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Biomedical subjects

C M Rutter

Publications and source records attributed to C M Rutter.

11 recordsLinked to original sources
PubMed1998

Comparison of Doppler US and CT angiography for evaluation of renal artery stenosis.

RATIONALE AND OBJECTIVES: The authors compared Doppler ultrasound (US) with computed tomographic (CT) angiography in the evaluation of stenosis of the main renal artery. MATERIALS AND METHODS: Fifty-six patients who had undergone conventional angiography of the renal arteries participated in a prospective comparison of Doppler US (45 patients) and CT angiography (52 patients). US evaluation included both the main renal artery and segmental renal arteries. RESULTS: There were 27 main renal arteries with at least 50% stenosis in 20 patients. In 36 patients, there was no significant stenosis. All cases of main renal artery stenosis detected with Doppler US of the segmental arteries were also identified with Doppler US of the main renal artery. The by-artery sensitivity (63%) of US of the main renal artery was greater than that (33%) of US of the segmental arteries. CT angiography was more sensitive (96%) than Doppler US (63%) in the detection of stenosis, but the specificity of CT (88%) was similar to that of US (89%). The difference in the area under the receiver operating characteristic curve (AUC) between CT (AUC = 0.94) and US (AUC = 0.82) was statistically significant (P = .038). CONCLUSION: Doppler US of the main renal artery is more sensitive than Doppler US of segmental arteries in the detection of stenosis. CT angiography is more accurate than Doppler US in the evaluation of renal artery stenosis.

Adult↗
PubMed1997

Achieving guidelines for the treatment of depression in primary care: is physician education enough?

OBJECTIVES: The authors examine whether physician education has enduring effects on treatment of depression. METHODS: Depressed primary care patients initiating antidepressant treatment from primary care clinics of a staff-model health maintenance organization were studied. Quasi-experimental and before-and-after comparisons of physician practices, supplemented with patient surveys, were used to compare the process of care and depression outcomes. Intervention consisted of extensive physician education that spanned a 12-month period. This included case-by-case consultations, didactics, academic detailing (eg, clearly stating the educational and behavioral objectives to individual physicians), and role-play of optimal treatment. Main outcome measures were divided into two groups. Quasi-experimental samples included: (1) antidepressant medication selection and (2) adequacy (dosage and duration) of pharmacotherapy. Survey samples included: (3) intensity of follow-up; (4) physician delivered educational messages regarding depression treatment; (5) patient satisfaction; and (6) depression outcomes. RESULTS: No lasting educational effect was observed consistently in any of the outcomes measured. CONCLUSIONS: There was no enduring improvement in the treatment of depression for primary care patients. Depression treatment guidelines were achieved contemporaneously, however, for intervention patients enrolled in a multifaceted program of collaborative care during the training period. These results suggest that continuing programs of reorganized service delivery to support the role of a primary care physician (eg, on-site mental health personnel, close monitoring of patient progress and adherence), in addition to physician training, are essential for the success of guideline implementation.

Depressive Disorder↗
PubMed1995

Multicenter trial to evaluate vascular magnetic resonance angiography of the lower extremity. American College of Radiology Rapid Technology Assessment Group.

