Biomedical subjects

J R Hebel

Publications and source records attributed to J R Hebel.

At least 55 records · Page 3Linked to original sources

PubMed1998

Accuracy of medical records in hip fracture.

OBJECTIVE: To determine the accuracy of diagnoses and procedure codes in medical records for hip fracture patients. DESIGN: A validation sample of hip fracture medical records was used to compare the facesheet data with progress notes, operative reports, and discharge summaries for patients in a prospective study of functional recovery. SETTING: Eight Baltimore hospitals with the highest volume of older hip fracture patients. PATIENTS: Study subjects were 343 community-dwelling patients, 65 years of age and older, admitted to one of eight Baltimore hospitals between January 1990 and June 1991 with a diagnosis of hip fracture. MAIN OUTCOME MEASURES: Facesheet diagnosis codes were compared with admitting notes, discharge summary, and/or progress notes. The abstracted surgical procedure was compared with postoperative radiographs. RESULTS: Excess coding of diagnoses on the hospital facesheet was evident in 12% of charts. In 17% of charts, a complication identified in the chart was not coded on the facesheet. More complications with low severity were omitted. Agreement between the abstractor's procedure review and radiograph readings for arthroplasty was 84%. In 15% of patients, the abstractor coded total arthroplasty when hemiarthroplasty was done. CONCLUSIONS: Discrepancy between the hospital facesheet and the medical record and between the abstracted surgical procedure and radiographs was found for hip fracture patients. This may make findings from health outcomes research relying on administrative databases uncertain and reimbursement inaccurate.

Aged↗

PubMed1998

Comparison of Escherichia coli strains recovered from human cystitis and pyelonephritis infections in transurethrally challenged mice.

Urinary tract infection, most frequently caused by Escherichia coli, is one of the most common bacterial infections in humans. A vast amount of literature regarding the mechanisms through which E. coli induces pyelonephritis has accumulated. Although cystitis accounts for 95% of visits to physicians for symptoms of urinary tract infections, few in vivo studies have investigated possible differences between E. coli recovered from patients with clinical symptoms of cystitis and that from patients with symptoms of pyelonephritis. Epidemiological studies indicate that cystitis-associated strains appear to differ from pyelonephritis-associated strains in elaboration of some putative virulence factors. With transurethrally challenged mice we studied possible differences using three each of the most virulent pyelonephritis and cystitis E. coli strains in our collection. The results indicate that cystitis strains colonize the bladder more rapidly than do pyelonephritis strains, while the rates of kidney colonization are similar. Cystitis strains colonize the bladder in higher numbers, induce more pronounced histologic changes in the bladder, and are more rapidly eliminated from the mouse urinary tract than pyelonephritis strains. These results provide evidence that cystitis strains differ from pyelonephritis strains in this model, that this model is useful for the study of the uropathogenicity of cystitis strains, and that it would be unwise to use pyelonephritis strains to study putative virulence factors important in the development of cystitis.

Animals↗

PubMed1998

Outcome after hemiarthroplasty for femoral neck fractures in the elderly.

A prospective outcome study was performed on 270 patients, 65 years of age and older, who sustained a femoral neck fracture and underwent hemiarthroplasty. The treatment compared was the use of a noncemented unipolar versus either a cemented or a press fit bipolar prosthesis. The outcome variables assessed included the occurrence of a postoperative complication, length and cost of hospitalization, and function in various quality of life measurements. Patients who underwent bipolar hemiarthroplasty with either a cemented or a press fit prosthesis had better pain relief and function than patients who had a noncemented unipolar prosthesis at a minimum of 24 months after surgery. However, the mean hospitalization cost for patients who had a bipolar prosthesis was $12,290 compared with $8876 for a unipolar prosthesis.

Activities of Daily Living↗

PubMed1998

Eight-year outcome associated with clinical options in the management of femoral neck fractures.

