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Biomedical subjects

C Phillips

Publications and source records attributed to C Phillips.

At least 145 records · Page 8Linked to original sources
PubMed1995

The Short Form-36 is preferable to the SIP as a generic health status measure in patients undergoing elective total hip arthroplasty.

OBJECTIVE: To assess the comparative usefulness of the Short Form-36 (SF-36) and the Sickness Impact Profile, (SIP) as generic health status measures in total hip arthroplasty. METHODS: Analysis of preoperative and 3-month data of 54 consecutive patients undergoing total hip replacement for osteoarthritis or rheumatoid arthritis. Instruments were mailed to patients preoperatively and 3 months postoperatively. RESULTS: In 10 of the 12 SIP subscales, but just 1 of the 8 SF-36 subscales, more than 40% of the patients had scores of zero. On a 100-point scale, the median global SIP was 12 (range 0-40) whereas the median global SF-36 was 50 (range 10-85). This indicates that many items of the SIP were not germane to patients undergoing joint arthroplasty. The global and, particularly, the physical dimensions of the SF-36 were more responsive than their SIP counterparts, as measured both by the standardized response mean (1.26 and 0.88, respectively) and the correlation with self-perceived improvement in quality of life (r = 0.37 and 0.26, respectively). The SF-36, but not the SIP, discriminated between patients with relatively good physical performance at 3 months with respect to their ability to work, to play sports, or to garden. CONCLUSION: The SF-36 is briefer, more relevant, and more responsive than the SIP and is preferable as a generic health status measure in patients undergoing elective hip arthroplasty. The SF-36 should be tested in other populations as well as other conditions to determine whether it is a superior generic health status instrument for evaluative research in orthopedic surgery.

Aged↗
PubMed1995

Short- and long-term outcome of esophageal perforation.

Esophageal perforation is an important complication of endoscopy and dilation, but few data are available regarding long-term outcome in these patients. Thirty-one consecutive patients with esophageal perforation were studied. Long-term outcome was determined by office follow-up and questionnaires via mail or telephone. The study group included 16 men and 15 women with a mean age of 61 +/- 4 years. Instrumentation was the principal cause of perforation (77%), and pain was the principal symptom in the majority of cases. However, some patients reported no pain, their only symptom being shortness of breast or dysphagia on swallowing saliva. Contrast examinations were used to establish the diagnosis, but results were initially negative in 3 of 27 patients (11%). Seven patients were treated nonsurgically (nasogastric drainage, antibiotics, and intravenous alimentation). Fourteen patients underwent primary closure of the esophageal rent. Six patients underwent surgical drainage, 3 underwent total esophagectomy, and 1 died during surgery before the esophagus was exposed. Thirty-day mortality was 6.4%. Mean hospital stay was 26 +/- 5 days. Postdischarge follow-up was available in 28 of the 29 patients (97%) surviving initial hospitalization, and the mean follow-up was 47 +/- 9 months. Nineteen patients had persistent dysphagia, and 6 underwent dilation again. One of these patients had a second perforation. Contrary to results of some earlier studies, the mortality from esophageal perforation was low in our study because of early intervention in suspected cases. Results of contrast studies are sometimes negative in the early stages after perforation, and studies may need to be repeated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

The accuracy of video imaging in orthognathic surgery.

Video imaging is an important emerging technology in planning orthognathic surgery and educating patients about the esthetic effects of treatment. The presurgical cephalograms of 56 patients, 41 with mandibular advancement alone and 15 with mandibular advancement plus genioplasty, were digitized, and the computer-generated soft tissue "line drawing" predictions were compared with the actual posttreatment cephalograms. Video images of the patients' presurgical lateral view were obtained, and two experienced clinicians compared the computer generated video image predictions with the actual posttreatment profile. Video images judged very good or excellent were considered acceptable for treatment planning; 60% to 83% met this criterion, depending on the profile area viewed. The percentage of acceptable images in the lower lip, labiomental fold, and chin area decreased with the addition of a genioplasty. The predicted and actual posttreatment soft tissue line drawings were quite similar for all areas except for the lower lip region, where statistically significant differences were noted, with the predicted lower lip more retrusive and thinner than the actual contours. For the lower lip and chin, a 2 mm or more discrepancy was observed in 20% of the patients. In all cases, the actual image was judged more esthetic than the predicted image, allaying fears of unrealistically optimistic computer generated predictions.

Adult↗
PubMed1995

The randomized clinical trial as a powerful means for understanding treatment efficacy.

