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PubMed1996

Observations on drug abuse deaths in the State of Maryland.

The problem of drug abuse in America encompasses all ages, economic, and ethnic groups. The Office of the Chief Medical Examiner (OCME) has recorded a continuous increase in drug abuse deaths in Maryland over the past seven years. This report focuses on the epidemiological characteristics and pathological findings of victims of fatal drug abuse in Maryland investigated by the OCME in 1992 and 1993. A retrospective study of OCME cases in 1992 and 1993 yielded a total of 605 deaths caused by drugs of abuse. 426 deaths were the result of narcotic drug use, 66 deaths due to cocaine, 102 deaths involved both narcotics and cocaine, 6 deaths were due to phencyclidine (PCP) and 5 involved both PCP and narcotic drugs. Drug abuse deaths most often involved individuals who were male (86%) and black (64%). Their ages ranged from 15 to 68 years with the majority (58%) of victims being in their 30's. Of the 605 drug deaths, 393 (65%) had a known history of drug abuse. 279 (46%) exhibited needle tracks, of which only 94 (16%) had identifiable fresh needle puncture marks. Drug paraphernalia (needles, syringes, etc.) was found at the scene in 22% of the cases. Twenty-nine (4.8%) cases showed complications of drug abuse which included pneumonia, endocarditis or myocarditis, pulmonary embolism, AIDS and intracerebral hemorrhage. 87 (14.4%) were positive for HIV antibodies, an incidence much higher than that identified in our general autopsy population (2.6%). Drugs of abuse were also found in a significant portion of the homicides examined at this office in 1992 and 1993. 323 of the 1265 homicide victims (25%) showed evidence of some form of illicit drug activity.

Adolescent↗
PubMed1996

Maryland women living with HIV/AIDS.

Approximately one-quarter of the acquired immunodeficiency syndrome (AIDS) cases reported in Maryland are women. African-American women account for 80% or more of the cases in the Baltimore-Metropolitan area. Human immunodeficiency virus (HIV)-positive women are frequently dealing with a constellation of social problems including lack of resources, care-taking responsibilities for extended families, histories of substance abuse, and loss of others to AIDS. This article is an attempt to describe the social context of living with HIV/AIDS to Maryland physicians.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Pancreas transplantation at the University of Maryland.

1. The University of Maryland pancreas transplant program was initiated in July 1991. Through December 1996, 230 pancreas transplants were performed (145 SPK, 64 PAK, 21 PTA). Overall one-year patient and graft survival rates were 95.5% and 78.9%, respectively. 2. The majority of pancreases have been transplanted simultaneously with a kidney. The one-year patient, pancreas and kidney survival rates for SPK transplants were 95.5%, 91.9%, and 82.5%, respectively. 3. Pancreas alone (PA = PAK or PTA) transplants have represented an increasing proportion of the total in recent years. Although the results of PA were previously inferior to SPK transplants, recent developments have made the outcomes equivalent. The advent of FK and MMF have sharply reduced graft losses due to irreversible rejection. Percutaneous pancreas biopsy now provides a safe and effective means to diagnose acute rejection in a timely manner. Anticoagulation protocols have markedly reduced the risk of idiopathic postoperative graft thrombosis. The most recent series of 71 PA cases at our center had a one-year graft survival rate of 75.8% overall, and 88.2% for the 61 technically successful ones. 4. The most widely practiced pancreas transplant technique in the US today includes bladder drainage of exocrine secretions. This results in a high incidence of bladder complications, which can be avoided by enteric exocrine drainage. The most recent series of pancreas transplants at the University of Maryland have been enteric drained, encompassing about half of all cases. Adoption of this technique has eliminated bladder complications, and has not been associated with an increase in anastomotic leaks, infectious complications or graft loss. 5. Most pancreas transplants have had systemic venous drainage via the iliac vein. We recently adopted the portal venous drainage technique, since it eliminates the peripheral hyperinsulinemia associated with systemic drainage, and may therefore improve lipid metabolism and possibly reduce the risk of progression of atherosclerosis. Early results have been favorable. 6. At present the major determinant of pancreas transplant outcome is donor quality. We have emphasized the importance of using pancreases free of fatty or fibrotic transformation, which have been skillfully procured from young, stable, non-obese donors.

