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Biomedical subjects

J E Goin

Publications and source records attributed to J E Goin.

At least 19 recordsLinked to original sources
PubMed1995

Sex differences in patient acceptance of cardiac transplant candidacy.

BACKGROUND: The overwhelming majority of cardiac transplant recipients are men. This can be partially explained by the earlier age at which heart failure develops in men. However, an underrepresentation of women also may reflect physician referral or selection biases or differences in patients' access to or acceptance of heart transplantation. METHODS AND RESULTS: We investigated whether sex bias occurred in the transplant candidate selection process at a single cardiac transplant center. We prospectively evaluated 386 individuals < 70 years of age (295 men, 91 women) referred for management of moderate to severe heart failure and/or cardiac transplant evaluation. Age, race, sex, heart failure type, New York Heart Association class, left ventricular ejection fraction, peak exercise oxygen consumption, disease duration, resting hemodynamic measurements, comorbidity index score, health insurance coverage, and estimated household income were recorded. For patients not accepted for transplantation, the reason for rejection was also obtained. Univariable and multivariable (logistic regression) analyses were performed comparing men and women and patients accepted and those not accepted for cardiac transplantation. Female sex was independently associated with rejection for cardiac transplantation (odds ratio, 2.57; P = .01). However, the reason for rejection (odds ratio, 2.57; P = .01). However, the reason for rejection was more likely to be patient self-refusal for women than for men (29% versus 9%), and female sex was independently associated with patient self-refusal (odds ratio, 4.68; P = .003). When patients who refused transplant were reclassified as accepted for transplant, female sex was no longer associated with nonacceptance. However, lower patient income was associated with nonacceptance for transplant. CONCLUSIONS: We found no evidence of sex bias in the selection of cardiac transplant recipients at our center. These findings suggest that the underrepresentation of women among cardiac transplant recipients may result, in part, from a sex difference in treatment preference, with a decreased willingness of women to undergo transplantation. The reasons for the difference in acceptance rates between men and women need to be elucidated.

Female↗
PubMed1995

Efficiency pattern analysis for medical rehabilitation.

Efficiency pattern analysis (EPA) is a technique proposed for use in medical rehabilitation that links patient functional gain to resource use, as approximated by length of stay (LOS), after adjusting for initial severity. The Functional Independence Measure version of the Function Relation Groups (FIM-FRGs) is used to adjust for patient severity and to define the efficiency groups. The efficiency groups are based on LOS and functional gain cut point values in the statistical distribution that are above, below, or within the national interquartile range for each of 53 FRGs. Data from 32,494 patients discharged in 1990 from 123 rehabilitation facilities were used. EPA is a simple way to monitor change in functional gain in response to transformations in health care practices and resource availability. The technique could also provide individual facilities with a means to evaluate treatment efficiencies across time and to compare patterns of LOS and functional gain to national norms.

Activities of Daily Living↗
PubMed1994

A case-mix classification system for medical rehabilitation.

Dissatisfaction with Medicare's current system of paying for rehabilitation care has led to proposals for a rehabilitation prospective payment system, but first a classification system for rehabilitation patients must be created. Data for 36,980 patients admitted to and discharged from 125 rehabilitation facilities between January 1, 1990, and April 19, 1991, were provided by the Uniform Data System for Medical Rehabilitation. Classification rules were formed using clinical judgment and a recursive partitioning algorithm. The Functional Independence Measure version of the Function Related Groups (FIM-FRGs) uses four predictor variables: diagnosis leading to disability, admission scores for motor and cognitive functional status subscales as measured by the Functional Independence Measure, and patient age. The system contains 53 FRGs and explains 31.3% of the variance in the natural logarithm length of stay for patients in a validation sample. The FIM-FRG classification system is conceptually simple and stable when tested on a validation sample. The classification system contains a manageable number of groups, and may represent a solution to the problem of classifying medical rehabilitation patients for payment, facility planning, and research on the outcomes, quality, and cost of rehabilitation.

Activities of Daily Living↗
PubMed1994

A comparison of low- with high-osmolality contrast agents in cardiac angiography. Identification of criteria for selective use.

