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Biomedical subjects

V Goel

Publications and source records attributed to V Goel.

At least 19 recordsLinked to original sources
PubMed2004

Efficacy of a standardized echinacea preparation (Echinilin) for the treatment of the common cold: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: Recently, echinacea has regained popularity as one of the treatments chosen most commonly by consumers with the expectation that it will reduce the severity and duration of the common cold. However, the results from a limited number of clinical trials for this application have thus far been inconclusive. This incongruity may be the result of investigators utilizing poorly standardized echinacea products, likely devoid of sufficient quantities of active constituents necessary to exert a definitive clinical effect. Therefore, a formulation containing alkamides, cichoric acid, and polysaccharides at concentrations of 0.25, 2.5, and 25 mg/mL, respectively, was prepared from freshly harvested Echinacea purpurea plants (commercially available as Echinilin, Natural Factors Nutritional Products, Inc., Vancouver, BC, Canada). The objective of this study was to test the efficacy of this highly standardized formulation in reducing the severity and duration of symptoms of a naturally acquired common cold. METHODS: In a randomized, double-blind, placebo-controlled trial, 282 subjects aged 18-65 years with a history of two or more colds in the previous year, but otherwise in good health, were recruited. The subjects were randomized to receive either echinacea or placebo. They were instructed to start the echinacea or placebo at the onset of the first symptom related to a cold, consuming 10 doses the first day and four doses per day on subsequent days for 7 days. Severity of symptoms (10-point scale: 0, minimum; 9, maximum) and dosing were recorded daily. A nurse examined the subjects on the mornings of days 3 and 8 of their cold. RESULTS: A total of 128 subjects contracted a common cold (59 echinacea, 69 placebo). The total daily symptom scores were found to be 23.1% lower in the echinacea group than in placebo in those who followed all elements of the study protocol (P<0.01). Throughout the treatment period, the response rate to treatments was greater in the echinacea group. A few adverse event profiles were observed in both groups. CONCLUSIONS: Early intervention with a standardized formulation of echinacea resulted in reduced symptom severity in subjects with naturally acquired upper respiratory tract infection. Further studies with larger patient populations appear to be warranted.

Adult↗
PubMed2003

Assessing the evidence for organised cancer screening programmes.

The aim of this study was to review the evidence in the literature for organised cancer screening programmes. A Medline search for publications related to organised cancer screening programmes and their components was done. While there is a broad descriptive literature on various cancer screening programmes, there are few published studies that evaluate the impact of organised cancer screening. Most of the evidence to date is from Scandinavian cervical and breast cancer screening programmes. There is a moderate amount of literature that evaluates specific components of cancer screening programmes (such as quality control and recruitment). There is a substantial body of literature on organised cancer screening programmes. However, the studies tend to describe organised screening programmes rather than evaluate their effectiveness relative to opportunistic screening. Furthermore, most studies focus on individual components of organised screening programmes, rather than on the programmes as a whole. More research is needed that directly compares organised with opportunistic cancer screening.

Breast Neoplasms↗
PubMed2003

Fenestration of the posterior communicating artery.

A 21-year-old male presented with sudden onset of right-sided third nerve paresis. Angiogram showed a fenestrated posterior communication artery on the right side and no other vascular anomalies. There was no other lesion that could suggest a cause for the third nerve weakness. Fenestration of the posterior communicating artery has not been reported till date. The case is discussed and the literature on the subject is reviewed.

Adult↗
PubMed2001

Waiting times from abnormal breast screen to diagnosis in 7 Canadian provinces.