The comparison of technologies, ie, alternative ways to accomplish the same aim, is inherently difficult. In orthodontics, technology covers a wide spectrum of areas: variations in treatment approach, appliances, wires, diagnostic procedures, and patient management techniques. Clinical trial methodology has been developed to minimize the effect of bias and to provide more objective answers to questions of comparative efficacy and benefits of particular treatments or procedures. The randomized controlled clinical trial (RCT) is now generally considered the strongest research design for the comparison of treatments. This report reviews four issues that should be addressed in planning an RCT: defining the study cohort, selecting the treatment allocation technique, estimating sample size, and performing the trial.

Data Interpretation, Statistical↗
PubMed1995

Stability of the palatal rugae as landmarks for analysis of dental casts.

The aims of this study were to determine if the palatal rugae are stable during normal growth, and whether treatment with either headgear or functional appliances affects the position of the rugae. Initial and 15-month recall dental casts of 94 patients enrolled in a study of early Class II treatment were evaluated. The children had been randomly assigned to one of three groups: control (n = 34), headgear (n = 30), and functional appliance (n = 30). Landmarks on the palatal raphe and palatal rugae were recorded using the Reflex Metrograph. A median palatal plane was constructed using the digitized raphe points as reference. Offsets from this plane to the ruga points and transverse and anteroposterior linear distances between ruga points were obtained for all casts. Transverse offsets and linear distances between medial points of the first rugae and the anteroposterior distances between the medial points of the second and third rugae did not show statistically significant changes in all groups. Significant changes were observed for the lateral points of the rugae, particularly in the headgear group. The medial rugae appear to be suitable anatomic points for the construction of stable reference planes for longitudinal cast analysis.

Analysis of Variance↗
PubMed1995

The influence of video imaging on patients' perceptions and expectations.

Seventy-four patients, ranging in age from 15 to 50 and presenting with a moderate to severe dentofacial deformity requiring orthognathic surgery, were randomly assigned to a video imaging or a standard case presentation (CP) group. Motives for treatment did not differ significantly between the video image and standard CP groups. Two weeks after the case presentation, 60% of the standard CP group and 74% of the video image group ranked the anticipated change in facial appearance as an important factor in making a treatment decision. Seventy percent of the standard CP group and 83% of the video image group agreed with the statement that surgery would be necessary to correct their problem. In the standard CP group, 47% of the patients ranked dental casts as the most helpful physical record in making a treatment decision, and 46% said the acetate profile tracing was the most helpful tool for understanding what to expect from treatment. In the video imaging group, 42% of the patients said the video imaging presentation was the most helpful tool in making a treatment decision, and 39% of the patients said it was the most helpful tool for understanding treatment expectations. The proportion of patients in the video image case presentation group with elevated self-image expectations following treatment was significantly higher (P = .045) than in the standard case presentation group. The presentation of video images appears to be a valuable information source for conveying treatment options to patients, but caution may be needed to prevent elevated or possibly unrealistic treatment expectations.

Adolescent↗
PubMed1995

Self-concept, Class II malocclusion, and early treatment.

Increased overjet has been associated with teasing, negative stereotyping, and low self-concept. Early treatment for children with Class II malocclusion is often recommended under the assumption that an improved dental appearance may benefit a child by increasing his or her social acceptance and hence self-concept. The self-concept of 208 patients, age 7 to 15 years and with increased overjet, was measured before treatment using the Piers-Harris self-concept scale; a subset of 87 of these children were measured again after 15 months of early growth modification. The mean self-concept score for these children was above the population norm, and there was no association between the child's score and the magnitude of his or her overjet or age. Although some significant associations were found between Class II malocclusion features and self-concept scores, the explained variation in self-concept scores was low (R2 from 5% to 8%). There was no change in the mean self-concept score of these children during early treatment, nor was there any association between reduction of Class II malocclusion features and improved self-concept. These findings suggest that children with Class II malocclusion do not generally present for treatment with low self-concept and, on average, self-concept does not improve during the brief period of early orthodontic treatment.

Adolescent↗
PubMed1995

The structure of social engagement among nursing home residents.

This research tests the reliability and construct validity of social engagement, a new quality of life measure embedded in the federally mandated Resident Assessment Instrument (RAI) for the nursing home population. The sample consisted of 1,848 residents from 268 homes in 10 states with data collected by trained research nurses. Three resident groups were formed based on residents' cognitive and ADL functioning. Social engagement was significantly related to average time spent in activities across all three groups. We hypothesized a four-factor model with social engagement distinct from mood problems, conflicted relationships, and behavior problems. LISREL confirmatory factor analysis found the data to be consistent with this hypothesis (Fit Index > .98). Intercorrelations between factors showed that for high-functioning residents, engagement was negatively related to conflict but was positively related to conflict among the most impaired. The validity of the social engagement measure and its stability across types of residents suggest its potential utility as a marker of nursing home quality.

Activities of Daily Living↗
PubMed1995

Evaluating Alzheimer's special care units: reviewing the evidence and identifying potential sources of study bias.