OBJECTIVES: To assess the value of magnetic resonance angiography (MRA) in presurgical evaluation of patients with severe lower limb atherosclerotic occlusive disease and to assess the feasibility of rapidly conducting rigorous technology assessment. DESIGN: Blinded, prospective study of consecutive patients with signs or symptoms of severe infrainguinal peripheral vascular disease who were candidates for percutaneous or surgical intervention. Using both descriptive statistics and multivariate logistic analyses, MRA was compared with contrast arteriography (CA) (the current technique) for imaging 15 arterial segments of the leg and foot. Intraoperative contrast angiography was the "gold" standard. Also studied was the effect of adding MRA to the information used in planning treatment. SETTING: Six US hospitals, one a community hospital. PATIENTS: A total of 155; 84% with either rest pain or tissue loss. RESULTS: Sensitivity in distinguishing patent segments from completely occluded segments was 83% for CA and 85% for MRA; both had 81% specificity. For distinguishing near-normal segments (suitable as bypass graft termini), CA was less sensitive than MRA (77% vs 82%), but more specific (92% vs 84%). After adjusting for same-reader effects, odds of correctly distinguishing patent segments were 1.6 times as great for MRA as for CA (P < .01); for distinguishing near-normal segments, the odds for CA were 1.5 times as great as for MRA (P < .05). The addition of MRA changed the treatment plan in 13% of patients; in 86% of these cases, the surgery actually performed indicated that the MRA-inclusive plan was superior. CONCLUSIONS: Individually, MRA and CA are approximately equivalent in diagnostic accuracy. The addition of MRA to treatment plans based only on CA and other diagnostic information clearly improves the plans. Completed in 15 months (as planned), our study demonstrates the feasibility of conducting rigorous technology assessment rapidly enough to be timely even in fields in which diagnostic and treatment techniques are rapidly changing.

Adult↗
PubMed1995

Platelet activation by healing ePTFE grafts.

The purpose of this study was to examine the effect of the in vivo maturing ePTFE graft surface on platelet activation. Ten canines were randomized to receive either a carotid to infrarenal aorta ePTFE graft or sham operation. Animals were sampled at specific time points up to 3 months postoperatively. Whole blood platelet aggregometry (arachidonic acid, ADP, and collagen agonists) and ATP secretion (in response to arachidonic acid, ADP, collagen, and thrombin) were measured. Additionally, complete hematologic analysis and histology were performed. With time, graft animals showed significantly more decrease in platelet aggregation in response to ADP compared to sham animals (P = .023). The total amount of ATP per platelet was not different, as demonstrated by equivalent ATP release per platelet in response to thrombin. Over the first week, grafted dogs developed a decrease in systemic platelet count of 50% (P < .001) that persisted over the 3-month follow-up period. With time, overall regression model slopes of graft and sham platelet count data were not statistically different (P = .29). Histologically, the grafts demonstrated limited cellular ingrowth at both anastomoses, with fibrin matrix along the remainder of the blood-biomaterial interface. These data suggest that, similar to Dacron, exposure to an ePTFE surface results in significant changes in platelet biology, and these platelet-ePTFE interactions persist even after the graft has formed a mature pseudointima. The pseudointima appears to be the primary determinant of the blood-biomaterial interaction.

Adenosine Triphosphate↗
PubMed1994

Analysis of longitudinal data: random coefficient regression modelling.

We review random coefficient regression (RCR) models and methods for fitting these models from an applications perspective. Methods for data with exponential family distributions are presented with the Gaussian distribution as a special case. Attention is given to interpretation of fixed effects and the correlation structures implied by RCR models. Estimation methods are presented wtih computational approaches. Problems associated with testing fixed effects include accurate variance estimation and robustness to misspecification of the covariance structure. Methods for model selection and assessment are presented. An example is used to demonstrate recommended approaches.

Adult↗
PubMed1991

Depression in the community: an investigation into age of onset.

Age of onset of any lifetime depressive disorder was investigated to identify periods of the life course associated with increased risk of depression. In this large community-based sample of adults, one fourth of those with a major depressive disorder at some point in their lives reported onset during childhood or adolescence; over one half reported onset by age 25. Women were likely to have an earlier onset of depression than were men; non-Hispanic Whites and Mexican Americans born in the United States reported earlier onset than did Mexican-American immigrants. Age of onset did not appear to be consequential in terms of the number, type, or severity of the symptoms occurring during the worst depressive episode or with the probability of relapse. These findings imply that age of onset may contribute to group differences in prevalence rates.

Adolescent↗
PubMed1991

Transgenerational patterns of suicide attempt.

