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Biomedical subjects

R Steele

Publications and source records attributed to R Steele.

At least 145 records · Page 8Linked to original sources
PubMed1966

The relationship of antenatal and postnatal factors to sudden unexpected death in infancy.

In the investigation of sudden unexpected death in infancy (S.U.D.) the antenatal and immediate postnatal history of the child and associated maternal circumstances have been virtually unexplored. These areas were studied using data gathered in a perinatal mortality study carried out in Ontario. By using rigid criteria, 80 cases of S.U.D. were identified and matched with live controls. Subsequent analysis showed that S.U.D. occurred slightly more often in males than females, and that the majority of deaths occurred under 4 months of age. S.U.D. was shown to be significantly related to prematurity; feeding other than at the breast; low maternal age at time of marriage, first pregnancy and the delivery of the infant under study; delayed first prenatal visits; maternal blood group and cigarette smoking. Confirmation of these findings may allow the construction of profiles of infants particularly at risk and permit the institution of preventive measures. Further prospective studies in this field are required.

Adolescent↗
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Diagnostic patterns and temporal trends in the evaluation of adult patients hospitalized with syncope.

BACKGROUND: Syncope is a common clinical problem that is often difficult and expensive to diagnose. We examined diagnostic patterns and trends and use of specialty consultations in the evaluation of syncope. METHODS: We retrospectively reviewed the medical records of consecutive adult patients hospitalized with the principal diagnosis of syncope (International Classification of Diseases, Ninth Revision, code 780.2) during 1994 and 1998 at 2 community teaching hospitals. RESULTS: A total of 649 patients (57% female) with a mean (+/-SD) age of 68 +/- 15 years were identified in 1994 (n = 451) and 1998 (n = 198). Three hundred forty-one patients (53%) underwent at least 1 neurologic test, including brain computed tomographic (CT) scan (n = 283), electroencephalography (n = 253), carotid Doppler echocardiography (n = 185), and brain magnetic resonance imaging (n = 10). Only brain CT scan and electroencephalography yielded diagnoses in 5 (2%) and 6 patients (2%), respectively with history consistent with seizures or stroke. Cardiovascular tests providing the highest diagnostic yields (postural blood pressure check in 52 [30%], head-up tilt-table test in 32 [24%], and electrophysiologic study in 5 [16%]) were used in 176 (27%), 132 (20%), and 31 patients (5%), respectively. Differences in the use of some tests were noted at the participating hospitals and over time (1994 vs 1998). The total number of diagnosed cases was similar for patients undergoing evaluation by primary care physicians alone (65/103 [63%]), compared with cardiology (48/85 [56%]), neurology (29/48 [60%]), or both (81/141 [57%]). After a mean (+/-SD) length of stay of 5 +/- 4 days, 320 (49%) of 649 cases remained undiagnosed. CONCLUSIONS: Despite a reduction in the use of some tests (eg, brain CT scan and carotid Doppler) over time, lower-yield neurologic tests were overused and higher-yield cardiovascular tests were likely underused. The untargeted, seemingly random use of specialty evaluations did not seem to contribute to an increase in the overall number of diagnosed cases. Increased use of specific tests directed by history and results of physical examination may improve diagnostic yield and decrease the cost of evaluating syncope.

Aged↗
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Community Health Nursing↗
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Changes in plasma inorganic phosphorus and alkaline phosphatase activity during the adolescent growth spurt.

Longitudinal data on changes in the concentrations of plasma inorganic phosphorus and plasma alkaline phosphatase activity in 23 girls and 44 boys during the adolescent growth spurt are reported together with the height velocities, ages and sexual maturity ratings. The average age at the peak of the growth spurt was 12.5 years in the girls and 14.1 years in the boys with mean annual height gains of 7.0 and 9.7 cm/year respectively. In both sexes, plasma alkaline phosphatase activity rose and fell with the growth velocity during the growth spurt. Plasma inorganic phosphorus rose to reach a peak in the 4 months before the peak of the growth spurt in height; this rise was statisically significant in the boys but not in the girls. Values subsequently fell rapidly towards the normal adult concentrations. Plasma calcium, total protein, and albumin concentrations were also followed during this time, but were not at any point significantly different from normal adult values. These findings provide a guide for the interpretation of plasma biochemistry in adolescent patients.

Adolescent↗