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Biomedical subjects

M Katz

Publications and source records attributed to M Katz.

At least 109 records · Page 6Linked to original sources
PubMed1999

Assessment of patient capacity to consent to treatment.

OBJECTIVE: To compare results of a specific capacity assessment administered by the treating clinician, and a Standardized Mini-Mental Status Examination (SMMSE), with the results of expert assessments of patient capacity to consent to treatment. DESIGN: Cross-sectional study with independent comparison to expert capacity assessments. SETTING: Inpatient medical wards at an academic secondary and tertiary referral hospital. PARTICIPANTS: One hundred consecutive inpatients facing a decision about a major medical treatment or an invasive medical procedure. Participants either were refusing treatment, or were accepting treatment but were not clearly capable according to the treating clinician. MEASUREMENTS AND MAIN RESULTS: The treating clinician (medical resident or student) conducted a specific capacity assessment on each participant, using a decisional aid called the Aid to Capacity Evaluation. A specific capacity assessment is a semistructured evaluation of the participant's ability to understand relevant information and appreciate reasonably foreseeable consequences with regard to the specific treatment decision. Participants also received a SMMSE administered by a research nurse. Participants then had two independent expert assessments of capacity. If the two expert assessments disagreed, then an independent adjudication panel resolved the disagreement after reviewing videotapes of both expert assessments. Using the two expert assessments and the adjudication panel as the reference standard, we calculated areas under the receiver-operating characteristic curves and likelihood ratios. The areas under the receiver-operating characteristic curves were 0.90 for specific capacity assessment by treating clinician and 0.93 for SMMSE score (2p =.48). For the treating clinician's specific capacity assessment, likelihood ratios for detecting incapacity were as follows: definitely incapable, 20 (95% confidence interval [CI] 3. 6, 120); probably incapable, 6.1 (95% CI 2.6, 15); probably capable, 0.39 (95% CI 0.18, 0.81); and definitely capable, 0.05 (95% CI 0.01, 0.29). For the SMMSE, a score of 0 to 16 had a likelihood ratio of 15 (95% CI 5.3, 44), a score of 17 to 23 had a likelihood ratio of 0. 68 (95% CI 0.35, 1.2), and a score of 24 to 30 had a likelihood ratio of 0.05 (95% CI 0.01, 0.26). CONCLUSIONS: Specific capacity assessments by the treating clinician and SMMSE scores agree closely with results of expert assessments of capacity. Clinicians can use these practical, flexible, and evaluated measures as the initial step in the assessment of patient capacity to consent to treatment.

Aged↗
PubMed1999

Characteristics of parturients who choose to deliver without analgesia.

The purpose of the study was to characterize parturients who prefer to deliver without the use of analgesia. The study population consisted of 446 consecutive low risk laboring women in early active stage of labor. Data were collected prospectively by an obstetrician, using a structured questionnaire. The degree of pain was assessed by using a visual analog scale (VAS). An obstetrician and a midwife together estimated the degree of pain as was exhibited by the parturients, using the same scale. Univariate analysis found women who undertake labor without analgesia to be significantly older, with higher birth order, of Bedouin ethnicity and to be of lower educational level than those taking analgesics during labor. Women who refused analgesia had experienced and apparently expressed lower degrees of pain (mean VAS score = 7.4 and 6.7, respectively) than those who consented to analgesia (mean VAS score = 8.6 and 8.0, respectively; p < 0.001). A multiple logistic regression model found only the severity of pain (odds ratio (OR) = 0.67, 95% confidence interval (CI) 0.51-0.88; p = 0.004), as well as high maternal age (OR = 1.12, 95% CI 1.16-2.04; p = 0.038) to be independent factors affecting the decision not to accept analgesia during labor. In conclusion, parturients refusing analgesia were older and had experienced less pain during labor than women using analgesia.

Adult↗
PubMed1998

A bizarre bezoar: case report and review of the literature.

A bizarre case of a foreign-body bezoar is presented. A 16-year-old girl swallowed large amounts of toilet paper as a means of dieting. She presented with a palpable abdominal mass, multiple bezoars in the bowel, and paper excretion in the feces before admitting intentional ingestion of toilet-paper balls. Administration of Gastrografin via a nasogastric tube and enemas resulted in gradual excretion of the paper balls.

Adolescent↗
PubMed1998

Routine revision of uterine scar after cesarean section: has it ever been necessary?

Although a trial of labor after cesarean section (VBAC) is successful and relatively safe, few studies have directly addressed the necessity of routine transcervical revision of uterine scar after prior cesarean section. We performed a longitudinal study of 3469 women who had VBAC. In all patients, uterine scar integrity was examined immediately after placental expulsion. The detection rate of uterine scar dehiscence or rupture was 0.23% (8/3469). Only one woman with complete uterine rupture needed immediate laparotomy for severe hemorrhage. Out of seven patients (0.2%), who had evidence of uterine dehiscence, three underwent explorative laparotomy. In conclusion, the potential benefit of routine examination of uterine scar after VBAC is doubtful. Transcervical revision should be performed only in symptomatic patients.

