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Biomedical subjects

D Magid

Publications and source records attributed to D Magid.

At least 19 recordsLinked to original sources
PubMed2000

Universal versus targeted screening of infants for sickle cell disease: a cost-effectiveness analysis.

OBJECTIVE: To compare the health outcomes, costs, and incremental cost-effectiveness of universal neonatal screening for sickle cell disease (SCD) with screening targeted to African Americans. STUDY DESIGN: A cost-effectiveness analysis was done by using a Markov simulation model that considered the costs and outcomes associated with the prevention and treatment of sepsis in those with sickle cell anemia and sickle beta(0)-thalassemia. Three strategies were compared: (1) no screening, (2) targeted screening of African Americans, and (3) universal screening for SCD. RESULTS: In the base case analysis, targeted screening of African Americans compared with no screening cost $6709 per additional year of life saved, and universal screening compared with targeted screening cost $30,760 per additional year of life saved. In a sensitivity analysis, the cost per additional year of life saved with universal screening compared with targeted screening was positively correlated with the delivery rate of targeted screening and was inversely related to the proportion of African Americans in the population. CONCLUSIONS: Targeted screening of African American newborns for SCD compared with no screening is always cost-effective. Universal screening compared with targeted screening always identifies more infants with disease, prevents more deaths, and is cost-effective given certain delivery rates for targeted screening and proportions of African Americans in the population.

Anemia, Sickle Cell↗
PubMed2000

Interpretation of Emergency Department radiographs: a comparison of emergency medicine physicians with radiologists, residents with faculty, and film with digital display.

OBJECTIVE: We determined the relative value of teleradiology and radiology resident coverage of the emergency department by measuring and comparing the effects of physician specialty, training level, and image display method on accuracy of radiograph interpretation. MATERIALS AND METHODS: A sample of four faculty emergency medicine physicians, four emergency medicine residents, four faculty radiologists, and four radiology residents participated in our study. Each physician interpreted 120 radiographs, approximately half containing a clinically important index finding. Radiographs were interpreted using the original films and high-resolution digital monitors. Accuracy of radiograph interpretation was measured as the area under the physicians' receiver operating characteristic (ROC) curves. RESULTS: The area under the ROC curve was 0.15 (95% confidence interval [CI], 0.10-0.20) greater for radiologists than for emergency medicine physicians, 0.07 (95% CI, 0.02-0.12) greater for faculty than for residents, and 0.07 (95% CI, 0.02-0.12) greater for films than for video monitors. Using these results, we estimated that teleradiology coverage by faculty radiologists would add 0.09 (95% CI, 0.03-0.15) to the area under the ROC curve for radiograph interpretation by emergency medicine faculty alone, and radiology resident coverage would add 0.08 (95% CI, 0.02-0.14) to this area. CONCLUSION: We observed significant differences between the interpretation of radiographs on film and on digital monitors. However, we observed differences of equal or greater magnitude associated with the training level and physician specialty of each observer. In evaluating teleradiology services, observer characteristics must be considered in addition to the quality of image display.

Analysis of Variance↗
PubMed1999

Efficacy of three-phase bone scans in evaluating diabetic foot ulcers.

To evaluate the utility of bone scans in determining the treatment of diabetic patients with foot ulcers, a retrospective study was conducted. Medical records were reviewed for clinical signs of infection, laboratory data, and the radiologists' interpretations of imaging studies. During the study period, 34 bone scans were obtained by the treating physicians to evaluate diabetic foot ulcers. Among these, 22 of 34 bone scans were markedly confirmatory of being "consistent with osteomyelitis," 8 of 34 were moderately confirmatory ("indeterminate with regard to osteomyelitis"), and 4 of 34 were not confirmatory ("not consistent with osteomyelitis"). Of the 22 patients in the markedly confirmatory group, eight patients with clinical findings of uncontrolled infection or gangrene were treated with partial or complete amputation, whereas all others (14 patients) were treated with local wound care+/-intravenous antibiotics. Among the eight bone scans interpreted as indeterminate, three patients required partial or complete amputation, whereas the other five patients were managed with local wound care. Of the four patients with nonconfirmatory bone scans, two patients had evidence of dry gangrene and required amputation, whereas the other two patients did not have clinical evidence of infection or gangrene and were treated with local wound care. There was no significant difference in the amputation rate for patients with confirmatory, indeterminate, or nonconfirmatory bone scans for osteomyelitis (36%, 37%, and 50%, respectively) (P > 0.5). Therefore, the authors concluded that the ultimate treatment should be based on clinical indicators of the presence of uncontrolled infection or gangrene rather than on bone scan findings.

