Biomedical subjects

V M Taylor

Publications and source records attributed to V M Taylor.

36 records · Page 2Linked to original sources

PubMed1996

Peri-operative hypoxaemia in children undergoing application of a plaster jacket for scoliosis.

Twenty children (six female), median age 24 months (range 12-156) who presented for application of a plaster jacket for scoliosis were studied pre-operatively with pulse oximetry overnight and on the first postoperative night. Pre-operatively the median (range) arterial oxygen saturation was 97 (95-98)%, although eight children had short episodes of desaturation to < 90%. Postoperatively the median saturation was unchanged, and nine children had short episodes of desaturation. Neither the presence of episodes of desaturation pre-operatively, nor the median or lowest saturation recorded were predictors of postoperative median saturation or the presence of episodes of desaturation. Despite the presumed reduction in chest wall compliance, the application of a plaster jacket for scoliosis in these young children was not associated with a significant change in their oxygenation.

Adolescent↗

PubMed1995

Community organization to promote breast cancer screening among women ages 50-75.

BACKGROUND: To reduce breast cancer mortality, ways to promote the use of mammography screening among women age 50 and above are needed. Community organization may be a useful approach. METHODS: The Washington State Community Breast Cancer Screening Project involved implementation of promotional activities initiated by physician and lay community boards in two communities. Two comparable communities served as controls for evaluation purposes. Random-digit-dial telephone interviews were used to assess recent use of mammography at baseline and follow-up in independent samples of women ages 50 to 75 from the four communities. The extent of exposure to intervention activities and the relationship between exposure to intervention activities and mammography use were estimated from data collected at follow-up. RESULTS: Exposure to patient reminders from physicians, wallet reminder cards, and newspaper advertisements were consistently related to mammography use. Physician office staff encouragement and a display board were significantly related to mammography use only in Intervention Communities A and B, respectively. Neither exposure to promotional activities nor the change in prevalence of mammography use was significantly higher in the intervention communities than in the comparison communities at follow-up. CONCLUSIONS: Although several activities were useful in promoting mammography use, organization of the community did not enhance efforts undertaken spontaneously by comparable communities.

Aged↗

PubMed1995

Increased risk of placenta previa among women of Asian origin.

OBJECTIVE: To investigate the frequency of placenta previa among Asian women. METHODS: We conducted a population-based case-control study using Washington state birth certificate data from 1984-1987. Our study population included 810 women with pregnancies complicated by placenta previa and 2917 randomly selected controls. Unconditional logistic regression was used to estimate odds ratios (OR) and their 95% confidence intervals (CI), and interaction terms were used to examine effect modification. Potential confounding by maternal age, gravidity and parity, maternal smoking during pregnancy, and a history of abortion or cesarean delivery was adjusted for in the analysis. RESULTS: The frequency of placenta previa during the study period was 3.3 per 1000 live births. Women of Asian origin were 86% more likely (OR 1.86, 95% CI 1.38-2.51) to have a delivery complicated by placenta previa than were white women. This association was stronger among women without a previous live birth (OR 2.51, 95% CI 1.57-4.01) than those who previously had experienced a live birth (OR 1.50, 95% CI 1.01-2.25). CONCLUSION: Asian women residing in the United States are at increased risk of placenta previa. If confirmed by others, our results suggest that obstetricians should consider meticulous ultrasound evaluations during pregnancy to rule out the presence of placenta previa in Asian-American women.

Abortion, Induced↗

PubMed1995

Repeat mammography use among women ages 50-75.

