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Biomedical subjects

C M Schmitt

Publications and source records attributed to C M Schmitt.

18 recordsLinked to original sources
PubMed2003

The burden of illness of gastro-oesophageal reflux disease: impact on work productivity.

BACKGROUND: The impact of gastro-oesophageal reflux disease on work productivity has become increasingly important, as the symptoms of gastro-oesophageal reflux disease affect individuals in their productive years of life. AIMS: To assess the impact of gastro-oesophageal reflux disease on reduced work productivity and to identify the predictors of reduced productivity. METHODS: A sample of employed individuals reporting chronic heartburn was selected from US household mail survey respondents. Heartburn severity and frequency were recorded using a diary, and work productivity was assessed using the Work Productivity and Activity Impairment Questionnaire for Patients with Symptoms of Gastro-oesophageal Reflux Disease. Predictors of reduced productivity were evaluated. RESULTS: Over 30% of heartburn sufferers reported reduced productivity. Individuals with symptoms of gastro-oesophageal reflux disease (n = 1003) reported 6.0% reduced productivity attributable to symptoms. Over 48% of respondents with severe symptoms reported reduced productivity, compared with 40% and 12% of respondents with moderate and mild symptoms, respectively. Using logistic regression, severity, a younger age and nocturnal symptoms were associated with increased odds of reduced productivity. In those reporting nocturnal heartburn, medication use and sleep interference increased the odds of reduced productivity. CONCLUSIONS: Reduced work productivity is seen in a large proportion of subjects on prescription medication for gastro-oesophageal reflux disease. Symptom severity and nocturnal heartburn are significantly associated with reduced work productivity, particularly when nocturnal heartburn interferes with sleep.

Adult↗
PubMed2001

Pulmonary dysfunction in patients with femoral shaft fracture treated with intramedullary nailing.

BACKGROUND: This study was undertaken to determine whether alveolar dead space increases during intramedullary nailing of femoral shaft fractures and whether alveolar dead space predicts postoperative pulmonary dysfunction in patients undergoing intramedullary nailing of a femoral shaft fracture. METHODS: All patients with a femoral shaft fracture were prospectively enrolled in the study unless there was evidence of acute myocardial infarction, shock, or heart failure. Arterial blood gases were measured at three consecutive time-periods after induction of general anesthesia: before intramedullary nailing and ten and thirty minutes after intramedullary nailing. The end-tidal carbon-dioxide level, minute ventilation, positive end-expiratory pressure, and percent of inspired and expired inhalation agent were recorded simultaneously with the blood-gas measurement. Postoperatively, all subjects were monitored for evidence of pulmonary dysfunction, defined as the need for mechanical ventilation or supplemental oxygen (at a fraction of inspired oxygen of >40%) in the presence of clinical signs of a respiratory rate of >20 breaths/min or the use of accessory muscles of respiration. RESULTS: Seventy-four patients with a total of eighty femoral shaft fractures completed the study. Fifty fractures (62.5%) underwent nailing after reaming, and thirty fractures (37.5%) underwent nailing with minimal or no reaming. The mean alveolar dead-space measurements before canal opening and at ten and thirty minutes after canal opening were 14.5%, 15.8%, and 15.2% in the total series of seventy-four patients (general linear model, p = 0.2) and 20.5%, 22.7%, and 24.2% in the twenty patients with postoperative pulmonary dysfunction (general linear model, p = 0.05). Of the twenty-one patients with an alveolar dead-space measurement of >20% thirty minutes after nailing, sixteen had postoperative pulmonary dysfunction. According to univariate and multivariate analysis, the alveolar dead-space measurement was strongly associated with postoperative pulmonary dysfunction. CONCLUSIONS: According to our data, intramedullary nailing of femoral shaft fractures did not significantly increase alveolar dead space, and the amount of alveolar dead space can predict which patients will have pulmonary dysfunction postoperatively.

Adolescent↗
PubMed2000

Establishing a clinical research practice.

A clinical research practice can provide numerous benefits to a clinical gastroenterology practice. These benefits include new learning opportunities, enhanced community image, increased referral base, and improved practice revenues for the practitioner, as well as new treatment opportunities for the patient. A deliberate, business-like approach with appropriate personnel and space is necessary for a successful clinical research practice. All personnel should have a thorough understanding of good clinical practices. Avenues for obtaining a research grant are available, even for novice investigators, if the site is patient and committed. The purpose of this review is to explore the positive as well as the negative aspects of starting a clinical research practice, the requirements for getting the site started, finding the first study grant, and tasks to be anticipated during the conduct of a study.

