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Biomedical subjects

V Goel

Publications and source records attributed to V Goel.

At least 55 records · Page 3Linked to original sources
PubMed1999

Hereditary breast cancer. Psychosocial issues and family physicians' role.

OBJECTIVES: To outline the psychosocial issues in hereditary breast cancer (HBC) assessment and discuss the role of family physicians. QUALITY OF EVIDENCE: A literature search using MEDLINE, CINAHL, CancerLit, and HealthStar databases was conducted from January 1990 to April 1998, using the key words breast cancer or neoplasm and familial or hereditary, genetic testing or screening, primary care or family physician or counseling, genetic counseling, psychosocial or psychological. We found only a few studies focusing on a small number of well-studied "research families." MAIN FINDINGS: Women with a family history of breast cancer were likely to be highly interested in genetic testing for cancer risk. The benefit of testing for those with negative results is reassurance. Those found to be carriers of genetic mutations might benefit from increased surveillance and prophylactic therapy. Risks of testing include anxiety, depression, guilt, altered self-image, and insurance and employment discrimination. A family physician's role is to assess risk, to provide information and support so women can make informed choices about referral to familial cancer clinics, to offer cancer surveillance, and to provide support once genetic test results are available. CONCLUSION: Genetic testing is rapidly moving from research to clinical applications. Family physicians play an integral role in educating and managing women at risk for HBC. Physicians must prepare themselves with knowledge and counseling skills to meet the challenges of this new technology.

Adult↗
PubMed1998

Effect of population-based interventions on laboratory utilization: a time-series analysis.

CONTEXT: Previous studies have identified methods of decreasing laboratory utilization. However, most were hospital-based, relatively small, single-centered, or of limited duration. OBJECTIVE: To determine the effect of 3 population-based interventions (physician guidelines, laboratory requisition form modification, and changes to funding policy) on laboratory utilization in Ontario. DESIGN: Interventional time-series analysis in which data analysis was based on all claims made to the Ontario Health Insurance Program between July 1, 1991, and April 1997 for laboratory tests affected by the interventions. SETTING: All clinical laboratories (not based in hospitals) in Ontario. INTERVENTIONS: Physician guidelines, modification of laboratory requisition form, and changes in funding policy for the use of the erythrocyte sedimentation rate test (ESR), microscopic urinalysis, tests for renal function, iron stores, serum urea, and serum iron determinations, and tests for thyroid dysfunction (total thyroxine and thyroid-stimulating hormone [TSH]). MAIN OUTCOME MEASURES: Change from 1991 to 1997 in utilization rates of ESR, microscopic urinalysis, serum urea and iron determinations, and tests for total thyroxine and TSH. RESULTS: Age- and sex-standardized rates for laboratory tests unaffected by the interventions were stable during the study period. Utilization of ESR and urea determination decreased by 58% (P<.001) and 57% (P<.001), respectively, after they were removed from the requisition form and guidelines discouraging their use were disseminated. Rates for urinalyses without microscopy increased by 1700% (P<.001), while microscopic urinalysis decreased by 14% (P<.001), after a policy change eliminated microscopic urinalysis from routine urinalysis. Rates of iron determination declined by 80% (P<.001) and ferritin rates increased by 34% (P= .05) when policy changes eliminated iron testing when ordered with ferritin and guidelines advocating ferritin alone for investigating iron deficiency were disseminated. Utilization of total thyroxine testing declined by 96% (P = .02) when the provincial health plan stopped its funding. When TSH was removed from the laboratory requisition form, a 12% decline (P= .03) in its use was observed. Through April 1997, these interventions saved more than 625000 tests or $210400. CONCLUSIONS: The combination of guideline dissemination, laboratory requisition form modification, and changes to funding policy was associated with significant reductions in laboratory utilization.

Clinical Laboratory Techniques↗
PubMed1998

Psychological outcomes following maternal serum screening: a cohort study.

