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Biomedical subjects

B Skipper

Publications and source records attributed to B Skipper.

29 records · Page 2Linked to original sources
PubMed1985

Clostridial necrotizing enterocolitis.

In a bacteriologic investigation of infants with necrotizing enterocolitis (NEC), 16 of 50 infants had clostridia in cultures of blood or of peritoneal fluid obtained by paracentesis. Twenty-eight of the 50 infants had enteric bacteria other than clostridia, and six infants had sterile cultures. Of the 16 infants with clostridia, nine had C. perfringens and seven had other species of clostridia. Compared to infants with nonclostridial NEC, those with clostridial NEC were larger and more mature, had more extensive pneumatosis intestinalis and gangrene and more rapid progression of NEC. The nine infants with C. perfringens had a fulminant form of NEC, analogous to gas-gangrene of the intestine. Mortality in this group was 78% (7/9). The seven infants with clostridial species other than C. perfringens had a mortality comparable to that of infants with nonclostridial NEC (32%). Improved survival from NEC associated with C. perfringens may be possible only by prevention, rather than earlier diagnosis and improved heroic treatment.

Clostridium perfringens↗
PubMed1983

The Syed-Neblett interstitial template in locally advanced gynecological malignancies.

Twenty-eight patients with locally advanced malignancies of the cervix and vagina were treated with a combination of external radiation therapy and afterloading Syed-Neblett iridium template. There were 22 patients with squamous cell cancer and two patients with adenocarcinomas of the cervix. Four patients with squamous cell cancer of the vagina were treated with this method. Only patients with locally advanced disease (cervical lesion greater than 4 cm in diameter) and poor vaginal anatomy were selected for this modality of therapy. In our series the incidence of distant failures of 39% seems to confirm the significance of local volume of disease as a prognostic indicator; despite a local control rate of 59%, only 33% of our patients are alive from 25-51 months. Complications occurred in 12 patients (42%). Six patients (22%) developed severe rectal stricture or rectovaginal fistula necessitating diverting sigmoid colostomy; five patients (18%) developed hemorrhagic proctitis with diarrhea and tenesmus; one patient developed vaginal vault necrosis. Complications occurred 7 to 24 months following therapy. Six of the 12 patients developing complications are dead of disease. On the basis of this study and because of the low cure rate and high incidence of complications, the value of the Syed-Neblett template in locally advanced gynecologic malignancies should be reconsidered.

Adenocarcinoma↗
PubMed1983

Characteristics of clinical information-searching: investigation using critical incident technique.

A total of 293 medical students, residents, and physicians were surveyed concerning their everyday information needs and the resources used to address these needs. The results of this study were used to identify goals of information-searching education for medical students. The participants' heavy reliance on their personal libraries, their basing their first choice of resource on physical convenience, and their need to obtain information quickly document the need to educate students in organizing and maintaining personal libraries and reprint files. In this study, the authors found that familiarity with a resource is often the basis of the choice of the resource and identified different types of information needs. These results revealed the need to educate medical students to be able to use the characteristics of the information problem to tailor information-search strategy to retrieve information expeditiously from a variety of resources outside the personal library.

Education, Medical, Undergraduate↗
PubMed1980

Use of a semiquantitative microscopic method for detecting bacteriuria.

We evaluated a microscopic examination for bacteriuria, performed by experienced observers and by 25 house officers who were less practiced in the technique. Simulated urine samples containing known concentrations of Escherichia coli with or without polymorphonuclear leukocytes were examined uncentrifuged in a wet mount with a methylene blue stain. The experienced observers were able to determine whether a sample contained greater or less than 10(5) organisms per milliliter with a high degree of sensitivity and specificity. The house officers demonstrated a lessened discrimination, and leukocytes in the samples altered their decisions as to whether samples contained significant numbers of bacteria. Experienced observers can successfully use the microscopic examination as a rapid and inexpensive diagnostic tool to diagnose significant bacteriuria.

Bacteriuria↗
PubMedDate not supplied

Public health and clinical implications of high hemoglobin A1c levels and weight in younger adult Native American people with diabetes.

