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Biomedical subjects

B Hillman

Publications and source records attributed to B Hillman.

11 recordsLinked to original sources
PubMed2001

Patients' role in the use of radiology testing for common office practice complaints.

BACKGROUND: Radiological studies are an important component of ambulatory medical costs, and guidelines often focus on their appropriate use. However, little is known about the correlates of the use of those services, particularly the influence of patients' preferences on physicians' utilization decisions. OBJECTIVES: To study patients presenting for outpatient treatment of respiratory problems and low back pain, and to examine the magnitude of the effect of the patients' perceived need for radiological studies (radiology preference score) on use of those services. DESIGN: Cross-sectional survey. SETTING: Office practices of generalist physicians in predominantly rural areas of 8 states. PARTICIPANTS: A total of 52 generalist physicians agreed to enroll consecutive Medicare-eligible patients making office visits for respiratory problems or low back pain. Of 1785 eligible patients invited to participate, 132 (7%) refused and 1137 (69%) of 1653 returned questionnaires. MEASUREMENTS: Radiology utilization rates (plain film, computed tomographic scan, or magnetic resonance image scan) were determined by patient self-report. To assess perceived need for radiological studies, we asked patients how necessary they believed an x-ray film was in the evaluation of 4 common complaints (respiratory problems, low back pain, knee pain, and knee swelling). A summary radiology preference score was created from 3 of the 4 items, excluding the item referring to the patients' index complaint. RESULTS: Six hundred fifteen respiratory and 522 low back pain patients were enrolled; mean ages were 69 and 64 years, respectively. Radiology utilization rates were 37% for respiratory and 26% for low back pain patients. In multiple logistic regression models, for respiratory patients radiology utilization was related significantly to the radiology preference score (odds ratio [OR] for fourth quartile compared with first quartile, 1.94; 95% confidence interval [CI], 1.11-3.37; P = .02), to having a physician who owned radiology equipment (OR, 1.81; 95% CI, 1.23-2.66; P = .002), and current smoking (OR, 1.58; 95% CI, 1.04-2.41; P = .03). For low back pain patients, radiology utilization was significantly related to the radiology preference score (OR for fourth compared with first quartile, 2.55; 95% CI, 1.29-5.06; P = .007), bothersomeness of the pain (OR for fourth compared with first quartile, 3.74; 95% CI, 1.74-8.04; P<.001), and a diagnosis of osteoporosis (OR, 1.67; 95% CI, 1.01-2.75; P = .04). CONCLUSIONS: Patients' perceived need for radiological studies was significantly associated with use of those services for outpatients with respiratory problems and low back pain. These findings suggest that patients communicate their wishes to physicians, either directly or indirectly, regarding services they think are necessary. Differences in physicians' adherence to guidelines regarding radiology utilization may in part reflect variations in patients' perceived need for those services. Efforts to educate patients about when radiological studies are medically indicated may be an important complement to practice guidelines or other utilization-related financial incentives.

Aged↗
PubMed1991

Enzyme, lectin and immunohistochemistry of plastic embedded undecalcified bone and other hard tissues for light microscopic investigations.

Enzymes and tissue antigens were localized on plastic embedded undecalcified bones and teeth using Technovit 7200 VLC (Kulzer, Germany). This resin is hard enough for cutting and grinding procedures on rotating plates with diamond layers. The pores between the diamond grains are not obstructed with this resin. The procedure described here permits localization of antigens in the soft tissues adjacent to, or in the biological hard tissues themselves and in dental implants (ceramic or metallic) on the light microscopic level. The undecalcified bone is fixed and embedded in plastic and cut at 100-150 microns. The slices are ground automatically by a grinding machine to a thickness of 5-10 microns. After application of the substrates for alkaline and acid phosphatases and the required dyes, the distribution of these enzymes can be demonstrated. Tissue antigens also can be detected with slightly modified standard techniques of immunohistochemistry and lectin histochemistry using the peroxidase technique or fluorescence microscopy.

Ameloblasts↗
PubMed1981

Deep venous thrombosis: predictive value of signs and symptoms.