Gastroenterology↗
PubMed1999

Misrepresentation of research criteria by orthopaedic residency applicants.

BACKGROUND: Previous studies have shown that applicants for postgraduate training may misrepresent research citations. We evaluated the research citations that were identified in a review of the Publications and Work and Research sections from the Electronic Residency Application Service (ERAS) data for all applicants to our orthopaedic residency program for the 1998 to 1999 academic year. METHODS: The citations were searched for on Medline. We initially used the name of the first author, then the name of the applicant, the name of the journal, the volume number, the issue number, and the page numbers. When a journal was not listed in Medline, an interlibrary search was instituted with use of the same format. When no match was made for any category, the citation was defined as misrepresented. Point estimates are reported as percentages. RESULTS: Publications were listed on sixty-four (30.0 percent) of 213 applications. One hundred and thirty-eight publications were cited; there were fifteen citations (10.9 percent) to book chapters, twenty-six (18.8 percent) to journals not listed in Ulrich's International Periodicals Directory, and twenty-one (15.2 percent) to articles listed as in press, in print, or submitted for publication. Seventy-six articles that had been cited as appearing in journals listed in Ulrich's Directory were checked and verified. Fourteen (18 percent) of these seventy-six publications were misrepresented. Misrepresentations included citations of nonexistent articles in actual journals and nonauthorship of existing articles. CONCLUSIONS: We concluded that publications listed on postgraduate applications should be scrutinized carefully. Copies of cited publications should be required by residency programs before applications are considered complete. The importance of professionalism needs to be emphasized in the curricula of medical schools. Residency training programs should develop guidelines regarding misrepresentation.

Authorship↗
PubMed1999

Overview of tools for outcomes assessment.

Tools for outcomes research can encompass local concepts such as a computerized database of endoscopy reports, or broader concepts such as a national database capturing similar data. Outcomes research may be defined by the investigator, but its results are important to the consumer, be it the patient or the payor. Databases, common to many endoscopy units, become outcomes research tools when the data are scrutinized for outcomes such as quality of life, mortality, and interventions that may improve cost-effective care. Enhanced knowledge of methods to capture these data will benefit all gastrointestinal endoscopists.

Endoscopy, Gastrointestinal↗
PubMed1999

Procedure-specific outcomes assessment for esophagogastroduodenoscopy.

For many, if not most, of our new technology applications, it is time for a broadening of study goals to include clinical endpoints such as health-related quality of life. Similarly, effectiveness studies to evaluate the application of known and new technology in every day practice, are needed. Establishing uniform definitions and terminology for important constructs such as comorbidity, disease severity, endoscopic findings, and complications must be undertaken in order to ensure accuracy of conclusions. Critical evaluation of how we deliver care to patients with upper GI diseases requiring endoscopy, must proceed with the knowledge that medical care is a process, and within that process, is the means to deliver care of ever increasing quality and efficiency. In this context, this article provides a brief overview of our current knowledge and potential of outcomes research in upper GI endoscopy.

Endoscopy, Digestive System↗
PubMed1997

Health-related quality of life after ileoanal pull-through evaluation and assessment of new health status measures.

BACKGROUND & AIMS: Health-related quality of life (HRQL) after proctocolectomy is a critical parameter for management decisions in patients with chronic pancolitis. The aim of this study was to evaluate the HRQL of patients with ileoanal pull-through and to validate new, easy-to-administer HRQL measures. METHODS: The Sickness Impact Profile (SIP), Short Form 36 (SF-36), Rating Form of Inflammatory Bowel Disease (IBD) Patient Concerns (RFIPC), and the time trade-off (TTO) were used to measure HRQL of pull-through patients. The SF-36 and the RFIPC were validated. RESULTS: HRQL of patients with ileoanal pull-through was better than that of a national sample of patients with IBD (SIP and RFIPC) and similar to that of a normal population (SF-36). Physical and psychosocial subscales of the SF-36 correlated with the SIP, affirming the construct validity of the SF-36. The RFIPC results correlated with the SIP and SF-36 results, suggesting that it is also a valid health status measure for these patients. TTO results correlated with the physical subscales of the SIP and SF-36, reflecting the impact of physical health on this group. CONCLUSIONS: HRQL of patients with ileoanal pull-through is excellent. The SF-36 and RFIPC are valid health status measures that can be used by clinicians and researchers in these patients.

Adult↗
PubMed1995

ERCP following laparoscopic cholecystectomy: a safe and effective way to manage CBD stones and complications.