Diabetes Mellitus, Type 1↗
PubMedDate not supplied

The social and demographic correlates of smoking among young adults in Maryland.

OBJECTIVES: We examine the utility of pooling data from the 1987 through 1994 Maryland Behavioral Risk Factor Surveillance system (BRFSS) surveys in order to increase sample size, and we investigate the social and demographic correlates of smoking in Maryland among 18-24-year-olds. METHODS: The data are from 1,714 subjects who were between 18 and 24 years of age and the principle method was multiple logistic regression. RESULTS: African Americans are less likely to smoke than Caucasians, and people with some college or more are less likely to smoke than those with a high school diploma/GED or less. Men who are in an informal sexual union (cohabitation) are more likely to smoke than men who are not. There is a negative association between being a student and smoking among all young women, which does not exist for men enrolled in postsecondary schools. There is no gender difference in the level of smoking, despite the fact that the predictors of smoking are somewhat different for men and women. CONCLUSIONS: Pooling data from several BRFSS studies is a useful way to increase sample size. Analyses of the correlates of smoking among people from a narrow age range is a useful way of highlighting the unique correlates of smoking across the life course.

Adolescent↗
PubMed1996

The Maryland State Board of Dental Examiners and the chemically dependent dentist.

The Maryland State Board of Dental Examiners (SBDE) has adopted the disease model in dealing with chemically dependent dentists. SBDE has found that a punitive attitude toward chemical dependence is not productive. The SBDE works closely with the Dentists' Well-Being Committee of the Maryland State Dental Association to help dentists regain productive lives while observing its responsibility to protect the public. The SBDE's concern for patient welfare is a top priority, but it does not lessen SBDE's compassion for dentists who may be suffering from this illness.

Dentists↗
PubMed1996

Maryland Dental Hygienists' Association Rehabilitation Committee.

The Maryland Dental Hygienists' Association Rehabilitation Committee was formed in 1990 and is patterned after the Maryland State Dental Association (MSDA) Dentists' Well-Being Committee. The Rehabilitation Committee serves to assist dental hygienists who may be impaired by alcohol or drug abuse; chemical dependency; or other physical, emotional, or mental conditions.

Dental Hygienists↗
PubMed1998

A characterization of older AIDS patients in Maryland.

This retrospective study evaluated Maryland acquired immunodeficiency syndrome (AIDS) patients who were > or = 50 years at the time of AIDS diagnosis. All patients diagnosed between January 1987 and June 1996 who were > 50 years were included in the cohort. A total of 610 male (82.7%) and 128 female (17.3%) AIDS patients aged > or = 50 were identified. The most common mode of human immunodeficiency syndrome (HIV) transmission was male-to-male sexual contact (34.7%). Additionally, 146 (19.8%) patients contracted HIV through blood transfusions, 93 (12.1%) were infected through heterosexual contact, 134 (18.6) were infected through i.v. drug abuse, and the remaining 109 (14.8%) had unknown risk factors. Data from this preliminary study demonstrate that an alarming percentage of AIDS patients (approximately 10%) in Maryland are aged > or = 50. Sexual contact, either male-to-male or heterosexual transmission, was the route of transmission for nearly 47% of this patient population. However, few research projects, educational programs, or public health initiatives are specifically targeted to this patient population. The increasing life expectancy of AIDS patients as well as the advent of new drug treatments highlights the need for further research to investigate the diagnosis and treatment of AIDS and HIV infection among older patients.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Anesthesia-related lawsuits in Maryland: CRNA and anesthesiologist claims.

