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Biomedical subjects

E R McAnarney

Publications and source records attributed to E R McAnarney.

At least 19 recordsLinked to original sources
PubMed2001

Promoting education, mentorship, and support for pediatric research.

Pediatricians have an important role to play in the advancement of child health research and should be encouraged and supported to pursue research activities. Education and training in child health research should be part of every level of pediatric training. Continuing education and access to research advisors should be available to practitioners and academic faculty. Recommendations to promote additional research education and support at all levels of pediatric training, from premedical to continuing medical education, as well as suggestions for means to increase support and mentorship for research activities, are outlined in this statement.

Career Choice↗
PubMed2000

Measuring contributions to the clinical mission of medical schools and teaching hospitals.

This is the final report of a panel convened as part of the Association of American Medical College's (AAMC's) Mission-based Management Program to examine the use of metrics (i.e., measures) in assessing faculty and departmental contributions to the clinical mission. The authors begin by focusing on methods employed to estimate clinical effort and calculate a "clinical full-time equivalent," a prerequisite to comparing productivity among faculty members and departments. They then identify commonly used metrics, including relative-value units, total patient-care gross charges, total net patient fee-for-service revenue, total volume per CPT (current procedural terminologies) code by service category and number of patients per physician, discussing their advantages and disadvantages. These measures reflect the "twin pillars" of measurement criteria, those based on financial or revenue information, and those based on measured activity. In addition, the authors urge that the assessment of quality of care become more highly developed and integrated into an institution's measurement criteria. The authors acknowledge the various ways users of clinical metrics can develop standards against which to benchmark performance. They identify organizations that are sources of information about external national standards, acknowledge various factors that confound the interpretation of productivity data, and urge schools to identify and measure secondary service indicators to assist with interpretation and provide a fuller picture of performance. Finally, they discuss other, non-patient-care, activities that contribute to the clinical mission, information about which should be incorporated into the overall assessment. In summary, the authors encourage the use of clinical productivity metrics as an integral part of a comprehensive evaluation process based upon clearly articulated and agreed-upon goals and objectives. When carefully designed, these measurement systems can provide critical information that will enable institutional leaders to recognize and reward faculty and departmental performance in fulfillment of the clinical mission.

Efficiency, Organizational↗
PubMed1998

Effects of providing comprehensive ambulatory services to children with chronic conditions.

OBJECTIVE: To document the effects of a comprehensive program of care on the resource utilization and cost of care for children with chronic conditions. DESIGN: Descriptive study of 10715 admissions between 1984 and 1995 with analyses of costs based on charges. Comparisons were made with data from a national consortium of academic medical centers and from a national survey of hospitals. A 2-week survey of staff was conducted to identify their use of time in the care of these patients. PATIENTS: Children aged birth through 18 years meeting International Classification of Diseases, Ninth Revision, Clinical Modification criteria for chronic conditions. Patients with acute conditions were used as controls. INTERVENTION: A program of expanded care funded since 1989 by a regional insurance company. RESULTS: Between 1984 and 1995, mean length of stay for children with chronic conditions decreased from 83.9 to 10.6 days; mean annual admissions decreased from 2796 to 1622. Median hospital inpatient charges, adjusted for cost of living, decreased from $26.1 to $14.6 million. A $77.7 million savings occurred for inpatient care, with total expenditures from the insurance program of $3.6 million (a 21:1 ratio). Almost half the professional activities provided for these children were for services that could not be reimbursed in a fee-for-service model. Median adjusted inpatient charges were lower in Rochester, NY ($8746) than in other academic medical centers ($12773) or in a national survey of hospitals ($12462), and fewer children were readmitted within 30 days in Rochester (12.7%) than in other academic medical centers (15.0%). CONCLUSIONS: An investment of funds by a regional insurance company was associated with reduced costs, admissions, and lengths of stay for children with chronic conditions, and resulted in significant savings for the company. This model may be applicable to other centers.

Adolescent↗
PubMed1995

Maternal prepregnant weight and weight gain: relationship to placental microstructure and morphometric oxygen diffusion capacity.