This study involved a review of the medical records of 367 patients treated surgically after femoral neck fracture. Linkage of these records with claims files from the Health Care Financing Administration allowed as many as 8 years of followup to analyze the rates of hospital readmission rates for revision, other postoperative complications and mortality. The results revealed: (1) a significantly higher revision rate was associated with internal fixation for the treatment of displaced femoral neck fractures in patients older than 80 years of age; no differences in revision rates were seen between internal fixation or hemiarthroplasty for the treatment of nondisplaced femoral neck fractures in this patient age group; (2) no differences in revision rates were found between internal fixation or hemiarthroplasty for the treatment of displaced femoral neck fractures in patients between the ages of 65 to 80 years; (3) a significantly higher mortality rate was associated with internal fixation than hemiarthroplasty for patients who were between the ages of 65 and 80 years; and (4) no differences in medical or surgical complications, revision rates, or other outcomes were found between unipolar and bipolar prostheses, or between anterior and posterior surgical approaches for hemiarthroplasty in patients who were age 65 years or older.

Age Factors↗

PubMed1998

Performance characteristics of microcatheter systems in a standardized tortuous pathway.

BACKGROUND AND PURPOSE: Published reports of controlled experiments designed to evaluate the performance of over-the-wire microcatheter systems are rare and have often been based on subjective impressions from small clinical series. This investigation was designed to compare the load forces required to propel state-of-the-art, hydrophilically coated microcatheters from each of four manufacturers through a standardized tortuous pathway constructed of polytetrafluoroethylene tubing. METHODS: Currently available hydrophilically coated microcatheters were provided by four manufacturers. A 20-cm long, three-dimensional pathway simulating the intracranial carotid circulation was constructed of 0.065-in. (inner diameter) polytetrafluoroethylene tubing and immersed in a water bath at 37 degrees C. Testing was performed using an Instron tabletop load frame fitted with a 2-lb load cell. Durability and load force tests were conducted using a 0.014-in. stainless steel noncoated guidewire, with the wire tip protruding 1 cm beyond the catheter tip. At least four samples of microcatheters from each manufacturer were tested. RESULTS: Extensive trackability testing of the guidewire alone established reproducible performance with maximum load forces of less than 8 g. Maximum gram forces for the four reinforced microcatheters were not greatly different, measuring between 9 and 14 g. Excessive buckling of the only nonreinforced catheter was initially overcome early in the pathway in a staccato, stepwise fashion. After reaching a critical load, however, the catheter and guidewire prolapsed. CONCLUSION: All reinforced microcatheters tested established good and reproducible performance in our model. Reinforced microcatheters provided superior trackability over the one nonreinforced device tested.

Angioplasty, Balloon↗

PubMed1997

Proxy reporting in five areas of functional status. Comparison with self-reports and observations of performance.

Proxy ratings of functional status were compared with subject self-reports in five domains relevant to the study of older persons and with observations of subject performance in two areas (physical and instrumental functioning). Data were derived from 233 proxy-subject pairs evaluated in a prospective study of hip fracture patients aged 65 years or more in Baltimore, Maryland (1990-1991). Agreement between proxy and subject reports was highest for a summary measure of instrumental functioning and lowest for a measure of depression. Proxies tended to report more disability than did subjects, although bias varied by function. Patterns of agreement for proxy reports versus observations of performance compared with patterns for proxy reports versus subject reports were lower for measures of instrumental functioning, and bias was generally more extreme for instrumental and physical functioning measures. The authors conclude that agreement and bias differ by functional domain, by the way summary measures are created and scored, and by the criterion against which proxy reports are compared.

Activities of Daily Living↗

PubMed1997

Psychoactive substance use disorders among seriously injured trauma center patients.

