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Biomedical subjects

S B Sheps

Publications and source records attributed to S B Sheps.

At least 37 records · Page 2Linked to original sources
PubMed1989

Practice patterns of family physicians with 2-year residency v. 1-year internship training: do both roads lead to Rome?

Are there differences in patterns of practice between actively practising physicians who have been certified after a 2-year family practice residency and matched physicians without certification who have completed the standard 1-year internship? With the use of billing files prepared by the British Columbia Medical Association a group of 65 family practice certificants in active practice in British Columbia was compared with a control group of 130 internship trainees matched by year and school of graduation, category of billing (i.e., solo or group) and region. A wide range of practice features was assessed for the fiscal years 1984-85, 1985-86 and 1986-87. No differences were detected between the groups in 1986-87 for the following practice variables: number of patients (1888 and 1842 respectively), number of personal services billed for (7265 and 7173), number of personal services per patient (3.9), amount of funding for personal services ($140,192 and $140,100) and amount per patient for personal services ($77 and $79). Age-adjusted costs for male and female patients were similar in the two groups. Of six services thought to be influenced by type of training, only maternity care generated a significantly higher number of billings in the study group (341 v. 249). These results suggest that there is no demonstrable effect of training on patterns of practice. However, the question of the effect of training on quality of care and whether the 2-year residency may have a longer effect on practice patterns should be the focus of future research.

Accounting↗
PubMed1989

Randomized, double-blind, controlled trial of long-term diuretic therapy for bronchopulmonary dysplasia.

The effects of continuous therapy with hydrochlorothiazide and spironolactone on pulmonary function in 34 premature infants with severe bronchopulmonary dysplasia were assessed in a randomized double-blind controlled trial. Subjects were greater than or equal to 30 days old, were supported by mechanical ventilation in greater than or equal to 30% oxygen, and had radiographic evidence of bronchopulmonary dysplasia. The treatment group (n = 19) and the placebo group (n = 15) were similar in all respects except for distribution of gender. Anthropometrics, ventilatory measurements, and the results of pulmonary function tests were evaluated at study entry and at 1, 4, and 8 weeks into therapy. Poststudy chest radiographs were compared with those obtained before the study. The proportion of infants alive at discharge was significantly increased (84%) in the treatment group compared with the placebo group (47%) (p = 0.05). There were no statistically significant differences in total hospital days or in total ventilator days. Total respiratory system compliance at 4 weeks was higher in the treatment group (0.61 +/- 0.18) than in the placebo group (0.45 +/- 0.13) (p = 0.016). No difference in outcome was detected between male and female infants in the treatment group. These results suggest that long-term diuretic therapy improves outcome in infants with bronchopulmonary dysplasia.

Bronchopulmonary Dysplasia↗
PubMed1989

A comparison of photoscreening techniques for amblyogenic factors in children.

We screened 236 consecutive patients aged 6 years or less using an Off-Axis photoscreener and an Otago-type photoscreener. With a masked standardized clinical assessment as the standard, an overall comparison of the results obtained with the two techniques revealed a sensitivity and specificity in the neighbourhood of 0.85 and 0.87 respectively for the Off-Axis photoscreener and 0.94 and 0.94 respectively for the Otago photoscreener. Both techniques, but especially the Off-Axis technique, were less sensitive and specific in younger children (24 months or less). Fundus colour (light or dark) did not greatly affect sensitivity or specificity. Photoscreening with the pupil dilated led to an increase in false-positive results with both techniques. Our results showed the Otago photoscreener to be superior in this clinical trial.

Amblyopia↗
PubMed1989

Retinopathy of prematurity: a new epidemic?