It has been demonstrated clearly that the use of regular screening mammography reduces mortality among women ages 50 years and over. The primary objective of this study was to investigate factors associated with repeat mammography participation. A random sample of women ages 50-75 years residing in four Washington State counties was surveyed by telephone during mid-1989. The Health Belief Model was used as a conceptual framework for the analysis. Three groups of women with different mammography experiences in the previous 5 years were compared: (a) nonusers; (b) onetime users; and (c) repeat users. The survey response rate was 72%, and the study sample included 1357 women. One time users were more likely to have health insurance coverage, to visit a gynecologist or other primary care physician regularly, and to believe mammography is more effective than breast self-examination; they were less likely to think that at least 1 in 10 women are diagnosed with breast cancer or that mammography is inconvenient to obtain than were nonusers. Factors associated with repeat versus onetime use included routinely visiting a gynecologist, thinking the lifetime risk of breast cancer is at least 10%, and perceiving a high personal susceptibility to disease. Women who perceive themselves as being vulnerable to breast cancer are more likely to report repeat mammograms. Visiting a gynecologist regularly is associated with repeat as well as initial mammography use. These factors could be considered as the focus of promotional efforts moves from encouraging women to obtain their first mammogram to encouraging repeat use.

Aged↗

PubMed1995

Low back pain hospitalization in Washington State: recent trends and geographic variations.

For several years, interest in clinical practice patterns has increased due to concerns about the costs and quality of health care. Our objectives were to examine recent trends and geographic variations in low back pain hospitalization. We analyzed data from a Washington State automated database for 1987-1992. Low back surgery rates in Washington changed little during the study years. In contrast, nonsurgical hospitalization rates fell from 15.5 to 5.1 per 10,000. The proportion of operations involving fusion decreased from 15.8% in 1987 to 11.7% in 1990, and then remained stable. During 1990, important county-to-county variations were observed in surgery rates, nonsurgical hospitalization rates, the proportion of operations involving fusion, and the percentage of surgical patients undergoing reoperation within 3 years. Wide county variations suggest that there may be overutilization or underutilization of low back pain treatments in some geographic areas. A more consistent approach to the management of back problems may benefit patients.

Adult↗

PubMed1994

Analysis of automated administrative and survey databases to study patterns and outcomes of care.

Large computerized databases often arise from national surveys, insurance claims, and statewide health care registries. These databases are increasingly used to examine patterns of medical care and certain outcomes of care and may be helpful in planning clinical trials. They are highly representative of defined populations, but have limited clinical information. Methods have been developed to identify episodes of low back pain and to quantify the severity of unrelated, comorbid medical conditions. Pitfalls in analysis are discussed, including limitations of diagnosis and procedure coding, cross-sectional nature of most data, limited clinical detail, and the necessarily observational (not experimental) nature of any group comparisons. There is growing interest in expanding the clinical information in such databases, for both quality improvement and research purposes.

Cross-Sectional Studies↗

PubMed1994

Low back pain hospitalization. Recent United States trends and regional variations.

STUDY DESIGN: This study describes recent United States trends and regional variations in the management of low back pain. OBJECTIVES: The authors investigated recent temporal trends and compared practices in different geographic regions. SUMMARY OF BACKGROUND DATA: Controversy exists concerning the appropriate medical and surgical management of patients with low back pain. METHODS: National Hospital Discharge Survey data from 1979 through 1990 were analyzed. Case selection was based on previously developed algorithms intended to exclude nonmechanical causes of back pain. RESULTS: Over the period of study, nonsurgical hospitalizations for low back pain decreased dramatically. In contrast, low back operation rates, particularly for fusion surgery, increased substantially. In recent years, surgery and hospitalization rates were highest in the South and lowest in the West. CONCLUSIONS: Rapidly increasing surgical rates and wide geographic variations suggest the need for a more consistent approach to back problems.

Algorithms↗

PubMed1994

Use of screening mammography by general internists.