Fifty-two anesthesia-related claims filed with the Maryland Office of Health Claims Arbitration from January 1990 through February 1994 were analyzed in terms of patient care variables, types of anesthesia, surgical categories, legal causes of action, and patient outcomes to determine whether differences existed in the rate of filing of cases provided by CRNAs and anesthesiologists. In Maryland, all claims against a healthcare provider in excess of $20,000 must be filed with the Office of Health Claims Arbitration. During the study period, 70% of the claims were filed against anesthesiologists, 17% were against nurse anesthetists, and 13% named both the anesthesiologist and the nurse anesthetist. Claimants ranged from 13 to 78 years of age; the mean age was 45 years. Slightly more than half of the claims (54%) were on behalf of women. The majority of the claims originated in community hospitals (73%) and medical teaching centers (23%). The remainder of claims (4%) originated in military hospitals, medical offices, and surgicenters. Study findings indicated that general anesthesia accounted for two thirds of the claims, followed by regional anesthesia care (23%), local anesthesia (3.8%), and monitored anesthesia care (2%). Gynecological, neurosurgical, and orthopedic surgeries accounted for more than half of the claims. Two thirds of all claims alleged failure to attend to changes in the perioperative status of the patient. This included inadequate monitoring of the patient's position and failure to respond to changes in cardiopulmonary status. The second most prevalent cause of action concerned problems securing or maintaining a safe airway. Death was the most frequent adverse outcome (21.2%). Airway trauma (15.4%), nerve damage (15.4%), and brain damage (7.7%) were also cited as adverse outcomes.

Adolescent↗
PubMed1999

Assessing the appropriateness of coronary revascularization: the University of Maryland Revascularization Appropriateness Score (RAS) and its comparison to RAND expert panel ratings and American College of Cardiology/American Heart Association guidelines with regard to assigned appropriateness rating and ability to predict outcome.

BACKGROUND: Significant regional variation in procedural frequencies has led to the development of the RAND and American College of Cardiology/American Heart Association (ACC/AHA) guidelines; however, they may be difficult to apply in clinical practice. The University of Maryland Revascularization Appropriateness Score (RAS) was created to address the need for a simplified point scoring system. HYPOTHESIS: The study was undertaken to compare revascularization appropriateness ratings yielded by the RAND Expert Panel Ratings, ACC/AHA guidelines, and the University of Maryland RAS. METHODS: We applied these three revascularization appropriateness scoring systems to 153 catheterization laboratory patients with a variety of cardiac diagnoses and treatments. For each patient, appropriateness scores assigned by each of the three systems were compared with each other and with the actual treatment delivered. Concordance of care with appropriateness score was then correlated with outcome. RESULTS: There were significant differences among all three scoring systems in their ratings and in the concordance of treatment with appropriateness rating. When treatment provided was concordant with RAND ratings, there was a lower occurrence of subsequent coronary artery bypass grafting (CABG), the composite end point of either CABG or percutaneous transluminal coronary angioplasty (PTCA), and the composite end point of death, myocardial infarction (MI), or revascularization. When treatment was concordant with the ACC/AHA guidelines, there was lower occurrence of all-cause mortality, PTCA, the composite end point of either CABG or PTCA, and the composite end point of death, MI, or revascularization. When treatment provided was concordant with the RAS, there was lower occurrence of cardiac death, all-cause death, CABG, the composite end point of either CABG or PTCA, and the composite end point of death, MI, or revascularization. CONCLUSIONS: The RAS is a simple scoring system to assess revascularization appropriateness. When the RAND, ACC/AHA, and RAS systems are compared in a catheterization laboratory population, they rate the same patient differently and vary in their correlation of appropriateness rating with outcome.

Adult↗
PubMed2005

A culturally targeted intervention to promote breast cancer screening among low-income women in East Baltimore, Maryland.