BACKGROUND: Delay to breast cancer diagnosis following an abnormal screening result is associated with anxiety and personal disruption. We assessed the patterns and timeliness of diagnostic follow-up after breast cancer screening for women with abnormal results who attended organized screening programs in 7 provinces. METHODS: Using data from the Canadian Breast Cancer Screening Database, we identified 203,141 women aged 50-69 years who underwent screening in 1996 through provincially organized breast cancer screening programs in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Nova Scotia and Newfoundland. We prospectively followed women with an abnormal screening result through to the completion of the assessment process. We evaluated the waiting times from screening examination to first assessment, from screening examination to first imaging, from screening examination to diagnosis and from first assessment to diagnosis for 13,958 women, stratified according to screening program, mode of detection, whether a biopsy was performed and whether cancer was diagnosed. RESULTS: We observed considerable variations between and within programs in the time to diagnosis. The median time from screening examination to first assessment was 2.6 weeks. The median time from screening examination to diagnosis was 3.7 weeks; this time increased to 6.9 weeks for women undergoing biopsy. Even when no biopsy was performed, 10% of the women waited 9.6 weeks or longer for a diagnosis, as compared with 15.0 weeks or longer for 10% of the women undergoing biopsy. Among the women who had a biopsy, the use of core biopsy was associated with a shorter median time to diagnosis than was open biopsy, and those found to have cancer had shorter waiting times than women with benign biopsy findings. INTERPRETATION: Women undergoing assessment of an abnormal breast cancer screening result waited many weeks for a diagnosis, especially when a biopsy was performed. To ensure that targets for timeliness, adopted nationally in 1999, are realized, improved models of care or dissemination of existing efficient techniques to reach a diagnosis will be needed.

Aged↗
PubMed2001

Comparison of breast magnetic resonance imaging, mammography, and ultrasound for surveillance of women at high risk for hereditary breast cancer.

PURPOSE: Recommended surveillance for BRCA1 and BRCA2 mutation carriers includes regular mammography and clinical breast examination, although the effectiveness of these screening techniques in mutation carriers has not been established. The purpose of the present study was to compare breast magnetic resonance imaging (MRI) with ultrasound, mammography, and physical examination in women at high risk for hereditary breast cancer. PATIENTS AND METHODS: A total of 196 women, aged 26 to 59 years, with proven BRCA1 or BRCA2 mutations or strong family histories of breast or ovarian cancer underwent mammography, ultrasound, MRI, and clinical breast examination on a single day. A biopsy was performed when any of the four investigations was judged to be suspicious for malignancy. RESULTS: Six invasive breast cancers and one noninvasive breast cancer were detected among the 196 high-risk women. Five of the invasive cancers occurred in mutation carriers, and the sixth occurred in a woman with a previous history of breast cancer. The prevalence of invasive or noninvasive breast cancer in the 96 mutation carriers was 6.2%. All six invasive cancers were detected by MRI, all were 1.0 cm or less in diameter, and all were node-negative. In contrast, only three invasive cancers were detected by ultrasound, two by mammography, and two by physical examination. The addition of MRI to the more commonly available triad of mammography, ultrasound, and breast examination identified two additional invasive breast cancers that would otherwise have been missed. CONCLUSION: Breast MRI may be superior to mammography and ultrasound for the screening of women at high risk for hereditary breast cancer.

Adult↗
PubMed2001

The health care information directive.

BACKGROUND: Developments in information technology promise to revolutionise the delivery of health care by providing access to data in a timely and efficient way. Information technology also raises several important concerns about the confidentiality and privacy of health data. New and existing legislation in Europe and North America may make access to patient level data difficult with consequent impact on research and health surveillance. Although research is being conducted on technical solutions to protect the privacy of personal health information, there is very little research on ways to improve individuals power over their health information. This paper proposes a health care information directive, analogous to an advance directive, to facilitate choices regarding health information disclosure. RESULTS AND DISCUSSION: A health care information directive is described which creates a decision matrix that combines the ethical appropriateness of the use of personal health information with the sensitivity of the data. It creates a range of possibilities with in which individuals can choose to contribute health information with or without consent, or not to contribute information at all. CONCLUSION: The health care information directive may increase individuals understanding of the uses of health information and increase their willingness to contribute certain kinds of health information. Further refinement and evaluation of the directive is required.

Advance Directives↗
PubMed2001

Breast cancer survival by teaching status of the initial treating hospital.

