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PubMed2006

Role of stereotactic radiosurgery and fractionated stereotactic radiotherapy in the management of intracranial ependymoma.

Ependymoma accounts for 5-10% of all childhood CNS tumors and less than 5% of intracranial tumors in adults. Ependymomas typically have a sharp tumor-brain parenchyma interface and this characteristic lends itself well to stereotactic radiation delivery. Data on the use of stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) for ependymoma in various settings have emerged over the past 10 years. SRS has been used in recurrent disease and as a boost after external beam radiation therapy. FSRT has been used in pediatric brain tumors and can potentially limit the long-term toxicities associated with radiation therapy by reducing the amount of normal brain parenchyma treated. Long-term follow-up is needed to determine the long-term efficacy and toxicities associated with these treatment modalities.

Brain Neoplasms↗
PubMed1996

Connections between primary vaginismus and procreation: some observations from clinical practice.

So far, the literature on vaginismus has mainly been contemplative. Quantitative data are scarce, while fertility and obstetrical aspects are almost never considered. In this article, these two aspects are addressed. A cohort of patients received a questionnaire, developed to obtain information about possible connections between the vaginistic reaction, the patient's treatment goals and, if relevant, obstetrical characteristics. Our data reveal that the desire to have a child is not a negative predictor for treatment outcome in terms of consummation. In some instances, however, self-insemination, as a bedroom procedure, is an effective treatment option to enable the couple to reach their fertility goal. Some women will conceive without intercourse experience; according to our data, delivery in this group is hardly more problematic than in a group of women who, after treatment for vaginismus, conceived by sexual intercourse. Having delivered a child may have a slightly positive effect on the capability to have intercourse, but only in a minority. Obstetricians should be aware that not infrequently, women give birth who suffer from severe penetration phobias.

Adult↗
PubMed1999

Effects of prenatal zidovudine treatment on learning and memory capacities of preweanling and young adult mice.

The present study analyzed the short and long-term effects of prenatal zidovudine (AZT) exposure on learning and memory capacities of CD-1 mice. Two tasks normally used in rodents were used, namely a passive avoidance step-through task and a Morris navigation task. AZT (0, 0.4, and 0.8 mg/ml) was administered via drinking water to pregnant CD-1 females from day 10 of gestation to delivery. Data on reproductive performance, such as gestation length, litter size, and pup mortality were collected. Avoidance learning in the offspring was tested on postnatal day (PND) 15, while spatial learning performances in the Morris water maze were obtained on PND 45. Retention of the passive avoidance response was mildly impaired in the offspring exposed to the 0.8 mg/ml AZT solution, whereas spatial learning on PND 45 was unaffected.

Animals↗
PubMedDate not supplied

Does a prosthodontist spend more time providing mandibular two-implant overdentures than conventional dentures?

PURPOSE: In this article, the time taken by a prosthodontist to fabricate and maintain mandibular overdentures retained by two implants and conventional dentures is compared. MATERIALS AND METHODS: Sixty edentulous patients between the ages of 65 and 75 completed a randomized clinical trial. All received new maxillary conventional dentures and either a mandibular conventional denture (n = 30) or a two-implant overdenture on ball attachments (n = 30). The time spent by the prosthodontist and the number of visits required for treatment, including both scheduled and unscheduled visits, were recorded for each patient from preliminary impressions to 6 months following delivery. Data from the two groups were compared using Mann-Whitney U tests. RESULTS: The prosthodontist spent a mean total time of 296 minutes in treating an implant overdenture patient and 282 minutes on a conventional denture patient during the period from preliminary impressions to the 6-month follow-up. The mean numbers of appointments were 10.1 (implant group) and 10.8 (conventional group). These differences were not significant. CONCLUSION: Although additional knowledge is required to treat patients with implant prostheses, the time required by the prosthodontist to provide two-implant mandibular overdentures with ball attachments was not significantly different than the time needed for conventional denture treatment.

Aged↗
PubMed2002

[Application of process management in nephrology. Hemodialysis process management].

Total Quality Management techniques have recently been introduced into clinical practice. We describe the application of process management to hemodialysis therapy in a Spanish public hospital. The "ownership" of the hemodialysis process and its limits have been defined. We present a flowchart with all the activities involved in the process and the task description. Monitoring indicators have been selected according to the recommendations of the US Committee on the National Report on Health Care Delivery. Data sources for indicators have also been described.

Hemodialysis Units, Hospital↗
PubMed2005

Survival of very-low-birth-weight infants according to birth weight and gestational age in a public hospital.