The clinical assumption that suicide attempts demonstrate familial aggregation was examined with data from a survey of 2,304 community residents. Approximately 1 in 15 persons (6.6%) in the general population was aware that a parent, sibling, son, or daughter had attempted suicide. Self-reports of suicide attempts were more common among persons with than without a family history of suicide (13.0% vs. 2.8%, p less than .05). Nearly 1 in 4 persons who attempted suicide (24.8%) reported a family history of suicide. In addition to being female and unmarried, respondent mental disorder, parent mental disorder, and parent suicide attempt each exerted independent direct effects on the risk of respondent suicide ideation. Parent attempt was not significantly associated with respondent suicide attempt when a host of risk factors were held constant. Possible mediating factors are discussed, focusing on social isolation as an underlying factor.

Adolescent↗
PubMed1990

Symptoms of major depression among Mexican-Americans and non-Hispanic whites.

The lifetime prevalence of symptoms of a major depressive episode was estimated in two large samples of randomly selected community residents that included many Mexican-Americans. Approximately 5% to 40% of the subjects reported each symptom cluster. The rates for Mexican-Americans born in the United States resembled those for non-Hispanic whites born in the United States; however, the rates for Mexican-Americans born in Mexico were lower in eight of nine symptoms clusters. Language differences did not account for this pattern. Cultural similarity to non-Hispanic whites born in the United States was associated with a higher rate of depressive symptoms.

Adult↗
PubMedDate not supplied

Relapse of depression in primary care. Rate and clinical predictors.

OBJECTIVE: To determine the clinical predictors and rate of relapse for major depression in primary care. DESIGN: A cohort study of subjects in 2 randomized trials of depressed patients diagnosed and prescribed antidepressant medicine by primary care physicians. Baseline, 7-month, and 19-month assessments were conducted. SETTING: A large primary care clinic of a staff-model health maintenance organization. PATIENTS: Two hundred fifty-one primary care patients who did not satisfy Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) criteria for major depression at 7 months. MAIN OUTCOME MEASURES: Relapse was defined as (1) satisfying DSM-III-R criteria for major depression at 19 months, or (2) reporting an interval episode of 2 weeks or more of depressed mood and symptoms between 7 and 19 months. Predictors examined included demographic characteristics, medical comorbidity, disability, and psychological symptoms. Depressive symptoms were measured by Inventory of Depressive Symptoms and Hopkins Symptoms Checklist. RESULTS: Of the patients, 37.1% reported relapse of depression in the 12-month relapse-risk period. The 2 major risk factors associated with relapse were (1) persistence of subthreshold depressive symptoms 7 months after the initiation of antidepressant therapy (odds ratio, 3.3; 95% confidence interval, 2.74-3.93) and (2) history of 2 or more episodes of major depression, or chronic mood symptoms for 2 years (odds ratio, 2.1; 95% confidence interval, 1.41-2.76). Patients with both risk factors were approximately 3 times more likely to relapse than patients with neither. CONCLUSIONS: The relapse rate among primary care patients treated for depression approached that of specialty samples, with more than one third reporting relapse in 1 year. Clinical characteristics can help target high-risk patients for relapse prevention efforts.

Adult↗
PubMedDate not supplied

Percutaneous varicocele embolization versus surgical ligation for the treatment of infertility: changes in seminal parameters and pregnancy outcomes.

PURPOSE: To compare the success of percutaneous varicocele embolization to surgical ligation with regard to changes in semen characteristics and pregnancy outcome. MATERIALS AND METHODS: Infertility records from 346 men who underwent correction of their varicocele for infertility (surgical ligation 149; embolization 197) were reviewed retrospectively. Preprocedural and postprocedural semen analyses and pregnancy outcomes were obtained with use of chart and telephone follow-up. RESULTS: In men who successfully impregnated their partners, there were significant improvements in sperm density, percent total improvement, motility, and progression. Postprocedural (embolization vs surgery) percentage increases in seminal parameters were density, 156.8% versus 138.5%; total, 168.8% versus 157.91%; and motility, 2.7% versus 3.2%. The percent of individuals who had a change in sperm progression was 31% versus 41%. There was no statistical difference between the techniques based on t tests. The pregnancy rates were similar for the two groups, 39% and 34% for embolization and surgery, respectively. CONCLUSION: There is no significant statistical difference in seminal values or pregnancy outcome between the two techniques.

Adult↗