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S Ringer

Publications and source records attributed to S Ringer.

At least 19 recordsLinked to original sources
PubMed1996

Normal birth weight intensive care unit survivors: outcome assessment.

UNLABELLED: RATIONALE/OBJECTIVE: Although the short- and long-term outcome of low birth weight neonatal intensive care unit (NICU) survivors has been extensively studied, much less information is available for normal birth weight (NBW) infants (greater than or equal to 2500 g) who require NICU care. METHODS: To address this issue, we retrospectively examined the neonatal hospitalizations and 6-month health status of 521 consecutive NBW admissions to a single NICU. Information on the neonatal hospitalization was obtained from a review of medical records. Postdischarge health status was collected by using telephone survey techniques. RESULTS: NBW infants comprised 88.1% of births in this hospital and 35.4% of NICU admissions during the study period. The in-hospital mortality rate for this group was 2%. The median length of stay was 7.7 days (range 1 to 110 days) with median hospital charges of $5222 (range $565 to $317,820). Only 59% of infants required active intensive care therapy; the remainder received only intensive monitoring. The need for intensive therapy on admission day along with the presence of prematurity and congenital anomalies were significant predictors of hospital charges (R2 = 0.31, P < .01). After initial discharge, 10.1% of these infants required rehospitalization in the first 6 to 8 months of life. The rate of readmission among infants with congenital anomalies was over 30%. In addition to its association with neonatal resource consumption, the presence of congenital anomalies along with low 5-minute Apgar scores was associated with higher postdischarge resource use, as measured by frequency of physician visits, need for special medical items, and rate of rehospitalization (P < .05). CONCLUSIONS: NBW infants represent a significant percentage of NICU admissions, but for many of these patients NICU admission could be avoided if alternative care settings that provided intensive monitoring were available. In addition, these infants also incur higher rates of postdischarge use of medical care.

Birth Weight↗
PubMed1995

A clinical trial of active management of labor.

BACKGROUND: Active management of labor is a multifaceted program that, as implemented at the National Maternity Hospital in Dublin, is associated with a lower rate of cesarean delivery than the rate usually found in the United States. We conducted a randomized trial to evaluate the efficacy of this approach in lowering the rate of cesarean section among women delivering their first babies. METHODS: We randomly assigned 1934 nulliparous women at low risk of complications of pregnancy, before 30 weeks' gestation, to active management of labor or to a usual-care group. The components of active management were customized childbirth classes; strict criteria for the diagnosis of labor; standardized management of labor, including early amniotomy and treatment with high-dose oxytocin; and one-to-one nursing. A low-risk subgroup was defined as including women with full-term, uncomplicated pregnancies who spontaneously went into labor (the protocol-eligible subgroup). Women meeting these criteria who had been randomly assigned to the active-management group were admitted to a separate unit where their labor was managed by trained, certified nurse-midwives. RESULTS: There was no difference between groups in the rate of cesarean section either among all women (active management, 19.5 percent; usual care, 19.4 percent) or in the protocol-eligible subgroup (active management, 10.9 percent; usual care, 11.5 percent). In the protocol-eligible subgroup, the median duration of labor was shortened by 2.7 hours by active management (from 8.9 to 6.2 hours), and the rate of maternal fever was lower (7 percent vs. 11 percent, P = 0.007). The percentage of women in whom labor lasted longer than 12 hours was three times higher in the usual-care group than in the active-management group (26 percent vs. 9 percent, P < 0.001). CONCLUSIONS: Active management of labor did not reduce the rate of cesarean section in nulliparous women but was associated with a somewhat shorter duration of labor and less maternal fever.

Adult↗
PubMed1989

Quantitative calibration and use of DNA probes for investigating chromosome abnormalities in the Prader-Willi syndrome.

Ten genomic DNA probes, subcloned from inserts derived from a phage library constructed from the DNA of flow-sorted chromosomes, have now been mapped to locations within 15q11-15q13. By dosage blotting and densitometry, 5 of these probes map to the 15q11.2-15q12 segment missing in one 15 chromosome of a Prader-Willi syndrome (PWS) patient with a prominent cytological deletion. A sixth probe most likely maps to the same region. The other 4 probes map outside of this segment but within 15q11-15q13. Several of the 15q11.2-15q12 probes, and a cDNA probe homologous to one, have been used to test the DNA from 8 patients exhibiting a wide range of the clinical manifestations expected for PWS patients. DNA deletion was observed in all 3 patients with cytological 15q1 deletions as well as in a patient with an unbalanced (Y;15) translocation. DNA from 1 PWS patient with an unbalanced (5;15) translocation and an inverted duplication of the short arm and proximal long arm of 15 showed at least 1 and possibly 2 extra copies of each genomic probe tested. In the other 3 patients with no cytological deletions, no DNA deletions were found. Thus, the molecular probes described can be used in most PWS patients to analyze the region of proximal 15q implicated in this syndrome.

Adolescent↗