Biomedical subjects

G S Cooper

Publications and source records attributed to G S Cooper.

113 records · Page 7Linked to original sources

PubMedDate not supplied

The clinical prognosis of HIV-1 infection: a review of 32 follow-up studies.

Thirty-two follow-up studies of patients with HIV-1 infection, but without AIDS at baseline, were examined for information on the risk of developing AIDS or other conditions. Disease progression in asymptomatic groups was similar to that found in patients with persistent generalized lymphadenopathy (PGL) without other symptoms. Among these asymptomatic and PGL groups, the risk of developing AIDS reached 10% to 15% between 24 and 36 months of follow up. The risk of progression to AIDS continued to increase in the studies with longer follow-up periods, reaching 36% at 88 months. However, more than 40% of "high-risk" groups (characterized by the presence of constitutional symptoms, oral thrush, herpes zoster, and/or low T4 counts) developed AIDS after only 36 months of follow-up. Reliable information about progression to other states (e.g., AIDS-related complex) has not been consistently provided.

AIDS-Related Complex↗

PubMedDate not supplied

How accurate are faculty evaluations of clinical competence?

OBJECTIVE: To determine the degree and sources of variability faculty evaluations of residents for the American Board of Internal Medicine (ABIM) Clinical Evaluation Exercise (CEX). DESIGN: Videotaped simulated CEX containing programmed resident strengths and weaknesses shown to faculty evaluators, with responses elicited using the open-ended form recommended by the ABIM followed by detailed questionnaires. SETTING: University hospital. PARTICIPANTS: Thirty-two full-time faculty internists. INTERVENTION: After the open-ended form was completed and collected, faculty members rated the resident's performance on a five-point scale and rated the importance of various aspects of the history and physical examination for the patient shown. MEASUREMENTS AND MAIN RESULTS: Very few of the resident's strengths and weaknesses were mentioned on the open-ended form, although responses to specific questions revealed that faculty members actually had observed many errors and some strengths that they had failed to document. Faculty members also displayed wide variance in the global assessment of the resident: 50% rated him marginal, 25% failed him, and 25% rated him satisfactory. Only for performance areas not directly related to the patient's problems could substantial variability be explained by disagreement on standards. CONCLUSIONS: Faculty internists vary markedly in their observations of a resident and document little. To be useful for resident feedback and evaluation, exercises such as the CEX may need to use more specific and detailed forms to document strengths and weaknesses, and faculty evaluators probably need to be trained as observers.

Clinical Competence↗

PubMedDate not supplied

An analysis of the quality of research reports in the Journal of General Internal Medicine.

Forty-four "original articles" published in the Journal of General Internal Medicine were reviewed using a rating instrument with 13 items developed from previously published standards for the design, analysis, and presentation of medical research. Each item was rated on a four-point (poor-to-excellent) scale. Inter-rater agreement was good (86% agreement; kappa = 0.65). Seven items received excellent or good ratings in 80% or more of the articles, but six problem areas were identified: description of study scope (generalizability), informed consent procedures, reliability assessments, references for statistical procedures or computer programs, and the use of descriptive and comparative statistics. Guidelines for these and other criteria are offered to help researchers prepare clear and informative reports.

Internal Medicine↗

PubMedDate not supplied

Exposure to 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDT) in relation to bone mineral density and rate of bone loss in menopausal women.

The organochlorine pesticide 2,2-bis(p-chlorophenyl)-1,1,1,-trichloroethane (DDT) and its metabolite 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE) are examples of an environmental contaminant that may have hormonal properties. Bone metabolism is both estrogen- and androgen-dependent. Exposures to various environmental endocrine disrupters can affect bone metabolism in animals, but there are no published data concerning the effect of DDE exposure on bone metabolism in humans. We hypothesized that high levels of DDE would be associated with lower bone density in peri- and postmenopausal women than in premenopausal women. Study subjects were drawn from the cohort of women who had participated in the Mount Sinai Medical Center Longitudinal Normative Bone Density Study (1984-1987). We used serum samples obtained at study entry to measure DDE levels in 103 (50 black, 53 white) women (mean age = 54.5 y [standard deviation = 5 y]). Measurements of bone mineral density at the lumbar spine and radius were made at 6-mo intervals during a 2-y period. DDE concentrations were significantly (p < .001) higher in blacks (13.9 ng/ml) than in whites (8.4 ng/ml), but there was no correlation between DDE concentration and bone density at the spine (mean levels = 1.065 g/cm2 and 1.043 g/cm2 in the lowest and highest quartiles, respectively, of DDE [trend p value = .85]) or at the radius (mean levels = 0.658 g/cm and 0.664 g/cm in the lowest and highest quartiles, respectively, of DDE [trend p value = .34]). Longitudinal analyses revealed no correlation between DDE and the rate of bone loss at either bone site. Similar results were seen in race-stratified analyses, as well as in analyses in which we controlled for lactation history and other potential confounders. We found little evidence that chronic low-level DDT exposure is associated with bone density in peri- and postmenopausal women.

Absorptiometry, Photon↗

PubMedDate not supplied

Small-area variations in rates of hospitalization and surgery within Rhode Island.

We analyzed variations in the usage rates and costs of 13 surgical procedures among 37 cities and towns in the state of Rhode Island. To compare different operations and years, we defined the deviation index, a percentage indicator similar to the coefficient of variation, but with chance variation removed. Tonsillectomy and disc excision were the procedures for which rates varied most around the state average; their deviation indexes for 1981 were 40.5 percent and 38.9 percent, respectively. In 14 areas, rates for one of these two procedures (standardized for age and sex) were significantly (p less than .01) above or below the state average; such outlying observations would have been expected for only one area if rates had been uniform statewide. To indicate the relative amount of surgery in an area combining rates for all 13 procedures, we computed the area's surgical index. This index, the average of the ratios of observed to expected cases (based on standardized statewide rates), doubled from the lowest- to the highest-rate areas. Overall, surgical hospital days, nonsurgical days, total hospital days, and hospital costs (all per 1,000 population) doubled from lowest- to highest-rate areas. If the rates of these 13 surgical procedures could be lowered in high-rate areas to not more than 20 percent above the state average, usage could drop by 4 percent. We conclude that even within the small state of Rhode Island, surgical practice varies considerably across communities. Identifying and studying areas with extremely high or low rates should enable more explicit consideration of the indications for surgery and perhaps lead to lower costs for medical care.

Adolescent↗