Biomedical subjects

Ilana F Gareen

Publications and source records attributed to Ilana F Gareen.

6 recordsLinked to original sources

PubMed2003

Explaining the association of maternal age with Cesarean delivery for nulliparous and parous women.

METHOD: We used data on 6,805 live births from the National Maternal and Infant Health Survey to examine the positive association between maternal age and Cesarean delivery. RESULTS: For parous women, the unadjusted risk ratio [RR] for Cesarean, comparing 35 year olds with 20 year olds, was estimated to be 1.40 [95% confidence limits (CL)=1.18, 1.65]; this association disappeared upon adjustment for obstetrical predictors and other factors (adjusted RR=1.04; 95% CL=0.80, 1.35). In contrast, for nulliparous women, the unadjusted risk ratio was 2.16 (95% CL=1.78, 2.63) and remained substantial upon adjustment (RR=1.74; 95% CL=1.25, 2.43). CONCLUSION: These results, along with baseline risk information, suggest that older nulliparous women and their obstetricians should be the target of future efforts to control Cesarean rates.

Adult↗

PubMed2003

Transportable versus fixed platform CT scanners: comparison of costs.

PURPOSE: To compare the aggregate hospital technical costs of a transportable computed tomographic (CT) scanner used to image patients in an intensive care unit with those of a fixed platform CT scanner in the radiology department. MATERIALS AND METHODS: Direct fixed costs (ie, machine and service contract costs) and direct variable costs (ie, personnel costs) were calculated. Indirect costs, including space costs and departmental overhead, were calculated. Total costs were calculated as the sum of indirect, direct fixed, and direct variable costs. Personnel costs were calculated from time-motion analyses involving 95 patients who underwent brain CT with either a transportable (n = 51) or a fixed platform (n = 44) CT scanner. Costs per examination were calculated by using both low- and high-examination-volume models and compared with use of the Wilcoxon rank sum test. RESULTS: The total cost per examination for the transportable scanner ranged from 108.98 dollars to 167.20 dollars for the high- and low-volume models. Total cost per examination for the fixed platform scanner ranged from 75.24 dollars to 112.39 dollars for the high- and low-volume models. For the transportable scanner, direct fixed, variable, and overhead costs were 87.05 dollars, 70.73 dollars, and 9.42 dollars per examination, respectively, with the low-volume model. The corresponding costs for the fixed platform scanner were 46.66 dollars, 55.69 dollars, and 10.04 dollars, respectively. CONCLUSION: The technical cost of using an in-hospital transportable CT scanner is higher than that of using a fixed platform scanner.

Costs and Cost Analysis↗

PubMed2003

Primer on multiple regression models for diagnostic imaging research.

This article provides an introduction to multiple regression analysis and its application in diagnostic imaging research. We begin by examining why multiple regression models are needed in the evaluation of diagnostic imaging technologies. We then examine the broad categories of available models, notably multiple linear regression models for continuous outcomes and logistic regression models for binary outcomes. The purpose of this article is to elucidate the scientific logic, meaning, and interpretation of multiple regression models by using examples from the diagnostic imaging literature.

Confounding Factors, Epidemiologic↗

PubMed2003

Intrauterine devices and pelvic inflammatory disease.

The intrauterine device (IUD) has experienced a resurgence of popularity. Much of this popularity is attributable to reassessments of the association between IUD use and pelvic inflammatory disease (PID) in which authors conclude that the association is attributable to factors other than the IUD. This article examines recent studies that assess the risk of PID with IUD use, explains why some of the assumptions on which the arguments regarding a lack of an association between IUD use and PID are based might not be correct, and recommends additional trials to evaluate IUDs as one of several contraceptive options.

Female↗

PubMed2002

Failure of macrolide antibiotic treatment in patients with bacteremia due to erythromycin-resistant Streptococcus pneumoniae.

The rate of macrolide resistance among Streptococcus pneumoniae is increasing, but some investigators have questioned its clinical relevance. We conducted a matched case-control study of patients with bacteremic pneumococcal infection at 4 hospitals to determine whether development of breakthrough bacteremia during macrolide treatment was related to macrolide susceptibility of the pneumococcal isolate. Case patients (n=86) were patients who had pneumococcal bacteremia and an isolate that was either resistant or intermediately resistant to erythromycin. Controls (n=141) were patients matched for age, sex, location, and year that bacteremia developed who had an erythromycin-susceptible pneumococcus isolated. Excluding patients with meningitis, 18 (24%) of 76 case patients and none of 136 matched controls were taking a macrolide when blood was obtained for culture (P=.00000012). Moreover, 5 (24%) of 21 case patients with the low-level-resistant M phenotype and none of 40 controls were taking a macrolide (P=.00157). These data show that development of breakthrough bacteremia during macrolide or azalide therapy is more likely to occur among patients infected with an erythromycin-resistant pneumococcus, and they also indicate that in vitro macrolide resistance resulting from both the efflux and methylase mechanisms is clinically relevant.

Adolescent↗

PubMed2002

Preferential use of sonographically guided biopsy to minimize patient discomfort and procedure time in a percutaneous image-guided breast biopsy program.

OBJECTIVE: To determine whether preferential use of sonographic guidance for percutaneous biopsy of breast masses results in a subset of patients with a shorter procedure time and less discomfort compared with patients undergoing stereotactic biopsy. METHODS: A prospective observational study was performed on 193 women undergoing percutaneous image-guided breast biopsy between 1997 and 1999. Data were collected on room time, physician time, and patient comfort levels for 122 stereotactic and 71 sonographically guided biopsies. Differences between stereotactic and sonographically guided biopsy for all lesions and for masses were analyzed for statistical significance. RESULTS: Mean room times were 62.2 minutes for stereotactic biopsy and 39.4 minutes for sonographically guided biopsy (P < .0001). Mean physician times were 23.0 minutes for stereotactic biopsy and 15.8 minutes for sonographically guided biopsy (P < .0001). When we limited our analyses to women undergoing biopsy for masses, the difference in physician time largely disappeared, but the difference in room time remained (P < .0001). Women undergoing stereotactic biopsy were more likely to report discomfort due to body positioning than were women undergoing sonographically guided biopsy (P < .001). These differences existed whether we included all lesions or restricted our analyses to masses. CONCLUSIONS: Preferential use of sonographically guided breast biopsy for masses results in shorter procedure times and less patient discomfort compared with prone stereotactic biopsy.

Aged↗