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Biomedical subjects

J S Goodwin

Publications and source records attributed to J S Goodwin.

At least 19 recordsLinked to original sources
PubMed1992

Geographic variation in the use of breast-conserving treatment for breast cancer.

BACKGROUND: In the past decade there has been an increase in the use of treatment designed to conserve the breast for women with breast cancer. The extent to which such treatment has been adopted in various regions of the country and whether characteristics of hospitals and patients predict its use is not known, however. METHODS: We used national data on Medicare claims for inpatient care provided in 1986 to study 36,982 women 65 to 79 years of age, who had local or regional breast cancer and underwent either mastectomy or breast-conserving treatment (local excision, quadrantectomy, or subtotal mastectomy). Information about the hospitals at which these women were treated was obtained from an American Hospital Association survey. RESULTS: Of the 36,982 women, 12.1 percent had breast-conserving surgery and 87.9 percent had a mastectomy. The frequency of breast-conserving surgery ranged from 3.5 percent to 21.2 percent in various states. The highest rate of use was in the Middle Atlantic states (20.0 percent) and New England (17.2 percent), and the lowest was in the East South Central states (5.9 percent) and the West South Central states (7.3 percent). Breast-conserving treatment was used more often in urban than in rural areas, in teaching hospitals than in nonteaching hospitals, in large hospitals than in small hospitals, and in hospitals with on-site radiation therapy or geriatric services than in others. Most of the geographic variation persisted after adjustment for the characteristics of hospitals and patients for which data were available. CONCLUSIONS: There is substantial geographic variation in the use of breast-conserving surgery, which cannot be explained by differences in hospital characteristics. Hospital characteristics that were independently redictive of greater use of breast-conserving surgery were the size of the metropolitan area, the status of the institution as a teaching hospital, and the availability of radiation therapy and geriatric services.

Aged↗
PubMed1992

Characteristics of diabetic ketoacidosis in older versus younger adults.

OBJECTIVE: To describe how diabetic ketoacidosis in those aged 65 or over differs from that in younger adults. DESIGN: Retrospective chart review of all adult patients with a primary or secondary discharge diagnosis of diabetic ketoacidosis (n = 338). SETTING: Three urban teaching hospitals in Milwaukee, WI from January 1, 1987 to May 31, 1990. PATIENTS: Two hundred twenty cases in 150 patients met our criteria for severity of illness to be included in the study. Twenty-seven cases were in patients > or = age 65; 193 cases were in patients < age 65. RESULTS: The older patients were less likely to have been using insulin before hospitalization (55.6% vs 80.2%, P = 0.004) and less likely to have had a prior episode of diabetic ketoacidosis (8.0% vs 51.4%, P = 0.001). The presenting laboratory data were not significantly different between older and younger subjects. There was a trend toward a higher mean insulin dosage to bring the patient's blood glucose to < or = 300 mg/dL for those age 65 or older; 69.1 units vs 44.9 units (P = 0.06). The time required to obtain a glucose < 300 mg/dL was greater in older patients (10.5 vs 7.7 hours, P = 0.01). The average length of stay for those age 65 or older was 12.4 days vs 6.7 days (P = 0.001). Thirdly, of those age 65 or older, 7% vs 29% of younger subjects had a blood glucose or Accucheck < or = 49 mg/dL at some time during their hospital course. The hypoglycemic episodes were more likely to be asymptomatic in older patients (P = 0.03). The mortality rate was 22% for those age 65 or older vs 2% for younger subjects (P = 0.001). The mortality rate for those in age groups 60-69 years, 70-79 years, and > or = 80 years was 8%, 27%, and 33%, respectively. In patients > or = 65, mortality was confined to those with coexisting renal disease or infection. CONCLUSION: Older patients with diabetic ketoacidosis are less likely to have been using insulin before hospitalization. They tend to receive more insulin therapy during their acute management, have a longer average length of hospital stay, and have a higher mortality rate.

