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T B Newman

Publications and source records attributed to T B Newman.

At least 37 records · Page 2Linked to original sources
PubMed1995

Problems with the report of the Expert Panel on blood cholesterol levels in children and adolescents.

An Expert Panel convened by the National Cholesterol Education Program has recommended selective screening and treatment of children for high blood cholesterol levels, based on family history of cardiovascular disease or high blood cholesterol. This recommendation is problematic for several reasons. First, the recommended diets are likely to cause only a slight decrease in low-density lipoprotein cholesterol levels, the projected benefits of which will be offset by a similar decrease in high-density lipoprotein cholesterol levels. Lack of efficacy of the recommended diets could lead to use of more restrictive diets or to cholesterol lowering drugs. Second, even under optimistic assumptions, beneficial effects of cholesterol intervention will be small and delayed for many decades. As a result, childhood cholesterol-lowering efforts will not be cost-effective. Third, the Expert Panel's recommendations do not address important gender differences. Girls have higher average cholesterol levels than boys. They will therefore qualify for more dietary and drug treatment despite their lower age-adjusted risk of heart disease and the lack of association between cholesterol levels and cardiovascular mortality in women. Finally, recent evidence from randomized trials, cohort studies, and animal experiments suggests that cholesterol lowering may have serious adverse effects. This evidence was not discussed in the Expert Panel's report. Given current evidence, any screening and treatment of children for high blood cholesterol levels is, at best, premature.

Adolescent↗
PubMed1995

Kernicterus in otherwise healthy, breast-fed term newborns.

OBJECTIVE: To document the occurrence of classical kernicterus in full-term, otherwise healthy, breast-fed infants. METHODS: We reviewed the files of 22 cases referred to us by attorneys throughout the United States during a period of 18 years, in which neonatal hyperbilirubinemia was alleged to be responsible for brain damage in apparently healthy, nonimmunized, full-term infants. To qualify for inclusion, these infants had to be born at 37 or more weeks' gestation, manifest the classic signs of acute bilirubin encephalopathy, and have the typical neurologic sequelae. RESULTS: Six infants, born between 1979 and 1991, met the criteria for inclusion. Their peak recorded bilirubin levels occurred 4 to 10 days after birth and ranged from 39.0 to 49.7 mg/dL. All had one or more exchange transfusions. One infant had an elevated reticulocyte count (9%) but no other evidence of hemolysis. The other infants had no evidence of hemolysis, and no cause was found for the hyperbilirubinemia (other than breast-feeding). CONCLUSIONS: Although very rare, classic kernicterus can occur in apparently healthy, full-term, breast-fed newborns who do not have hemolytic disease or any other discernible cause for their jaundice. Such extreme elevations of bilirubin are rare, and we do not know how often infants with similar serum bilirubin levels escape harm. We also have no reliable method for identifying these infants early in the neonatal period. Closer follow-up after birth and discharge from the hospital might have prevented some of these outcomes, but rare, sporadic cases of kernicterus might not be preventable unless we adopt an approach to follow-up and surveillance of the newborn that is significantly more rigorous than has been practiced. The feasibility, risks, costs, and benefits of this type of intervention need to be determined.

Breast Feeding↗
PubMed1994

Cat scratch disease.

Explore the source record for details and available documents.

Case-Control Studies↗
PubMed1994

Screening for major depression in Vietnamese refugees: a validation and comparison of two instruments in a health screening population.

OBJECTIVES: 1) Using standard cutoffs, to determine the accuracy of two Vietnamese-language depression screening instruments for major depression in a nonpsychiatric setting, 2) to examine the utility of other cutoffs, and 3) to compare the instruments' overall accuracies. DESIGN: 1) A research assistant administered the Vietnamese Depression Scale (VDS) and the Indochinese Hopkins Symptom Checklist Depression Subscale (HSCL-D) to all subjects. 2) The "gold standard" was determined by a native Vietnamese-speaking psychiatrist using a written translation of a standard semistructured clinical interview. SETTING: A health screening clinic at a large public hospital. PATIENTS: A convenience sample of 206 newly arrived adult Vietnamese refugees undergoing routine, mandatory health screening. RESULTS: The psychiatrist diagnosed 7% of the refugees as having major depression. At standard cutoffs, the VDS had a 64% sensitivity, a 98% specificity, a 75% positive predictive value, and a 97% negative predictive value. Corresponding results for the HSCL-D were 86%, 93%, 48%, and 99%. More than half of the patients who had false-positive results had other clinical disorders. For each instrument, adjusting the cutoff improved sensitivity and positive predictive value. Receiver operating characteristic (ROC) curve analysis showed no difference in accuracy between the two instruments. Each instrument took approximately 5-10 minutes to administer. CONCLUSIONS: These instruments accurately identified Vietnamese refugees with major depression and should be of use to clinicians in primary care settings. Standard cutoffs may need to be adjusted in nonpsychiatric settings.

