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Biomedical subjects

C J Rosenquist

Publications and source records attributed to C J Rosenquist.

At least 19 recordsLinked to original sources
PubMed2001

Abilities underlying decoding differences in children with intellectual disability.

Researchers in recent years have made much progress towards understanding why some children struggle to learn to read. However, little of this research has involved children with intellectual disability associated with an IQ < 70 (ID, also called mental retardation). In the present analysis, the authors examined cognitive similarities and differences between stronger and weaker decoders, all of whom have ID. The 65 children with ID in the present analysis were initially referred by their teachers for a study that involved training basic phonological reading skills. The present analysis compares 21 children who were excluded from the training study because their decoding skills were already too high with 44 children whose decoding skills were low enough for the training study. The groups were compared on general intelligence, language ability, phonemic awareness and phonological memory. Initial analyses showed that the stronger decoders were significantly better than weaker decoders in language ability, phonemic awareness and rehearsal in phonological memory, but not in intelligence. They were also significantly older than weaker decoders. When age was covaried out, the groups differed significantly only in rehearsal in phonological memory, although the difference for phonemic awareness was marginally significant when the poorest performers were excluded. When intelligence is substantially limited, the ability to rehearse or refresh phonological codes in working memory plays a major role in determining children's success in learning to read. This ability appears to be more important than intelligence, language ability and phonemic awareness. It is possible that the reason the phonemic awareness measure was not as good at distinguishing the groups as the phonological rehearsal measure was because the former did not involve assembling phonological output. It is suggested that it is the combination of poor phonological representation and poor phonological output assembly that makes decoding difficult for some children with ID.

Child↗
PubMed2001

Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs.

OBJECTIVE: To compare outcomes, quality of life (QOL), and costs of laparoscopic and open gastric bypass (GBP). SUMMARY BACKGROUND DATA: Laparoscopic GBP has been reported to be a safe and effective approach for the treatment of morbid obesity. The authors performed a prospective randomized trial to compare outcomes, QOL, and costs of laparoscopic GBP with those of open GBP. METHODS: From May 1999 to March 2001, 155 patients with a body mass index (BMI) of 40 to 60 kg/m2 were randomly assigned to undergo laparoscopic (n = 79) or open (n = 76) GBP. The two groups were similar in age, sex ratio, mean BMI, and comorbidities. Main outcome measures included operative time, estimated blood loss, length of hospital stay, operative complications, percentage of excess body weight loss, and time to return to activities of daily living and work. Changes in QOL were assessed using the SF-36 Health Survey and the bariatric analysis of reporting outcome system (BAROS). Operative and hospital costs of the two operations were also compared. RESULTS: There were no deaths in either group. Mean operative time was longer for laparoscopic GBP than for open GBP, but operative blood loss was less. Two (2.5%) of the 79 patients in the laparoscopic group required conversion to laparotomy. Median length of hospital stay was shorter for laparoscopic GBP patients (3 vs 4 days). The rate of postoperative anastomotic leak was similar between groups. Wound-related complications such as infection (10.5 vs 1.3%) and incisional hernia (7.9 vs 0%) were more common after open GBP; late anastomotic stricture was less frequent after open GBP (2.6 vs 11.4%). Time to return to activities of daily living and work were shorter after laparoscopic GBP than after open GBP. Weight loss at 1 year was similar between groups. Preoperative SF-36 scores were similar between groups; however, at 1 month after surgery, laparoscopic patients had better physical conditioning, social functioning, general health, and less body pain than open GBP patients. At 6 months, the BAROS outcome was classified as good or better in 97% of laparoscopic GBP patients compared with 82% of open GBP patients. Operative costs were higher for laparoscopic GBP patients, but hospital costs were lower. CONCLUSIONS: Laparoscopic GBP is a safe and cost-effective alternative to open GBP. Despite a longer operative time, patients undergoing laparoscopic GBP benefited from less blood loss, a shorter hospital stay, and faster convalescence. Laparoscopic GBP patients had comparable weight loss at 1 year but a more rapid improvement in QOL than open GBP patients. The higher initial operative costs for laparoscopic GBP were adequately offset by the lower hospital costs.

Activities of Daily Living↗
PubMed2001

Memory training for children with Down syndrome.

One well-established fact concerning cognitive and language development in individuals with Down syndrome is that working memory is particularly poor, with auditory working memory worse than visual working memory. Working memory serves the functions of control, regulation, and active maintenance of information and is critical in daily complex cognitive activities. Thus, there is a strong need to find effective and practical interventions targeted at improving working memory in individuals with Down syndrome. The present paper reviews research on rehearsal training and concludes that it can be used successfully to increase working memory in individuals with Down syndrome. However, there are still questions about whether auditory working memory can be improved reliably, whether improvement can be maintained over the long term, and whether improvement exists beyond any effect of increased attention. We describe our in-progress study which addresses these concerns.