Adult↗
PubMed1999

Feline asthma syndrome in African lions (Panthera leo).

Feline asthma syndrome, previously recognized only in domestic cats, was diagnosed in three captive African lions (Panthera leo), one of which died as a result of the condition. Two of the lions displayed progressive signs for 7 yr, including severe bouts of coughing, wheezing, dyspnea, rhonchi, and tachypnea that were most severe during the spring and summer, and the third lion displayed acute signs only once. Scattered to diffuse increased interstitial markings, peribronchial cuffing, and focal atelectasis were visible in radiographs. At necropsy, multiple subpleural bullae, 2-3 cm in diameter, were scattered throughout the lung tissue. There were thick-walled bronchi and bronchioles filled with thick grayish mucus, and alveolar spaces were enlarged with severe, diffuse, banded multifocal areas of alveolar wall fibrosis. The lions had significantly elevated IgE type I immediate hypersensitivity responses to recognized aeroallergens. The captive management of lions should address the design and maintenance of allergen-free air supplies. Ventilation systems should be examined routinely and thoroughly cleaned of any residue. The frequency of examination should increase during the summer. Lions and other large cats should be routinely screened for IgE aeroallergen-specific titers, asthma cases should be treated promptly with prednisolone, and investigations of etiology should be initiated.

Air Microbiology↗
PubMed1997

Reliability of radiographic evaluation for acromial morphology.

OBJECTIVE: Bigliani's classification system of acromial morphology utilizing the standard outlet radiograph has become in accepted method for evaluating patients with rotator cuff disease. This study evaluates the interobserver and intraobserver reliability of Bigliani's classification system using observers at various levels of training. PATIENTS AND DESIGN: Supraspinatus outlet view radiographs of 40 patients (aged 18-78 years) with shoulder pain were reviewed twice, 4 months apart, in a masked protocol by six reviewers, including two attending (fellowship-trained) shoulder surgeons, an attending musculoskeletal radiologist, an orthopedic surgery sports fellow, and two orthopedic residents (PGY-2 and PGY-5). The reviewers were given standard diagrams of the Bigliani classification system and were asked to classify each film as a type I, II, or III acromion. Interobserver reliability and intraobserver repeatability values were calculated using kappa statistic analysis (0-0.2 slight, 0.21-0.4 fair, 0.41-0.6 moderate, 0.61-0.8 substantial, and 0.8-1.0 excellent). RESULTS AND CONCLUSION: For each of the two readings, all six observers agreed only 18% of the time. Kappa values for pairwise comparison of interobserver reliability among the six observers ranged from 0.01 to 0.75 (mean 0.35), and intraobserver repeatability ranged from 0.26 (PGY-5 resident) to 0.80 (fellowship-trained surgeon), with a mean of 0.55. Intraobserver repeatability was not significantly different for the different levels of expertise. More definitive criteria are needed to distinguish and classify the acromion.

Acromion↗
PubMed1996

Doxycycline compared with azithromycin for treating women with genital Chlamydia trachomatis infections: an incremental cost-effectiveness analysis.

OBJECTIVE: To compare the economic consequences of doxycycline therapy with those of azithromycin therapy for women with uncomplicated cervical chlamydial infections. DESIGN: Decision analysis in which the health outcomes, costs, and cost-effectiveness of two provider-administered treatment strategies for women with uncomplicated cervical chlamydial infections were compared: 1) initial therapy with doxycycline, 100 mg orally twice daily for 7 days (estimated cost, $5.51) and 2) initial therapy with azithromycin, 1 g orally administered as a single dose (estimated cost, $18.75). RESULTS: Under baseline assumptions, the azithromycin strategy incurred fewer major and minor complications and was less expensive overall than the doxycycline strategy despite a higher initial cost for acquiring antibiotic agents. In univariate sensitivity analyses, the azithromycin strategy prevented more major complications but was more expensive than the doxycycline strategy when doxycycline effectiveness was greater than 0.93. In a multivariate sensitivity analysis combining 11 parameter estimates selected so that the cost-effectiveness of the doxycycline strategy would be maximized relative to that of the azithromycin strategy, the azithromycin strategy resulted in fewer complications but was more costly. The incremental cost-effectiveness was $521 per additional major complication prevented. However, if the difference in the cost of azithromycin and doxycycline decreased to $9.80, the azithromycin strategy was less expensive and more effective, even under these extreme conditions. CONCLUSIONS: On the basis of the best available data as derived from the literature and experts, the azithromycin strategy was more cost-effective than the doxycycline strategy for women with uncomplicated cervical chlamydial infections. Despite the dominance of the azithromycin strategy over the doxycycline strategy, the adoption of the azithromycin strategy may be limited by the practical financial constraints of our currently fragmented health care system, in which the costs and benefits of preventing chlamydia sequelae are often incurred by different components of the system.