OBJECTIVES: To determine the survival rates for infants weighing 500 - 1 499 g according to birth weight (BW) and gestational age (GA). DESIGN: This was a retrospective cohort study. Pregnancy and delivery data were collected soon after birth and neonatal data at discharge or at death. SETTING: Chris Hani Baragwanath Hospital (CHBH), a public-sector referral hospital, affiliated to the University of the Witwatersrand. SUBJECTS: Live births weighing between 500 g and 1 499 g delivered at or admitted to CHBH from January 2000 to December 2002. OUTCOME MEASURES: BW and GA-specific survival rates for all live infants born at CHBH and for those admitted for neonatal care. RESULTS: Seventy-two per cent of infants survived until discharge. The survival to discharge rate was 32% for infants weighing < 1 000 g, and 84% for those weighing 1 000 - 1 499 g. Survival rates at 26, 27 and 28 weeks' gestation were 38%, 50% and 65% respectively. Survival rates for infants admitted to the neonatal unit were better than rates for all live births, especially among those weighing < 1 000 g or with a GA < 28 weeks. There was a marked increase in survival between the 900 - 999 g and 1 000 - 1 099 g weight groups. Provision of antenatal care, caesarean section, female gender and an Apgar score more than 5 at 1 or 5 minutes were associated with better survival to hospital discharge. CONCLUSION: Survival among infants weighing less than 1 000 g is poor. In addition to severe prematurity, the poor survival among these infants (< 1 000 g) is most likely related to the fact that they were not offered mechanical ventilation. Mechanical ventilation should be offered to infants weighing < 1 000 g as it may improve their survival even in institutions with limited resources.

Apgar Score↗
PubMed2006

Context-aware workflow management of mobile health applications.

We propose a medical application management architecture that allows medical (IT) experts readily designing, developing and deploying context-aware mobile health (m-health) applications or services. In particular, we elaborate on how our application workflow management architecture enables chaining, coordinating, composing, and adapting context-sensitive medical application components such that critical Quality of Service (QoS) and Quality of Context (QoC) requirements typical for m-health applications or services can be met. This functional architectural support requires learning modules for distilling application-critical selection of attention and anticipation models. These models will help medical experts constructing and adjusting on-the-fly m-health application workflows and workflow strategies. We illustrate our context-aware workflow management paradigm for a m-health data delivery problem, in which optimal communication network configurations have to be determined.

Computer Communication Networks↗
PubMed1991

Factors affecting birth weight in Kuwait. Part I, Maternal, dietary and socioeconomic factors.

The aim of this study was to determine the effect of maternal nutrition, vitamin supplementation and socioeconomic status on infants birth weight in Kuwait. The weight of 1995 newborn Kuwaiti infants was recorded shortly after delivery. Data on mothers' bodyweight just before pregnancy, height, weight gain during pregnancy and vitamin intake were recorded. Mothers were interviewed to collect data in family income, educational level and employment during pregnancy. The results show that mean birth weight in Kuwait (3.50 Kg) compares favourably with any country. The birth weight was affected by several factors. Maternal body weight, height and weight gain during pregnancy were positively correlated with birth weight. The results also show that the intake of vitamin supplement during pregnancy did not have a significant inference on birth weight. Obese mothers consuming a reducing diet delivered babies with birth weight slightly above normal. The results show that mothers from high income families had heavier babies when compared with a low income group. On the other hand, educated and employed mothers were more liable to have slightly smaller babies when compared with illiterate or unemployed mothers.

Birth Weight↗
PubMed1988

[Effect of perinatal hypoxia on blood triglycerides and total cholesterol including high density lipoproteins].

Cholesterol, low/high density lipoprotein cholesterol (LDLc, HDLc), triglycerides and phospholipids plasma concentrations were measured in arterial (UA) and venous (UV) cord blood samples collected at birth in 22 healthy newborn infants (G-I) in 24 intrapartum stressed newborn infants (G-II) and in plasma of their 46 mothers at delivery. Chol was measured by ALLAIN'S, HDLcUA by LOPES-VIRELLA'S (and LDLc by FRIEDEWALD'S formula), TG by HOPPE'S and Ph by TAKAYAMA'S enzymatic methods. TGUA concentrations were higher (p less than 0.01) and HDLc ones lower (p less than 0.005) in G-II than in G-I group. These phenomena were found to be a sign of fetal stress, since there was a significant correlation between TGUA and pHUA (r, -0.42; p less than 0.005) and HDLc and pHUA (r, 0.41; p less than 0.0025). Furthermore, there was a correlation between TGUA HDLUA (r, 0.46; p less than 0.0025). Intrapartum hypoxia has a profound effect on lipid stores of the fetus during delivery. Data suggest that high levels of triglycerides in plasma might fall lecitin cholesterol acid transferase activity and this way to explain lower HDLc concentrations of newborn infants with intrapartum acidosis.