This study provides the first empiric evidence for the existence of a new epidemic of retinopathy of prematurity-induced blindness. Data from a population-based register of handicapping conditions in the Canadian province of British Columbia, and a birth weight-specific census of live-born infants in British Columbia, were used to determine annual, population-level incidences of retinopathy of prematurity-induced blindness during 1952 to 1983. Changes in incidence since the end of the original epidemic (1954) were determined by subdividing the 29-year period (1955 to 1983) into two intervals (1955 to 1964 and 1965 to 1983). Standardized incidence ratio analyses revealed a marginally significant increase in the overall incidence of retinopathy of prematurity-induced blindness in the later as compared with the earlier period. Infants weighing 750 to 999 g at birth had a significantly increased standardized incidence ratio of 3.07 (95% confidence interval 1.26, 11.06). No increases in risk were observed in heavier or lighter weight infants. Because ascertainment and diagnostic changes do not explain the weight-specific increases in incidence, these results provide the first population-level evidence for a new epidemic.

Blindness↗
PubMed1988

Prenatal care: a comparative evaluation of nurse-midwives and family physicians.

We evaluated the prenatal care provided to 44 low-risk women by nurse-midwives (NMs) at a special clinic of a large obstetric referral hospital and a sample of 88 low-risk women attended by family physicians (FPs) in their offices. The women were matched on the basis of date of delivery, age, parity, number of previous miscarriages, gravidity, socioeconomic status and delivery after 32 weeks' gestation. The Burlington Randomized Controlled Trial criteria, which reflect community standards of care, were updated and used to assess the information, which was provided on standard provincial prenatal care forms. Scoring was carried out blindly, and interrater reliability was high. A highly significant difference was found in the proportions of NM and FP charts that were rated adequate, superior or inadequate: 77% v. 24%, 7% v. 16% and 16% v. 60% respectively. The rate at which procedures were omitted (leading to an inadequate score) in the categories of initial assessment, monitoring and management also varied between the two patient groups. These findings, even when considered in terms of several biases that may have resulted in the high proportion of NM charts rated at least adequate, suggest that NMs provide prenatal care to low-risk women that is comparable, if not superior, to the care provided by FPs.

Adult↗
PubMed1988

Evaluation of a postocclusive reactive circulatory hyperaemia (PORCH) test for the assessment of ulnar collateral circulation.

This prospective double-blind study compared Doppler assessment of the ulnar collateral circulation with the Allen's test and a postocclusive reactive circulatory hyperaemia (PORCH) test in 144 patients (288 hands). The PORCH test involves inflation of a blood pressure cuff on the upper arm to a supra systolic (+50 mmHg) pressure for two minutes. Prior to cuff deflation, both radial and ulnar arteries are occluded at the wrist; the cuff is then deflated and a 15-second period allowed so as to restore blood flow down to the wrist. Ulnar artery compression is now released and the time to revascularization measured. Fifty-eight per cent of hands with an abnormal Allen's test had a normal ulnar collateral circulation. Results of Allen's test were not significantly affected by patients' sex or smoking status (p greater than 0.1) but there was a significant difference (p = 0.001) in the false positive rates between patients over 40 years of age (0.2) and those under 40 years of age (0.03). Results of the PORCH test were not significantly affected by patients' age, sex or smoking status (p greater than 0.1). With a revascularisation time of 19 sec as a "cut off" for ulnar abnormality the PORCH test, unlike the Allen's test, was perfectly predictive of an abnormal ulnar collateral circulation and had no false positives.

Aged↗
PubMed1987

Prison health services: a utilization study.

A prospective study of health service utilization carried out in the Correctional Services of Canada (CSC), Pacific Region, is reported. Health service encounters occurring at the six Regional Institutions with on-site health care centers between May 29th and June 28th, 1984 were surveyed using a health clinic encounter form. There were 7,449 encounters during the study period. The mean rate of encounters was 5.2 per inmate. Seventy-two percent of these encounters occurred at wickets, and 28% occurred at clinics. Physician visits occurred at a mean estimated annual rate of 6.7 visits per year. This is 2.4 times higher than the mean annual physician visit rate for non-institutionalized men in Canada. The reason for visits was new illness (57%), chronic illness (31%), injuries (5%), psychosocial problems (2%), and administrative (5%). The encounter rate per 100 inmates varied from 19.7 to 1,203.6 across the institutions studied. Overall 89% of all visits were seen by health service nurses, while 11% were seen by physicians. Using ICHPPC-2 Defined, the ten most common complaints presented to the health service were headache, sore throat, stomach complaint, other respiratory complaint, tension headache, limb pain, other/not codable, medical examination, back pain and upper respiratory tract infection. These ten complaints accounted for 4896 (59%) of the total complaints recorded. The majority of visits took less than five minutes, were most often treated with medication, and did not require scheduled follow-up. The 50 most frequent visitors, those making 25 or more visits during the study period, while only 3.5% of the study population, accounted for 25% of all encounters.