Analysis of Variance↗
PubMed1995

Economic analysis of roentgenogram use in the closed treatment of stable ankle fractures.

Fractures of the ankle are one of the most commonly treated injuries by orthopedic surgeons. The adequacy of closed treatment of stable lateral malleolar ankle fractures is frequently assessed by repeated roentgenograms. There are no standards, nor studies, however, that provide guidelines as to the necessity of such roentgenograms. This study was designed to determine the average frequency of follow-up roentgenograms in ankle fractures treated by casting, as well as the clinical impact of these roentgenograms. The clinical radiographic data base of a university hospital was reviewed to identify all ankle fractures treated between January 1, 1992 and June 30, 1993. A total of 82 patients satisfied the study criteria of having sustained a stable ankle fracture that was treated by closed means, with sufficient clinical and radiographic follow-up to assess healing of the fracture. All patients healed their fractures at an average of 8.4 weeks (+/- 3.0 weeks), with weight-bearing initiated at 4.0 weeks (+/- 2.7 weeks). No patients developed radiographic evidence of a talar shift during treatment, and none required surgery for a failure of closed treatment. At no time did any ankle exhibit a significant change in fibular alignment relative to the initial injury films. Each patient had an average of 4.5 (+/- 2.0) radiographic studies performed throughout their treatment. This study indicates that secondary displacement of either the talus or fibula in a stable ankle fracture is very unusual. In conjunction with the generally excellent outcome for such fractures, this suggests that frequent roentgenograms are not justified on clinical grounds.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Occupational injuries in a poor inner-city population.

This study aims to characterize occupational injuries in a defined poor inner-city population in terms of demographic features, types, and circumstances of injuries, and medical and financial consequences. It is a case series drawn from a larger population-based injury registry in emergency departments that serve 17 poor census tracts in Philadelphia. Of 335 patients from the study area who had been treated at the emergency departments under study for occupational injuries, 107 could be contacted by telephone 2 to 3 years after their injuries. Interviews sought information on the patients, their employment, their injuries, and the consequences. Respondents were almost all African-American, approximately 50% male, and had a median age of 32. Approximately one third were employed in the health care industry, one fourth in the service sector (including conventional service firms, restaurants, and hotels), and the remainder in construction, retail and wholesale trade, education, transportation, and manufacturing. Major causes of injuries included overexertion, contact with sharp objects, and falls. Major types on injuries included sprain/strains and lacerations. Approximately half the respondents had missed more than 3 days of work, with 15% missing more than 1 month. Almost 40% of respondents reported persistent health problems after their injuries. Only about one quarter had received workers' compensation. We conclude that poor and minority workers are at risk of a wide range of occupational injuries, which may result in considerable lost work time and have serious medical and economic consequences. More, attention to the workplace risks of these relatively marginalized workers and more vigorous preventive interventions are needed.

Accidents, Occupational↗
PubMed1995

The anatomy of the pelvis in the exstrophy complex.

We compared computerized tomography scans of the pelvis of twenty-four patients who had exstrophy of the bladder with scans of age-matched controls in order to analyze the pelvic deformity that accompanies the variably severe manifestations of this condition. The patients who had classic exstrophy of the bladder were found to have a mean of 12 degrees of external rotation of the posterior aspect of the pelvis on each side, retroversion of the acetabula, a mean additional 18 degrees of external rotation and 30 per cent shortening of the pubic rami, and progressive diastasis of the symphysis pubis. The foot-progression angle demonstrated 20 to 30 degrees of external rotation beyond the normal limits seen in early childhood, but this improved with age. The patients who had exstrophy of the cloaca and the bladder not only had all of these pelvic deformities to a greater degree but also had asymmetry of measured parameters between the right and left sides of the pelvis, malformation of the sacro-iliac joints, and occasional dislocation of the hip. An understanding of the pelvic anatomy that accompanies exstrophy is essential when corrective approaches are planned. Such an understanding will improve the rate of success of both closure of the bladder and control of urinary continence postoperatively.

Adolescent↗
PubMed1994

Computed tomographic imaging of the musculoskeletal system. Current status.

Computed tomography has emerged as the "workhorse" of specialized musculoskeletal imaging. It provides rapid, detailed, clinically relevant studies of bones, joints, and associated soft tissues. Applications in trauma, inflammatory disease, neoplasia, pediatric orthopedics, and joint reconstruction are discussed. Advances in prosthetic design, radiation oncology applications, and data acquisition techniques will also be addressed.

Fractures, Bone↗