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Biomedical subjects

E McGuire

Publications and source records attributed to E McGuire.

8 recordsLinked to original sources
PubMed1990

A bleeding risk index for estimating the probability of major bleeding in hospitalized patients starting anticoagulant therapy.

PURPOSE: To construct and test prospectively a bleeding risk index for estimating the probability of major bleeding in hospitalized patients starting long-term anticoagulant therapy. PATIENTS AND METHODS: In an inception cohort of 617 patients starting long-term anticoagulant therapy in one hospital, data were gathered retrospectively and bleeding was classified using reliable explicit criteria. We constructed a bleeding risk index by identifying and weighting independent predictors of major bleeding using a multivariate proportional-hazards model. The bleeding risk index was tested in 394 other patients prospectively identified in a second hospital. The index was compared to physicians' predictions. RESULTS: Major bleeding developed before discharge in 61 of all 1,011 patients (6%). The bleeding risk index included four independent risk factors for major in-hospital bleeding: the number of specific comorbid conditions; heparin use in patients aged 60 years or older; maximal prothrombin or partial thromboplastin time 2.0 or more times control; liver dysfunction worsening during therapy. In the testing group, the index predicted major bleeding, which occurred in 3% of 235 low-risk patients, 16% of 96 middle-risk patients, and 19% of 63 high-risk patients (p less than 0.001). The bleeding risk index performed as well as physicians' predictions, and integration of the bleeding risk index with physicians' predictions led to a classification system that was more sensitive (p = 0.03) than physicians' predictions alone. In 86% of patients with a high risk of major bleeding, we identified specific ways of improving therapy, e.g., avoiding overanticoagulation and nonsteroidal anti-inflammatory agents. CONCLUSION: The bleeding risk index provides valid estimates of the probability of major bleeding in hospitalized patients starting long-term anticoagulant therapy and complements physicians' predictions. The possibility that bleeding can be prevented in high-risk patients warrants prospective evaluation.

Aged↗
PubMed1990

Clinical findings associated with acute proximal deep vein thrombosis: a basis for quantifying clinical judgment.

PURPOSE: To identify clinical findings useful in estimating the probability of acute proximal deep vein thrombosis (DVT). PATIENTS AND METHODS: The records of 355 symptomatic patients who underwent ascending venography were reviewed. Data on 76 clinical items were collected using standardized forms. Venograms were interpreted according to standard criteria and interobserver agreement was evaluated in a sample of 119 venograms. Independent clinical correlates of proximal DVT were identified using multivariate discriminant analysis in 236 randomly chosen patients; they were tested in the remaining 119 patients. RESULTS: Acute proximal DVT was shown by venogram in 96 patients (27%). Five independent clinical correlates of proximal DVT--swelling above the knee of the affected leg, swelling below the knee, recent immobility, cancer, fever--predicted proximal DVT in the testing group; in patients with none, one, or two or more of these clinical findings, proximal DVT was present in 5%, 15%, and 42%, respectively. If venography had been performed only in patients with one or more of the five factors, 97% of cases of proximal DVT would have been diagnosed and venography would have been avoided in 26% of patients with normal test results. CONCLUSION: These data provide a quantitative basis for estimating the probability of proximal DVT on the basis of clinical findings in symptomatic patients. How these findings can best be integrated with noninvasive testing and venography into diagnostic strategies for DVT remains to be determined.

Adult↗
PubMed1987

Construction of a low pressure reservoir and achievement of continence after "diversion" and in end stage vesical dysfunction.

Creation of a continent low pressure urinary reservoir was attempted in 33 patients: 11 with a supravesical diversion, 6 with a vesicostomy, 9 treated by catheter drainage and 7 with end stage bladder disease. The common problems were poor urine storage associated with bladder fibrosis, defunctionalization and decentralization or spinal cord injury coupled with a poorly functional urethral continence mechanism. The over-all outcome at a mean of 21 months (range 4 months to 11 years) was excellent in terms of upper tract function, reservoir capability and continence.

Adult↗
PubMed1976

The antecubital fossa fistula.

We have reviewed our experience with 19 proximal forearm arteriovenous fistulas used in chronic hemodialysis. Thirteen functioned adequately, and of these 10 were complicated by dislodge needles during dialysis, arm edema or hematomas. Although 3 patients developed symptoms of arterial steal, none required ligation of the fistula. This experience suggests that antecubital fossa fistulas might best be used as a second line angioaccess when distal forearm fistulas have been unsuccessful or are impossible to contruct.

Adolescent↗
PubMedDate not supplied

Students' sexual behavior, knowledge, and attitudes relating to the acquired immunodeficiency syndrome.

Five hundred ninety students receiving primary care in a university health service were surveyed anonymously in 1985-86 to study their self-reported sexual behavior and knowledge and attitudes about acquired immunodeficiency syndrome (AIDS). Most students (75%) were heterosexual; 3% were homosexual, 3% bisexual, and 15% had never been sexually active. Many students (32%) had greater than or equal to 2 sexual partners in the past year, but only 23% of these had changed their sexual practices because of concern about AIDS. Some students with high-risk sexual behavior were not very knowledgeable: among homosexual or bisexual men, those with greater than or equal to 6 recent sexual partners knew less than others (P less than 0.001). Overall, less knowledgeable students had more personal concerns about AIDS, favored limiting the social activities of people infected with human immunodeficiency virus (HIV), and favored screening for HIV-antibody; these associations between knowledge and attitudes were significant even when controlling for demographic characteristics and sexual behavior with multiple linear regression. The authors conclude that many students receiving primary care reported sexual behavior that could spread HIV, and that less knowledgeable students had particular concerns and attitudes about AIDS.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Sexual behavior, knowledge, and attitudes about AIDS among college freshmen.

We surveyed 158 college freshmen on an urban campus to determine their sexual practices and their knowledge and attitudes about acquired immunodeficiency syndrome (AIDS). Many students (47%) were heterosexually active; 1% were homosexual, 1% were bisexual, and 51% had not been sexually active. Among the 77 sexually active students, many engaged in activities that can facilitate transmission of human immunodeficiency virus (HIV): 58% did not always use condoms with a new partner; 31% had had two or more sex partners in the last year; 8% engaged in anonymous sex; and 14% of sexually active women had anal intercourse. Although most sexually active students said they would use condoms more or reduce the number of their sexual partners if they believed these changes would reduce "my risk for getting AIDS," few students had adopted these safer sexual practices. Safer sexual practices were associated with heightened personal concerns about AIDS but not with knowledge, which was at a high level. These findings underscore the need for preventive programs that overcome the gap between knowledge and safer sexual behaviors in this and similar groups of adolescents and suggest that programs that heighten personal concerns may be most effective. Community-based physicians who care for adolescents should develop such preventive programs and integrate them into their practices.

Acquired Immunodeficiency Syndrome↗