BACKGROUND: Maternal serum screening is used to assist in the prenatal detection of congenital anomalies. Its use is controversial, and one concern that has been expressed is its psychological effects on women. The authors examined whether this test leads to an increase in anxiety and depression among women who have a false-positive result as compared with those who have a true-negative result or do not undergo testing. METHODS: A prospective cohort study with baseline assessment at 15 to 18 weeks' gestation and follow-up at 24 weeks' gestation was conducted. Pregnant women at 8 geographically diverse sites across Ontario were recruited. The main outcome measures were the state portion of the State--Trait Anxiety Inventory and the Center for Epidemiologic Studies Depression Scale. RESULTS: Of the 2418 potential subjects 2020 (83.5%) were enrolled and eligible; 1741 (86.2%) completed the follow-up. A total of 1177 women (67.6%) underwent maternal serum screening. No overall adverse psychological effects as a result of testing were found at 24 weeks' gestation. Women with a false-positive result had a mean increase in anxiety score of 1.6 (95% confidence interval [CI] -1.7 to 4.9), whereas women with a true-negative result had a mean decrease of 1.1 (95% CI -1.8 to -0.3) and those not tested had a mean decrease of 0.4 (95% CI -1.3 to 0.5). The mean depression score increased by 0.5 (95% CI -0.9 to 2.0) in the false-positive group, was unchanged (95% CI -0.3 to 0.4) in the true-negative group and increased by 0.2 (95% CI -1.7 to 1.2) in the not tested group. Of the women who underwent testing, 87 (7.6%) were unsure of their result at the time of follow-up. INTERPRETATION: The results suggest that maternal screening in Ontario is not causing serious psychological harm to women. Communication regarding test results could be improved, since a substantial proportion of women were unsure of their test result.

Adult↗
PubMed1998

Outbreak of nosocomial Acinetobacter baumannii bacteremia in a high risk ward.

Acinetobacter baumannii is emerging as a major cause of nosocomial infections particularly in high risk patients. Being resistant to adverse environmental conditions, it can stay for prolonged periods in the hospital environment. We report an outbreak in the medical oncology ward where nine patients suspected of bacteraemia were blood culture positive for A. baumannii from the two samples each, one collected through the i.v. cannula and another through the peripheral veneous puncture. The bacteria was also isolated from the environmental sources from the various samples collected. The biotype, antibiogram, cellular protein profiles on SDS-PAGE and the restriction enzyme analysis patterns of the patient isolates and the environmental isolates were similar. This points to the environment as a source of infection. With reinforcement of proper barrier nursing and use of disposable heparine ampoules it was possible to control the outbreak.

Acinetobacter Infections↗
PubMed1998

Prostate-specific antigen utilization in Ontario: extent of testing in patients with and without cancer.

OBJECTIVES: To ascertain the extent of prostate-specific antigen (PSA) testing in patients with prostate cancer (PC), with other cancers (OC), and with no cancer (NC) in two clinical laboratory databases. DESIGN AND METHODS: PSA test records were obtained from a tertiary care hospital, Sunnybrook Health Science Centre (SHSC) and from a private laboratory, Gamma-Dynacare Medical Laboratories (GDL), during the period 1988 to 1995. These records were linked with the Ontario Cancer Registry (OCR) to establish a diagnosis of PC, OC, or NC. Trends in PSA testing according to diagnostic category, testing laboratory, patient age (by decade), and PSA value (in microgram/L) were determined. RESULTS: Major cancer sites identified in the patients tested for PSA were prostate (60%), bladder and colon (7% each), lung (5%), kidney (3%), and rectum (3%). There were 11,867 patients (8.5%) with PC, 8,002 (5.9%) with OC, and 118,954 (86%) with NC. The total number of PSA tests performed on these patients was 230,756, of which 21% were on PC, 5% on OC, and 74% on NC; of these tests, 64% were performed through GDL and 36% through SHSC. The mean (median) number of tests per patient was: PC, 4.0 (2); OC, 1.4 (1); and NC, 1.5 (1). For PC 89% and for OC 72% of all tests occurred after diagnosis. Between 1990 and 1995 the number of PSA tests increased two-fold in PC and OC, and 20-fold in NC. We estimate that about one-half of the PSA tests in the NC group were for screening purposes. The proportion of PSA tests occurring in PC, OC, and NC for patients 50 to 70 years of age was 41%, 50%, and 63%, respectively; for patients over 70 years of age, this proportion was 58%, 46%, and 22% respectively; and for patients under 50 it was 1%, 4%, and 15%, respectively. Between 1990 and 1995, the largest increase in testing frequency was in the NC group, particularly in patients 50 to 70 years of age, which was accompanied by a decrease in patients over 70. Less than 10% of testing occurred in patients under 50 in all diagnostic groups. We estimate that about 26% of PSA screening tests in NC occurred outside the guidelines for patient age. Between 1988 and 1995, the proportion of PSA results below our detection limit (< 0.2 micrograms/L) showed a steady rise in the PC group, as did the proportion between 0.2 and 3.9 micrograms/L; these were accompanied by a fall in the proportion > 20.0 micrograms/L. However, the proportion of PSA results within these ranges did not change much during the same time period for the OC and NC groups. At cutoffs of PSA = 4.0 micrograms/L (or PSA = 10.0 micrograms/L), estimates of clinical specificity were 84.0% (or 96.3%), and of clinical sensitivity were 83.4% (or 47.1%). CONCLUSIONS: Most (86%) PSA testing occurred in men with NC, consistent with diagnosis or screening. There were more PSA tests per patient in PC than in OC, and most testing occurred after diagnosis. PSA testing in the NC group continues to increase rapidly. The proportion of PSA tests in patients over age 70 decreased in the order of PC > NC > OC. Between 1990 and 1995, there was an increase in the proportion of patients tested who were between 50 and 70 in the NC group, which may suggest more screening in this group. Over this same time period, there was an increase in the proportion of undetectable PSA values, possibly suggesting increased use of radical therapy; there was also a decrease in the proportion of PSA > 20 micrograms/L, possibly suggesting a decrease in the prevalence of advanced stage PC.

