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Biomedical subjects

M C Mahoney

Publications and source records attributed to M C Mahoney.

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

Improving diabetes preventive care in a family practice residency program: a case study in continuous quality improvement.

BACKGROUND AND OBJECTIVES: The paradigm of continuous quality improvement (CQI) holds promise for application in clinical settings. This paper highlights results of a CQI project developed and implemented in a residency-based, ambulatory family medicine center for management of non-insulin-dependent diabetes mellitus. METHODS: We developed a CQI program that used several indicators of diabetes management as measures of quality care. These included dietary counseling, exercise counseling, foot care counseling, ophthalmology referral, and measurement of hemoglobin AIC and renal function. RESULTS: Overall, compliance with recommendations for diabetes management increased from a baseline proportion of 40% to a level of 70% at the end of 1 year. During the second year, overall compliance was maintained at this level despite the inclusion of additional performance indicators. CONCLUSIONS: The CQI process can improve physician performance in managing patients with diabetes.

Clinical Competence↗
PubMed1998

Persistent dysphagia and dysphonia following cervical spine surgery.

Persistent dysphagia and dysphonia following anterior cervical spine surgery have been underdiagnosed. Understanding the physiologic mechanism resulting in post-surgical dysphagia and dysphonia is essential to providing appropriate treatment. Two cases of protracted dysphagia and dysphonia following left anterior cervical corpectomy were reviewed. Videofluoroscopic evaluation, videostroboscopic assessment and laryngeal nerve-conduction testing were used to determine swallowing, vocal fold and cranial nerve integrity; to assess the ability to achieve oral nutrition; and to direct therapy and surgical procedures to improve swallowing and voice. With a multidisciplinary approach, the physiologic problems of post-surgical dysphagia and dysphonia can be addressed and therapeutic and/or surgical treatments initiated promptly.

Cervical Vertebrae↗
PubMed1996

Native American Cancer Conference III. Cognitive correlates and impressions of attendees.

BACKGROUND: The results of preconference and postconference surveys, as well as conference evaluation forms, distributed to attendees at the "Native American Cancer Conference III: Risk Factors, Outreach and Intervention Strategies," Seattle, Washington, June 16-19, 1995, are presented. METHODS: Conference attendees were requested to complete a multi-item survey designed to assess knowledge and perceptions relating to cancer among native peoples at the beginning and end of the conference. The evaluation instrument solicited qualitative impressions of the conference. RESULTS: Survey respondents were predominantly female (70%), and approximately half were native persons representing 48 different American Indian and Alaska Native communities. Knowledge levels were generally high at baseline for most items relating to cancer, with evidence of significant improvement for several items on the postconference survey. The majority of respondents believed that cancer was of equal importance compared with other health problems and that cancer services for American Indians and Alaska Natives are generally less extensive compared with the majority population; there was no evidence of opinion change noted in the postconference survey. Results from the qualitative evaluation expressed the unique and affirmative experiences among participants in terms of the social, cultural, and informational sharing that occurred. CONCLUSIONS: It is hoped that the positive experiences of conference attendees will serve to stimulate the organization of similar programs and the design of research projects that both assess and expand cancer control services among Native peoples.

Adult↗
PubMed1996

Tribal-based cancer control activities. Services and perceptions.

BACKGROUND: Cancer is becoming a significant health problem for American Indians and Alaska Natives. Despite the precipitous increase in cancer rates in these populations, limited data are available regarding the extent of cancer control services available in these communities. METHODS: A cross-sectional survey of tribal health directors of all federally recognized tribes was undertaken to discover the breadth of cancer control activities offered and directors' perceptions of and priorities ascribed to cancer. RESULTS: Little more than half (53%) of respondents perceived cancer rates to be increasing. Cancer was found to rank fifth among seven health conditions when directors were asked to rank their tribe's commitment to confronting each. Lower relative levels of awareness of cancer patterns coupled with competing health problems relegated cancer control activities to low-priority issues. CONCLUSIONS: Findings from this study underscore the need to elevate the issue of cancer in Indian Country and to educate investigators to become more sensitive and responsive to other tribal health issues.

Alaska↗
PubMed1996

Gravid health status, medication use, and risk of neuroblastoma.