Asphyxia Neonatorum↗
PubMed1987

Quality assurance of obstetrical care in Belgium.

OBJECTIVE: To assist Obstetric Departments in observing their own performance and comparing it with other departments. METHODS: Voluntary questionnaire concerning performance filled in at the time of delivery. Data processed by the Ministry of Health and Universities. Coordination by the College of Obstetricians and Gynaecologists. RESULTS: Thirty seven per cent of the Flemish obstetrical departments were participating at the end of the first year. The profiles show wide variations in intervention rates.

Belgium↗
PubMed1984

[The epileptic mother and her child].

This study is a review of the literature on the influence of epilepsy and antiepileptic medication on the course of pregnancy and the foetus, as well as of the effect of pregnancy on the disease. Antiepileptic treatment is supposedly responsible for the increased rate of abnormal bleeding after delivery. Data on the perinatal mortality of epileptics are conflicting. The offspring of epileptic women are often smaller than normal neonates, indicating retarded growth, and the incidence of malformations is 1.25 times higher. Until now there has been no direct evidence of a teratogenic effect of the commonly used antiepileptic drugs, and the risk of malformations may possibly be correlated with the severity of the epilepsy. The effect of pregnancy on seizure frequency seems to be quite variable. Higher seizure frequency is seen during pregnancy, but this is not a universal phenomenon. The incidence of seizures in gestational epilepsy has no predictive value with respect to the course of later pregnancy. A positive correlation seems to exist between the development of eclampsia and later epilepsy, a family history of epilepsy and cerebral dysrhythmias. Status epilepticus is uncommon in pregnancy. The requirement of several antiepileptic drugs is increased during pregnancy. The metabolism of carbamazepine, primidone, and clorazepate is probably accelerated in the gestational period, but data on other antiepileptic drugs are inconclusive or lacking. The intestinal absorption of antiepileptic drugs may be impaired during pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Anticonvulsants↗
PubMed1984

Child abuse and neglect on Oahu, Hawaii: description and analysis of four purported risk factors.

Four factors are commonly considered to indicate "high risk" for child abuse/neglect: (1) low birth weight, (2) young maternal age, (3) mother with single marital status, and (4) low socioeconomic status (SES). These factors were investigated for Oahu, Hawaii, in four separate retrospective studies (using 100 abused cases and 100 controls), to evaluate their usefulness for screening at delivery. Data were obtained from a sample of 2,036 confirmed cases, during the period from 1977 to 1979. Contrary to many studies from mainland United States, low birth weight and single marital status were not associated with increased risk of child abuse/neglect. Single marital status in Hawaii may not be associated with increased risk because it does not have the same social and cultural connotations as it does on the mainland United States. This observation suggests a need to consider regional and cultural variations in investigating and screening for child abuse/neglect.

Adolescent↗
PubMed1981

Disclosure of computerized health care information: provider privacy rights under supply side competition.

This Article explores the constitutional, statutory and common law privacy rights of physicians given the inescapable role of delivery data under supply side competition. The Article begins with a general review of the federal constitutional right of privacy. It then discusses the statutory protection given to physician-specific data under current federal law, and considers the insights gained from the controversy over physician data and the federal Freedom of Information Act. The remainder of the Article analyzes the usefulness of several common law causes of action to remedy the misuse of physician data, and concludes with recommendations which may obviate the need for litigation to protect against misuse of physician-specific data.

Civil Rights↗
PubMedDate not supplied

Dimensions of the staff nurse role in ambulatory care: Part IV--Developing nursing intensity measures, standards, clinical ladders, and QI programs.

Ambulatory care nurse executives must design valid mechanisms to support new models of nursing care delivery. Data from a national survey of practicing ambulatory care nurses can assist in this process. Research data can be used as a resource for developing ambulatory nursing intensity measures, standards, clinical ladders, and quality improvement programming. This is Part IV of a four-part series.

Ambulatory Care↗
PubMed1994

Distribution of surgical pathology reports by a computer-driven telephone facsimile (FAX) device.

