PubMed Health⌕ Search

Biomedical subjects

B Simmons

Publications and source records attributed to B Simmons.

At least 19 recordsLinked to original sources
PubMed1997

Dental caries among Australian Aboriginal, non-Aboriginal Australian-born, and overseas-born children.

Few studies have specifically compared the prevalence of dental caries among contemporary Australian Aboriginal and non-Aboriginal children. Historically, Aboriginal groups have had substantially fewer dental caries than non-Aboriginal peoples. More recently, however, this trend appears to have been reversed, with improvements in the oral health of non-Aboriginal children and a deterioration in that of Aboriginal children; this tendency has important implications for dental health services. This study compared the caries experience among a weighted sample of Community Dental Service patients aged 4-13 years for the period January-December 1992 among 4138 Aboriginal children, 9674 non-Aboriginal Australian-born children, and 957 overseas-born children resident in Northern Territory, Australia. The outcomes considered included the aggregate numbers of decayed, missing and filled deciduous (dmft) and permanent (DMFT) teeth. Oral disease experience and prevalence of untreated oral disease were higher among Aboriginal and overseas-born children. An analysis of variance using planned comparisons indicated that there were significantly more decayed teeth and higher aggregate caries experience in the deciduous and permanent dentition of Aboriginal and overseas-born children than of non-Aboriginal Australian-born children, while overseas-born children also had more fillings and fissure sealants than the non-Aboriginal Australian-born children.

Adolescent↗
PubMed1996

Managed care and the infectious diseases specialist.

There is growing demand to contain health care costs and to reassess the value of medical services. The traditional hospital, academic, and research roles of the infectious disease (ID) specialist are threatened, yet there is an increasing need for expertise because of growing antimicrobial resistance and emerging pathogens. Opportunities exist to develop and expand services for the care of patients infected with human immunodeficiency virus and in infection control, epidemiology, outcomes research, outpatient intravenous therapy, and resource management. It is important for ID physicians to appreciate the principles involved in managed care and the areas in which ID services can be valuable. To be effective, physicians need to know about tools such as practice guidelines, physician profiling, outcomes monitoring, computerized information management, risk sharing, networking, and marketing, as well as related legal issues. With a positive attitude toward learning, application, and leadership, ID physicians can redefine their role and expand their services through managed care.

Ambulatory Care↗
PubMed1995

A cadaveric study of the single-portal endoscopic carpal tunnel release.

Forty-three human cadavers underwent single-portal endoscopic carpal tunnel release using the Agee technique. Subsequent independent open dissection revealed complete release of all potentially compressing transverse structures in 19 specimens and incomplete release in 24 specimens. There were 2 specimens with vascular injuries; one transection of a perforating branch of the palmar arch, and one transection of the ulnar artery at the entry portal. The 43 specimens were divided into three groups: group 1 (13 specimens) were released by the senior author in 1989; group 2 (13 specimens) were released by the senior author in 1992; and group 3 (17 specimens) were released by surgeons learning the technique under direct supervision of the senior author. Complete release was 5 of 13 for group 1, 6 of 13 for group 2, and 8 of 17 for group 3. This study indicates that incomplete release is an inherent feature of this technique regardless of the surgeon's experience and despite blade redesign. The significance of incomplete release is unknown and must be determined in long-term clinical studies.

Cadaver↗
PubMed1995

An 81-year-old woman with an abdominal mass.

An 81-year-old woman was admitted with a large abdominal mass that had grown rapidly over the previous few months. The differential diagnosis, pathology, and treatment of such masses are discussed.

Aged↗
PubMed1992

The prognostic role of left ventricular hypertrophy in patients with or without coronary artery disease.

OBJECTIVE: To examine the association between echocardiographically determined left ventricular hypertrophy and mortality in patients with and without coronary artery disease. DESIGN: Cohort study with a mean follow-up period of 4 years. SETTING: An inner-city public hospital in Chicago. PATIENTS: A cohort of 785 patients, most of whom were black and had hypertension. INTERVENTIONS: Coronary arteriography for presumed coronary artery disease and echocardiography. MAIN OUTCOME MEASURE: All-cause and cardiac mortality. RESULTS: Left ventricular hypertrophy, based on left ventricular mass corrected for body surface area, was present in 194 of 381 patients (51%) with coronary artery disease and in 162 of 404 patients (40%) without coronary artery disease. Patients with left ventricular hypertrophy had worse survival than those without hypertrophy in both the group with coronary artery disease and the group without coronary artery disease. After adjustment was made for age at baseline, sex, and hypertension, the relative risk for death from any cause in patients with hypertrophy compared with patients without hypertrophy was 2.14 (95% CI, 1.24 to 3.68) among those with coronary artery disease and 4.14 (CI, 1.77 to 9.71) among those without coronary artery disease. CONCLUSIONS: Echocardiographically determined left ventricular hypertrophy is an important prognostic marker in patients with or without coronary artery disease. The effect of reversing ventricular hypertrophy in patients with and without coronary disease deserves further study.