Child↗
PubMed1998

Screening mammography beginning at age 40 years: a reappraisal of cost-effectiveness.

BACKGROUND: Several recent studies have added significant information regarding the benefit of screening mammography, especially in the 40-49-years age group. This new information makes it important to reassess the cost-effectiveness of screening. METHODS: A Markov model was used to study the cost-effectiveness of 4 age-related screening strategies: 1) annually from ages 40-79 years; 2) annually from ages 40-64 years and biennially from ages 65-79 years; 3) annually from ages 40-49 years and biennially from ages 50-79 years; and 4) annually from ages 40-79 years in high risk women (10%) and biennially from ages 40-49 years followed by annually from ages 50 -79 years in normal risk women (90%). An additional strategy simulating hormone status and estrogen exposure was evaluated. Cost-effectiveness was expressed as marginal cost per year-life saved (MCYLS). RESULTS: The MCYLS varied from $18,800 to $16,100. For all strategies this was within the range of other generally acceptable diagnostic and therapeutic medical procedures. There was a 14% decrease in MCYLS from the least cost-effective to the most cost-effective strategy. CONCLUSIONS: Cost-effectiveness of four age-related mammographic screening strategies was evaluated. The MCYLS for all strategies was within a generally accepted range. With increasing concerns regarding the cost of health care, this information may be useful in health policy decision-making.

Adult↗
PubMed1996

The use of low-osmolar contrast agents: technological change and defensive medicine.

The escalating cost of medical care in the United States, especially in the past decade, has resulted in efforts to identify the factors contributing to rising costs. One factor often assumed to cause higher medical costs is the physician's fear of liability for not using the latest available technology. In this article, we report the results of a case study we conducted to better understand the relationship between the introduction and use of one particular technology, low-osmolar contrast agents, and liability concerns. Our study suggests that both clinicians and administrators are primarily guided by the medical benefits of low-osmolar contrast agents, and that liability concerns, although widespread, are of secondary importance. The inability to control this and similar technologies is likely to put a far greater strain on the nation's health care resources than is the practice of defensive medicine. These findings may be helpful to health policy makers, physicians, administrators, and legislators considering choices for health care reform in general and for medical liability reform in particular.

Attitude of Health Personnel↗
PubMed1995

The cost-effectiveness of mammographic screening strategies.

OBJECTIVE: To compare and analyze the cost-effectiveness of different mammographic screening strategies. DESIGN: A computer simulation model was developed to compare mammographic screening with observation without screening. Cost-effectiveness was expressed as marginal cost per year of life saved (MCYLS) and was calculated for the following mammographic screening strategies: (1) annual for ages 40 to 79 years; (2) annual for ages 50 to 79 years; (3) biennial for ages 50 to 79 years; (4) annual for ages 40 to 49 years with biennial for ages 50 to 79 years; (5) annual for ages 40 to 64 years with biennial for ages 65 to 79 years; (6) biennial for ages 40 to 49 years with annual for ages 50 to 79 years; and (7) annual for high-risk and biennial for normal-risk women aged 40 to 49 years with annual for ages 50 to 79 years. DATA SOURCES: The probability and cost of all outcomes were established from previously published data or community experience. RESULTS: The most cost-effective screening strategy is biennial mammography for women aged 50 to 79 years, with an MCYLS of $16,000. Adding annual mammography for women aged 40 to 49 years increases the MCYLS to $20,200, but is more cost-effective than other tested protocols that included women in their 40s; annual mammography for ages 40 to 49 years with biennial for ages 50 to 79 years is also more cost-effective than annual mammography for ages 50 to 79 years. CONCLUSION: Screening programs that include women in their 40s can be as cost-effective as some that exclude such women. Choice of a screening strategy depends on financial resources and desired effectiveness.

Adult↗
PubMed1995

How many radiologists will be needed in the years 2000 and 2010? Projections based on estimates of future supply and demand.

Predicting the appropriate number of diagnostic radiologists needed in the United States for the next decade is an important but difficult task. Previous attempts have been characterized by incomplete data, conflicting results, and ultimately, as the future revealed itself, erroneous conclusions [1-3]. Nonetheless, with major changes expected in health care, estimation of physician workforce needs is perhaps more critical than ever before. In this study, both the future supply of diagnostic radiologists and the demand for diagnostic radiology services in the United States were analyzed. Projected supply of diagnostic radiologists was calculated by using data about the number presently in practice, the current number of radiology residents, and the rate at which diagnostic radiologists leave the profession through either retirement or death. Demand for radiologic services in the future was evaluated by estimating effects of possible changes in population and demography, health care reform, technology, universal health insurance, and women in radiology.

Forecasting↗
PubMed1994

Needle core biopsy guided with mammography: a study of cost-effectiveness.