OBJECTIVE: To assess the prevalence of psychoactive substance use disorders (PSUDs) among a large, unselected group of seriously injured trauma center patients, using a standardized diagnostic interview and criteria. DESIGN: Prevalence study. SETTING: A level I regional trauma center. PATIENTS: Trauma center patients fulfilling the following criteria were eligible subjects: aged 18 years or older, admission from injury scene, length of stay of 2 days or longer, and intact cognition. OUTCOME MEASURES: The PSUDs were diagnosed using the Structured Clinical Interview (SCID) for the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) and were categorized as abuse or dependence and past or current (within past 6 months). The SCID results were analyzed with respect to demographic factors, injury type, and blood alcohol concentration and urine toxicology results, using chi2 and logistic regression techniques. RESULTS: Of the 1220 patients approached for study, 1118 (91.6%) consented. More than half (54.2%) had a diagnosis of a PSUD in their lifetime. Approximately 90% of alcohol and other drug use diagnoses were for dependence and more than 62% were current. Overall, 24.1% of patients were currently alcohol dependent (men, 27.7%; women, 14.7%; P<.001), and 17.7% were currently dependent on other drugs (men, 20.2%; women, 11.2%; P<.001). Current alcohol dependence rates were not associated with race; rates of dependence on other drugs were higher among nonwhites and victims classified with intentional injuries. While 54.3% of blood alcohol-positive patients were currently alcohol dependent and 38.7% of patients with positive urine screening test results for drugs other than alcohol and nicotine were currently drug dependent, 11.7% of blood alcohol-negative and 3.9% of drug-negative patients, respectively, had current diagnoses of dependence on psychoactive substances. CONCLUSIONS: A high percentage of seriously injured trauma center patients are at risk of having current PSUDs. Patients with positive toxicology screening test results and/or positive screening questionnaire responses should be referred for formal evaluation and treatment.

Adult↗

PubMed1997

Relation of social network characteristics to 5-year mortality among young-old versus old-old white women in an urban community.

This study examines age-related differences in the association between social network characteristics and mortality for aged white women. Subjects include a community-dwelling sample of white women aged > or = 65 years (n = 806), who lived in northeast Baltimore, Maryland, in 1984. Three characteristics of social networks were measured: availability of network resources; contact with network resources; and integration into the neighborhood. The association of social network with 5-year mortality was examined with a proportional hazards model adjusting for perceived health status, impairment in physical activities of daily living, number of chronic conditions, and years of education. Analyses were stratified by age (65-74 years, > or = 75 years). Elements of social network contact and neighborhood integration were associated with reduced mortality among women aged > or = 75 years, but not among women aged 65-74 years. In the > or = 75 years group, women who had no contact with children, friends, and group organizations showed hazard ratios (95% confidence intervals (CI)) of 3.1 (1.2-7.5), 2.2 (1.0-4.9), and 2.8 (1.2-6.5), respectively. Women who had lived < or = 10 years in the neighborhood and women who had no interaction with local merchants showed hazard ratios of 2.5 (95% CI 1.3-4.8) and 2.2 (95% CI 1.2-3.9), respectively. Thus, both age and specific aspects of network structure were found to influence the association between social networks and mortality in elderly women.

Aged↗

PubMed1997

Alcoholism at the time of injury among trauma center patients: vehicular crash victims compared with other patients.

A structured in-depth interview employing standardized criteria was used to determine the prevalence of lifetime and current alcohol dependence (alcoholism) in unselected consecutive patients admitted to a regional Level I trauma center. Of 629 patients, 157 (25.0%) were current alcoholics at the time of injury. An additional 87 (13.8%) were diagnosed as lifetime non-current alcoholics. There was no significant difference in the rates of current alcohol dependence among patients injured in vehicular crashes (23.5%), other unintentional trauma victims (29.3%), and those injured as a result of violence (24.6%). Of BAC+ (blood alcohol concentration positive) patients, 54.5% were current alcoholics. However, 14.4% of alcohol-negative patients were also diagnosed as alcohol dependent.

Accidents, Traffic↗

PubMed1997

Concentrations of specific epithelial growth factors in the urine of interstitial cystitis patients and controls.