Special Care Units (SCUs) for Alzheimer's disease have been proliferating in long-term care, but their effectiveness remains unproven. This review summarizes the published studies, presents and discusses the many potential sources of bias that pose special problems for SCU research, and proposes strategies for conducting and interpreting future outcome studies in this difficult research setting.

Aged↗
PubMed1995

Recounts of elderly deaths: endorsements for the Patient Self-Determination Act.

Circumstances in the last 3 days of life were examined for a sample of 1,227 elderly decedents in Fairfield County, Connecticut, in 1985. Interviews were with a surviving next-of-kin or a nonrelative about 3 months after the event of death. Most decedents were in a hospital or a nursing home the night before death (45% and 24%, respectively). In the days preceding death, about 34% of the decedents knew that death was impending and about 40% had difficulty recognizing family members. These and other findings support the need for elderly people to complete advance directives.

Advance Directives↗
PubMed1995

Evaluation of the use of orthodontic records to measure the width of keratinized tissue.

Understanding the gingival tissue response in patients undergoing orthodontic treatment requires accurate pretreatment measurements of the width of the attached and keratinized tissue. Even though these may not be routinely recorded, it has been suggested that the orthodontic records can provide an accurate method of assessing the pretreatment keratinized tissue width. This clinical study was conducted to compare measures of the width of the keratinized tissue calculated from intraoral photographs and study models with direct clinical measures. Maxillary and mandibular study models and intraoral photographs were obtained from 33 patients. The width of the keratinized gingiva facial to the mandibular incisors was measured on two occasions to the nearest 0.5 mm. The width of the gingiva was calculated for the same teeth from two measures taken from projected photographic slides and the study models using a modification of Coatoam's technique. The method error was determined to be 0.43 mm for clinical measures and 0.32 mm for the calculated gingival tissue width. The reliability of measurement from orthodontic records was slightly greater than direct clinical measurement, with intraclass correlations of 0.93 and 0.90, respectively. The differences between the averaged clinical measure and averaged calculated measure for each tooth were small and not statistically significant (paired t-test, P = 0.21, 0.66, 0.24, 0.24 for teeth 23 through 26 respectively). The results indicate that carefully taken photographic slides and study models can provide an accurate measure of keratinized tissue width.

Adolescent↗
PubMed1995

An unusual foreign body in the hand: delayed presentation of an intact human tooth. A case report.

A 44 year old man presented with a painful, swollen right hand 10 days after a brawl. A radiography showed an intact human tooth embedded in the soft tissue between the metacarpals of the middle and index fingers. The tooth was removed, and the wound debrided and left to heal by second intention. He made a complete recovery. This case emphasizes the importance of a plain radiography, particularly when skin has been breached, and of removal and adequate debridement. Our patient was lucky to have had a successful outcome after so long a delay in treatment.

Adult↗
PubMed1995

In vitro and in vivo validation of time domain velocity and flow measurement technique.

This study was undertaken to validate the time domain processing method for measuring (1) the peak velocity in comparison to pulsed-wave spectral Doppler findings in an in vitro system; (2) the volumetric flow in comparison to the actual flow measured by a graduated cylinder in an in vitro circulation; and (3) the volumetric flow in comparison to a transit time flowmeter in a permanently instrumented neonatal lamb model. A prototype implementation of time domain processing in a commercial ultrasound device was used. For velocimetry, both time domain processing and Doppler methods showed low variance, low intrarater variability (0.03 and 0.09%, respectively), high reliability coefficients (97% and 96%, respectively), and a significant correlation (r = 0.96; P < 0.001). For in vitro flow quantification, time domain processing and graduated cylinder methods showed low variance, low intrarater variability (0.09 and 0.01%, respectively), high reliability coefficients (99.60% and 99.96%, respectively), and a significant correlation (r = 0.98, P < 0.001). For in vivo flow quantification, time domain processing and transit time flowmeter showed a significant correlation (r = 0.96; P < 0.001). Within the limits of the in vitro and in vivo experimental conditions, this study proves the validity of the time domain processing sonographic technique for measuring peak flow velocity and volumetric flow.

Analysis of Variance↗
PubMed1995

The impact of transrectal ultrasound on stage migration in a predominantly African-American population.

An important question left unanswered is whether transrectal ultrasound will result in earlier diagnosis in African Americans. Tumor registry data for 1985 and 1990 for a predominantly African-American population were reviewed to determine whether transrectal ultrasound influenced the stage at diagnosis of prostate cancer. Diagnosis by ultrasound increased from 0% to 60% of cases in those 5 years. Curable diseases (stages A and B) increased from 38% to 57% of cases. It is concluded that transrectal ultrasound can increase the diagnostic yield of potentially curable disease in a predominantly African-American population.

Aged↗