BACKGROUND: A number of studies have documented variation in treatment patterns by treatment setting or by region. In order to better understand how treatment setting might affect survival, we compared the survival outcomes of women with node-negative breast cancer who were initially treated at teaching hospitals with those of women initially treated at community hospitals. METHODS: We constructed a retrospective cohort consisting of a random sample of 938 cases, initially diagnosed in 1991, drawn from the Ontario Cancer Registry. Exposure was defined by the type of hospital in which the initial breast cancer surgery was performed. Outcomes were ascertained through follow-up of vital statistics. RESULTS: The crude 5-year survival rate was 88.7% for women who had their initial surgery in a community hospital and 92.5% for women who had their initial surgery in a teaching hospital. Women in higher income neighbourhoods experienced better survival at 5 years regardless of which type of hospital they were treated in. Multivariate proportional hazards regression modelling demonstrated a 53% relative reduction in risk of death among women with tumours less than or equal to 20 mm in diameter who were treated at a teaching hospital (relative risk [RR] = 0.47, 95% confidence interval [CI] 0.23-0.96), whereas among those with larger tumours there was no demonstrated difference in survival (RR = 1.32, 95% CI 0.73-2.32). Other variables that were significant in the model were age at diagnosis, estrogen receptor status and the use of radiation therapy. INTERPRETATION: Women with node-negative breast cancer and tumours less than or equal to 20 mm in diameter who were initially seen at a teaching hospital had significantly better survival than women with similar tumours who were initially seen at a community hospital. Survival among women with larger tumours was not statistically significantly different for the 2 types of hospital.

Actuarial Analysis↗
PubMed2001

Functional neuroanatomy of three-term relational reasoning.

In a recent study we demonstrated that reasoning with categorical syllogisms engages two dissociable mechanisms. Reasoning involving concrete sentences engaged a left hemisphere linguistic system while formally identical arguments, involving abstract sentences, recruited a parietal spatial network. The involvement of a parietal visuo-spatial system in abstract syllogism reasoning raised the question whether argument forms involving explicit spatial relations (or relations that can be easily mapped onto spatial relations) are sufficient to engage the parietal system? We addressed this question in an event-related fMRI study of three-term relational reasoning, using sentences with concrete and abstract content. Our findings indicate that both concrete and abstract three-term relational arguments activate a similar bilateral occipital-parietal-frontal network. However, the abstract reasoning condition engendered greater parietal activation than the concrete reasoning condition. We conclude that arguments involving relations that can be easily mapped onto explicit spatial relations engage a visuo-spatial system, irrespective of concrete or abstract content.

Adult↗
PubMed2001

Health-related quality of life and cost-effectiveness studies in the European randomised study of screening for prostate cancer and the US Prostate, Lung, Colon and Ovary trial.

Decisions on policies for screening for prostate cancer require that information upon health-related quality of life (HRQL) and cost-effectiveness (CE) be available, as the lead time for some of the cases detected by screening will be very long and detriments in quality of life could have a major impact on the subjects remaining life-span. A framework within which both HRQL and cost-effectiveness of prostate cancer screening can be assessed is presented. Studies of both are ongoing in the European Randomised Study of screening for prostate cancer and the US Prostate, Lung, Colon and Ovary trial. Preliminary information confirms that it is important to study screened subjects and controls, and not to assume that inferences derived from study of prostate cancer outside screening trials can be extrapolated to the trials. However, it will require prolonged study to enable the overall effects on quality of life, and on cost-effectiveness to be determined. Such studies are ongoing for the two trials.

Colonic Neoplasms↗
PubMed2001

Prophylactic oophorectomy in Ontario.