Adolescent↗
PubMed1992

Frequent hypoglycemic episodes in the treatment of patients with diabetic ketoacidosis.

BACKGROUND: Previous studies of the management of diabetic ketoacidosis have noted a wide range of incidence of hypoglycemia but have not studied the risk factors associated with it. METHODS: To describe the incidence of hypoglycemia in patients hospitalized with diabetic ketoacidosis, we retrospectively reviewed the charts of all adult patients with the diagnosis of diabetic ketoacidosis at three private, community hospitals in Milwaukee, Wis, between January 1, 1987, and May 31, 1990. Two hundred twenty admissions in 150 patients met our inclusion criteria. RESULTS: In 30% (66/220) of cases of diabetic ketoacidosis, a serum glucose level or Accu-Chek (Boehringer-Mannheim, Indianapolis, Ind) finding was 2.7 mmol/L or less during the first 14 days of hospitalization. No factors could be identified that were associated with a significantly increased risk of early hypoglycemia (within the first 48 hours of admission). The risk of a "late" occurrence of hypoglycemia (after 48 hours of hospitalization) was increased by fever (relative risk, 2.05; 95% confidence interval [CI], 1.16 to 3.63), "nothing orally" status (relative risk, 3.01; 95% CI, 1.88 to 4.83), hepatic disease (relative risk, 2.56; 95% CI, 1.39 to 4.70), and renal disease (relative risk, 2.07; 95% CI, 1.26 to 3.39). A logistic regression analysis showed "nothing orally" status to be associated with an increased risk of any hypoglycemia occurring during the hospitalization (relative risk, 2.39; 95% CI, 1.63 to 3.51). Physicians and nurses documented the first episode of hypoglycemia in their notes 45.5% and 80.3% of the time, respectively. CONCLUSION: Hypoglycemia is still a common complication of diabetic ketoacidosis, is associated with hepatic and renal disease as well as fever and "nothing orally" status, and is not documented well in physician notes.

Adolescent↗
PubMed1991

The utilization of fecal occult blood testing in the institutionalized elderly.

OBJECTIVE: To examine physician use of stool guaiac testing in order to determine indications for testing, how the test was used, and the consequences of a particular test result. DESIGN: Retrospective case series. SETTING: Large midwestern inpatient nursing home facility. PATIENTS: All patients with positive fecal occult blood tests (FOBT) and one-third of patients with negative FOBT. RESULTS: In an 18-month period, 916 occult blood tests were performed on 339 patients (37% of the nursing home census). Patients over age 90 were as likely to receive FOBT as those under age 70. Fourteen percent of those tested had at least one positive test. Fifty-eight percent of the patients with positive tests underwent no additional diagnostic testing. No cause for the positive FOBT was found for 68% of patients receiving the test for routine screening. Physician estimates of how frequently they employed FOBT for these patients correlated very poorly with their actual practices (r = .17). CONCLUSION: There is a high prevalence of positive results from FOBT among nursing home patients. In most cases, such results do not cause a change of therapy or result in additional workup. Lack of information on the role of FOBT in nursing home patients contributes to the great diversity in utilization of this test by nursing home physicians.

Aged↗
PubMed1991

Spontaneous fractures of the long bones in nursing home patients.

Six long-term nursing home residents who experienced fractures of the long bones in the absence of obvious trauma are described. All patients had been essentially non-weight-bearing for at least 2 years before the episode. Four patients experienced fractures on more than one occasion. There was no evidence of physical abuse in any of these of patients; indeed, evidence against abuse was fairly good. Nonetheless, physical abuse was alleged by the patients' families in four of the cases. Long bone fracture in the absence of trauma in patients after prolonged bed rest has been well described in the radiologic and orthopedic literature, but not previously in geriatrics. It is important that this phenomenon be recognized, lest all unexplained fractures in nursing home patients automatically be taken as evidence of abuse or neglect.