PURPOSE: To analyze the cost-effectiveness of needle core biopsy (NCB) in a breast cancer screening program. MATERIALS AND METHODS: A computer model was used to compare two hypothetical groups of women: those who undergo annual mammographic screening and those observed without screening. All clinically significant outcomes for each group were included in the model, which reflected the state of a woman's health each year beginning at age 40 years and ending at age 85 years. RESULTS: The marginal cost per year of life saved by screening was reduced a maximum of 23% (from $20,770 to $15,934) with use of NCB instead of surgical biopsy. The cost of NCB had less effect on cost-effectiveness than the number of women who underwent NCB. CONCLUSION: When used for the same indications as surgical biopsy, NCB substantially reduces the cost of a breast cancer screening program.

Adult↗
PubMed1994

Screening mammography in women aged 40-49 years: analysis of cost-effectiveness.

PURPOSE: To evaluate the cost-effectiveness of screening mammography in women 40-49 years old. MATERIALS AND METHODS: A Markov model compared two hypothetical groups; one underwent screening mammography and the other, observation without mammography. Variables tested included frequency of mammography, reduction in breast cancer mortality, and cost-effectiveness by age group. Results were expressed as marginal cost per year of life saved. RESULTS: If the estimated mortality reduction from mammographic screening was 15% or greater, the marginal cost per year of life saved was comparable to that of other generally accepted medical procedures. Annual screening with an assumed 30% reduction in mortality had a cost-effectiveness similar to that of biennial screening with a 20% reduction. Screening mammography was less cost-effective in the 40-49-year-old age group than in women aged 50-79 years but more cost-effective than in those aged 80-84 years. CONCLUSION: Although the parameters for screening mammography in women aged 40-49 years are not known with certainty, the results of this analysis may help establish priorities for utilization of medical resources.

Adult↗
PubMed1992

Dysphagia following stroke: quantitative evaluation of pharyngeal transit times.

Forty stroke subjects referred for dysphagia and studied by videofluoroscopy were compared with 16 individuals with no known pharyngeal swallowing difficulty. Kinematic pharyngeal transit time was defined as the time from the first movement of the bolus posteriorly resulting in a complete swallow to the return of the epiglottis to its original position. The mean transit time was 1.00 second for the comparative group and 6.15 seconds for the stroke group (p less than 0.001). Other component transit times are described and were all significantly prolonged for the stroke group. There was no significant difference in transit times between right-sided and left-sided lesions except for the segmental interval from onset of bolus movement to arrival at the valleculae, which was significant at p = 0.05. Measurement of transit times using the method described in this study requires equipment available in most hospitals. These measurements may be used in the evaluation of dysphagia in various pathologic disorders, in following the progress of patients with dysphagia, and in evaluating the effects of remedial therapies.

Adult↗
PubMed1988

The introduction of low-osmolar contrast agents in radiology. Medical, economic, legal, and public policy issues.

This case study of the public policy implications of introducing a new technology in radiology, namely, low-osmolar contrast media (LOCM), raises the issues of whether and how to place appropriate limits on new technologies. Although these contrast media represent small episodic costs, they may add up to an aggregate expenditure of nearly $1 billion per year if used for all contrast injections. As a result, this technology raises a number of important medical, economic, legal, and public policy questions. Our cost-effectiveness analysis and an analysis of the medical evidence suggest that LOCM should be limited to high-risk patients. We discuss in this article how the legal system might respond to such limitations, and we consider various public policy options for adopting restrictions on use. We conclude that the medical profession should take the lead in developing protocols for appropriate assessment, reimbursement, and use of LOCM.

Contrast Media↗
PubMed1987

Queueing analysis: a useful planning and management technique for radiology.

Queueing analysis is a mathematical technique which is used for studying characteristics of queueing (waiting) for service. Recent development of improved software systems has made the technique easily available and versatile using a microcomputer. In this study the characteristics of examination time and interarrival time were determined for an emergency room radiology service, and two examples were analyzed that demonstrate the usefulness of queueing analysis in radiology. In the first example the effects of a 5% annual increase in patients on waiting time are shown, while the second example shows the use of the technique for cost analysis. Radiologists and medical administrators should be aware of the availability and value of queueing analysis for department planning and management.

Appointments and Schedules↗
PubMed1983

Studies of gallbladder contraction using intramuscular sincalide.

Intramuscular sincalide (the carboxy terminal octapeptide of cholecystokinin) was evaluated as an agent for producing gallbladder contraction. Following oral cholecystography 35 patients received intramuscular sincalide in one of two dosages, 18 patients received intravenous sincalide, and six patients were given intramuscular placebo. Generalized symptoms, often similar to those noted clinically, were more common following intravenous injection of sincalide; gallbladder contraction was greater following intramuscular injection. Both of these findings may be related to lower but more sustained blood levels of sincalide following intramuscular administration. Intramuscular sincalide may be useful for further studies of the value of cholecystokinin cholecystography.

Cholecystography↗