OBJECTIVE: To determine the indications, patterns of practice, and complication rates for prophylactic oophorectomy in Ontario. METHODS: From hospital discharge abstracts, 82 hospitals were identified where at least one patient had a prophylactic oophorectomy since 1992. Ethics approval for the chart review was obtained from 41 hospitals (50%), was denied at 10 (12%) and is pending at 31 facilities. Using the International Classification of Disease diagnostic code for family history of ovarian cancer (V16.4) and prophylactic oophorectomy (V50.42), the medical records departments were asked to retrieve the charts. One abstractor reviewed the charts using a standard form to collect demographic information, indications for surgery, details of surgery and complications. RESULTS: From 1992-1998, 263 women underwent PO in 41 hospitals. A BRCA1 or BRCA2 mutation was recorded in 16 cases. Thirty-six patients had a past history of breast cancer. In 127 women, a family history was the sole reason for surgery; the remaining 136 women had a coexisting gynecologic complaint. Laparotomy was used exclusively in 155 cases, laparoscopy in 79 and vaginal access in 12 cases. Seventeen women required conversion to laparotomy during the operation. The mean length of hospital stay was 3.7 days (0-14 days). Thirty-six women (14%) had complications. CONCLUSION: We have described the indications for surgery, trends in surgical practice and surgical complications for women receiving prophylactic oophorectomy in Ontario. Prior to prophylactic oophorectomy, the indications and benefits should be clear to both patient and physician. Optimally, all women should receive genetic counseling to help define risk for ovarian and breast cancer, medical and surgical options, impact of oophorectomy on cancer risk, risk of surgical complications, and the consequences and management of surgical menopause.

Adult↗
PubMed2001

Meaning and measurement: an inclusive model of evidence in health care.

Evidence-based approaches are assuming prominence in many health-care fields. The core ideas of evidence-based health care derive from clinical epidemiology and general internal medicine. The concept of evidence has yet to be analysed systematically; what counts as evidence may vary across disciplines. Furthermore, the contribution of the social sciences, particularly qualitative methodology, has received scant attention. This paper outlines a model of evidence that describes four distinct but related types of evidence: qualitative-personal; qualitative-general; quantitative-general and quantitative-personal. The rationale for these distinctions and the implications of these for a theory of evidence are discussed.

Evidence-Based Medicine↗
PubMed2001

Can the health utilities index measure change?

BACKGROUND: The Health Utilities Index (HUI) is a multidimensional, preference-weighted measure of health status. It comprises eight health attributes, aggregated into a single utility score. OBJECTIVES: The purpose of the study was to investigate the ability of the HUI to detect changes in health status in a general population cohort. RESEARCH DESIGN: Health status changes were analyzed in the full cohort and in persons who were diagnosed with chronic conditions, hospitalized, or became restricted in daily activities. SUBJECTS: To assess responsiveness, longitudinal data was used from the National Population Health Survey conducted in Canada in 1994 - 1995 and 1996 - 1997. We used cross-sectional data from the 1996 sample to classify chronic conditions into mild, moderate, and severe. MEASURES: Two measures of responsiveness were calculated: Standardized Response Mean (SRM) and Sensitivity Coefficient (SC). The HUI was compared with a global health index-the Self-Rated Health (SRH) scale. RESULTS: HUI scores improved between the two NPHS cycles in all age-sex groups, except men 65 years of age and older. Among the respondents who remained free of chronic conditions, improvements were seen primarily in the cognitive and emotional domains. The HUI deteriorated among persons who were diagnosed between the two cycles with a severe chronic condition, were hospitalized, or became restricted in activity, but not in those diagnosed with a moderate condition. The SRMs were generally smaller for the HUI compared with the SRH. CONCLUSIONS: The HUI responds to changes in health status associated with serious chronic illnesses. However, changes in the HUI do not always coincide with changes in self-reported health. Properties of the HUI scales require further study.

Adolescent↗
PubMed2001

Decision aids: are they worth it? A systematic review.