British Columbia↗
PubMed1987

The epidemiology of school injuries: the problem of measuring injury severity.

In the few surveys of injuries occurring in schools, severity has been defined using a priori criteria based on the nature of injury and by the area injured. The validity of these methods of classifying injury severity has not been established. The association between two commonly used measures of injury severity (nature of injury and body area injured) with referral to medical assessment was explored, based on a simple model derived from the literature. Kendalls Tau-b was used to assess the association between the indicators of injury severity and referral; controlled for both school level (elementary school and secondary school) and the degree of behavioural control that could be exerted in the location of the injury. There was a very low association between indices of injury severity and referral for medical assessment regardless of level of school or degree of behavioural control. It is concluded that the simple model derived from the literature does not adequately describe the relationship between injury severity and referral in the school setting. The major issue facing school staff is not the measurement of injury severity per se, but the appropriate referral of the injured child for medical assessment and treatment.

Adolescent↗
PubMed1987

Epidemiology of school injuries: a 2-year experience in a municipal health department.

School injuries occurring in a municipal school system during a 2-year period were reviewed to identify epidemiologic features of school injuries, to determine data requirements for ongoing injury surveillance, and to identify potential preventive strategies. Overall, 3,009 injuries were reported (2.82/100 students per year). Elementary school students had only a slightly higher rate (2.85) than secondary school students (2.78). However, the cause, nature, school location of injury, and body area injured formed distinct patterns in these two groups. Playgrounds were responsible for the highest overall and elementary school rates, whereas sports areas and classrooms had the highest rates among secondary school students. Falls were the most frequent cause of injury in elementary schools whereas, as expected, sports injuries were the most frequent cause among secondary school students. Contusions and abrasions of the head were the most frequent type of injury for both groups, although more common among elementary school students, whereas fractures, sprains, strains, and dislocations were more frequent among secondary school students. Although the proportion of severe injuries to secondary school students was slightly higher (39 v 35%), the rate of referral of students to a hospital or physicians among secondary school students (1.21 per 100 student-hours) was almost twice the rate of elementary school students (0.65 per 100 student-hours). Problems with definition of injury severity and the need to explore the social aspects of schools as a factor in injuries emerged as important considerations for future research.

Accidental Falls↗
PubMed1985

Diagnostic testing revisited: pathways through uncertainty.

To aid physicians who may be having difficulty applying the principles of decision analysis to diagnostic data according to the methods published in the past several years, the authors of this paper set out a few principles and schemes for using and interpreting diagnostic data obtained from dichotomous tests. They also present a simple BASIC program for calculating post-test probabilities from likelihood ratios and pretest probabilities that a particular disease is present in a particular patient; the program can be adapted for use on microcomputers.

Clinical Laboratory Techniques↗
PubMed1984

The assessment of diagnostic tests. A survey of current medical research.

To study current diagnostic test evaluation, 129 recent articles were assessed against several well-known methodological criteria. Only 68% employed a well-defined "gold standard." Test interpretation was clearly described in only 68% and was stated to be "blind" in only 40%. Approximately 20% used the terms sensitivity and specificity incorrectly. Predictive values were considered in only 31% and the influence of disease prevalence and study setting was considered in only 19%. Overall, 74% failed to demonstrate more than four of seven important characteristics and there was an increased proportion of high specificities reported in this group. Articles assessing new tests reported high sensitivities and specificities significantly more often than articles assessing existing tests. These results indicate a clear need for greater attention to accepted methodological standards on the part of researchers, reviewers, and editors.