Adult↗
PubMed1998

Pregnancy outcome after repeated blunt abdominal trauma.

During a four-year period, five of 49671 parturients were admitted on a prospective study protocol for repeated direct blunt abdominal trauma due to falls during pregnancy. Preterm contractions were noted in three patients one of which delivered preterm. No delayed abruptio placentae, intrauterine growth restriction or antepartum death were encountered. All patients delivered spontaneously. Repeated blunt abdominal trauma occurs rarely in pregnancy. Routine hospitalised surveillance in the absence of vaginal bleeding or uterine contractions may not be warranted.

Abdominal Injuries↗
PubMed1998

Meconium stained amniotic fluid in preterm delivery is an independent risk factor for perinatal complications.

OBJECTIVE: To determine the prevalence and clinical significance of meconium stained amniotic fluid (MSAF) in women with preterm delivery. STUDY DESIGN: The study population consisted of consecutive patients who arrived with intact membranes and delivered preterm, singleton neonates at the Soroka Medical Center between 1 January 1985 and 31 December 1995. Only vertex presentation was included. Antepartum death was excluded from the study. Patients were classified according to the color of amniotic fluid into two groups: MSAF and clear amniotic fluid. Maternal puerperal complications were defined in our study as the presence of at least one of the next variables: clinical chorioamnionitis; major puerperal infection including endometritis, cesarean section or postpartum hemorrhage. Perinatal complications were defined in our study as: (1) intrapartum death (IPD) or postpartum death (PPD); (2) one or more of the following: 1-min Apgar score <3, 5-min Apgar score <7 or small for gestational age. Rates of perinatal complications were assessed at: (1) 24-27 weeks; (2) 28-31 weeks; (3) 32-36 weeks. Logistic regression was used to investigate the relationship of MSAF to perinatal complications and maternal morbidity in a multivariate model. RESULTS: During the study period, a total of 96 566 deliveries occurred in our institution and 4872 (5.0%) deliveries were preterm. Among the women delivering preterm meeting eligibility criteria, 276 (5.7%) women had intrapartum MSAF. A higher rate of IPD and PPD was observed only between 32 and 36 weeks' gestation in patients with MSAF in comparison with patients with clear amniotic fluid [6.1% (14/230) vs. 2.1% (85/4045), respectively, P=0.0001]. A statistically significant higher rate of perinatal complications was found between 28 and 31 weeks' gestation, and even a higher rate was noted between 32 and 36 weeks' gestation in the MSAF group in comparison with patients with clear amniotic fluid [51% (18/35) vs. 27.2% (93/341), respectively, P=0.003; 20% (46/230) vs. 9.8% (396/4045), respectively, P=0.0004]. CONCLUSIONS: (1) MSAF is an independent risk factor for perinatal complications in preterm deliveries (OR=1.73, CI: 1.057-2.43, P=0.001; OR=2.35, CI:1.34-4.12, P=0.002, respectively). (2) MSAF was not found to be an independent risk factor for maternal morbidity.

Adult↗
PubMed1998

Peripartum complications in grand multiparous women: para 6-9 versus para > or =10.

OBJECTIVE: To assess the importance of birth order and advanced maternal age on maternal and peripartum complications. STUDY DESIGN: The study population consisted of 12 296 multiparous women (six deliveries or more) with singleton gestation. Patients were classified into two groups according to the birth order: grand multiparous (between six and nine deliveries) and huge multiparous (ten or more deliveries). Peripartum complication was defined when at least one of the following conditions occurred: massive hemorrhage, uterine rupture, abruptio placentae, dysfunctional labor or malpresentations. Logistic regression analysis was used to evaluate the relationship between birth order and maternal age and peripartum complications. RESULTS: Among the study population, 9587 (78%) were grand multiparous and the remaining 2709 were huge multiparous women. The rate of peripartum complications was higher in huge multiparous than in grand multiparous women: malpresentation (6.2% versus 5%, P<.005), massive hemorrhage (0.7% versus 0.4%, P<.001) and dysfunctional labor (6.4% versus 3.5%, P<.001). Huge multiparous women also had a higher rate of the following complications than grand multiparous women: cesarean section (14.4% versus 10.4%, P<.01), chronic hypertension (7.9% versus 3%, P<.001), severe pregnancy induced hypertension (2.6% versus 1.1%, P<.01), diabetes class A (10.7% versus 7.5%, P<.005), diabetes class B-R (4.3% versus 2%, P<.01) congenital anomalies (3.3% versus 2.6%, P<.05) and large for gestational age infant, (17% versus 12.4%, P<.01). When adjusted for maternal age, high birth order remained strongly associated with the occurrence of peripartum complications. CONCLUSIONS: Huge multiparity was associated with a higher rate of maternal and peripartum complications than grand multiparity. Higher birth order remained an independent risk factor for peripartum complications after adjustment for maternal age.