While physician endorsement has been shown to be highly important in motivating women to obtain screening mammograms, there is evidence that doctors do not refer women for the procedure as often as they should. The objective of this study was to help understand why physicians do not routinely utilize screening mammography. Randomly selected Washington State general internists were surveyed by mail, concerning mammography, during 1989. An expanded theory of reasoned action was used as a broad conceptual framework for considering factors potentially associated with use. The survey response rate was 66%, yielding a study sample of 85. Only 38% of the respondents reported they always ordered mammograms for women aged 50 years and over during preventive office visits. Nearly half (43%) had no reminder system for the test. Correlates of use included beliefs concerning the screening behavior of other doctors, the location of mammography facilities in relation to physician offices, and age. Physician-related barriers, such as doubts about effectiveness, were found to affect use more than patient-related barriers, such as cost. The recommendations of professional organizations were shown to have been important in influencing physician use of screening mammography. This study indicates a proportion of general internists are not routinely ordering mammograms for their age-eligible female patients. The findings identify barriers to use of mammography that need to be overcome if national efforts to promote use of the procedure by primary care physicians are to succeed. Implications for intervention are reviewed.

Aged↗

PubMed1994

Placenta previa and prior cesarean delivery: how strong is the association?

OBJECTIVE: To investigate the occurrence of placenta previa following a cesarean delivery. METHODS: We conducted a case-control study using 1984-1987 Washington state birth certificate data. Analysis was restricted to women who reported one or more previous live births. The study population included 490 women with a pregnancy complicated by placenta previa and 1477 randomly selected controls. Unconditional logistic regression was used for statistical analysis. RESULTS: After adjustment for confounding factors, the odds ratio for placenta previa in association with one or more previous cesarean deliveries was 1.48 (95% confidence interval 1.13-1.95). CONCLUSIONS: Women with a history of cesarean delivery are 50% more likely to have a subsequent birth complicated by placenta previa than those without such a history. This magnitude of excess risk is lower than the relative risks reported in previous studies.

Abortion, Induced↗

PubMed1993

Placental previa in relation to induced and spontaneous abortion: a population-based study.

OBJECTIVE: To evaluate the impact of induced abortion and spontaneous abortion on the occurrence of placenta previa in later pregnancies. METHODS: A population-based, case-control study was conducted using 1984-1987 Washington state birth certificate data. The study population included 486 white women with a pregnancy complicated by placenta previa and 1598 randomly selected controls without placenta previa. Unconditional logistic regression was used to estimate odds ratios and 95% confidence intervals (CIs). RESULTS: After adjustment for confounding variables, the odds ratio in association with one or more induced abortions was 1.28 (95% CI 1.00-1.63). For one or more spontaneous abortions, the odds ratio was 1.30 (95% CI 1.01-1.66). CONCLUSIONS: Women who report one or more induced or spontaneous abortions are 30% more likely to have a subsequent pregnancy complicated by placenta previa than women without such a history. The results should not be generalized to areas where suction curettage is not the preferred method of induced abortion.

Abortion, Induced↗

PubMed1991

Occupational respiratory disease in the United Kingdom 1989: a report to the British Thoracic Society and the Society of Occupational Medicine by the SWORD project group.

A voluntary scheme for the surveillance of work related and occupational respiratory disease (SWORD) was established in January 1989 with help from the British Thoracic Society and the Society of Occupational Medicine and support from the Health and Safety Executive. Three hundred and fifty four chest physicians representing 90% of the chest clinics in the United Kingdom and 361 occupational physicians submit reports regularly of newly diagnosed cases of work related respiratory illness with information on age, sex, residence, occupation, and suspected causal agent. In 1989 2101 cases were notified, of which frequent diagnoses were asthma (26%), mesothelioma (16%), pneumoconiosis (15%), benign pleural disease (11%), and allergic alveolitis (6%). Incidence rates calculated against denominators from the Labour Force Survey showed very large differences between occupational groups, especially for asthma and asbestos related diseases. Substantial regional variation in the incidence of asthma was not explained by the geographical distribution of high risk industries and was probably due to differing levels of ascertainment. The results imply that the true frequency of acute occupational respiratory disease in the United Kingdom may have been three times greater than that reported.

Acute Disease↗

PubMed1986

Continuous flow ventilation without respiratory movement in cat, dog and human.

