Preliminary report on finding of mycoplasma in malignancy.
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Adenocarcinoma↗
Biomedical subjects
M White
Publications and source records attributed to M White.
Continuity of care after July: what happens to the resident's patients?
When internal medicine residents leave teaching programs, continuity of care for outpatients is affected. The authors had departing residents send their patients computer-generated letters identifying another physician to provide continuing care. The letters were randomly withheld from 20% of the patients (NL), and they were compared with patients who received letters (RL). A telephone survey was administered and visits and no-show rates were determined. The RL patients more often knew of the change in provider (84% vs 54%, p less than 0.01) and identified the resident as the source of the information (77% vs 43%, p less than 0.01) than NL patients. There were no significant differences between RL and NL patients in mean numbers of appointments (1.0 vs 0.8) or no-show rates (24% vs 21%) following housestaff turnover. Both groups wanted to be told by the physician about future changes and were willing to be informed by letter. A computer-generated letter appears to be an effective way of notifying patients about transfer of care during the annual housestaff turnover in teaching programs.
Appointments and Schedules↗
Prevention of heart allograft and kidney xenograft rejection by monoclonal antibody to CD45RB.
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Animals↗
Reference values for normal adult transesophageal echocardiographic measurements.
Normal transesophageal echocardiographic measurements have not been presented previously relative to the effects of age, sex, and body surface area. This comparison was obtained by measuring cardiac and aortic dimensions in 60 patients (20 to 75 years old; 33 women) with normal transesophageal echocardiograms. We found a variable and usually important relationship between body surface area and 11 of 20 structures measured. A gender effect was not significant after indexing for body surface area for all but one structure. Age correlated with the diameter of the aortic root, descending aorta, superior vena cava, and right pulmonary artery. Similar dimensions were noted for certain paired structures as the two atria, the mitral and tricuspid annuli, and the aortic root and right ventricular outflow tract. Although multiple factors underlie what is normal in a given individual, our reference values serve to facilitate recognition of cardiac and aortic disease.
Adult↗
Comparison of acute rest myocardial perfusion imaging and serum markers of myocardial injury in patients with chest pain syndromes.
BACKGROUND: Newer diagnostic modalities such as serum markers and acute rest myocardial perfusion imaging (MPI) have been evaluated diagnostically in patients with chest pain in the emergency department (ED), but never concurrently. We compared these two modalities in distinguishing patients in the ED with symptomatic myocardial ischemia from those with non-cardiac causes. METHODS: Serum markers and acute technetium-99m sestamibi/tetrofosmin rest MPI were obtained in 75 patients admitted to the ED with chest pain and nondiagnostic electrocardiograms. Venous samples were drawn at admission and 8 to 24 hours later for total creatine kinase, CK-MB fraction, troponin T, troponin I, and myoglobin. Three nuclear cardiologists performed blinded image interpretation. Coronary artery disease (CAD) was confirmed either by diagnostic testing or by the occurrence of myocardial infarction (MI). RESULTS: Acute rest MPI results were abnormal in all 9 patients with MI. An additional 26 patients had objective evidence of CAD confirmed by diagnostic testing. The sensitivity of acute rest MPI for objective evidence of CAD was 73%. Serum troponin T and troponin I were highly specific for acute MI but had low sensitivity at presentation. Individual serum markers had very low sensitivity for symptomatic myocardial ischemia alone. In the multivariate regression model, only acute rest MPI and diabetes were independently predictive of CAD. CONCLUSION: At the time of presentation and 8 to 24 hours later, acute rest MPI has a better sensitivity and similar specificity for patients with objective evidence of CAD when compared with serum markers.
Biomarkers↗
Culturally relevant "Navigator" patient support. The Native sisters.
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Continuity of Patient Care↗
Effects of intermittent ozone exposure on peak expiratory flow and respiratory symptoms among asthmatic children in Mexico City.
In a panel study of Mexican children (5-13 y of age) with mild asthma, the authors studied the relationship between ozone exposure and the course of childhood asthma. Decrements in peak expiratory flow rate were associated with ozone, and respiratory symptoms were associated with both ozone level and ambient particulate matter (< 10 microm) level. After the authors adjusted for minimum temperature and autocorrelation in the data, they determined that an increase of 50 ppb in a daily ozone 1-h maximum was related to an 8% increase in cough (95% confidence interval = 2, 15); a 24% increase in phlegm (95% confidence interval = 13, 35); and an 11% increase in low respiratory symptoms index (95% confidence interval = 5, 19). The authors concluded that children with mild asthma who resided in the south of Mexico City were affected adversely by the high ozone ambient levels observed in this area.