Adult↗
PubMed1992

Listeria monocytogenes causing endovascular infection.

Listeria monocytogenes is an uncommon cause of mycotic aneurysms, endocarditis, and other endovascular infections. When they occur, these infections usually involve patients with relatively normal host defenses, but with abnormal vascular intima or cardiac valves. We have reported a Listeria monocytogenes infection at the site of a posttraumatic aortic aneurysm.

Aged↗
PubMed1992

Racial differences in mortality from cardiovascular disease in Atlanta, 1979-1985.

Mortality from cardiovascular disease (CVD) for the period 1979 to 1985 in the Atlanta metropolitan population was reviewed for racial differences. About 28% of the population was black in 1980. Of 22,585 deaths from hypertension, stroke, ischemic heart disease, and atherosclerosis, 78.7% occurred among whites and 21.3% among blacks. Overall, ischemic heart disease accounted for 47.7% of these four types of CVD deaths for both races and sexes. Age-specific and age-adjusted rates were compared. Among these four causes of death, blacks have the greatest excess of deaths from hypertension over whites for both males and females; the excesses were more than 200% when the rates were age-adjusted. The excess risk of death from hypertension occurred for all ages in blacks, with an excess of about 10 times in 30- to 49-year-olds. An excess risk from stroke also occurred in blacks below the age of 75; the risk reversed afterward. The age-specific mortality rates revealed an excess from ischemic heart disease only between the ages of 30 and 59 years and from atherosclerosis between 40 and 59 years of age for black men. This age-related crossover in females did not occur until the age of 75 years for deaths attributed to these causes. These data suggest that blacks were at highest risk for all four causes at younger age groups.

Adult↗
PubMed1990

Serum lipids, lipoproteins and apolipoproteins in black patients with angiographically defined coronary artery disease.

The association between angiographically defined coronary artery disease (CAD) and serum lipids, lipoproteins, and apolipoproteins was evaluated in 151 black men and 245 black women. Patients with 70% or greater narrowing of at least one coronary artery or greater than or equal to 50% stenosis of the left main coronary artery (n = 179) were compared to those with lesions of less than 50% stenosis (n = 217) for total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), LDL-C/HDL-C, triglycerides, apolipoprotein A-I, apolipoprotein B, and apolipoprotein A-I/B. A consistently more atherogenic pattern of lipids, lipoproteins, and apolipoproteins occurred only among the women. Using stepwise selection multiple logistic regression analysis, the ratio of apolipoprotein A-I/B (odds ratio = 0.38, 95% confidence limits 0.24-0.61) was the only statistically significant association of CAD in women, after adjusting for the effects of age, body mass index, and histories of smoking, hypercholesterolemia, hypertension, and diabetes. When stratified by median of total cholesterol, the ratio of apolipoprotein A-I/B was the most strongly associated with the presence of CAD in the lower half of the total cholesterol distribution (less than 208 mg/dl), whereas in the upper half of the total cholesterol distribution the total cholesterol/HDL-C ratio was more strongly associated with CAD. None of the variables studied was associated with CAD in men. These results support other studies suggesting that apolipoproteins may be better predictors of CAD.

Angiography↗
PubMed1990

Transtelephonic defibrillation.

STUDY OBJECTIVES: This study was undertaken to assess the safety and reliability of a device for transtelephonic defibrillation. DESIGN: The transtelephonic system consists of a patient unit and a base station. The patient unit contains a monitor-defibrillator, electrode pads, microphone, microprocessor, and DC defibrillator. The base station comprises a control panel, computer, and ECG display. SETTING: Fifteen patients who were treated in our emergency department for cardiac arrest were placed on patient units that activated our base station in a remote location within the ED. TYPE OF PARTICIPANTS: Thirteen patients were treated for ventricular fibrillation, and two patients were treated for ventricular tachycardia. INTERVENTIONS: Thirty-one shocks were delivered transtelephonically. MEASUREMENTS AND MAIN RESULTS: In all cases, voice and ECG transmission were established without difficulty. CONCLUSIONS: We conclude that this system represents a safe and reliable method for the treatment of ventricular fibrillation, and we advocate additional use to study the prehospital applications of transtelephonic defibrillation.

Aged↗
PubMed1990

The role of handwashing in prevention of endemic intensive care unit infections.