PURPOSE: Interstitial cystitis (IC) is a chronic bladder disease for which the etiology is unknown. Because the bladder epithelium is often abnormal in IC, we determined whether the levels of specific urine growth factors postulated to be important for bladder epithelial proliferation are altered in IC. MATERIALS AND METHODS: ELISAs were used to determine levels of epidermal growth factor (EGF), insulin-like growth factor 1 (IGF1), insulin-like growth factor binding protein 3 (IGFBP3), and heparin binding epidermal growth factor-like growth factor (HB-EGF) in urine specimens from women with IC, asymptomatic women without bladder disease, and women with bacterial cystitis. RESULTS: Urine HB-EGF levels were specifically and significantly decreased in IC patients as compared to asymptomatic controls or patients with bacterial cystitis, whether expressed as concentration (amount per volume of urine) or the amount relative to urine creatinine in each specimen. In contrast, urine EGF, IGF1, and IGFBP3 levels were all significantly elevated in IC patients compared to asymptomatic controls. Further, the amounts of urine EGF and IGF1 were also elevated in IC patients as compared to patients with bacterial cystitis, and urine IGFBP3 levels were significantly elevated when expressed per milligram of urine creatinine. CONCLUSIONS: These findings indicate that complex changes in the levels of urine epithelial cell growth factors (EGF, IGF1, and HB-EGF) and a growth factor binding protein (IGFBP3) are associated with IC. While EGF, IGF1, and IGFBP3 levels are either the same or increased in the urine of IC patients as compared to patients with bacterial cystitis or asymptomatic controls, HB-EGF levels are significantly decreased in the urine of IC patients. Understanding the reasons for these changes may lead to understanding the pathogenesis of this disorder.

Adult↗

PubMed1997

The accuracy of the CAGE, the Brief Michigan Alcoholism Screening Test, and the Alcohol Use Disorders Identification Test in screening trauma center patients for alcoholism.

OBJECTIVE: To evaluate the accuracy of questionnaire screening instruments to identify lifetime alcohol dependence among trauma center patients. METHODS: The study was conducted at a Level I trauma center between September 1994 and November 1996. Patients meeting eligibility requirements (> or = 18 years old, admission from injury scene, > or = 2 days of hospitalization, intact cognition) were evaluated for alcohol abuse and dependence. Screening instruments consisted of the CAGE, the Brief Michigan Alcoholism Screening Test, and the Alcohol Use Disorders Identification Test. Screening results were compared with lifetime alcohol dependence diagnoses made using the in-depth Psychoactive Substance Use Disorders section of the Structured Clinical Interview. Accuracy was quantified as sensitivity, specificity, positive/negative predictive values, and receiver operating characteristic curves (used to calculate area under the curve). RESULTS: Of the 1,118 patients studied, lifetime alcohol dependence was diagnosed by Structured Clinical Interview in 397 (35.5%), and abuse was diagnosed in 90 (8.1%) others. The CAGE was the best predictor of lifetime alcohol dependence, i.e., had the largest area under the curve (93%) and the highest sensitivity (84%), specificity (90%), positive predictive value (82%), and negative predictive value (91%). Among patients testing positive for alcohol, 63% had a lifetime alcohol dependence diagnosis. CONCLUSION: The CAGE is an efficient screening test to detect alcohol dependence in trauma center populations. It should be used in combination with alcohol testing to identify patients at risk of alcohol use problems.

Adolescent↗

PubMed1997

Proxies' decisions about clinical research participation for their charges.

OBJECTIVE: To examine the process by which proxies decide about their charges' participation in clinical research. DESIGN: Using eight hypothetical research studies encompassing a variety of risks and benefits, we interviewed 315 competent persons > or = 65 years old (charges) and, separately, the individuals who would be designated as their proxies if the charges were to become incompetent. The proxies were asked what they thought their charges would decide and what decisions they would make for their charges and for their own participation. SETTINGS: A medical house-call program, two apartment complexes, and three nursing homes. PARTICIPANTS: Charges > or = 65 years old and their proxies. MAIN OUTCOME MEASURE: Comparison of decisions made by charges and by proxies for their charges. RESULTS: The agreement between the proxies' and charges' decisions was not significantly different from random agreement (range of kappa statistics, 0.05-0.15). Rather, proxies' decisions for their charges were significantly related to the proxies' decisions for themselves (kappas, 0.52-0.86). When the paired proxies' and charges' decisions differed, the proxies were protective, more frequently refusing their charges' participation in the perceived riskier research studies. CONCLUSIONS: Proxies did not know what their charges would decide. Their choices for the charges related more to the proxies' decisions about their own participation (which they knew) than to the decisions of their charges (which they didn't know). This is similar to the process of a reasonable person making the decision, a characteristic of decisions made in the best interests of the patient.

Adult↗

PubMed1997

Excess mortality attributable to hip fracture in white women aged 70 years and older.

