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J B Goldman

Publications and source records attributed to J B Goldman.

4 recordsLinked to original sources
PubMed1999

A randomized comparison of extra-amniotic saline infusion and intracervical dinoprostone gel for cervical ripening.

OBJECTIVE: To compare extra-amniotic saline infusion to intracervical dinoprostone gel for preinduction cervical ripening. METHODS: Women with Bishop scores less than 5 were assigned randomly to either extra-amniotic saline infusion (n = 26) or intracervical dinoprostone gel (n = 26) for preinduction cervical ripening. A sample size of 50 would have 80% power to detect a 10-hour difference in the mean time from start of cervical ripening to delivery for the two methods of intervention, with a type I error of .05. RESULTS: The study populations were similar in age, gestational age, and initial Bishop score. They differed in parity, with 22 nulliparas in the extra-amniotic saline infusion group versus 13 in the dinoprostone gel group (relative risk [RR] 1.69, 95% confidence interval [CI] 1.11, 2.57). The number of women achieving a favorable Bishop score at 6 hours was greater with extra-amniotic saline infusion (n = 20) than dinoprostone gel (n = 9) (RR 2.14, 95% CI 1.22, 3.75). Mean time from start of ripening to delivery was 25.9 hours with extra-amniotic saline infusion and 30.2 hours with dinoprostone gel (P = .25). Birth weight, Apgar scores, umbilical artery pH, and infectious morbidity were similar between groups. CONCLUSION: More women achieved a favorable Bishop score at 6 and 12 hours after the start of cervical ripening with extra-amniotic saline infusion compared with dinoprostone gel. Saline infusion is as safe as dinoprostone gel for preinduction cervical ripening.

Adult↗
PubMed1991

Biomechanical evaluation of a biodegradable composite as an adjunct to internal fixation of proximal femur fractures.

Internal fixation of comminuted unstable fractures of the severely osteoporotic proximal femur is sometimes supplemented with polymethyl-methacrylate (PMMA). We here report an in vitro biomechanical evaluation of a biodegradable particulate composite that might be used for similar purposes. The composite includes a matrix phase consisting of a hydrolyzable prepolymer [polypropylene fumarate (PPF)] cross-linked with methacrylate monomer, and a particulate phase consisting of tricalcium phosphate and calcium carbonate. We implanted dynamic hip screws in 22 cadaveric proximal femora and measured the yield load for an oblique force applied to the femoral head. The hip screws were then reinforced with either PMMA or the PPF composite and tested again. On the basis of analysis of variance, the average increases in yield load for PMMA and PPF reinforcement of 1,750 and 1,130 N were statistically significant (p less than 0.00005), suggesting that both materials enhance congruence between implant and bone and thereby increase the projected load-bearing area of the implant. The increase in yield force with PMMA was slightly higher than the increase with PPF (p less than 0.05), but both values after reinforcement were close (3,790 +/- 561 N for PMMA vs. 3,240 +/- 669 N for PPF). If we can demonstrate that appropriate rates of degradation, bony ingrowth, and static and fatigue properties can be achieved in vivo with this system, our data suggest that this PPF composite may have potential as an adjunct to the internal fixation of unstable fractures of the osteoporotic hip.

Aged↗
PubMedDate not supplied

The significance of identity in the adjustment to diabetes among insulin users.

In this study, the social theory of identity was used to gain a better understanding of the complex process of how individuals adjust to having insulin-requiring diabetes. Semistructured interviews were conducted with 30 individuals to explore issues related to their personal experience with diabetes. Narrative methods were used to analyze the data. An exploration of participants' stories revealed significant identity issues underlying their interpretation and management of diabetes. The diagnosis of diabetes was conceptualized as an assault on personal identity. This initial disruption was followed by a process of negotiation whereby individuals grappled with identity issues to adapt to the condition and integrate it into their lives. This process was socially shaped and influenced individuals' perceptions of their diabetes management. The main concepts examined in this paper are diagnosis and identity, identity and treatment management, and identity and the ongoing nature of adjustment. The implications for diabetes education are presented.

Adaptation, Psychological↗