Age Factors↗
PubMed1998

Assessing the extent of contamination in the Canadian National Breast Screening Study.

OBJECTIVE: To estimate the proportion of Canadian National Breast Screening Study (NBSS) participants who went outside the trial for a mammogram, based on health insurance claims data. METHOD: Prospective cohort study linking trial subjects with population-based administrative data. SUBJECTS: All NBSS participants enrolled in the Winnipeg screening center who had health insurance claims to Manitoba Health (n = 9,780). ANALYSIS: Claims for bilateral mammograms were compared by screening arm allocation and age group at enrollment. Mammograms likely to be "screening" were defined based on prior claim history. RESULTS: For women aged 40 to 49 at enrollment, 5.3% in the intervention group and 21.8% in the control group had a claim for at least one bilateral mammogram. After excluding nonscreening mammograms these proportions fell to 2.2% and 14.1% (P < 0.0001). For women aged 50 to 59, 4.5% in the intervention group and 16.7% of the control group had at least one claim for a bilateral mammogram. These proportions were 2.1% and 10.5% for screening (P < 0.0001). CONCLUSION: Health care utilization data can be used to estimate contamination in a screening trial. The levels of contamination resulting from participants going outside the study for a screening test can have an impact on the power of the study and need to be considered when interpreting results and planning future screening studies.

Adult↗
PubMed1998

Sex differences in the factors related to hospital utilization: results from the 1990 Ontario Health Survey.

We assessed the factors associated with hospital admission in Ontario, Canada, across age-specific and sex-specific groups. Data from the cross-sectional, population-based 1990 Ontario Health Survey (OHS) were used to examine the relationships between hospital admission and sociodemographic, health care need, psychosocial, and lifestyle factors. The OHS sample of 42,698 adults aged > or = 16 years, weighted to represent more than 7 million Ontarians, was used. Hospitalization rates per 1000 in the prior year were 130 for men and 203 for women. The higher rates for women are attributed in part to admissions related to childbearing. Women who delivered a child in the year before the OHS were excluded from subsequent analyses. Multivariate logistic regression models revealed that health care need (increasing number of health problems, fair/poor health status, older age) was the most important factor associated with higher hospitalization rates for men. For women, in addition to health care need, psychosocial (low/average well-being) and sociodemographic factors (married, low income, unemployed, English/French spoken in the home) were related to higher hospital utilization. Health care need is the most important factor for describing hospital use in men and women. However, rates of hospital utilization for women are more sensitive to sociodemographic factors even in a setting with universal health insurance. This suggests that among women, societal factors may exist that relate to potential disparities in access to health services. Efforts to assess how these factors operate are necessary to aid the development of interventions to minimize disparities that may exist.

Adolescent↗
PubMed1998

In vitro activities of ampicillin-sulbactam and amoxicillin-clavulanic acid against Acinetobacter baumannii.