This study examines the effects of maternal prepregnant weight and gestational weight gain on the size, microstructure, and function of the human placenta. Standard gross, histologic, and histomorphometric techniques were used to examine placentas obtained from the deliveries of 77 poor, black 12- to 30-year-old subjects in relation to maternal prepregnant weight and the rate of maternal weight gain during gestation. The weight, volume, and fetal capillary surface area of the placenta increased significantly in relation to both maternal prepregnant weight and the rate of maternal weight gain during gestation. Prepregnant weight was a more important determinant of placental size and fetal capillary surface area than was the rate of maternal weight gain. The rate of maternal weight gain was a more important determinant of the density of fetal capillary tissues within the placenta and of placental resistance to oxygen diffusion than was prepregnant weight. Both maternal prepregnant weight and the rate of maternal weight gain during gestation relate positively to the size of the placenta, but they have different, potentially complementary effects on placental microstructure and function.

Adolescent↗
PubMed1995

Violence among children and adolescents and the role of the pediatrician.

Violence has reached epidemic proportions in the United States and has become the single most important public health problem affecting adolescent males. It is believed that violence and its subsequent morbidity and mortality have a multifactorial origin, including developmental factors, gang involvement, access to firearms, drugs, the media, poverty, and family violence. Pediatricians have a critical role in reducing violence through early identification of family violence, education and counseling to decrease well-known risk factors, and provision of nonviolent problem-solving and coping strategies to children, youth, and their families. It is essential that we initiate preventive measures now rather than be paralyzed by the weight of the crisis.

Adaptation, Psychological↗
PubMed1995

Further evidence of reproductive immaturity among gynecologically young pregnant adolescents.

OBJECTIVE: To obtain further information about the reproductive maturity of adolescents who become pregnant soon after menarche. We hypothesized that the length of the follicular phase of the menstrual cycle antedating conception is related inversely to the gynecological age of the adolescent mother at conception. DESIGN: Observational clinical study. SETTING: Pregnant volunteers in a multidisciplinary adolescent-oriented maternity program. PATIENTS: Pregnant adolescents with accurate pregnancy dating. MAIN OUTCOME MEASURE: We studied the difference between the estimated date of confinement (EDC) computed from the stated last menstrual period (EDCLMP) and the EDC computed from ultrasound studies (EDCUS) in a group of 66, 12 to 19 year olds. A prolonged follicular phase was defined as EDCUS-EDCLMP > 0 and shortened follicular phase was defined as EDCUS-EDCLMP < or = 0. RESULTS: Pearson correlations revealed a statistically significant inverse relationship between gynecological age and the duration of the follicular phase antedating conception when the follicular phase was prolonged. Within this subgroup of patients EDCUS exceeded EDCLMP by 15.6 +/- 7.3 days when conception occurred within 3 years of menarche and 6.2 +/- 6.0 days when conception occurred > or = 3 years after menarche. CONCLUSIONS: Our findings support the hypothesis that some adolescents conceive before establishing a fully mature adult ovulatory pattern.

Adolescent↗
PubMed1994

Childhood victimization: relationship to adolescent pregnancy outcome.

Childhood sexual abuse is a common antecedents of adolescent pregnancy. We studied the pregnancies of 127 poor, black, 12- to 18-year-olds; 42 (33%) of whom reported that they had been physically or sexually abused prior to conception. We hypothesized that during pregnancy: (a) Previously abused adolescents report more stress and depression and less adequate social support than do nonabused adolescents; and (b) Previously abused adolescents obtain less prenatal care, gain less weight, engage in more substance abuse, and give birth to smaller babies than do nonabused adolescents. Consistent with the first study hypothesis, we found that abused adolescents scored significantly higher on stress and depression scales and rated their families as less supportive than did nonabused adolescents. Although there were no group differences in the rate of weight gain or the quantity of prenatal care obtained during pregnancy, abused adolescents were more likely to report substance use during pregnancy and gave birth to significantly smaller, (2,904 +/- 676 vs. 3,198 +/- 443 grams; p = .01), less mature (38.0 +/- 3.4 vs. 39.1 +/- 1.7 weeks; p = .05) infants. Our finding demonstrate the importance of asking pregnant adolescents about abuse.