The insufflation of oxygen at 1 litre kg-1 min-1 via two endobronchial catheters (called continuous flow ventilation (CFV)) maintained a normal PaCO2 and a constant PaO2 in anaesthetized paralysed dogs and in five out of seven cats. In two cats with a high carbon dioxide production, CFV failed to maintain carbon dioxide homeostasis since gas flows greater than 1 litre kg-1 min-1 caused thoracic distension and a decrease in arterial pressure. In five patients, endobronchial insufflation of oxygen 0.5 litre kg-1 min-1 caused approximately a 30% decrease in the increase in PaCO2 compared with apnoeic oxygenation (P less than 0.05) during a period of 6 min. CFV at 1 litre kg-1 min-1 can be used for physiological measurement without respiratory movement while maintaining blood-gas homeostasis in dogs and in cats with a normal carbon dioxide production. Ethical constraints have so far prevented the investigation of the effects of comparable gas flows in man.

Adult↗

PubMed1985

Perinatal mortality in infants of two different ethnic groups.

In a retrospective survey of 1433 Chinese and 1130 Gurkha (Nepali) births in an Armed Services environment in Hong Kong, neonatal mortality rates were analysed according to birthweight. The data thus obtained were compared with similar data from published surveys with the aim of ascertaining any differences in mortality rates.

Hong Kong↗

PubMedDate not supplied

Understanding mammography intention and utilization among women in an inner city public hospital clinic.

BACKGROUND: Most research on mammography utilization has been conducted among middle-class women. There is a need for research to identify factors affecting mammography utilization among low-income women to develop effective interventions for this underserved subgroup. METHODS: An expanded theory of reasoned action guided this research among low-income inner-city women who use a public hospital. Qualitative interviews were conducted to develop a questionnaire with items relevant to this population. The questionnaire included 5 affect measures, 13 behavioral beliefs, 5 sources of influence, and 6 facilitator/constraint measures. The survey was mailed to 584 women ages 50 to 69 identified through the hospital database. RESULTS: After those ineligible and undeliverable were excluded, responses rates were obtained from 361 women (84% adjusted response rate). Sixty-six percent had a mammogram within the previous year and 58% were very sure that they would get a mammogram in the next year. Affect, attitude, subjective norm, and facilitator scores were computed. All four constructs had significant correlations (r = 0.38 to 0.41) with intention to get a mammogram in the next year and all had significant multiple regression weights (R = 0.54). All but three items making up the model components were significantly correlated with screening intention. CONCLUSIONS: The data from applying a behavioral model indicate that intervention efforts to increase mammography utilization among low-income women should target all four model components. A clinic-based intervention could use multiple methods to deliver messages developed to target each of the model component items found to be associated with mammography intention.

Aged↗

PubMedDate not supplied

Can evidence change the rate of back surgery? A randomized trial of community-based education.

CONTEXT: Timely adoption of clinical practice guidelines is more likely to happen when the guidelines are used in combination with adjuvant educational strategies that address social as well as rational influences. OBJECTIVE: To implement the conservative, evidence-based approach to low-back pain recommended in national guidelines, with the anticipated effect of reducing population-based rates of surgery. DESIGN: A randomized, controlled trial. SETTING: Ten communities in western Washington State with annual rates of back surgery above the 1990 national average (158 operations per 100,000 adults). PARTICIPANTS: Spine surgeons, primary care physicians, patients who were surgical candidates, and hospital administrators. INTERVENTION: The five communities randomized to the intervention group received a package of six educational activities tailored to local needs by community planning groups. Surgeon study groups, primary care continuing medical education conferences, administrative consensus processes, videodisc-aided patient decision making, surgical outcomes management, and generalist academic detailing were serially implemented over a 30-month intervention period. OUTCOME MEASURE: Quarterly observations of surgical rates. RESULTS: After implementation of the intervention, surgery rates declined in the intervention communities but increased slightly in the control communities. The net effect of the intervention is estimated to be a decline of 20.9 operations per 100,000, a relative reduction of 8.9% (P = 0.01). CONCLUSION: We were able to use scientific evidence to engender voluntary change in back pain practice patterns across entire communities.