Aged↗
PubMed1991

Are prostaglandins proinflammatory, antiinflammatory, both or neither?

Research on the role of prostaglandins (PG) in inflammation has been divided along 2 lines of inquiry. One supposes that PG are proinflammatory, explaining why nonsteroidal antiinflammatory drugs (NSAID), which prevent conversion of arachidonic acid to stable PG through cyclooxygenase inhibition, exert their antiinflammatory effects. The other supposes that PG are antiinflammatory, explaining the reductions in inflammation produced by these substances in various experimental models of arthritis. A number of proinflammatory actions of PG have been identified, including vasodilatation and hyperalgesia. However, these activities are relatively modest and do not appear to account for the antiinflammatory effects of NSAID; indeed, mechanisms for these effects that do not depend on cyclooxygenase inhibition have been advanced. A number of potential mechanisms for antiinflammatory effects of PGE have been identified, including inhibition of neutrophil activation, O2 release and leukotriene B4 and cytokine production. It is likely that the availability of orally active PGE analogs will permit study leading to an integrated understanding of PG activity and an answer to the question whether such agents will prove useful in the treatment of chronic inflammatory diseases.

Adjuvants, Immunologic↗
PubMed1991

Hearing and cognition in the elderly. New findings and a review of the literature.

The purpose of this study was to determine the relationship between hearing status and cognitive status initially and at 5-year follow-up in a cohort of healthy elderly men and women and to relate the results to published reports on this topic. Volunteers older than 60 years with no major illnesses and taking no long-term prescription medications were examined. Baseline testing of hearing and cognition was performed in 224 subjects; 112 subjects underwent cognitive testing at 5-year follow-up. Hearing was measured by the Speech Perception in Noise test; cognition was measured by two parts of the Wechsler Memory Scale and by the Jacobs Cognitive Screening Test, an oral screening instrument. At baseline there were small correlations between hearing acuity and memory scores, but these disappeared after adjustment for age and gender. Analysis of follow-up memory and cognitive screening test scores in relation to baseline hearing ability showed no correlation between hearing at entry and cognitive function at 5 years. In addition, baseline hearing level did not predict change in memory or cognitive screening test scores during the follow-up period. The power of the study was 90% to detect a correlation of .30 between measures of hearing and cognition. There was no evidence for a major effect of hearing acuity on cognitive function over time in this group of healthy elderly. Review of published studies suggests that hearing ability is related to cognitive status in demented subjects, but there is little to suggest that in the normal elderly, hearing impairment leads to cognitive decline.

Aged↗
PubMed1991

A population-based study of functional status and social support networks of elderly patients newly diagnosed with cancer.

We assessed the functional status and social support networks of 799 men and women aged 65 years or older newly diagnosed with cancer and living in six New Mexico counties. Functional limitations included depending on others for transportation (33%) and mental incompetence or poor recent memory (42%). The percentage of patients with functional limitation increased sharply with increasing age. In a substantial number of patients there was also evidence for poor social support networks; 26.5% of subjects lived alone and 38.9% had no children living in the vicinity. In a multiple logistic regression analysis, the predictors of having a poor social support network included non-Hispanic white ethnicity, advanced age, low income, and being a recent migrant to the area. Subjects with functional limitations were more likely to have poor social support networks than subjects without such limitations. The deleterious combination of impaired functional status and a limited social support network may explain why elderly cancer patients are at increased risk for not receiving appropriate therapy. Given the potential complexities involving the evaluation and appropriate treatment of cancer, care must be taken to adequately assess functional status and support mechanisms of older patients, and to provide adequate support to ensure compliance with treatment.

Activities of Daily Living↗
PubMed1990

Determinants of cancer stage. A population-based study of elderly New Mexicans.