In vitro susceptibility patterns of newer beta-lactamase-inhibiting antibiotics ampicillin-sulbactam (A/S) and amoxicillin-clavulanic acid (A/C) for 100 consecutive isolates of Acinetobacter baumannii obtained from various clinical samples were studied. The A/C MIC for 86% of the strains was more than 16/8 microgram/ml, whereas there was an A/S MIC of more than 16/8 microgram/ml for only 38% of the strains. This showed that A/S has significantly superior in vitro activity compared to A/C against A. baumannii, although, theoretically, both should have similar activities. The therapeutic superiority of A/S over A/C needs to be studied, or else the breakpoints for these agents in in vitro tests need to be redefined.

Acinetobacter↗
PubMed1998

A novel function of the DNA repair gene rhp6 in mating-type silencing by chromatin remodeling in fission yeast.

Recent studies have indicated that the DNA replication machinery is coupled to silencing of mating-type loci in the budding yeast Saccharomyces cerevisiae, and a similar silencing mechanism may operate in the distantly related yeast Schizosaccharomyces pombe. Regarding gene regulation, an important function of DNA replication may be in coupling of faithful chromatin assembly to reestablishment of the parental states of gene expression in daughter cells. We have been interested in isolating mutants that are defective in this hypothesized coupling. An S. pombe mutant fortuitously isolated from a screen for temperature-sensitive growth and silencing phenotype exhibited a novel defect in silencing that was dependent on the switching competence of the mating-type loci, a property that differentiates this mutant from other silencing mutants of S. pombe as well as of S. cerevisiae. This unique mutant phenotype defined a locus which we named sng1 (for silencing not governed). Chromatin analysis revealed a switching-dependent unfolding of the donor loci mat2P and mat3M in the sng1(-) mutant, as indicated by increased accessibility to the in vivo-expressed Escherichia coli dam methylase. Unexpectedly, cloning and sequencing identified the gene as the previously isolated DNA repair gene rhp6. RAD6, an rhp6 homolog in S. cerevisiae, is required for postreplication DNA repair and ubiquitination of histones H2A and H2B. This study implicates the Rad6/rhp6 protein in gene regulation and, more importantly, suggests that a transient window of opportunity exists to ensure the remodeling of chromatin structure during chromosome replication and recombination. We propose that the effects of the sng1(-)/rhp6(-) mutation on silencing are indirect consequences of changes in chromatin structure.

Chromatin↗
PubMed1998

Neuroanatomical correlates of human reasoning.

One of the important questions cognitive theories of reasoning must address is whether logical reasoning is inherently sentential or spatial. A sentential model would exploit nonspatial (linguistic) properties of representations whereas a spatial model would exploit spatial properties of representations. In general terms, the linguistic hypothesis predicts that the language processing regions underwrite human reasoning processes, and the spatial hypothesis suggests that the neural structures for perception and motor control contribute the basic representational building blocks used for high-level logical and linguistic reasoning. We carried out a [(15)O] H(2)O PET imaging study to address this issue. Twelve normal volunteers performed three types of deductive reasoning tasks (categorical syllogisms, three-term spatial relational items, and three-term nonspatial relational items) while their regional cerebral blood flow pattern was recorded using [(15)O] H(2)O PET imaging. In the control condition subjects semantically comprehended sets of three sentences. In the deductive reasoning conditions subjects determined whether the third sentence was entailed by the first two sentences. The areas of activation in each reasoning condition were confined to the left hemisphere and were similar to each other and to activation reported in previous studies. They included the left inferior frontal gyrus (Brodmann area 45, 47), a portion of the left middle frontal gyrus (Brodmann area 46), the left middle temporal gyrus (Brodmann areas 21, 22), a region of the left lateral inferior temporal gyrus and superior temporal gyrus (Brodmann areas 22, 37), and a portion of the left cingulate gyrus (Brodmann areas 32, 24). There was no significant right-hemisphere or parietal activation. These results are consistent with previous neuroimaging studies and raise questions about the level of involvement of classic spatial regions in reasoning about linguistically presented spatial relations.

Adult↗
PubMed1998

Health services research in breast cancer: background paper for a Canadian Breast Cancer Research Initiative workshop.