The epidemiology of neuroblastoma suggests that prenatal exposures may be important etiologic factors in this disease. The authors describe the role of maternal health status and prenatal medication usage and risk of neuroblastoma. This retrospective study was based on completed interviews with 183 histologically confirmed neuroblastoma cases aged 0-14 years diagnosed among residents of New York State (excluding New York City) between 1976 and 1987. Controls were matched to cases on year of birth and race and were drawn from the New York State live birth certificate registry. Interviews were satisfactorily completed with 85% of the cases and 87% of controls. Significantly elevated odds ratios were noted for vaginal infections during pregnancy (odds ratio (OR) = 2.2, 95% confidence interval (CI) 1.2-4.0), medical treatments for vaginal infection during pregnancy (OR = 2.4, 95% CI 1.2-4.9), and any reported use of sex hormones during pregnancy (OR = 3.0, 95% CI 1.3-6.9). Point estimates for any hormone use suggested elevated risk among male offspring (OR = 4.4, 95% CI 1.5-13.3). Among the individual exposures comprising any hormone use, only hormone use related to infertility was observed to be significant (OR = 10.4, 95% CI 1.2-89.9). A protective effect was noted for self-reported vitamin use (OR = 0.28, 95% CI 0.03-0.69). Although it is not possible to presume a specific role for prenatal hormone exposure as initiator or promoter, these findings lend support to an association between prenatal hormone exposure and risk of neuroblastoma.

Adolescent↗
PubMed1996

Correlates of cochlear implantation, 1986-1992.

There is a paucity of information regarding the use of cochlear implants within large populations. This article describes correlates of cochlear implantation procedures using a statewide hospital discharge database. Among the 146 implant procedures, 55% involved female patients, whereas the largest groups of patients were represented by younger and older persons (27% between ages 2 and 9 years and 24% 60 years and older). A bimodal distribution was apparent for average annual age-specific rates of cochlear implantation, with the highest rates among persons aged 2 to 9 years (5.4 implants per 1 million) and persons aged 60 to 69 years (3.7 implants per 1 million). Total hospital charges, excluding professional fees, exceeded $12,000 per implant and were found to vary significantly when examined by length of stay and by calendar year of procedure. The data presented are unique with regard to the total number of cochlear implant procedures included and the large, diverse population used. This study expands knowledge concerning the epidemiology and utilization of cochlear implantation.

Adolescent↗
PubMed1996

Colorectal cancer in patients aged 30 years or younger.

Colorectal cancer (CRC) is believed to carry a grim prognosis in young patients. A retrospective study of patients diagnosed with colorectal cancer at age 30 years or less between 1971 and 1994 was conducted. Statistical analyses were performed using non-parametric one way ANOVA tests and logistic regression models. Sixty-eight of the patients evaluated at our institution were suitable for this study. Risk factors were identified in 28% of patients. The median age at diagnosis was 27 years (range 14-30 years). Fifty-six patients (82%) were Stage III or IV at the time of diagnosis. Twenty-two of the 34 patients who underwent potentially curative surgery had recurring disease at a median of 12 months (range 1-43 months). At a median follow-up of 21.5 months, 54 patients had died from disease. At the time of death, abdominal carcinomatosis and distant disease were the most common patterns of failure. Stage of the primary tumour (P=0.0006) and recurrence (P=0.0001) were the only variables noted to be associated with survival. The stage of the primary tumour and whether the tumour recurred were each associated with survival in patients with colorectal cancer at age 30 years or less.

Adenocarcinoma↗
PubMed1996

Urban-based Native American cancer-control activities: services and perceptions.

BACKGROUND: Cancer has become a significant health concern in American Indian communities. Over the past several decades Native peoples have experienced significant increases in life expectancy and, with these gains, significant increases in cancer incidence and mortality. Limited data are available concerning cancer-control activities accessible to American Indian communities. Even less is known about control programs in place for American Indians resident in urban areas, where more that half of all Native peoples reside. METHODS: To ascertain the extent of available services and perceptions of health directors, a survey of all Indian-Health-Service-recognized urban clinics was undertaken. RESULTS: Results indicate that the cancer needs of American Indians resident in urban areas are not being adequately addressed. Only one-third of urban health directors reported perceived increases in cancer incidence and mortality rates. The directors ranked cancer fifth among seven health problems in terms of their clinics' commitment to addressing them. Findings from this study are juxtaposed with whose obtained in a separate survey of reservation-based health directors. CONCLUSIONS: Results indicate a need to develop more responsive cancer-control programs in Indian country and to sensitize researchers to other health needs of these communities.