OBJECTIVE: The purpose of this study was to estimate the excess mortality attributable to hip fracture. METHODS: The 6-year survival rate of community-dwelling White female hip fracture patients aged 70 years and older entering one of seven hospitals from 1984 to 1986 (n = 578) was compared with that of White female respondents aged 70 years and older interviewed in 1984 for the Longitudinal Study on Aging (n = 3773). RESULTS: After age, education, comorbidity, and functional impairment were controlled, the mortality differential between the two groups accumulated to an excess among hip fracture patients of 9 deaths per 100 women 5 years postfracture. Among those with three or more functional impairments or one or more comorbidities, the excess was 7 deaths per 100: the effect of the fracture had disappeared in these groups by 4 years. In contrast, those with two or fewer impairments and those with no comorbidities had a continuing trend of increased mortality, with an excess of 14 deaths per 100 by 5 years. CONCLUSIONS: There is an immediate increase in mortality following a hip fracture in medically ill and functionally impaired patients, whereas among those with no comorbidities and few impairments, there is a gradual increase in mortality that continues for 5 years postfracture.

Aged↗

PubMed1997

Urine autoantibodies in interstitial cystitis.

Interstitial cystitis is a chronic bladder disease with certain features that suggest autoimmunity may play a role in initiating or maintaining the disease process. We therefore determined whether immunoglobulin fractions from 14 IC patient and 19 control urine specimens bound in vitro to primary cultures of human bladder epithelial cells, as well as epithelial cells from a variety of other tissues. Urine autoantibodies that bound to normal human bladder epithelial cells were present in 8 of 14 IC specimens (from 6 of 9 IC patients) as compared to 3 of 23 control specimens (from 2 of 17 control patients). These antibodies, which were usually also present at low titers in sera from these persons, bound to at least four nuclear or cytoplasmic antigens, with the specificity of autoantibodies from a given individual varying over time. The autoantibodies were not specific for normal or malignant bladder epithelial cells, but bound to epithelial cells from a variety of tissues. These data show that anti-epithelial cell autoantibodies are present in the urine of IC patients, but suggest that these antibodies are not likely to be a primary cause of this disease.

Adult↗

PubMed1996

Use of proxies to measure health and functional status in epidemiologic studies of community-dwelling women aged 65 years and older.

Proxy and subject responses to survey questions about chronic conditions, health symptoms, and physical and instrumental functioning were compared to determine the extent of disagreement, the direction of nonrandom discrepancies (i.e., bias), and how disagreement and bias vary by proxy and subject characteristics. Subjects included 538 community-dwelling women aged 65 years and older who participated in the third home interview of a health survey in Baltimore, Maryland, 1986, and a self-designated proxy for each. The authors observed kappa values of > 0.6 (i.e., substantial to almost perfect agreement) for five of nine chronic conditions, no health symptoms, six of seven physical tasks of daily living, and seven of seven instrumental tasks of daily living. With few exceptions, proxies were more likely than subjects to report the presence of a condition, symptom, or functional problem. Variations in agreement and bias were noted by subject and proxy characteristics, with different patterns observed for different measurement areas. When using proxy reports in place of self-reports, it is important to evaluate the impact that using proxies has on study results.

Activities of Daily Living↗

PubMed1996

Traditional risk factors and ischemic stroke in young adults: the Baltimore-Washington Cooperative Young Stroke Study.