The clinical history, signs, symptoms, and laboratory and radiographic results of 154 consecutive patients who had contrast phlebography for evaluation of deep venous thrombosis were evaluated retrospectively to determine their relationship to deep venous thrombosis. Malignancy, history of recent blood transfusions, recent surgery, congestive heart failure, immobility, and infection exhibited the strongest correlation with acute thrombophlebitis. Receiver operating characteristic curves were constructed to demonstrate the additive value of certain signs and symptoms in predicting the development of or protection from deep venous thrombosis. With these curves, a cutoff point can be selected for this population that will aid in determining which patients should undergo further diagnosis and/or treatment in the evaluation of deep venous thrombosis.

Adolescent↗
PubMed1981

Evaluation of aneurysms by computed tomography.

It is possible to image a variety of anomalies and pathologic conditions of the vascular system by means of computed tomography (CT). Noninvasive preoperative evaluation of aneurysms frequently can best be accomplished by CT, often providing more usable information than angiograms or even ultrasound. The use of a "bolus" of contrast, with scans performed immediately following the injection, after an initial nonenhanced study, provides excellent definition of such lesions. In this report we relate our experience with CT in patients with aneurysms.

Adult↗
PubMed1980

Spatial filtering of electron micrographs of negatively stained alpha-amylase crystals.

Images of the alpha-amylase molecule from pig pancreas have been obtained in two projections by the application of spatial filtering techniques to electron micrographs of negatively stained microcrystals of the enzyme. The Fourier filtering was performed on a PPD 11/40 digital computer after microdensitometry on an Optronics P-1000 photoscan system. The set of procedures and programs we employed are described herein. We compared these images with equivalent images obtained by three-dimensional X-ray diffraction analysis using conventional isomorphous replacement at approximately twice the resolution. We find that there is quite good agreement between the two kinds of images, and that a number of gross structural features compare quite well. We conclude that the combination of electron microscopy with digital spatial filtering when applied to protein microcrystals yields very respectable results.

Amylases↗
PubMed1980

Experimental determination of flow patterns of gelfoam emboli: safety implications.

A major potential hazard of therapeutic occlusion of arteries by selectively injected Gelfoam pledgets is inadvertent reflux of nonopaque emboli into the aorta with resultant occlusion of other vessels. A simple method of injecting Gelfoam emboli through the standard nonoccluding arterial catheters customarily used for diagnostic arteriography was experimentally tested. The method incorporated certain safety features such as introduction of one embolus at a time using tuberculin syringes, low pressure injection technique, and frequent test injections of contrast to ascertain vessel patency. The results indicate that Gelfoam emboli can be safely and reliably employed using this technique, provided the catheter tip is properly positioned and emboli are only introduced as long as contrast test injections demonstrate rapid antegrade flow and continued patency of the artery. Once stasis or occlusion of most major branches are detected, blood flow in the catheterized artery has effectively ceased and further embolization is risky.

Animals↗
PubMed1979

Simplifying radiological examinations. The urogram as a model.

The diagnostic yield of one and three film urograms was compared with that of complete examinations to determine whether a moderately complex examination could be simplified without loss of important diagnostic information. Although sensitivity was high (88-93%) and was not altered by increasing the complexity of the examination, the definitive disease diagnoses were more accurate with the three film rather than the one film studies. Specificity increased from 69% to 77-80% with the more complex examinations. A strategy based on terminating the examination if the single film urogram is normal with a three-film examination in positive cases might effect considerable savings, both economic and in terms of gonadal radiation dose, without serious diagnostic loss.

Cost-Benefit Analysis↗
PubMed1976

Unusual noninfectious granulomas of the lung.

Illustrative cases of pulmonary granulomas with angitis and plasma cell granuloma of the lungs are presented. Experimental evidence suggests that the common pathogenesis of these processes is a cell-mediated immune response. Radiographic findings of these entities--nodules or infiltrates, some with cavities--are non-specific. Effective treatment is available for some of these processes. Lung biopsy as early as possible is recommended.

Adult↗