To assess the role of delay and other factors in determining stage of cancer at diagnosis, the authors interviewed a population-based sample of 800 elderly persons with newly diagnosed cancer at selected sites. Lengthening delay interval was associated with a declining proportion of local stage cases for breast cancer but not other sites. Of the other determinants of stage examined, older age, having a family physician, receiving medical checkups, having greater knowledge of cancer, and having no functional loss were most strongly predictive of local stage. For breast cancer, performance of breast self-examination also predicted local stage.

Activities of Daily Living↗
PubMed1990

Decreased specific antibody synthesis in old adults: decreased potency of antigen-specific B cells with aging.

The rise in rates of infection in adults over the age of 60 is accompanied by a decreased ability of older adults to make specific immune responses after immunization with a variety of specific antigens (Ag). This investigation delineates age-related changes in Ag-specific humoral immunity, comparing adults over age 60 to young adults aged 18-40, using tetanus toxoid (TT) as an immunologic probe. A culture system which does not require TT booster immunizations of study subjects was used to induce in vitro specific antibody responses. The amount of anti-TT antibody (Ab) produced in serum and in culture was measured by a TT-specific enzyme-linked immunosorbent assay (ELISA). The numbers of anti-TT Ab-secreting B cells were measured by a TT-specific ELISA-plaque assay. The TT-specific responses of old subjects were significantly less than that seen for young control subjects in the following measures: (1) serum anti-TT Ab titers (mean +/- S.E. log 2 titer = 3.3 +/- 1.1 vs. 9.5 +/- 1.4, P less than 0.01); (2) anti-TT Ab produced by peripheral blood lymphocytes (PBL) in cultures stimulated with TT (6 +/- 2.1 ng/ml vs. 22 +/- 8.4 ng/ml, P less than 0.01); (3) numbers of anti-TT Ab secreting B cells per million cells cultured (6.7 +/- 3.4 vs. 26.6 +/- 7.6, P less than 0.001) and (4) mean ng Ab secreted per anti-TT Ab-secreting B cell (0.6 +/- 0.4 ng vs. 12.7 +/- 7.8 ng, P less than 0.01). This study shows that both decreased numbers of Ag-specific immune B cells and decreased potency on a per cell basis contribute to the impaired immune responses to immunizations in older adults.

Adolescent↗
PubMed1990

Control of human T cell proliferation by platelet-activating factor.

Platelet-activating factor, 1-O-alkyl-2-acetyl-sn-glycero-3-phosphocholine (PAF), is a membrane phospholipid with immunomodulatory functions. We studied the influence of PAF on mitogen-stimulated proliferation of human peripheral blood mononuclear cells (PBMC), purified T cells and T cell subsets. High concentrations of PAF suppressed the proliferation of all cell populations studied (44% mean inhibition with 5 microM PAF and 78% inhibition with 10 microM PAF). In contrast, the deacetylated metabolite of PAF, lyso-PAF, had no effect on proliferation at micromolar concentrations. Lower, and presumably physiologically relevant, concentrations of PAF (10(-14) to 10(-8) M) stimulated a small increase in the proliferation of unfractionated T cells. When T cells were fractionated into CD4+ and CD8+ subsets, a difference in sensitivity to PAF was observed. PAF stimulated a modest, yet statistically significant, increase in the proliferation of CD4+ T cells at concentrations ranging from 10(-14) to 10(-10) M, while either having no effect or inhibiting the proliferation of CD8+ cells across the entire concentration range. Addition of indomethacin to the cultures further enhanced CD4+ proliferation, possible due to the blockade of PAF-induced PGE2 production by monocytes. The PAF receptor antagonist BN 52021 did not block the PAF effects in this system, and the PAF receptor antagonist SRI 63-675 caused a dose dependent inhibition of T cell subset proliferation. These findings suggest that while high concentrations of PAF suppress T cell proliferation, low concentrations selectively stimulate proliferation of the CD4+ subset, an effect which is partially counteracted by PAF-induced monocyte PGE2 production.

Adult↗