BACKGROUND: Controversy exists as to whether low-osmolality radiographic contrast agents, which have less detrimental pharmacological effects but are considerably more expensive than high-osmolality agents, should be used universally or only for selected high-risk patients. METHODS AND RESULTS: A randomized, double-blind study was used to compare the frequency and severity of adverse events in 2245 consecutive patients undergoing diagnostic cardiac angiography. Two thousand one hundred sixty-six patients were successfully randomized to either iohexol, a low-osmolality contrast agent, or diatrizoate (as Hypaque 76), a high-osmolality agent. The end point event included clinically important adverse events (which jeopardized the patient or required aggressive treatment), contrast agent-related procedure abbreviations, and conversion to open-label contrast agent. Clinically important end point events were associated with increased age, New York Heart Association functional class, left ventricular end-diastolic pressure, arteriovenous oxygen difference, severity of coronary artery disease, and history of a previous reaction to contrast agent. End point events were less frequent in patients receiving iohexol (2.6% versus 4.6%; adjusted odds ratio, 1.59; 95% confidence interval, 0.97-2.60; P = .07). The difference in event frequency between iohexol and diatrizoate was confined to the highest-risk quartile of the patient population. An algorithm was developed to classify patients as being at high or low risk for an event based on patient age, New York Heart Association class, history of a prior contrast reaction, and left ventricular end-diastolic pressure. Application of this algorithm for selective use of low-osmolality agents only for high-risk patients to a theoretical population of 1000 patients reduced contrast agent costs 66% without increasing the frequency of contrast agent-related adverse events. CONCLUSIONS: The advantages of low-osmolality contrast agents are clinically important in patients with severe heart disease but are not in less ill patients. Universal use of low-osmolality agents for cardiac angiography in an unselected population is not necessary. Appropriately guided selective use of low-osmolality contrast agents is feasible and has the potential to reduce cost substantially without compromising safety or effectiveness.

Algorithms↗
PubMed1994

Radiographic resolution of community-acquired pneumonia.

Clinicians are frequently faced with patients in whom the radiographic resolution of community-acquired pneumonia seems delayed. Previous studies of radiographic resolution of the disease have yielded conflicting results. We prospectively assessed the radiographic resolution of pneumonia in 81 non-immuno-compromised patients, presenting to the emergency room and ambulatory clinics of a large university hospital, who met clinical and radiographic criteria for pneumonia. Serial chest radiographs were obtained every 2 wk for an initial period of 8 wk, and then every 4 wk until 24 wk had passed, or until all radiographic abnormalities had cleared. Forty-one of the 81 patients (50.6%) demonstrated complete clearance after 2 wk. Fifty of the 75 patients (66.7%) followed to 4 wk demonstrated complete clearance. The rate of clearance was inversely correlated with age (p < 0.001) and involvement of single versus multiple lobes (p < 0.0001) (log-rank test). Clearance was faster in those patients treated as outpatients (3.8 wk versus 9.1 wk, p = 0.03) and in patients who were nonsmokers (4.5 wk versus 8.4 wk, p = 0.05) (log-rank test). Multivariate regression analysis demonstrated that only age (relative risk for clearance, +0.79 per decade) and single versus multiple lobes involved (relative risk for clearance, 0.55 for more than one lobe) had independent predictive value (Cox proportional hazards regression model). The radiographic resolution of pneumonia occurs more rapidly in younger patients and in those with only a single lobe involved.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Energy expenditure and genotype of children with cystic fibrosis.

Increased energy expenditure, poor dietary intake, and fat malabsorption in patients with cystic fibrosis (CF) frequently lead to growth failure and malnutrition, which are associated with pulmonary failure and decreased survival. The study purpose was to understand better the energy expenditure and requirements in the mild pulmonary disease state in children. Resting and total energy expenditure were measured in 6- to 9-yr-old, pancreatic-insufficient children with CF (n = 25) and control children (n = 25) of similar age, gender, and weight. The effect of the most common genotype, homozygous delta F508, on energy expenditure was also investigated. Dietary intake, degree of fat malabsorption, body composition, physical activity, and clinical status were determined. The CF group had a 9% increase in resting energy expenditure, which was not related to genotype or severity of lung disease. Both CF genotype subgroups (delta F508 homozygous and all others) had a similar, modest resting energy expenditure increase. Total energy expenditure was increased by 12% in the entire CF group and by 23% in the delta F508 homozygous CF subgroup compared with controls. The total energy expenditure increase in delta F508 homozygous children may be related to increased voluntary physical activity, reflecting no activity reduction associated with lung disease, or to an unidentified genotype-related mechanism. The clinical implication is that a detailed physical activity assessment should be evaluated along with resting energy expenditure, either measured or estimated by equations, when daily energy needs are being determined for children with CF.

Anthropometry↗
PubMed1994

Four methods for characterizing disability in the formation of function related groups.