OBJECTIVE: To determine the association of hypertension, diabetes, and cigarette smoking with incidence of ischemic stroke in young adults. DESIGN: Case-control study. SETTING: Population-based sample of cases and controls. SUBJECTS: The study included 296 cases of incident ischemic stroke among black and white adults aged 18 to 44 years in central Maryland counties from the Baltimore-Washington Cooperative Young Stroke Study and 1220 black and white adults aged 18 to 44 years from the Maryland Behavioral Risk Factor Survey, a telephone survey of a random sample of the same region, to serve as controls. MAIN OUTCOME MEASURES: Logistic regression models were developed to determine the age-adjusted odds ratios for each risk factor. Population-attributable risk percent were computed based on the odds ratios and prevalence of each risk factor. RESULTS: The age-adjusted odds ratios (95% confidence intervals) for white men (WM), white women (WW), black men (BM), and black women (BW) were as follows: current cigarette smoking: WM, 2.0 (1.1-3.8), WW, 2.1 (1.1-4.3), BM, 3.3 (1.6-6.6), and BW, 2.2 (1.3-3.9); history of diabetes mellitus: WM, 22.9 (5.8-89.6), WW, 6.2 (1.9-20.2), BM, 4.2 (0.8-21.9), and BW, 3.3 (1.4-7.7); and history of hypertension: WM, 1.6 (0.7-3.2), WW, 2.5 (1.1-5.9), BM, 3.8 (1.8-7.9), and BW, 4.2 (2.4-7.5). The population-attributable risk percent (95% confidence intervals) were as follows: current cigarette smoking: WM, 22.6 (3.1-38.2), WW, 17.2 (4.0-34.0), BM, 40.5 (23.1-54.0), and BW, 29.1 (13.5-41.9); history of diabetes mellitus: WM, 19.0 (8.2-28.5), WW, 15.8 (3.8-26.3), BM, 13.2 (5.3-20.4), and BW, 22.1 (12.5-30.7); and history of hypertension: WM, 21.7 (6.2-34.6), WW, 21.3 (5.4-34.5), BM, 53.5 (39.0-64.4), and BW, 50.5 (37.1-61.1). CONCLUSIONS: Hypertension, diabetes mellitus, and current cigarette smoking are important risk factors in a biracial young adult population. Cigarette smoking and hypertension, the 2 most modifiable risk factors, were particularly important risk factors in young blacks.

Adolescent↗

PubMed1996

A portable neuromuscular function assessment for studying recovery from hip fracture.

OBJECTIVE: To determine the reliability and applicability of a portable, performance-based assessment of balance and gait in characterizing recovery after hip fracture in elderly persons. DESIGN: The assessment was developed as part of a prospective, observational study of hip fracture recovery among elderly persons. Reliability was assessed in 24 subjects by administering the tasks twice within 1 week. SETTING: In-home assessments were performed on community-dwelling elderly. PATIENTS: Randomly selected subset of hip fracture patients, 65 years and older, admitted to 1 of 8 Baltimore hospitals between January 1990 and June 1991. Twenty-four patients were asked to repeat the gait and balance assessment at the 6-month follow-up visit. MAIN OUTCOME MEASURES: The evaluations included: (1) sitting balance, (2) arising from an armless chair, (3) standing balance, eyes open and closed, (4) one leg standing balance, (5) sitting down, (6) gait, and (7) range of motion in the knee and hip. RESULTS: The assessment took 15 to 20 minutes to complete and was feasible to perform for recent hip fracture patients, except for single leg standing. Interrater reliability was good for most tasks, with agreement between evaluators being 74% to 100% for tasks involving standing balance, chair rise, gait, and range of motion; kappas = 0.4 to 0.9. Single leg standing, knee extension, and balance while sitting were the least reliable tasks; 59% to 73% agreement, kappas = 0.1 to 0.4. CONCLUSIONS: We conclude that this instrument is a reliable measure of physical ability that will provide a clear indication of mobility impairment in patients recovering from a hip fracture. This instrument should prove useful in assessing patients with lower extremity difficulties.

Activities of Daily Living↗

PubMed1996

Ascertaining dementia by expert panel in epidemiologic studies of nursing home residents.

A new method for ascertaining dementia in epidemiologic research and the results of a study to evaluate it are described. The method relies on an expert panel of clinicians reviewing clinically relevant information collected by lay evaluators to arrive at a diagnosis based on DSM-III-R criteria. The approach was developed to study dementia in a statewide sample of over 2400 new admissions to 59 nursing homes in Maryland. Expert panel ascertainment of dementia was compared to that obtained by direct clinical evaluation for 100 nursing home residents. Agreement between the panel and direct assessment was 76% (kappa = 0.59) using a three-category classification of dementia, no dementia, and indeterminate. This ascertainment strategy provides an alternative to methods currently in use and is particularly well-suited for populations with a high prevalence, in those dispersed over large geographic areas, and when timely, cost-effective evaluations are required.

Aged↗