Acute Disease↗
Comparison of hair, nails and urine for biological monitoring of low level inorganic mercury exposure in dental workers.
Creatinine-corrected urine mercury measurements in spot urine samples are routinely used in monitoring workers exposed to inorganic mercury. However, mercury measurement in other non-invasive biological material has been used in some epidemiological studies. Dentists and dental nurses remain a group of workers with potential exposure to inorganic mercury through their handling of mercury-containing amalgam, although changes in work practices have reduced the current, likely exposure to mercury. Therefore, dental workers remain an occupational cohort in whom the value of using different biological media to identify exposure to low level inorganic mercury can be investigated. Samples of head hair, pubic hair, fingernails, toenails and urine were analysed for mercury content from a cohort of UK dentists (n=167) and a socioeconomically similar reference population (n=68) in whom any mercury exposure was primarily through diet. The mercury content in all biological material was significantly higher in the dental workers than in the control population (p<0.0001). The geometric mean and 90th percentile mercury concentrations in the urine samples from dentists were 1.7 and 7.3 micromol mol(-1) creatinine, respectively, with only one sample having a value at around the UK's Health and Safety Executive biological monitoring health guidance level of 20 micromol mol(-1) creatinine. Receiver operator characteristic analyses suggested that the ability of the biological material to discriminate between dentists and referents were fingernails>urine approximately equal to toenails>pubic hair approximately equal to head hair. Further investigation is warranted as to why fingernails appear to be such a good discriminator, possibly reflecting some contribution of direct finger contact with amalgam or contaminated surfaces rather than systemic incorporation of mercury into growing nails. Good correlation between head hair and pubic hair mercury levels in all subjects was obtained (r=0.832), which was significantly improved when hair samples weighing <10 mg were excluded (r=0.868). Therefore, under these exposure conditions and using the described pre-analytical washing steps, there is little influence from atmospheric contamination on the level of mercury content of head hair. The choice of non-invasive biological materials for mercury analysis depends on a number of considerations. These include the toxicokinetics of urinary mercury excretion, the growth rates of hair and nail, the nature and time-frame of exposure, and the fact that urine mercury may not reflect the body burden level from dietary methyl mercury. However, the data from this study suggests that urine mercury remains the most practical and sensitive means of monitoring low level occupational exposure to inorganic mercury.
Cohort Studies↗
Prepregnancy genetic testing for age-related aneuploidies by polar body analysis.
Current practice for prevention of chromosomal aneuploidies involves prenatal screening and termination of pregnancy, a procedure that is not universally acceptable. We introduced prepregnancy genetic testing by sampling and fluorescence in situ hybridization (FISH) analysis of the first and second polar body (PB), to avoid fertilization and transfer of embryos resulting from aneuploid oocytes. In 395 in vitro fertilization (IVF) patients of advanced maternal age, the first and second PBs were removed following their extrusion from oocytes and studied by FISH, using probes specific for chromosomes 13, 18, and 21, to detect and avoid the transfer of oocytes with common aneuploidies. Overall, 3,651 oocytes obtained from 598 IVF cycles were available for FISH analysis, with 2,952 showing interpretable FISH results (80.9%). The analysis revealed 1,271 (43.1%) oocytes with aneuploidy, which were excluded from transfer and subjected to follow-up FISH analysis to confirm PB diagnosis in the cleavage or blastocyst stage embryos. Only embryos originating from 1,681 aneuploidy-free oocytes were transferred back to patients, resulting in 119 pregnancies overall, from which 78 healthy children have already been born, 35 were spontaneously aborted, and 16 are ongoing, after confirming PB diagnosis by prenatal diagnosis. The results demonstrate that PB-based preimplantation diagnosis may be used for prepregnancy screening in women with age-related risk for common aneuploidies.
Aneuploidy↗
Assessing homeless population size through the use of emergency and transitional shelter services in 1998: results from the analysis of administrative data from nine US jurisdictions.