The Functional Independence Measure-Function Related Groups (FIM-FRGs) were developed to classify medical rehabilitation inpatients into homogeneous groups based on length of stay (LOS). Patients are first grouped into clinically relevant rehabilitation impairment categories, then by functional status, as expressed by the FIM, and in certain cases by patient age. The statistical approach used to form the final groupings was a recursive partitioning algorithm applied to the FIM scores and patient age within impairment category. This analysis compares four FIM-FRG classification schemes developed from four scale sets that combine FIM items differently: (1) use of the 18 FIM items as separate variables, (2) the combination of FIM items into six clinical subscales, (3) the combination of the six clinical subscales into motor and cognitive subscales, and (4) the combination of all FIM items into a single scale. The FIM-FRG schemes explain similar amounts of variance in the logarithm of LOS and contain approximately equal numbers of FRGs. The motor and cognitive subscale scheme is recommended for use in payment, however, this scheme and the other schemes have additional uses. Each FRG scheme provides different insight into the clinical relationship between disability and LOS.

Activities of Daily Living↗
PubMed1993

Patterns of authorship among chairmen of departments of medicine.

BACKGROUND: This study examines changes in the authorship patterns of chairmen of medicine departments from 1979 through 1990, a time when criteria for authorship were widely debated among medical journal editors. Chairmen were selected to be studied because, due to their leadership position and stature, they are likely to "set the example" for many scholars in the academic medicine community. METHOD: Computerized literature searches were conducted for all 233 persons who were chairmen during at least one year of the 12-year study period (1979-1990) to determine the average number of publications per chairman per year, the average number of coauthors per article published, the location of the chairman on the published list of authors, and other pertinent data required for a thorough analysis of authorship practices. Statistical methods included repeated-measure analysis, sensitivity analyses, and the use of linear models to analyze trends over time. RESULTS: Among all the chairmen, there was no statistically significant decrease in the average number of articles per year for which the chairmen were last authors, and there was a significant increase in the average number of coauthors per year on published articles. However, factors such as length of chairmanship, frequency of publication, and academic position (i.e., chair, pre-chair, or post-chair) were found to influence patterns of authorship; for example, the 61 individuals who were chairmen for ten years or more had a significant decrease in the number of last-author articles, whereas the 172 individuals who were chairmen for fewer than ten years had a significant increase. CONCLUSION: Changes in the definition of authorship by medical journal editors did not seem to be important influences on the authorship patterns of the chairmen, since the chairmen did not significantly decrease the number of articles for which they were the last authors, and they significantly increased the number of coauthors of their articles.

Authorship↗
PubMed1991

Quinidine-related mortality in the short-to-medium-term treatment of ventricular arrhythmias. A meta-analysis.

BACKGROUND: The interim results of the Cardiac Arrhythmia Suppression Trial requires physicians to use a higher threshold for employing antiarrhythmic agents in the treatment of benign or potentially lethal ventricular arrhythmias. Many have managed patients by switching to the traditional class I quinidine despite its known proarrhythmic tendency. METHODS AND RESULTS: To evaluate the relation between quinidine therapy and mortality in patients with benign or potentially lethal ventricular arrhythmias, we performed a meta-analysis on four randomized double-blind active controlled parallel trials evaluating 1,009 patients in which quinidine (n = 502) was compared to flecainide (n = 141), mexiletine (n = 246), tocainide (n = 67), and propafenone (n = 53). All four trials had similar patient selection, protocols, and methodology (e.g., placebo lead-in and Holter monitoring) but varying lengths of drug exposure. A total of 12 deaths were reported on quinidine and four deaths on the other drugs: two on mexiletine, one on flecainide, and one on tocainide. The statistical analysis of the mortality rates was based on techniques for combining data across separate strata. Based on maximum likelihood estimation, the combined risk of dying on quinidine was statistically significantly higher compared to the other four drugs with a risk difference of 1.6%. The 95% confidence interval was 0-3.1% (p = 0.05). The likelihood ratio test for uniformity of the risk difference across strata showed the trials to be homogeneous (p = 0.88). There was one death recorded for the placebo lead-in period (2 weeks' exposure for 624 patients and 1 week for 385 patients), and seven deaths were reported within 2 weeks on active drug treatment--six on quinidine and one on mexiletine. Furthermore, proarrhythmia was reported in 20 patients on quinidine versus 11 patients on the four other drugs (p = 0.09). CONCLUSIONS: These data suggest that quinidine may have an adverse effect on mortality as compared to other class I antiarrhythmic agents and that individualized patient selection for the use of this agent be carefully weighed relative to its potential for harm and benefit.

Anti-Arrhythmia Agents↗
PubMed1986

The "intelligent workstation" for cell-surface phenotyping based on principles of pattern recognition and image analysis.