Adolescent↗
PubMed1994

Adolescent pregnancy and subsequent obesity in African-American girls.

PURPOSE: Obesity is a significant contemporary health problem among African-American women. This study investigates whether excessive gestational weight gain during adolescent pregnancy is associated with subsequent obesity. METHODS: Thirty previously pregnant African-American adolescents on whom there were extensive extant anthropometric and psychosocial data were evaluated approximately 3.3 years following delivery. RESULTS: Rapid gestational weight gain (> .40 kg/wk) was associated with a 19.9% increase in body mass index (BMI); average gestational weight gain (.23 to .40 kg/wk) was associated with a 13.2% increase, and slow gestational weight gain (< .23 kg/wk) was associated with a 3.4% increase (difference between rapid and slow, p < 0.05). Adolescents who had high prepregnant BMIs were massively obese subsequently. CONCLUSIONS: 1. Rapid gestational weight gain is associated with a significantly greater percent change in the BMI compared with the slow gestational weight gain in adolescent pregnancy. 2. Adolescents who are obese prior to their first pregnancy often become even more obese on average 3.3 years following pregnancy. Such adolescents may be at particular risk of retaining gestational weight gain, and the consequences of their morbid obesity may be ultimately life-threatening.

Adolescent↗
PubMed1994

Pregnancy during adolescence.

Adolescent pregnancy continues to be one of our most challenging public health issues. Prevention is the most important goal that can be sought. Pediatricians can play a major role with young people and their families in pursuit of this goal. Young women who become pregnant must be referred early to obstetric care so that either early prenatal care can be established or an abortion can be performed early so as to prevent morbidity by delaying the procedure. New contraceptive methods such as contraceptive implants provide hope that improved contraceptive technology will aid in decreasing the likelihood of adolescent pregnancy.

Adolescent↗
PubMed1993

Skeletal maturity and growth of adolescent mothers: relationship to pregnancy outcome.

The purpose of this study was to evaluate the relationship between postpartum maternal bone age and the incidence of obstetric and neonatal complications in adolescent pregnancies. Bone age determinations were obtained on 93 poor, black 12- through 18-year-old adolescents during the puerperium. Results showed maternal bone ages ranging from 15 to 18 years; bone age was less than 18 years in 64 (68.8%) of the 93 adolescent mothers we studied. Maternal bone age correlated significantly with maternal chronologic age (r = 0.70) and prepregnant body size (r = 0.25) but did not correlate with total maternal weight gain and growth during pregnancy, the incidence of obstetric and neonatal complications, or infant birth weight and gestational age. Our findings suggest that many young, pregnant adolescents have the potential to grow during and after pregnancy, but do not support the hypothesis that ongoing maternal growth is an obstetric risk factor during adolescence.

Adolescent↗
PubMed1993

Factors associated with preterm delivery among pregnant adolescents.

The purpose was to identify characteristics of pregnant adolescents associated with preterm delivery. We studied 126 poor, black, 12 through 18-year-old pregnant adolescents and compared the prevalence of potentially high-risk maternal characteristics and obstetric complications in those who bore preterm and term infants. Of the adolescents studied, 12 (9.5%) delivered prematurely. Five maternal characteristics--conception within 3 years of menarche, a low body mass index, a past history of physical or sexual abuse, a socially deviant father of the baby, and vaginal bleeding during the first 8 weeks of gestation--were associated with preterm delivery. A theoretical model is proposed and the therapeutic implication of the study findings.

Adolescent↗
PubMed1993

Day care and teenage mothers: nurturing the mother-child dyad.

Children of adolescent mothers do not fare well cognitively or behaviorally over time. Both short-term and long-term studies corroborate these findings. Our preliminary data help us focus on the vulnerabilities and strengths of young mothers in their interactions with their children. We suggest, on the basis of these preliminary data, that intervention be directed toward nurturing the young mother and her infant or child in a day-care setting so that she can better learn to nurture her child. The gains to young mothers and children as well as to society will be substantial if we can decrease the very distressing morbidity observed long-term in the children of adolescent mothers.

Adolescent↗