Cancer Care Facilities↗
PubMed1995

Chronic sinusitis.

Explore the source record for details and available documents.

Chronic Disease↗
PubMed1994

Desmoid tumors in patients with familial adenomatous polyposis.

BACKGROUND: Sporadic desmoid tumors occur mainly in the abdominal wall and in extraabdominal sites. Desmoid tumors in patients with familial adenomatous polyposis (FAP) usually occur in the abdominal wall and in the bowel mesentery. Surgical resection of desmoids in patients with FAP has been controversial. METHODS: A retrospective review of patients with FAP and desmoid tumors treated from 1950 to 1991 was performed. Patients were evaluated for gender, age, site of desmoid tumors, treatment, recurrence, and survival. RESULTS: Twenty-one of 24 patients underwent 60 surgical procedures related to the desmoid tumors. Seven of nine patients who underwent potentially curative surgery had recurrences; three were reresected. Major morbidity after palliative or curative surgery was 47%. Five patients were alive with no evidence of disease at a median of 198 months, 10 patients were alive with disease at a median of 102 months, and 5 patients died with disease at a median of 31 months after diagnosis. CONCLUSIONS: Desmoid tumors are common in patients with FAP. Unresectability and recurrence are more common than cure. Palliative and curative resections have a high morbidity. Surgery should be reserved for those patients with symptomatic mesenteric desmoids.

Abdominal Neoplasms↗
PubMed1994

Provision of cancer control services to Native Americans by state health departments.

To examine the extent of cancer prevention and control programs for American Indian and Alaska Native (AI/AN) tribal groups directly supported by state public health agencies, a cross-sectional survey was completed by chronic disease directors in 50 states. Descriptive statistics were used to summarize responses. Sixteen states (32%) reported having sponsored/directly supported cancer prevention and cancer control services specifically targeted to AI/AN populations. Few state public health agencies had developed culturally-relevant cancer education materials for AI/ANs. Although the respondents directed chronic disease or cancer prevention/control programs in their states, many were unfamiliar with cancer patterns or general health problems among AI/ANs. Survey results indicate that cancer prevention and control services are available to AI/AN populations through most state public health agencies. It is hoped that dissemination of survey results will increase awareness of cancer as a health problem among AI/ANs and lead to an expansion of the services available to this "invisible minority" to levels accessible by the majority population.

Cross-Sectional Studies↗
PubMed1994

Historical and contemporary correlates of syphilis and cancer.

BACKGROUND: This study examined the relationship between antecedent syphilis infection and cancer incidence in an attempt to identify specific cancer patterns. METHODS: The study cohort consisted of 16,420 people diagnosed with syphilis between 1972 and 1987 and who were residents of New York State, exclusive of New York City, at time of diagnosis. Incident cancers among cohort members were identified through linkage with files maintained by the New York State Cancer Registry. RESULTS: A total of 350 cancer cases were diagnosed among cohort members. For males and females combined, incidence was significantly elevated for cancers of the oral cavity standardized incidence ratio (SIR = 169, 95% confidence interval [CI]: 109-249), and specifically for cancer of the tongue (SIR = 251, 95% CI: 108-494). Significantly elevated incidence was observed among males for Kaposi's sarcoma (SIR = 2000, 95% CI: 1290-2950). CONCLUSION: While no conclusions may be reached concerning causality, the data do argue for increased cancer surveillance among people with syphilis. Moreover, findings are discussed in light of historical considerations.

Adolescent↗
PubMed1993

Oestrogen replacement therapy and breast cancer risk: a case-control study.

The relationship between oestrogen replacement therapy and breast cancer risk was examined based on data obtained from a population-based case-control study of breast cancer on Long Island, New York, USA. Cases were defined as female residents of two Long Island counties, aged 20-79, who were diagnosed with breast cancer between 1 January 1984 and 31 December 1986. Age- and county-matched controls were selected from driver's licence files. Among all postmenopausal women, there was no significant association between ever-use of hormones to treat menopausal symptoms and breast cancer risk. There was also no significant positive association in any subgroup defined by type of menopause (natural, hysterectomy with at least one ovary intact, bilateral oophorectomy) or age at menopause. Additionally, there was no increasing trend in risk with duration of use either overall or in any subgroup, nor was there an effect at any interval since last use. A significant elevation in risk was observed in women with 10-19 years since first exposure, which was concentrated in women with a natural menopause or hysterectomy with at least one ovary remaining, and women aged > 45 at menopause. Results of logistic regression analysis revealed no important confounding by any of several established breast cancer risk factors. However, a significant interaction was observed between body mass index (BMI) and oestrogen use, with an effect of oestrogen use being seen only in the thinnest tercile. Although biologically plausible explanations for this finding exist, the effect of chance cannot be ruled out.