Abruptio Placentae↗
PubMed1998

The relationship between congenital cardiovascular malformations and spontaneous abortion in preceding pregnancy.

Previous studies have shown an increased frequency of spontaneous abortions in the pregnancy preceding a fetus or a newborn with neural tube defect (NTD) compared with a normal newborn. One explanation of this observation is the trophoblastic cell rest hypothesis put forward by Knox and Clarke, suggesting a teratogenic interaction between the developing embryo and pathological remnants of a previous pregnancy. The other explanation is that the previously lost fetus was also affected with neural tube defect. The aim of this study was to verify whether this observation is also valid for congenital cardiovascular malformations (CCVM). Demographic and obstetric data of 99 mothers (58 Jewish and 41 Bedouin) of newborns who died in the neonatal period from isolated CCVM were compared with those of 103 mothers (48 Jewish and 55 Bedouin) of newborns who died of congenital defects other than NTD and CCVM. Spontaneous abortions in the preceding pregnancy were found in 32% of the cases with CCVM compared with 14% of cases with other defects (ODs) (P=0.0012; odds ratio=3.1, 95% confidence interval 1.5-6.4). This significant difference was independent of maternal age and number of pregnancies or deliveries. No difference was found between Jews and Bedouins. As there is no indication in the literature that fetuses with isolated CCVM tend to be spontaneously aborted, our findings are more supportive of the trophoblastic cell rest theory.

Abortion, Spontaneous↗
PubMed1998

Demographic influences on free and cued selective reminding performance in older persons.

This study evaluated the influence of age, gender, race, and education on learning and memory in older persons. Free and Cued Selective Reminding (FCSR) was administered to a community-based sample of 216 Caucasian and 50 African American seniors as part of a larger medical and neuropsychological battery. Although age, education, and gender influenced FCSR performance, race did not. The study suggests that memory performance is not influenced by race and that race-adjustment may not be necessary in the norming of memory tests.

Black or African American↗
PubMed1998

Neuropsychological and neurophysiological indices of auditory processing impairment in children with multiple complex developmental disorder.

OBJECTIVE: To evaluate whether children with borderline disorder (also referred to as multiple complex developmental disorder) (BD/MCDD) and comorbid attention-deficit hyperactivity disorder (ADHD) demonstrate evidence of abnormal attention and/or auditory processing impairments as indexed by both behavioral and physiological measures. METHOD: Three groups of children were compared in two different experiments on behavioral rating scales (Conners Parent Rating Scale and Child Behavior Checklist), behavioral accuracy to auditory and visual target detection tasks, selected neuropsychological tests, and brain physiology (event-related potentials) collected during auditory and visual target detection tasks. RESULTS: The results demonstrate that children with BD/MCDD differ from children with ADHD in the (1) prevalence of internalizing and externalizing behaviors, (2) neuropsychological deficits related to auditory processing, and (3) event-related potential brain physiology associated with auditory cognitive target attention tasks. CONCLUSION: Some of the pervasive pathology described in children with BD/MCDD may be due to biological vulnerabilities, particularly problems with auditory processing. Auditory processing impairments in such children deserves special attention with respect to both understanding their behavioral symptoms and developing a comprehensive treatment plan.

Adolescent↗
PubMed1998

Clinical issues surrounding the use of terbutaline sulfate for preterm labor.

beta-mimetics have been prescribed by physicians to arrest or prevent premature labor for more than 20 years. Although not approved by the Food and Drug Administration (FDA) for tocolytic use, terbutaline sulfate has been the most widely prescribed beta-mimetic in the United States. Recently, the role of terbutaline in the treatment and prevention of preterm labor has been questioned by the FDA. Because the off-label use of drugs is a formally accepted practice in medicine when scientific studies support such use, we reviewed the currently available clinical literature on terbutaline use in various routes of delivery: intravenous, oral, and subcutaneous via infusion pump. This review describes the clinical evidence that supports the safe and effective use of terbutaline as a tocolytic agent in certain patient populations. Practicing physicians should continue to have unrestricted use of terbutaline for tocolysis as one of the few remaining therapeutic options remaining in the fight against preterm birth.

Administration, Oral↗
PubMed1998

Virtual bronchoscopy in children: early clinical experience.

OBJECTIVE: Virtual bronchoscopy is a new noninvasive technique that provides an internal view of the tracheobronchial tree. The purpose of our study was to assess the role of this technique as compared with fiberoptic bronchoscopy in the evaluation of suspected compression or narrowing of the trachea and main bronchi in children. CONCLUSION: Preliminary results suggest that virtual bronchoscopy may have a useful complementary role to fiberoptic bronchoscopy in evaluation of the tracheobronchial tree of children.

Adolescent↗