BACKGROUND: Type 2 diabetes mellitus is a major public health issue for Native American people. Because glycemic levels are predictive of diabetes outcome, understanding determinants of high hemoglobin A(1c) (HbA(1c)) levels may provide targets for prevention efforts. OBJECTIVES: To investigate determinants of high HbA(1c) levels in Native American people. METHODS: We conducted a population-based, cross-sectional study of 206 participants with diabetes from 8 Native American communities in New Mexico. We used linear regression to assess the relationship of HbA(1c) level with age, body mass index (BMI), treatment type, duration of diabetes, physical activity, and diet. RESULTS: Age, dietary pattern, and treatment type were determinants of HbA(1c) levels. Participants younger than 55 years had the highest adjusted HbA(1c) levels at 9.5% and those 65 years and older had the lowest levels at 7.8%. According to a participant's dietary intake, HbA(1c) levels were highest for those who consumed the most fat and sugar, and high consumption of fat and sugar affected HbA(1c) levels most among those younger than 55 years. Participants treated with insulin had the highest hemoglobin A(1c) levels. Physical activity was not associated with HbA(1c) level. CONCLUSIONS: We found an increasing severity of diabetes among younger people. To avoid increased morbidity and mortality in the future, young Native American adults with diabetes need vigorous therapy to maintain tight glucose control. Arch Intern Med. 2000;160:3471-3476.

Adolescent↗
PubMedDate not supplied

Attrition in a follow-up study of driving while impaired offenders: who is lost?

High attrition rates seriously threaten the validity of follow-up studies of criminal justice populations. This study examines attrition from a follow-up study of drink-driving offenders referred 5 years earlier to a screening programme. The aim of the study was to determine which factors are most closely associated with: (1) inability to locate subjects, (2) subjects' refusal to participate; (3) the manner in which subjects refuse. Logistic regression models compared the following groups of subjects: located vs not located; interviewed vs not interviewed; type of refusal (direct vs indirect). Independent variables included gender, age group, ethnicity, whether the subject had a telephone, compliance with and completion of the screening programme, alcohol dependence or abuse diagnosis vs no diagnosis, breath-alcohol level (BAL) at the time of arrest, and whether the subject had an outstanding arrest warrant. Some factors (younger age, screening compliance, Mexican national ethnicity, and having an outstanding arrest warrant) predicted both inability to locate and type of refusal. Hispanic ethnicity and having a telephone predicted better success with locating subjects. Among refusers, non-Hispanic whites were more likely than other ethnic groups to refuse directly, and those with warrants were more likely to refuse indirectly. Non-compliance with the screening programme was also associated with differential follow-up rates. Neither arrest BAL nor alcohol diagnoses was associated with differential rates of follow-up. We conclude that alcohol diagnosis does not appear to influence successful follow-up in this criminal justice population. Rather, tracking and interviewing challenges differed among ethnic groups, suggesting a need for culturally sensitive recruitment strategies in these populations.

Adolescent↗
PubMedDate not supplied

Results of resting and ambulatory electrocardiograms in patients with hypothyroidism and after return to euthyroid status.

Hypothyroidism is not infrequently associated with an abnormally long QTc interval (> or = 450 msec). Rarely, marked prolongation of the QTc interval and malignant ventricular arrhythmias have been reported. In this study, QTc intervals on resting electrocardiograms (ECGs) were compared in 10 patients before and after treatment of hypothyroidism. The QTc interval increased in seven patients during euthyroidism compared with hypothyroidism, and decreased in three patients. During hypothyroidism, the QTc interval was mildly prolonged in 2 of the 14 patients; both had mild decreases in triiodothyronine (T3) or thyroxine (T4). The 24-hour ambulatory ECGs measured during hypothyroidism and after restoration of biochemical euthyroidism also were compared in 9 patients. There was no significant difference in ventricular ectopy. None of the 13 patients assessed during hypothyroidism had > or = 4 beats of ventricular tachycardia. There was no relationship between thyroid-stimulating hormone (TSH) or T3 levels and QTc intervals during hypothyroidism. A moderate correlation between lesser degrees of T4 depression and increasing QTc interval was present. Mild QTc prolongations are relatively common in patients with hypothyroidism and are usually associated with milder degrees of thyroid underactivity, but are not associated with clinically significant ventricular tachyarrhythmias.

Adult↗