Adult↗
PubMed1993

Safety and efficacy of kidney transplant biopsy: Tru-Cut needle vs sonographically guided Biopty gun.

OBJECTIVE: We evaluated the safety and efficacy of using a 14-gauge Tru-Cut needle without imaging guidance vs using an 18-gauge Biopty gun with sonographic guidance for percutaneous biopsy of kidney transplants. MATERIALS AND METHODS: We retrospectively analyzed data from 105 biopsies (in 68 patients) in which the Biopty gun with an 18-gauge needle was used and data from 100 biopsies (in 64 patients) in which a 14-gauge Tru-Cut needle was used. RESULTS: Significantly fewer major complications (p = .03) occurred when the Biopty gun was used (2%) vs when the Tru-Cut needle was used (10%). Two major complications (2%), both hematuria requiring transfusion, occurred in the 105 biopsies performed with the Biopty gun. Major complications occurred in 10 (10%) of the 100 biopsies done with the Tru-Cut needle: three obstructed allografts caused by blood clots, two episodes of hypovolemic shock, one case of shock and obstruction, and four intraperitoneal hemorrhages (one of which required nephrectomy). Biopsy specimens were adequate for histopathologic diagnosis in more than 98% of cases for both the Biopty gun and the Tru-Cut needle. CONCLUSION: We conclude that imaging-guided percutaneous biopsy of renal allografts with a Biopty gun is as accurate as and safer than biopsy with the Tru-Cut needle.

Adult↗
PubMed1993

Symptom relief after endoscopic sinus surgery: an outcomes-based study.

Previous studies of patients outcomes after sinus surgery have generally described only a summary measure of overall change in symptoms or health status. This paper describes an outcomes-based longitudinal study of sinus symptom prevalence among thirty-one patients treated with endoscopic surgery for chronic sinusitis. Patients completed structured data collection forms to quantify the prevalence of commonly experienced sinus-related symptoms during an eight-week period both before surgery and six months after undergoing sinus surgery. Significant decreases in nasal symptom prevalence (post-surgery versus pre-surgery) were noted for headaches, nasal drainage, nasal congestion, sinus infection, and breathing difficulties. In addition, the proportion of subjects who rated their current health as "better" compared to one year previously increased from 27% pre-surgery to 58% six months after sinus surgery. These findings aid in quantifying the magnitude of improvement experienced by sinus surgery patients and provide further evidence that endoscopic sinus surgery represents an effective treatment for chronic sinusitis.

Adult↗
PubMed1992

Population density and cancer incidence differentials in New York State, 1978-82.

Patterns of cancer incidence within five population density quintiles in New York State, exclusive of New York City, were investigated between 1978 and 1982. Sex-specific, standardized incidence ratios were calculated within each population density quintile for all cancer cases combined and for site-specific cancers based on cancer incidence patterns exhibited by the general population of New York State, exclusive of New York City. Areas with the highest population density demonstrated a 13 percent excess of cancer cases among males and a seven percent excess among females. In contrast, areas with the lowest population density exhibited lower cancer incidence, among both males (12 percent less) and females (12 percent less). Males demonstrated a significant, direct linear relationship between increasing population density and all cancer sites combined, and for cancers of the oral cavity and pharynx, esophagus, stomach, colon, rectum, liver, pancreas, larynx, lung, bladder, brain, and nervous system, and for Hodgkin's disease and multiple myelomas. Among females, a significant, direct linear relationship was observed between increasing population density and all cancer sites combined, and for cancers of the buccal cavity and pharynx, esophagus, stomach, lung, breast, and kidney. Malignant melanomas of the skin, and in situ and invasive cancers of the cervix exhibited unusual incidence patterns across the population density quintiles. These data are most useful in generating hypotheses for further studies to define specific etiologic factors operating within population density groupings. Population density, as measured in this investigation, may represent a surrogate measure for other factors which are related to cancer morbidity.

Female↗