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Biomedical subjects

S Schultz

Publications and source records attributed to S Schultz.

At least 109 records · Page 6Linked to original sources
PubMed1991

Using comparative clinical information to understand practice patterns and affect organizational change.

The University Hospital Consortium is collecting clinical, administrative and financial data from its members to develop a Clinical Information Network. The value of this collective data lies in how comparative information about peer hospitals and physicians in the same specialty can be used to influence practice. The raw data from each hospital is analyzed, classified, normalized and stored in a data repository which is easily accessible. This data becomes information when it is presented in a variety of ways, and is supported by a knowledge-base of health care rules. The "drilling down" technique to progressive levels of detail serves the needs of all levels in the organization--executives, managers, and analysts. The system combines the power of a mainframe for the data repository with the ease of use of a PC-based workstation. With an open-ended approach, the users can ask a variety of questions of the data, as well as perform statistical analysis, create graphical presentations and generate explanations of the analysis techniques.

Artificial Intelligence↗
PubMed1991

Syphilis treatment response in HIV-infected individuals.

The adequacy of treatment for syphilis has routinely been evaluated by the serological response, i.e. the rapid plasma reagin test (RPR). Since the description of AIDS and HIV aspects of both the natural history of syphilis and the response of Treponema pallidum to treatment have come under increased scrutiny. With concurrent epidemics of HIV and syphilis in New York City, a serological case-control study was done to determine whether HIV-infected individuals given treatment for primary or secondary syphilis have a modified serological response. All study participants had primary or secondary syphilis and paired specimens available for testing. Cases were defined as people who were HIV-positive and were compared with controls who were HIV-negative. HIV-infected patients with primary syphilis when compared with HIV-negative controls were less likely to have a fourfold or greater RPR decrease or seroreversion within 6 months of treatment [15 out of 28 versus 153 out of 210; odds ratio = 0.4, P less than 0.05]. Cases and controls with secondary syphilis had similar serological responses after treatment for syphilis. Although this study adds to the growing body of literature which suggests that HIV may alter the RPR response, prospective studies are needed to determine definitively whether HIV alters the serological response to therapy in patients with early syphilis.

Adolescent↗
PubMed1990

An international outbreak of type E botulism due to uneviscerated fish.

In October and November 1987, eight cases of type E botulism occurred in New York City and Israel. All eight patients had eaten uneviscerated, salted, air-dried whitefish known as kapchunka. Clostridium botulinum was isolated from samples of fish, and trypsinized portions of kapchunka contained type E toxin despite levels of salt that were far in excess of those considered adequate for safety. As C. botulinum has been found in the viscera of fish from the Great Lakes, possible explanations for the outbreak include multiplication of C. botulinum and production of toxin during shipping or during processing before the fish reached inhibitory salt levels. However, there was no evidence of mishandling of the fish. More likely, the viscera provided a relatively low salt "protective" environment for organism multiplication and toxin production. A major public health campaign was initiated and regulations were passed prohibiting the processing, distribution, and sale of raw, uneviscerated, salt-cured fish products within New York City.

Adult↗
PubMed1990

Risk factors for human immunodeficiency virus type 1 (HIV-1) infection in patients at a sexually transmitted disease clinic in New York City.

Patients who attended a sexually transmitted disease clinic in New York City in 1987 were offered enrollment in a nonblinded study to estimate human immunodeficiency virus type 1 (HIV-1) seroprevalence in adults with multiple sexual partners and to determine risk factors associated with HIV-1 infection. In addition, a blinded serosurvey of a representative sample of patients was performed to obtain an unbiased estimate of seroprevalence in clinic attendees. The seroprevalence in the blinded serosurvey was 7.5% (26/348), while the seroprevalence of the 1,201 volunteers for the nonblinded study was 11.2%. For men in the nonblinded study, the risk behaviors most strongly associated with HIV-1 infection were intravenous drug use, sexual contact with another man, and sexual contact with a female intravenous drug user. For women, intravenous drug use and sexual contact with a man at risk for HIV-1 infection (an intravenous drug user or a bisexual) were most important. The seroprevalence among persons who denied all high-risk behavior was 1% (7/723). The results of this study, conducted in a city with one of the nation's highest reported cumulative incidences of acquired immunodeficiency syndrome, suggest that HIV-1 infection in clinic attendees was primarily limited to intravenous drug users, homosexual/bisexual men, and the sexual partners of these two groups.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Time to recurrence varies inversely with thickness in clinical stage 1 cutaneous melanoma.