Adult↗
PubMed1994

Yield of reticulocyte counts and blood smears in term infants.

Reticulocyte counts and blood smears are commonly recommended to evaluate jaundice in newborns. To investigate the results and diagnostic yield of these tests, we reviewed a computerized database and medical records of term newborns who had reticulocyte counts (n = 799) or blood smears (n = 781) within the first week after birth at two hospitals. Nearly a threefold difference was noted in reticulocyte counts between the two hospitals (median 8.0% vs 2.8%; P < .0001), apparently due to differences in laboratory methods. Among the patients with "abnormal" reticulocyte counts or blood smears (n = 192), isoimmunization was diagnosed in 54, presumed hemolysis of unknown etiology in two, G6PD deficiency in one, and pyropoikilocytosis in one. We conclude that better standardization of reticulocyte counts is needed. When ordered as screening tests for hemolysis in jaundiced infants, reticulocyte counts and blood smears seldom lead to diagnoses of hemolysis other than isoimmunization.

Bilirubin↗
PubMed1994

Problems with serum IgM as a screening test for congenital infection.

The purpose of this study was to determine the usefulness of the total serum IgM level as a screening test for congenital infection in asymptomatic or mildly symptomatic infants. A retrospective medical record review was performed on 168 infants in whom the serum IgM was measured as a screen for congenital infection. The indications for testing, the yield of testing, and the adequacy of follow-up of abnormal values were examined. Only one infant was diagnosed with a congenital infection which was not specifically suspected prior to screening; this was a case of congenital cytomegalovirus (CMV). Inappropriate screening was frequently performed in infants in whom indications for specific evaluation were present. Appropriate follow-up testing was performed in only 30% (seven of 23) of the infants with elevated serum IgM who received their pediatric care at our institution. Because of the low yield (< 1%) and lack of follow-up shown in this study, as well as poor sensitivity, serum IgM was not a useful screening test for congenital infection in our institution.

Humans↗
PubMed1994

Obstacles and approaches to clinical database research: experience at the University of California, San Francisco.

With increasing availability of clinical data in machine-readable form, and decreasing cost of storing and manipulating that data, retrospective research using clinical databases has become more feasible. Nonetheless, much of the potential for clinical research using these data remains unrealized. Obstacles to clinical database research include difficulty accessing data, difficulty using retrospective data to draw valid inferences about medical tests and treatments, and a shortage of investigators trained and interested in using a clinical database to answer their questions. At the University of California, San Francisco, we have developed a Clinical Database Research Program (CDRP) to try to overcome these obstacles. The CDRP maintains a relational database of patient data obtained from diverse sources and a small staff dedicated to providing such data to researchers. The CDRP staff also provides support for design and analysis of studies using the database--the development of methods for such studies is our primary research interest. Finally, to increase the number of investigators using the database for research, we are integrating training in clinical epidemiology and clinical research methods into residency and fellowship training, and offering an elective in clinical database research for trainees who wish to undertake a specific project.

Databases, Factual↗
PubMed1993

Should we be measuring blood cholesterol levels in young adults?

Should we measure blood cholesterol levels in all adults, or only in those at high risk of coronary heart disease (CHD)? Most men under the age of 35 years and women under the age of 45 years--roughly half the adult population--are at very low short-term risk of CHD. One consequence is that drug treatment to lower high blood cholesterol levels in the average young adult is an extremely expensive means of prolonging life; the estimated $1 million to $10 million per year of life is 100 to 1000 times the cost of other approaches. Individualized dietary treatment is somewhat cheaper but relatively ineffective. Another consequence of the low CHD risk in young adults is the greater likelihood that intervention may have harmful effects that outweight the benefits. Meta-analysis of primary prevention trials in middle-aged men reveal an increase in non-CHD deaths among those randomized to cholesterol interventions, an unexpected finding that is more substantial than the decrease in CHD deaths. This raises the possibility that one or more of the cholesterol interventions could have very serious adverse effects among young adults, whose risk of non-CHD death is normally 100 times their risk of CHD death. We conclude that the policy of screening and treating high blood cholesterol levels in young adults is neither cost-effective, nor does it satisfy ethical standards requiring strong evidence that preventive interventions do more good than harm. Fortunately, cholesterol screening in young adults is also not necessary: most CHD events associated with high blood cholesterol levels in this population will not occur for decades and can be prevented by treatment that is begun in middle age. Cholesterol screening and treatment in young adults should be limited to individuals with known coronary disease or other unusual factors that place them at high short-term risk of CHD death.

Adult↗