In Maryland, outreach initiatives have been unsuccessful in engaging low-income African American women in mammography screening. This study aimed to identify factors influencing screening rates for low-income African American women. Based on the Health Belief Model, a modified time series design was used to implement a culturally targeted intervention to promote a no-cost mammography-screening program. Data were collected from women 40 years of age and older on their history of mammography use and their knowledge and beliefs about breast cancer. A 50% screening rate was achieved among 119 eligible participants. Significant predictors of screening behaviors were perceived barriers, lack of insurance, and limited knowledge. This culturally targeted intervention resulted in an unprecedented screening rate among low-income African American women in Baltimore, Maryland.

Adult↗
PubMed1984

The Maryland CNC Test: normative studies.

These studies were conducted to determine the performance-intensity functions of the Maryland CNC Test (male voice) with normal-hearing and hearing-impaired persons, to examine the equivalence of the 10 lists, and to determine test-retest reliability. There was a 2.1% increase per decibel in word recognition in the linear portion of the performance-intensity function for normal listeners and a 1.3% increase per decibel for hearing-impaired listeners. 6 lists were judged to be equivalent, and there was good test-retest reliability. Hearing-impaired subjects demonstrated a wide range of scores on the Maryland CNC Test, suggesting that this measure can distinguish among varying degrees of word recognition ability.

Acoustic Stimulation↗
PubMedDate not supplied

A community care initiative: Maryland and Hopkins students take to the streets in Baltimore City.

Medical students from University of Maryland and Johns Hopkins University, with a grant from the Maryland Chapter of the American College of Physicians, held a free health fair in a Baltimore City neighborhood. The goals were to heighten awareness of common health problems, learn more about a medically underserved community, and increase access to primary care services in that community. The students planned booths to offer information and screening on 19 common health topics. Fair organizers worked with a local clinic, People's Community Health Center, and a neighborhood development organization, the Safe and Smart Center, to create an event that would engage and educate people on relevant issues. Approximately 100 medical students participated in the event and 350 people attended the fair. An optional survey filled out by fair participants revealed that a diverse group of people attended the event. Comments about the day from medical students and fair participants show that the event was enjoyable and offered a tremendous learning opportunity for both groups. This paper also discusses problems that arose during the planning stages as well as suggestions for those interested in planning a similar event.

Adolescent↗
PubMedDate not supplied

[Use of the Maryland bridge in periodontology].

The authors have reported the investigations about the Maryland Bridge and its importance in periodontology. The Authors have suggested the clinical application of this kind of prosthesis and the Authors have reported about two clinical cases that have had first a periodontal treatment then a Maryland Bridge prosthesis.

Acid Etching, Dental↗
PubMed1995

Acquisition and use of needles and syringes by injecting drug users in Baltimore, Maryland.

Our objective was to determine how injection drug users (IDUs) in Baltimore, Maryland obtain and use needles and syringes (NS) for drug injection, before the opening of a needle exchange program (NEP). The method of this study was a cross-sectional structured interview survey in 1992 of active IDUs in a longitudinal study of human immunodeficiency virus (HIV) infection. For 466 IDUs (94.6% black, 83% male), usual sources of NS were "street" dealers (49.6%), pharmacies (29.8%), diabetics (16.3%), friends/neighbors (2.2%), and "shooting galleries" (1.9%). Half (53.5%) reported pharmacy purchase of NS, and 55.6% had diabetic friends/relatives. Twenty-three percent traded drugs, and 5% traded sex for NS. Eighty-eight and two-tenths percent would use a needle exchange program; 24.6% currently own no NS (median owned = 2.2). NS reuse was common (median = three times). Concern about (55.2%) or history of (33.9%) hassle/arrest for NS possession was typical; 81% kept NS at home, and 67% do not carry NS when purchasing drugs. Pharmacy purchasers (versus "street") were less likely to have been jailed, shared NS, or used shooting galleries during the preceding 6 months. In Maryland, although IDUs can legally purchase NS at pharmacist discretion, possession remains illegal; fewer than one-third of IDUs use pharmacies, and most obtain NS from illegal sources. Most IDUs reuse NS, but discard them after several uses. Current patterns of NS acquisition and use in Baltimore are likely to increase HIV transmission. Increased availability and decriminalization of NS possession could decrease the risk of injection-related HIV transmission.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Maryland Emergency Medical Services and Shock Trauma Centre.