Technical advancements in computer hardware and the associated computerized architectures allow the design and fabrication of dedicated, modestly expensive computerized workstations to aid humans in complex decision-making tasks. We refer to these as "Intelligent Workstations" because they accommodate the hypothesis-driven reasoning ability of the user into the system. Concomitant with the rapid developments in computers, diagnostic and therapeutic technologies related to cell analysis have undergone growth. Combining these technologies requires careful formulation and analysis of the diagnostic model involving image cytometry. Here we present a model of the intelligent workstation for image cytometry and illustrate its advantages in cell-surface phenotyping. Combining cell morphology with cell-surface phenotyping has clear diagnostic utility that no other widely available methods can supply. Although the reported results are based on samples of peripheral blood, cell suspensions of disaggregated cells can also be analyzed.

Aged↗
PubMed1983

Analysis of mammography: a blind interpretation of BCDDP radiographs.

An ROC curve analysis of mammography is presented. This study is based on a blind interpretation of radiographs of patients who underwent screening during the Oklahoma Breast Cancer Detection Demonstration Project (BCDDP). In particular, we evaluated the accuracy of mammography based on 38 incidence cancer cases. Incidence cases are those that develop in a patient after an initial visit and at least one additional annual visit before a biopsy is performed. Using 40 normal subjects, a sensitivity of 72% was attained at a 28% false positive rate. We also evaluated the contribution of viewing radiographs of both breasts (right and left) simultaneously as compared with viewing radiographs of the individual breasts singly. In cases on the threshold of detectability, the breast that did not result in the cancer diagnosis was occasionally identified as the most suspicious for cancer. When mammograms of the two breasts were compared, the false positive rate was lower. These results can be used to assess various screening strategies and to yield a more realistic accuracy estimate of mammography on a rescreened population than is currently available.

Biopsy↗
PubMed1983

Comparison of five digital scintigraphic display modes. An ROC curve analysis of detection performance.

In the last decade diagnostic imaging departments, even those of moderate size, have experienced unprecedented growth. Much of this expansion can be attributed directly to technological developments, including systems for the acquisition of diagnostic images in digital format. In modern imaging departments, digital-based systems are quite common and are found across the specialities of nuclear medicine, ultrasound, transmission and emission computed tomography, and angiography. Nuclear magnetic resonance is the newest digital-based modality, and it appears destined to achieve its place in the diagnostic arsenal. These systems all have one trait in common, which is the topic of this paper. They offer the potential of increasing diagnostic accuracy by varying the methods used to process and display the acquired imaged data. We present the results of a nuclear medicine study designed to compare observer performance among five digital scintigraphic display modes. The observer's task was to detect artificially created lesions in brain scintigrams. Each mode is defined by a combination of an image processing function and a method of display. Using 40 trained observers, a receiver operating characteristic curve analysis was performed. The results support the use of color displays in nuclear medicine.

Brain Diseases↗
PubMed1982

Diagnostic imaging system evaluation.

The purpose of this paper is to introduce new methodology for the evaluation of diagnostic imaging systems based on the assessment of diagnostic features by human observers. This methodology is intended to supplement the usual receiver operating characteristic (ROC) curve approach to imaging system evaluation. The approach is based on measuring the experimental evidence of a priori scientific propositions. The methodology requires simple calculations that can be implemented by clinical investigators. An example, based on diagnosis of sacroiliitis, is given to illustrate the method's usefulness in a diagnostic situation.

Arthritis↗
PubMed1982

Tomography for evaluation of sacroiliitis.

The radiographs and charts of 18 patients were reviewed to determine if sacroiliac joint tomography clarified the equivocal or clinically inconsistent findings of other imaging procedures. In six of eight patients with proven sacroiliitis, tomography detected joint erosions or sclerosis that were not detected on routine pelvis radiographs. In the other 10 patients, tomography excluded sacroiliitis which had been initially suggested by plain radiographs (four patients), quantitative sacroiliac scintigraphy (three patients), or clinical findings (three patients). The estimated average skin radiation exposure was 1.27 R (0.33 mC/kg) per tomographic section. The authors conclude that tomography improves delineation of sacroiliac joint abnormalities, but its use should be restricted to problem cases because of the high radiation exposure.

Adolescent↗
PubMed1982

A clinical study of the differences between the scoliotic angles measured on posteroanterior and anteroposterior radiographs.

The scoliotic angles of 128 curves in seventy-eight patients were measured on paired anteroposterior and posteroanterior upright radiographs that had been made on the same day. The association between the difference in the measured angles and the various clinical and curve parameters was examined. The angles on the anteroposterior and posteroanterior radiographs were highly correlated (r = 0.96). The angles on the posteroanterior radiographs were larger than those on the anteroposterior radiographs by a mean of 2.4 degrees for the thoracic curves and 1.7 degrees for the lumbar curves. Only the thoracolumbar scoliotic angles measured essentially the same on the two radiographic projections. The magnitude of the difference between the two measured angles was not correlated with the age of the patient, the direction of the curve, the magnitude of the curve, or the degree of deformity in the sagittal plane.

Adolescent↗