Education, Medical, Continuing↗

PubMedDate not supplied

Pap Testing Stages of Adoption among Cambodian Immigrants.

PURPOSE: We examined levels of Pap testing and factors associated with screening participation among Cambodian refugees. METHODS: A community-based, in-person survey was conducted in Seattle during late 1997 and early 1998. Interviews were completed by 413 women; the estimated response rate was 73%. We classified respondents into four Pap testing stages of adoption: precontemplation/contemplation (never screened), relapse (ever screened but did not plan to be screened in the future), action (ever screened and planned to be screened in the future), and maintenance (recently screened and planned to be screened in the future). Bivariate and multivariate techniques were used to examine various factors. FINDINGS: About one-quarter (24%) of the respondents has never been screened, and a further 22% had been screened but did not plan to obtain Pap tests in the future. Fifteen percent were in the action stage and 39% were in the maintenance stage. The following factors were independently associated with cervical cancer screening stages: previous physician recommendation; younger age; beliefs about Pap testing for post-menopausal women, screening for sexually inactive women, and regular checkups; provider ethnicity; prenatal care in the US; and problems finding interpreters. CONCLUSIONS: Our findings confirm low Pap testing rates among Cambodian immigrants, and suggest that targeted interventions should be multifaceted.

Journal Article↗

PubMedDate not supplied

Medical community involvement in a breast cancer screening promotional project.

The analysis, mobilization, and involvement of medical communities in two counties targeted for intervention by the Washington State Community Breast Cancer Screening Project is described. Principles of community organization were applied to the health care sectors in the counties, and the PRECEDE-PROCEED model was used as a conceptual framework for considering individual physician behavior. Quantitative and qualitative medical community assessment methods included a demographic study, a survey of primary care physicians, personal interviews with physicians, and medical office staff focus groups. In both intervention areas, physician planning groups selected, developed, and helped implement intervention activities targeting the health care sectors. These activities included informational mailings to physicians, training of medical office staff members and clinical mammographers, and support for a reminder system. The experience demonstrated that physicians practicing in medium-sized cities are willing to be active in community disease prevention programs.

Breast Neoplasms↗

PubMedDate not supplied

Conflicting national recommendations and the use of screening mammography: does the physician's recommendation matter?

BACKGROUND: This study evaluated whether women's perceptions of the conflicting recommendations for breast cancer screening were associated with decreased use of mammography. METHODS: We conducted a random-digit-dial telephone survey of 1024 women in four communities of western Washington State. In addition to collecting data for demographics, beliefs about mammography, and insurance coverage, we inquired whether the respondents were aware of any conflicting recommendations about when to begin or how frequently to perform screening mammography, whether their physicians had recommended a mammogram, and whether they were likely to do what their physicians recommended. After grouping women according to whether they perceived conflicting recommendations, we used chi-square statistics to compare the distribution of proportions of women by age, race, household income, education, and insurance coverage. To estimate the odds of their having a mammogram in the previous 2 years (yes or no), we used multivariate logistic regression and included the above variables as covariates. RESULTS: Sixty-two percent of eligible women completed the survey, and 49 percent (479 of 985) perceived conflicting recommendations. The association between perceiving conflict and mammography use was not significant. Eighty-three percent of women who perceived conflicting recommendations reported being more comfortable using their own judgment about getting the procedure. After controlling for whether women perceived conflicting recommendations and all other factors, women who said they followed their physician's advice but did not recall their physician recommending mammography were 71 percent less likely to have received a recent mammogram than were women who reported their physician did recommend it (odds ratio 0.29, confidence interval 0.16-0.51). CONCLUSIONS: The conflicting recommendations surrounding breast cancer screening are not influencing women's choices about mammography. The physician recommendation and women's self-reported likeliness to follow it are the most important factors associated with mammography use.

Aged↗