The author spent one year working as an attending Anaesthesiologist at the Shock Trauma Center in Baltimore. The Maryland trauma system is, in the author's opinion, one of the best in the United States and this article will outline the Maryland EMS (Emergency Medical Service) but with specific emphasis on the Shock Trauma Center in Baltimore.

Anesthesiology↗
PubMed2001

Invasive group B streptococcal disease in Maryland nursing home residents.

Between 1991 and 1995, among 999 nonpregnant adult Maryland residents with group B Streptococcus (GBS) isolated from a normally sterile site, 84 resided in nursing homes (NHs). The age-adjusted annual incidence of GBS infection (per 100,000 population) among those > or = 65 years old was 72.3 for NH residents and 17.5 for community residents (relative risk, 4.1; P < 0.001). Thirty-four case patients resided in 11 NHs with > or = 2 cases; 1 NH had 8 case patients within 22 months. Six of 8 case patients from 3 NHs had serotype V GBS. Molecular subtyping of several isolates identified 2 case patients in 1 NH with identical subtype patterns. NH residents have a markedly higher incidence of invasive GBS than do community residents > or = 65 years old and may serve as a target group for immunization when GBS vaccines become available. Further evaluation of intra-NH transmission of GBS is warranted.

Aged↗
PubMed2004

Correlating epidemiologic trends with the genotypes causing meningococcal disease, Maryland.

Epidemic meningococcal infection is generally caused by single clones; whether nonepidemic increases in infection are clonal is unknown. We studied the molecular epidemiology of meningococcal infection during a period that the incidence increased in two age groups. Serogroup C and Y meningococcal isolates were analyzed by pulsed-field gel electrophoresis and multilocus sequence typing. From 1992 to 1999, 96.4% (27/28) of serogroup C isolates from persons 15-24 years of age were in clonal group 1, compared with 65.6% (21/32) of isolates from persons < or =14 years, and 64.3% (9/14) of isolates from adults > or =25 years (p < or = 0.01). The proportion of clonal group 2 serogroup Y strains increased from 7.7% (1/13) in 1992 to 1993 to 52.0% (13/25) in 1998 to 1999 (p < 0.01). The nonepidemic age-specific increases in serogroup C meningococcal infection in Maryland were clonal in nature and the changes in serogroup Y incidence were associated with a shift in the genotypes of strains causing invasive disease.

Adolescent↗
PubMed1984

Maryland hospitals get plan for creating ethics committees.

The Maryland Hospital Association's Advisory Committee on Medical Ethics, charged to assist member hospitals in forming ethics committees, focused on four concerns: study and development, physician support, patient/family participation, and potential issues. The committee recommended as a first step in establishing an ethics committee the creation of a study group. It warned hospitals not to expect a fully operational ethics committee immediately. A start-up period, according to the committee, should be used to develop a process for handling ethical questions and for educating the hospital community about the committee's role. To promote the best possible decision making, the hospital ethics committee should function as a support unit, for physicians as well as for patients, families, and hospital personnel. Clearly stated policies will provide a basis for appropriate intervention and help gain physician cooperation, the committee said. Such policies should encourage ethics committees to anticipate problems and to review decisions already made. While recognizing the need to involve patients' families in decision making, the advisory group agreed that the question of their presence at committee meetings should be addressed by each institution. In cases of controversial treatment or disagreement about the course of treatment, patient/family access to the committee should be clearly defined. The advisory committee suggested that each institution prepare its own list of topics that an ethics committee might consider. It also prepared a "model statement" of an ethics committee's purposes, membership, and procedures.

Ethics Committees, Clinical↗