Handwashing is believed to be the most important means of preventing nosocomial infections. Previous studies of healthcare workers (HCWs) have shown that handwashing practices are poor. No one has shown that handwashing practices can be easily improved and that this prevents endemic (nonepidemic) nosocomial infection. Handwashing and infection rates were studied in two intensive care units (ICUs) of a community teaching hospital. Handwashing rates were monitored secretly throughout the study. After six months of observation, we started interventions to increase handwashing. Handwashing increased gradually, but overall rates before (22.0%) and after (29.9%) interventions were not significantly different (p = .071). Handwashing never occurred before intravenous care, whereas it occurred 67.5% for all other indications (p less than .0001). When questioned, nurses felt they were washing appropriately nearly 90% of the time. Infection rates seemed unrelated to handwashing throughout the study, and no clusters of infection were detected. We conclude that handwashing rates, when measured against arbitrary but reasonable standards, are suboptimal, difficult to change and not closely related to evidence of cross-infection. Further, nurses wash hands selectively, depending on the indication for handwashing, and generally believe they are washing much more frequently than an objective observer believes they are.

Cross Infection↗
PubMed1989

Severity of coronary artery disease among blacks with acute myocardial infarction.

A growing body of evidence suggests that survival after acute myocardial infarction (AMI) is considerably worse among blacks than whites. The severity of coronary artery disease (CAD), as measured by the number of diseased vessels and the degree of left ventricular dysfunction, is the major determinant of survival after AMI. To determine whether or not the severity of CAD could explain the poor prognosis in a cohort of blacks followed at this institution, cardiac catheterization was performed in a consecutive series of 51 patients less than 70 years of age. All patients were studied within 2 weeks after AMI. The mean age of the patients was 56 +/- 8 (mean +/- standard deviation) and 71% were men. A greater than or equal to 50 narrowing in 0, 1, 2 or 3 coronary arteries was noted in 5, 24, 40 and 31%, respectively. Left main stenosis was present in 3 patients (6%) and the mean left ventricular ejection fraction was 55%. In a subgroup of 20 patients echocardiographic estimates of left ventricular mass/height yielded a mean of 196 g/m, and left ventricular hypertrophy on echocardiogram was present in 74%. These data indicate that among blacks with AMI in this series CAD was only modestly more severe than expected and suggest that other factors most likely explain the high mortality in blacks after hospital discharge.

Black or African American↗
PubMed1989

Coronary arteriography and coronary bypass survey among whites and other racial groups relative to hospital-based incidence rates for coronary artery disease: findings from NHDS.

To assess racial differences in health care utilization for coronary artery disease (CAD) the data of the National Hospital Discharge Survey (NHDS) from 1979-84 were examined. Discharge rates for acute myocardial infarction (AMI) were utilized as a measure of hospital-based incidence and relative need for the designated cardiac procedures. Although 35-74 year old Black men had discharge rates of AMI that were 77 per cent of those observed for White men, they underwent coronary arteriography half as often and were only a third as likely to have coronary artery bypass graft (CABG) surgery. Black women in this age range were hospitalized at a slightly higher rate than White women for AMI, yet experienced a 19 per cent lower rate of coronary arteriography and a 52 per cent lower rate of CABG surgery. These data suggest a racial bias in the pattern of care delivered for CAD in US hospitals at the present time.

Adult↗
PubMed1988

Description of case-mix adjusters by the Severity of Illness Working Group of the Society of Hospital Epidemiologists of America (SHEA).

Hospitals, insurance companies, and federal and state governments are increasingly concerned about reducing patient cost expenditures while maintaining high quality patient care. One method of reducing expenditures has been to tie hospital reimbursement with a prospective payment system based on diagnosis-related groups (DRGs). However, reimbursement under the DRG system is not acceptable for all patients in all hospitals because it is neither an accurate predictor of costs nor of clinical outcome. This deficiency poses significant problems for hospitals because DRGs are used nationwide as the prospective payment system for inpatients covered by Medicare. Several case-mix adjusters have been proposed to modify DRGs to improve their accuracy in predicting costs and outcome. We reviewed five of the most widely available indices: Acute Physiologic and Chronic Health Evaluation (APACHE II), Coded Disease Staging, Computerized Severity Index (CSI), Medical Illness Severity Group System (MEDISGROUPS), and Patient Management Categories (PMC). Recommendations for the use of a single case-mix adjuster cannot be made at this time because all indices have not been compared in sufficiently diverse settings and because some are better predictors of costs while others are better predictors of clinical outcome. Hospital epidemiologists and other infection control practitioners should be informed about these indices and their potential applications as they expand their role beyond infection control problems to issues concerning cost containment, quality assurance, and reimbursement.

Cost Control↗