The efficacy of ERCP in detecting and treating post-laparoscopic cholecystectomy problems was examined in a series of consecutive patients undergoing directed examination of the biliary tree over a two-year period. Three major diagnostic groups were identified: leaks and bile duct injuries (n = 9), retained common bile duct stones (n = 18), and post-cholecystectomy pain (n = 13). These diagnostic groups differed in degree of abnormal bilirubin (p = .004) and time between surgery and ERCP (p = .0005). Diagnosis of a post-operative complication was successful in 92% of attempted cases. Therapy was successful in 92% of attempted cases. Three patients developed mild pancreatitis as a result of ERCP. This series underscores the efficacy of a multi-disciplinary approach to problems which occur after laparoscopic cholecystectomy.

Adolescent↗
PubMed1994

Clues to patient dissatisfaction with conscious sedation for colonoscopy.

OBJECTIVES: Most colonoscopy is performed using conscious sedation to facilitate the procedure. However, little is known about which patients are dissatisfied with sedation and why. The goal of this study was to examine whether certain patient- and procedure-specific variables are associated with patient dissatisfaction. METHODS: A total of 403 consecutive outpatients underwent colonoscopy during a 4-month study period. Of 342 patients who met entrance criteria, 328 completed the initial questionnaire and were enrolled. Subjects received standard conscious sedation; after colonoscopy, the primary endoscopist and nurse recorded the level of sedation as adequate or inadequate. Twenty-four to 72 hr after the procedure, an independent observer contacted the subjects by telephone and asked whether they were satisfied with the level of sedation achieved during the colonoscopy. A number of patient- (age, gender, anxiety level, and educational background) and procedure-specific variables (waiting time and procedure type, difficulty, and duration) were analyzed to determine their association with patient dissatisfaction. RESULTS: Forty-eight patients (15%) were dissatisfied with sedation. Univariable analysis showed that females, anxiety, higher education (at least 1 yr of college), procedure duration > or = 60 min, and procedure difficulty were all associated with the dissatisfaction with sedation (p < 0.05). Multivariable analysis revealed that only higher education (p = 0.009) and longer procedure duration (p = 0.018) were associated with patient dissatisfaction. CONCLUSIONS: Highly educated patients and those who underwent longer procedures were more likely to be dissatisfied with conscious sedation used for colonoscopy. A thorough discussion of expectations and/or patient-controlled sedation might improve satisfaction with colonoscopy in educated patients. Regular supplementation of sedation, termination of a lengthy procedure with the offer of a further attempt at a later date, and referral to a more experienced endoscopist when appropriate might all improve patient satisfaction with colonoscopy.

Anxiety↗
PubMed1986

[Brazilian biomedical publications in the international scientific literature. Endemic communicable diseases].

The number of Brazilian periodicals listed in the Index Medicus dropped from 70 in 1964 to 15 in 1983, or 78%, while the total number of listed periodicals from other countries fell only 11%. The total number of articles published in Brazil on Chagas' disease, schistosomiasis, leishmaniasis, leprosy, malaria, and filariasis, and listed in the Index Medicus did not change significantly between 1965 and 1982, because, with the exception of the journal O Hospital, the Brazilian periodicals that published 74% of all articles on those diseases remained listed throughout the period considered. The predominant subjects in articles on endemic diseases were Chagas' disease and schistosomiasis, and in the later years there was a tendency to index more articles on basic than on applied research. The number of articles on Chagas' disease published by Brazilian authors directly in foreign journals increased considerably during the latter decade. Analysis of all the data together suggests that the developed countries select a specific portion of the Brazilian output of biomedical literature--which is kept listed in secondary and international publications or published directly in foreign journals--while another portion of the same output gradually loses visibility on the international scene.

Bibliographies as Topic↗
PubMedDate not supplied

An in vitro, randomized, prospective study to maximize cellular yield during bile duct brush cytology.

Endoscopic retrograde brush cytology is useful for the evaluation of biliary strictures. Access across a stricture can be maintained by removing the cytology brush while leaving the sheath in the bile duct. We examined the potential for loss of diagnostic cellular material in this setting using the canine biliary system. Twenty consecutive samples were randomly collected by (1) pushing the brush from the end of the sheath or (2) pulling the brush through the length of the sheath. Slides prepared from cell suspensions were scored by a cytopathologist blinded to the collection method. Pulling the brush resulted in a significant loss of cellular material (p < 0.001). In a second phase, 23 consecutive samples were randomly obtained in the same fashion. Combining salvage cytology of material from the sheath with cytology of the pulled-brush specimens produced cellular yields similar to those of specimens obtained by pushing the brush from the sheath. If the brush is pulled from the sheath during bile duct brush cytology, we suggest that salvage cytology be performed in order to maximize the diagnostic sensitivity.

Algorithms↗