OBJECTIVE: To describe a systematic review of breast cancer health services research that was conducted to guide a Canadian Breast Cancer Research Initiative workshop. DESIGN: A literature review of major citation databases was conducted. The National Cancer Institute of Canada Framework for Cancer Control was adopted to classify articles by theme area and by type of health services research. RESULTS: The majority of the studies focused on screening for breast cancer and were descriptive studies on accessibility. Relatively few studies examined quality and outcomes of breast cancer services or interventions to improve such services. Furthermore, few health services research studies examined the areas of supportive care or palliation. CONCLUSIONS: The results help to identify the gaps in the Canadian and international research in this area. The material from the review was used as background for a workshop to support the work of the Canadian Breast Cancer Research Initiative Task Force on Health Services Research.

Breast Neoplasms↗
PubMed1998

Role of DNA probes in characterization of pathogenic and non-pathogenic E. histolytica.

Various tests have been described to differentiate the pathogenic and non-pathogenic types of E. histolytica. Recently DNA hybridization has been described to differentiate between the two subtypes. Using common HMC probe the presence of E. histolytica in stool was confirmed. Then on the basis of hybridization with DNA probe P 145 (pathogenic) and B 133 (non-pathogenic) E. histolytica was characterized as being pathogenic and non pathogenic respectively. Out of 137 patients studied 88 were symptomatic and 49 asymtomatic. 65 patients harboured E. histolytica as proved by microscopic examination of stool. Sixty-eight stool samples tested positive for DNA hybridization with common HMC probe, this included 65 microscopy positive samples and 3 microscopy negative samples. This gives a sensitivity of 100% and 96% specificity. All the 68 samples were then subjected to hybridization with P 145 and B 133 DNA probes. Out of 88 symptomatic patients stool samples of 57 patients were microscopy positive, however 58 were positive by common HMC probe and all of these were P 145 (pathogenic) positive and B 133 (non-pathogenic) negative. Of the 49 asymptomatic cases 8 were E. histolytica positive on microscopy and 10 positive on hybridization with common HMC probe and all 10 were P 145 negative and B 133 positive. It can be thus concluded that DNA hybridization is a reliable way to differentiate between pathogenic and nonpathogenic E. histolytica.

Animals↗
PubMed1998

The derivation of life tables for local areas.

Life tables are seldom derived at the local level, despite a shift toward health service planning to that level. We calculated life tables by sex for the 42 public health units in Ontario, using 1988 1992 mortality files. Traditional methods of life table construction were compared and validated. Data quality, particularly geographical coding of death certificates, poses the greatest difficulty in deriving accurate life tables for comparison between areas. Migration will affect estimates, but it is best considered during the interpretation of results. Except for the final age interval, methods of modelling life tables have little impact on final life expectancy estimates. It is feasible to calculate local level life tables with data and tools that are readily available. The results highlight the importance of examining such life tables, as variations within a province in life expectancy at birth may be as important as the differences between provinces.

Adolescent↗
PubMed1998

Visits by adults to family physicians for the common cold.

BACKGROUND: It is commonly believed that doctor's office visits for upper respiratory tract infections (URTI) occur too often given the self-limited nature of such illnesses. However, the frequency of visits for URTIs has not been well studied. We examined how often a large population of adults visited doctors when they had a cold, the degree to which they engaged in self care, and the characteristics of those seeking care. METHODS: We performed a secondary analysis of a population-based survey of 42,333 adults in the province of Ontario, Canada. Adults reporting an URTI in the previous 2 weeks were included. Multiple logistic regression was used to compare adults who made an office visit with those that did not, for differences in sociodemographic characteristics, health status, sick days, over-the-counter (OTC) medication use, and life satisfaction. RESULTS: Only 14% of the adults studied visited a doctor for an URTI. Most (76%) engaged in self care with OTC medications. Adults who visited a family physician were less likely to have taken an OTC medication (odds ratio [OR] = .11; 95% confidence interval [CI], .07-.19), and were more likely to have experienced three or more sick days (OR = 2.70; CI, 1.41-5.17), live in a larger household (OR = 1.88; CI, 1.37-2.57), not have completed high school, and be unhappy (OR = 2.47; CI, 1.35-4.52). CONCLUSIONS: The majority of adults do not visit a doctor when they have a cold, and most engage in self care. Illness severity, and its impact on patients and their families, seems to influence the decision to seek care.

Adult↗