The thickness of a tumor has been identified as the principal prognostic factor in cutaneous malignant melanoma. However, time to recurrence has not conclusively been related to thickness. A retrospective study of 216 patients with a primary cutaneous malignant melanoma that recurred was conducted to clarify this relationship and investigate possible independent relationships between age at diagnosis and sex of patients to time to recurrence. The results of analysis of linear regression revealed an inverse linear relationship between thickness and time to recurrence (p less than 0.001). Patients more than 50 years of age at the time of diagnosis were shown to relapse sooner than those less than 50 years of age (p = 0.014). Sex was not a significant factor in predicting time to recurrence (p greater than 0.10). These results suggest that thickness of tumor provides an indication of time to recurrence in those patients destined to recur and stress the need for long term surveillance in patients with a history of malignant melanoma because of the possibility of late relapse even with thin lesions.

Female↗
PubMed1990

Centrifugal ion-selective electrode system for potassium in whole blood.

We describe a novel ion-selective electrode (ISE) system that can be used in the Abbott Vision analyzer. A reusable sensor pack and a disposable test pack have been miniaturized to approximately the size and weight of a conventional Vision test pack, thus eliminating the need for a separate ISE module. The sensor pack contains a fluid path, battery-powered electronics, and screw-in electrodes. The test pack contains separate chambers and fluid channels for a blood specimen and two aqueous calibrators. During a run, plasma is separated from blood cells and is moved sequentially, along with the two calibrators, into and out of the sensor pack by centrifugal force. Each run includes checks for electromechanical integrity, fluid contamination, calibration slope and intercept, and specimen hemolysis. The system operates with CVs of less than 2% and gives results that correlate well with those by flame photometry and direct ISE methods. Either skin-puncture or venipuncture whole blood can be assayed, as well as serum or plasma.

Centrifugation↗
PubMed1989

Regulation of the hepatic response to glucagon: role of insulin, growth hormone and cortisol.

The hepatic response to glucagon was investigated in five groups of animals: (1) controls; (2) excess growth hormone (GH; tumor-bearing); (3) streptozotocin-induced diabetic; (4) cortisol-treated, and (5) insulin-treated animals. Blood samples were collected from the animal models and hepatocytes were prepared and used for glucagon-binding studies and studies of total glucose production, gluconeogenesis and glycogen determinations. Glucagon binding was elevated in GH-tumor-bearing and cortisol-treated hepatocytes but lower in hepatocytes from diabetic animals. Basal total glucose production wash higher in hepatocytes from diabetic rats but not changed in hepatocytes from GH-tumor-bearing, insulin-treated or cortisol-treated animals. Glucagon significantly stimulated total glucose production in hepatocytes from control, insulin-treated and cortisol-treated but not diabetic and GH tumor models. Gluconeogenesis as evaluated by alanine conversion to glucose was significantly increased in hepatocytes from diabetic and cortisol-treated animals and was significantly lower in hepatocytes from GH-tumor-bearing animals. Glucagon failed to significantly stimulate gluconeogenesis in hepatocytes from diabetic and tumor-bearing animals. Hepatic glycogen content was significantly decreased in diabetic and GH-tumor-bearing animals but not changed in insulin-treated and cortisol-treated animals. We conclude that increased glucagon binding was not always correlated with an increase in glucagon-stimulated glycogenolysis, gluconeogenesis or increased sensitivity to glucagon. Persistent hyperinsulinism may effectively suppress glucagon- or cortisol-stimulated pathways.

Alanine↗
PubMed1989

The pathophysiology and staging of cutaneous malignant melanoma.

The incidence of cutaneous malignant melanoma is increasing by 10% a year and by as much as 30% a year among whites living in the sunbelt. If present trends continue, it will soon be one of the most common cancers occurring in fair-skinned individuals who have sustained severe sunburns. Although sunlight is the major cause of melanoma, several other factors, such as hormones, have also been implicated. Malignancy should be suspected in any pigmented lesion that changes in color or size, begins to itch, or bleeds or oozes spontaneously. Because of these characteristic and often highly visible changes, the disease can usually be diagnosed when surgically curable. Microstaging allows prognostic categorization of risk, with thickness the single most important prognostic factor for patients with disease clinically limited to the primary site. Staging also determines the treatment plan.

Biopsy↗
PubMed1988

A larger spectrum of severe HIV-1--related disease in intravenous drug users in New York City.

Increasing mortality in intravenous (IV) drug users not reported to surveillance as acquired immunodeficiency syndrome (AIDS) has occurred in New York City coincident with the AIDS epidemic. From 1981 to 1986, narcotics-related deaths increased on average 32% per year from 492 in 1981 to 1996 in 1986. This increase included deaths from AIDS increasing from 0 to 905 and deaths from other causes, many of which were infectious diseases, increasing from 492 to 1091. Investigations of these deaths suggest a causal association with human immunodeficiency virus (HIV) infection. These deaths may represent a spectrum of HIV-related disease that has not been identified through AIDS surveillance and has resulted in a large underestimation of the impact of AIDS on IV drug users and blacks and Hispanics.

Acquired Immunodeficiency Syndrome↗