The current environment of medical economics increasingly mandates that written reports on surgical pathology specimens be distributed as soon as they are verified by responsible staff members and that they find their way infallibly to clinical physicians attending the patients in question. This brief overview describes the institutional experiences of the authors in managing this aspect of data delivery at large teaching hospitals. A system for FAX-transmittal of surgical pathology reports is described, used in conjunction with a commercial computer software package that was designed explicitly for anatomic pathology.

Hospitals, University↗
PubMed1994

Resolving discrepancies among studies: the influence of dose on effect size.

In conducting reviews or meta-analyses, epidemiologists frequently must reconcile conflicting results. This paper addresses heterogeneity in nonexperimental studies. The emphasis is on simple exploratory methods rather than formal approaches. Five examples illustrate how quantitative concordance among studies is possible, even when measured effects appear discrepant. The examples concern ethylene oxide and leukemias, methylene chloride and liver cancer, saccharin and bladder cancer, prenatal lead exposure and birthweight, and aspirin and bleeding tendencies in labor and delivery. Data examined here indicate that differences in dose levels frequently explain heterogeneous effect measures, often outweighing other sources of variability among studies. We present simple methods for combining dose information from the study of interest with dose-response data from other epidemiologic studies or animal studies to derive plausible hypothesized effect levels. These plausible effect sizes are the measures of association that would be predicted, for the actual exposures, by extrapolating from other studies with possibly differing exposure levels. Post hoc power calculations and comparisons of confidence intervals for overlap to reconcile "positive" and "null" studies may be misleading, since these approaches assume a uniform true association obscured by random fluctuations only. Whenever it can be estimated, a plausible effect size should be the starting point to assess findings of either positive or null studies. Without such calculations, comparisons among conflicting studies may not be meaningful.

Aspirin↗
PubMedDate not supplied

Paternal perspectives of the childbirth experience.

This study examined the responses given by first-time fathers who were asked to describe their feelings about their childbirth experience. The fathers answered three open-ended questions about their feelings concerning labor and childbirth, and the paternal behaviors believed to be most useful to their wives during labor and delivery. Data from fathers who attended prenatal childbirth education classes were examined separately from fathers who did not attend. The findings indicated that for all fathers, regardless of prenatal preparation, the labor experience evoked generally positive responses in addition to a significant number of negative responses, while perceptions of the birth experience were primarily characterized by positive or very positive feelings. The results also indicated that the fathers perceived that they were most helpful to their partner during labor.

Adult↗
PubMed1993

Successful delivery after age 50: a report of two cases as a result of oocyte donation.

BACKGROUND: Because of donor oocyte programs, women who previously were considered too old to successfully achieve conception and delivery can now bear children. To our knowledge, there have been no previous reports of pregnancy outcome in women over age 50 who conceived using donor oocytes. This study presents the pregnancy and delivery data on two women who delivered at age 52. CASES: Case 1 was a 51-year-old woman, gravida 3, para 3, whose three children had been conceived with her first husband more than 20 years previously. She had remarried 18 years before presentation and had been actively trying to conceive for the last 7 years. She was diagnosed as being in menopause based on elevated gonadotropins, amenorrhea, and failure to have progesterone-withdrawal menses. She conceived on her first embryo transfer cycle with embryos derived from donor oocytes and fertilized by her husband's sperm (oocytes were donated by a woman who was undergoing retrieval for in vitro fertilization). During pregnancy she remained healthy, but had uterine prolapse at 20 weeks. She delivered a normal healthy male at 40.5 weeks; cesarean was performed because of a presumptive diagnosis of fetal distress after 3 hours of labor, when monitoring revealed fetal heart decelerations. Case 2 was also a 51-year-old woman, gravida 6, para 4, who wished to conceive with her second husband's sperm through the donor oocyte program. She had amenorrhea of 2 years' duration and elevated gonadotropins. Conception occurred after fertilization of a donor oocyte by her husband's sperm. She had an uneventful pregnancy, but labor was induced at 38 weeks' gestation given the supposed high-risk status of this age group. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. CONCLUSION: Theoretically, the risks of pregnancy complications in older patients are magnified given the aging maternal cardiovascular system, which may predispose these women to placental insufficiency. These first two cases of donor oocyte pregnancies in women over age 50 found no maternal or fetal age-related complications. We hope these reports will encourage all researchers to share their findings so that prospective patients can make better, more informed decisions as to whether they want to participate in donor oocyte programs.

Embryo Transfer↗