OBJECTIVES: The field of consumer decision support interventions has grown rapidly in the last 20 years, particularly since the increased formalization of evidence-based decision-making in health care. However, little is known as yet about the effect these decision aids have on relevant outcomes. To identify outcomes influenced by consumer decision aids (CDAs) and the particular effects of CDAs on those outcomes. METHOD: Published reports of randomized controlled trials and other designs in English identified from searches of Medline, Cancerlit, CINAHL, PsycINFO, Social Science Abstracts, the Cochrane Library and Current Contents, and from ancestry searches, hand searches and consultation with key informants. Studies were included if consumers were the decision-makers, decisions were real and not hypothetical, the intervention met a strict definition of a CDA and decisions involved treatment or screening. Data on setting, subjects, decision types, decision aid features and outcomes were extracted. The validity of each study included was evaluated by two team members. Summative ratings were calculated and categorized as high, medium and low. RESULTS: Over 500 titles were initially assessed; 96 study reports were obtained and screened for inclusion. Twenty-two reports representing 20 studies met the inclusion criteria. Eight studies with a low rating were excluded. Results were synthesized from the remaining 12 studies. Published studies of CDAs are increasing although still few in number. Outcomes such as knowledge and decision-making processes are influenced by CDAs but effects on treatment preferences, the actual decision or other outcomes have yet to be clearly established. CONCLUSIONS: Improved outcomes result from the use of CDA in some categories of outcome but insufficient evidence exists yet to support improved outcomes in all categories or to evaluate whether, given the considerable costs of many CDAs, funding for extensive ongoing development and testing can be sustained.

Canada↗
PubMed2001

Comparison of the biomechanics of hydroxyapatite and polymethylmethacrylate vertebroplasty in a cadaveric spinal compression fracture model.

OBJECT: Polymethylmethacrylate (PMMA) has long been used in the stabilization and reconstruction of traumatic and pathological fractures of the spine. Recently, hydroxyapatite (HA), an osteoconductive, biocompatible cement, has been used as an alternative to PMMA. In this study the authors compare the stabilizing effects of the HA product, BoneSource, with PMMA in an experimental compression fracture of L-1. METHODS: Twenty T9-L3 cadaveric spine specimens were mounted individually on a testing frame. Light-emitting diodes were placed on the neural arches as well as the base. Motion was tracked by two video cameras in response to applied loads of 0 to 6 Nm. The weight-drop technique was used to induce a reproducible compression fracture of T-11 after partially coring out the vertebra. Load testing was performed on the intact spine. postfracture, after unilateral transpedicular vertebroplasty with 7 to 10 ml of PMMA or HA, and after flexion-extension fatiguing to 5000 cycles at +/- 3 Nm. No significant difference between the HA- and PMMA cemented-fixated spines was demonstrated in flexion, extension, left lateral bending, or right and left axial rotation. The only difference between the two cements was encountered before and after fatiguing in right lateral bending (p < or = 0.05). CONCLUSIONS: The results of this study suggest that the same angular rigidity can be achieved using either HA or PMMA. This is of particular interest because HA is osteoconductive, undergoes remodeling, and is not exothermic.

Biocompatible Materials↗
PubMed2001

Making decisions about cancer screening when the guidelines are unclear or conflicting.

OBJECTIVE: Our purpose was to determine the factors involved in the cancer screening decisions of family physicians in situations where the clinical practice guidelines are unclear or conflicting as opposed to when they are clear and uncontroversial. STUDY DESIGN: We analyzed discussions with focus groups using a constant comparative approach. POPULATION: A total of 73 family physicians in active practice participated in 10 focus groups (1 urban group and 1 rural group in each of 5 Canadian provinces). OUTCOME MEASURES: Our main outcome measures were participants' perceptions regarding cancer screening when the guidelines were unclear or conflicting. RESULTS: We propose a model of the determinants of cancer screening decision making with regard to unclear and conflicting guidelines. This model is rooted in the physician-patient relationship, and is an interactive process influenced by patient factors (anxiety, expectations, and family history) and physician factors (perception of guidelines, clinical practice experience, influence of colleagues, distinction between the screening styles of specialists and family physicians, and the amount of time and financial costs involved in performing the maneuver). CONCLUSIONS: Our model is unique, because it is embedded in the physician-patient relationship. Ultimately, a modified model could be used to design interventions to assist with the implementation of preventive services guidelines.

Adult↗