OBJECTIVES: This study reports findings from the first-ever systematic enumeration of homeless population size using data previously collected from administrative records of homeless services providers in nine US jurisdictions over a one year period. As such, it provides the basis for establishing an ongoing measure of the parameters of the homeless population and for tracking related trends on the use of homeless services over time. METHODS: Each participating jurisdiction collected data through its homeless services management information systems for persons and families who use emergency shelter and transitional housing. The jurisdictions organized the data by a standardized reporting format. These data form the basis for reporting homeless population size, both in raw numbers and as adjusted for each jurisdiction's overall population size, as well as the rate of turnover and average annual length of stay in emergency shelters and transitional housing. RESULTS: Individual jurisdictions had annual rates of sheltered homelessness ranging from 0.1% to 2.1% of their overall population, and 1.3% to 10.2% of their poverty population. Annual population size was 2.5 to 10.2 times greater than the point-prevalent population size. Results are broken down for adults and families. CONCLUSIONS: The prevalence of homelessness varies greatly among the jurisdictions included in this study, and possible factors for this diversity are discussed. Future reports of this nature will furnish similar series of homeless enumerations across a growing number of jurisdictions, thereby providing a basis for exploring the effects of different contextual factors on local prevalence rates of homelessness.
Adult↗
Visual testing for readiness to drive after stroke: a multicenter study.
OBJECTIVE: The purpose of this study was to determine the ability of a visual-perception assessment tool, the Motor-Free Visual Perception Test, to predict on-road driving outcome in subjects with stroke. DESIGN: This was a retrospective study of 269 individuals with stroke who completed visual-perception testing and an on-road driving evaluation. Driving evaluators from six evaluation sites in Canada and the United States participated. Visual-perception was assessed using the Motor-Free Visual Perception Test. Scores range from 0 to 36, with a higher score indicating better visual perception. A structured on-road driving evaluation was performed to determine fitness to drive. Based on driving behaviors, a pass or fail outcome was determined by the examiner. RESULTS: The results indicated that, using a score on the Motor-Free Visual Perception Test of < or =30 to indicate poor visual-perception and >30 to indicate good visual perception, the positive predictive value of the Motor-Free Visual Perception Test in identifying those who would fail the on-road test was 60.9% (n = 67/110). The corresponding negative predictive value was 64.2% (n = 102/159). Univariate logistic regression analyses revealed that older age, low Motor-Free Visual Perception Test scores and a right hemisphere lesion contributed significantly to identifying those who failed the on-road test. CONCLUSIONS: The predictive validity of the Motor-Free Visual Perception Test is not sufficiently high to warrant its use as the sole screening tool in identifying those who are unfit to undergo an on-road evaluation.
Aged↗
Effects of strength training on cardiovascular responses during a submaximal walk and a weight-loaded walking test in older females.
PURPOSE: The purpose of this study was to examine the effects of a total body strength training program on oxygen uptake (VO2), heart rate (HR), systolic blood pressure (SBP), and rate pressure product (RPP) during a submaximal walk and a weight-loaded walking test in healthy women 60-77 years old. METHODS: The submaximal walk (2 mph and 3.5% grade) took place during stage 3 of a graded exercise test. The weight-loaded walking task consisted of treadmill walking at 2 mph while carrying a box weighing 40% of maximum isometric elbow flexion strength. The women strength trained three times per week for approximately 1 hour per session for 16 weeks. RESULTS: Paired t tests determined that strength increased by 57% on six isotonic strength tests (one repetition maximum) and by 29% on two isometric strength tests. A repeated measures analysis of variance (ANOVA) was used to determine the pre- to post-differences between and within the two tests (alpha = 0.05). There was no change in VO2 but HR, SBP, and RPP decreased significantly during the submaximal walk and the weight-loaded walking test. However, average HR (135 to 120 bpm) and RPP (23.3 x 10(3) to 19.3 x 10(3)) decreased more during the weight-loaded walking test than during the submaximal walk (HR: 108 to 104 bpm; RPP 18.3 x 10(3) to 17.0 x 10(3)). CONCLUSIONS: In conclusion, the reduced HR, SBP, and RPP indicates that strength training may reduce cardiovascular stress during daily tasks in healthy older women.