Diagnosis↗
PubMed1981

Hospitalization of adolescents in a new Children's Hospital.

The amalgamation of two provincial pediatric referral centers into a single new Children's Hospital is examined from the perspective of the pattern of adolescent hospitalization in each. Ministry of Health hospital records for 11-19-year-olds discharged from the two pediatric referral centers during the period 1971-1978 were studied. Patients were divided into five arbitrary groups, based on their length of stay and discharge diagnosis. Level A patients accounted for 43.9% of discharges and were short-stay, uncomplicated, and primarily surgical cases. Level D patients were a much smaller group (16.3%) but accounted for 56.9% of bed days. Violence and pregnancy accounted for 37.8% of all discharges and were the most frequent reason for hospitalization. The present pattern of bed utilization by 11-19-year-olds admitted to these two centers requires an estimated 100 hospital beds per day. If this pattern were to be transposed, unmodified, to the new Children's Hospital, adolescents would use 50% of its 200-bed complement. Planning options to modify this requirement and the impact of changing patterns of hospital utilization are presented.

Adolescent↗
PubMed1979

Utilization of the preemployment health examination in a university staff health service.

This study assessed the utilization of a mandatory preemployment health examination (PEHE) for 507 new full-time university staff in 1976. A random sample of 126 new employees was interviewed by telephone. Of the 108(86%) who completed the interview, 80 (74%) had been examined by the staff health service. Notification to take the exam, a reminder, and the employee's perception of its importance were highly associated (p less than 0.0001) with compliance. Only 30% of the food handlers and maintenance personnel ahd their PEHE before employment started; the proportion was similar for all new employees (29%). Therefore, although this staff health service was moderately successful in getting most new employees to have a PEHE, if the value of the examination is to be enhances, more attention must be paid to notifying and reminding all prospective employees. Special consideration is needed to ensure that those in potentially high-risk jobs are examined prior to employment. The role of the university administration in improving compliance is emphasized.

Adolescent↗
PubMedDate not supplied

The assessment of diagnostic tests: a comparison of medical literature in 1982 and 1985.

To determine whether improvements have occurred since a survey of the 1982 literature assessing diagnostic tests, the authors evaluated all English-language articles that assessed clinical diagnostic tests in abridged Index Medicus journals in 1985, and that had the terms sensitivity and specificity in the title, abstract, or key words. The 89 articles were assessed against seven methodologic criteria, including use of a well-defined "gold standard," clearly defined test interpretation, blinding, clear data presentation, correct use of sensitivity and specificity, calculation of predictive values, and consideration of prevalence. In comparisons of 1985 vs. 1982 articles, there were significant improvements in five of the seven criteria. For example, the proportion of articles using a well-defined "gold standard" rose from 68% to 88%. Overall, the frequency of papers demonstrating five or more of the seven criteria increased from 26% to 47%. However, predictive values were discussed in only 54% of the articles without, necessarily, consideration of the influence of prevalence as well. This study raises the concern that while the concepts of sensitivity and specificity are now accepted, predictive values remain less well understood. Although there has been an improvement in the assessment of diagnostic tests in published research, attention to accepted methodologic standards is still needed on the part of researchers, reviewers, and editors.

Clinical Laboratory Techniques↗
PubMedDate not supplied

Research methods for surgeons: an overview.

The purpose of this paper is to outline a number of salient features in the design and conduct of clinical research in surgery. The key features emphasized are the need for clarity in the elaboration of study hypotheses, clear definition of the variables involved in the study, particularly the outcome variables, the need to confront the issue of bias and confounding, and a review of methodological issues associated with specific components in the research process. Particular attention is paid to patient selection, allocation of patients to experimental and control groups, randomization, problems of co-intervention and contamination, a brief discussion of analytic issues, and the critical importance of getting appropriate design and other methodological assistance prior to initiating a study. A short bibliography providing the reader with more in-depth discussions of the issues raised here is provided. It is the intention of this paper to introduce surgeons undertaking clinical research to these important methodological issues so that they can utilize appropriate consultative services more effectively.

General Surgery↗