establishing guidelines for managing such alliances. A future challenge is to determine the extent to which factors predicting accrual to cancer treatment clinical trials are equally important as predictors of accrual to cancer prevention and control trials.

Clinical Protocols↗