Age Factors↗
Relationship between peripheral intravenous catheter Dwell time and the development of phlebitis and infiltration.
The purpose of this study was to evaluate whether lengthening the dwell time of peripheral i.v. catheters from 72 hours to 144 hours resulted in increased rates of phlebitis and/or infiltration. The study was conducted in medical/surgical units at a 110-bed teaching hospital with an i.v. team. Kaplan-Meier estimates of the success and failure and conditional failure probabilities were calculated for phlebitis and infiltration scores. Log rank tests were used to test for an association between the covariates and the time until failure. Drug irritation was the most significant predictor of phlebitis and infiltration rates in this study. The total difference in the estimated failure rates for the catheter lasting 6 days versus a new catheter inserted for another 3 days is 1.3%. Because the conditional failure probability estimates for days 4, 5, and 6 are slightly higher than for days 1, 2, and 3, consideration may be given to extending the dwell time of a peripheral i.v. catheter beyond 72 hours under certain circumstances.
Adult↗
Parental evaluation of a tour of the neonatal intensive care unit during a high-risk pregnancy.
OBJECTIVE: To describe parents' reaction to a prenatal tour of the neonatal intensive care unit (NICU) during a high-risk pregnancy and identify advice they have for other parents and health care professionals who participate in a such a tour. DESIGN: Naturalistic inquiry, a qualitative approach. SETTING: Semistructured interviews were conducted in the hospital or parents' home. PARTICIPANTS: Thirteen expectant parents who had toured a NICU during a high-risk pregnancy. MAIN OUTCOME MEASURES: Three categories of information were described by the parents: (a) a description of the tour; (b) benefits of the tour; and (c) an evaluation of the way that the tour was arranged and conducted, including advice to health care professionals and other parents. RESULTS: All parents recommended that parents diagnosed with a high-risk pregnancy be offered a prenatal tour of the NICU. The tour benefited parents and (a) decreased fears, (b) inspired hope for the infant's prognosis, (c) provided reassurance about the care in the NICU, and (d) prepared parents for their infant's hospitalization in the NICU. CONCLUSIONS: Parents experiencing a high-risk pregnancy benefit from a tour of the NICU. The tour familiarized parents with the NICU and the type of care that their newborn would require. However, during the tour, more attention should be given to the parental role in the NICU.
Adaptation, Psychological↗
Coding considerations in design of cochlear prostheses.
Some basic considerations in design of multichannel auditory nerve array stimulators and sound processors for an electrical stimulation cochlear prosthesis are briefly reviewed. Considerations specific to the design of strict auditory nerve simulation-based prostheses are discussed, as are considerations for production of channel vocoder-based and more purely information-based prostheses.
Cochlear Implants↗
Electrode position and excitation patterns for a model cochlear prosthesis.
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Animals↗
Opto-isolated stimulators used for electrically evoked BSER: some observations on electrical artifact.
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Animals↗
Making treatment decisions with HIV infection: a pilot study of patient preferences.
The importance of understanding patient preferences in making treatment decisions is widely recognized. This pilot study utilized a forced-choice paired-comparison method in which 28 ambulatory HIV-infected patients were given a computer-generated presentation of all possible pairs of eight different treatment options for their disease (FDA-approved medications, experimental and alternative treatments, no medication). Preferences were analyzed using binary multidimensional scaling analyses to determine the utility of paired-comparison models for the study of treatment-decision making and to identify factors influencing patient decision making. Results indicated that a three-dimensional model provided the best fit for the data. One dimension correlated with medications that raise CD4+ lymphocyte counts (r = 0.92, p < 0.001) and a second dimension correlated with frequency of dosing (r = 0.97, p < 0.0001). Patients' internal consistency of decision making was inversely correlated with severity of AIDS dementia symptoms as measured by performance on a neuropsychological test battery (r = -0.55, p < 0.0025). This finding indicates that AIDS dementia may significantly hinder patients' ability to use a rational (internally consistent) decision-making strategy in making treatment choices. Results also suggested that AIDS patients base treatment decisions primarily on the likelihood of raising CD4+ cell counts and restrictiveness of dosing regimens, but are not influenced by FDA approval status, volume of empirical support for the medications, or even possible harmful side effects. The implications of these findings for the treatment of patients with AIDS are discussed.
Adult↗