Biomedical subjects

R G Cornell

Publications and source records attributed to R G Cornell.

At least 19 recordsLinked to original sources

PubMed1989

Quality of life activities associated with adherence to insulin infusion pump therapy in the treatment of insulin dependent diabetes mellitus.

The impact of continuous subcutaneous insulin infusion (CSII) pump therapy on patients' activities of daily living and the prevalence of acute complications were examined in order to characterize patients' experience while on CSII, and to ascertain whether any of these factors could be associated with continued use of CSII. Fifty-one of 55 patients (93%) identified as initiating CSII in our medical center patient population completed retrospective surveys; 37 individuals (73%) were still using pumps and 14 individuals (27%) had discontinued pump use. CSII appeared to affect the quality of daily activities only modestly, neither improving nor interfering with many activities to any great degree. Activities associated with greatest improvements were eating, working, traveling, sleeping, and exercising. Results of logit analyses adjusting for duration of pump therapy indicated that the prevalence of six different acute complications (skin infections at the needle site, mild insulin reactions, more severe insulin reactions requiring assistance, hypoglycemic coma, asymptomatic hypoglycemia, and ketoacidosis) was not statistically associated with patients' decisions to continue or to stop CSII. In contrast, significant differences (p less than 0.05) between the groups continuing and discontinuing CSII were found in 11 of 18 activities of daily living. In general, patients continuing CSII, in contrast to those discontinuing CSII, found that many of their activities were improved significantly during pump therapy. There were few differences between groups in the degree to which CSII was perceived to interfere with daily activities. However, those continuing CSII found it significantly less necessary to take the pump off while doing some activities than did those discontinuing CSII.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗

PubMed1989

Effects of peer-group intervention on metabolic control of adolescents with IDDM. Randomized outpatient study.

In children with insulin-dependent diabetes mellitus (IDDM), deterioration in metabolic control frequently occurs during early adolescence. To prevent this predictable increase in blood glucose levels, we randomly assigned young adolescents with IDDM to an intervention based on problem solving with self-monitoring of blood glucose (SMBG) integrated into standard outpatient care or to standard care only for an 18-mo period. At follow-up, 50% of the standard-care adolescents exhibited greater than 1% increase in glycosylated hemoglobin (HbA1) levels over baseline values, indicating a deterioration in metabolic control, compared to only 23% of the intervention group. Follow-up HbA1 means +/- SD were 10.10 +/- 2.00% for intervention and 11.04 +/- 2.28% for standard-care adolescents, indicating a significantly lower value in the intervention group (P = .04). At follow-up, a greater percentage of intervention than standard-care adolescents reported using SMBG information when they exercised (60.0 vs. 33.3%, chi 2 = 4.29, P = .04). Our data suggest that clinic-based problem-solving groups can be more effective with young adolescents with IDDM than conventional treatment in preventing the expected deterioration in blood glucose.

Adolescent↗

PubMed1988

Evaluation of hospital-based aeromedical transport programs using therapeutic intervention scoring.

The number of patients transported by hospital-based aeromedical transport programs is increasing rapidly across the country. How many of these patients really need this kind of transport and how to compare the performance of different services in this regard remain controversial issues. We examined these questions in a prospective analysis of 1,081 flights in 5 aeromedical transport programs using the Therapeutic Intervention Scoring System (TISS) as the basis for an index of appropriateness. An average of 41.5% of flights in all programs were clearly appropriate according to the index, i.e., had scores associated with a 99% probability of validation by direct review. Another 34.9% of flights had a greater than 50% probability of being appropriate. From 18 to 28% of flights had scores associated with only a 20% probability of justification. Although TISS scoring, which is carried out after transfer, cannot provide a means of selecting individual patients for aeromedical transfer, a TISS-based index appears to be a simple and useful method for examining overall appropriateness of program activity, and could be used to set objective standards of appropriateness for evaluation and comparison of aeromedical programs.

Aircraft↗

PubMed1986

Interpreting behavioral, biomedical, and psychological relationships in chronic disease from 2 x 2 tables using correlation.

Correlations of 0.3 and 0.4 in psychological studies in chronic illness (e.g. diabetes) have been criticized as having little clinical importance. The present article suggests that correlation coefficients be interpreted as binomial effect size displays (BESD) as a means of gleaning the clinical importance of a given correlation coefficient. The BESD is easily understood, computed, and applied to research in chronic disease. An illustration is provided in which a r of 0.2 is shown to correspond to a BESD in which the success rate is improved from 40 to 60%. Using BESD to interpret the meaningfulness of relationships, correlations as low as 0.2 may have clinical importance.

Behavioral Medicine↗

PubMed1985

Extracorporeal circulation in neonatal respiratory failure: a prospective randomized study.

A prospective controlled randomized study of the use of extracorporeal membrane oxygenation to treat newborns with respiratory failure was carried out using the "randomized play-the-winner" statistical method. In this method the chance of randomly assigning an infant to one treatment or the other is influenced by the outcome of treatment of each patient in the study. If one treatment is more successful, more patients are randomly assigned to that treatment. A group of 12 infants with birth weight greater than 2 kg met objective criteria for high mortality risk. One patient was randomly assigned to conventional treatment (that patient died); 11 patients were randomly chosen for extracorporeal membrane oxygenation (all survived). Intracerebral hemorrhage occurred in one of 11 surviving children. Extracorporeal membrane oxygenation allows lung rest and improves survival compared to conventional ventilator therapy in newborn infants with severe respiratory failure.

Birth Weight↗

PubMed1978