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Biomedical subjects

J S Wald

Publications and source records attributed to J S Wald.

4 recordsLinked to original sources
PubMed1998

Reproductive outcome after methotrexate treatment of tubal pregnancies.

OBJECTIVE: To evaluate subsequent pregnancy outcomes in women who have been treated with methotrexate for tubal pregnancies. METHODS: Descriptive study of subsequent pregnancy outcomes in 170 women who were treated with methotrexate for tubal pregnancy at Brigham and Women's Hospital during 1989-1994. Patients who agreed to participate were administered a telephone interview. Fertility rates and outcomes were calculated for patients who tried to conceive after receiving methotrexate. RESULTS: One hundred four of the 170 women with tubal pregnancies identified during the study period returned their consent forms. The other 66 patients were either unable to be reached by phone, and/or their consent form was returned without a forwarding address. Ninety-four patients (90%) agreed to participate in the study. Eighty-two (87%) women tried to conceive after receiving methotrexate for their tubal pregnancies, and 57 (70%) were successful. Forty-six (81%) of the 57 women experienced intrauterine pregnancies, and 11 (19%) had recurrent tubal pregnancies. When the first subsequent postmethotrexate outcome was examined, there were 26 (46%) term births, 5 (9%) preterm births, 11 (19%) recurrent ectopics and 15 (26%) spontaneous abortions. Over the six-year study period, 42 (74%) women had at least one live birth. There were no congenital anomalies or stillbirths in the subsequent pregnancies. CONCLUSION: Pregnancy outcomes after methotrexate treatment for tubal pregnancy are comparable to reported experience with surgical therapy. Patients who are treated with methotrexate for tubal pregnancies can be assured that their methotrexate exposure should have no untoward effects on subsequent pregnancies.

Female↗
PubMed1995

Patient entries in the electronic medical record: an interactive interview used in primary care.

We describe the development, implementation, and use of a computer-administered patient interview, the Health History Interview, by over 300 new patients in a primary care practice at Boston's Beth Israel Hospital. The interview has been well accepted by patients and rated positively by providers. It electronically captures clinical information directly from patients for use during their initial encounter with a provider. It facilitates aggregate analysis of clinical data for quality improvement efforts, such as aiming preventive medicine interventions at identified problem areas within the clinic. Expectations management has been an important task throughout the project. Increasing use of the interview beyond the 30-40% of new patients who have taken it will require greater communication with patients, greater convenience to patients and providers, and more evidence of the clinical, administrative, and research benefits of the technique. Most important, full implementation will require fundamental changes in physician practice habits and patterns of communication between patients and the health care system, as well as clearly demonstrated cost-benefit improvements through the use of these tools.

Adult↗
PubMed1987

Discounting an adverse maternal effect on severity of neurofibromatosis.

Neurofibromatosis, a common, progressive, autosomal dominant disorder, is markedly variable in its expressivity. Some authors have suggested that some contribution to neurofibromatosis's variability may be an adverse effect of a mother's neurofibromatosis on the overall severity seen in her offspring with neurofibromatosis. In the present study of 188 maternal affected, paternal affected, and sporadic von Recklinghausen neurofibromatosis cases, the maternal influence question was systematically examined. Overall severity, selected features most likely to reflect in utero maternal influence, and other common neurofibromatosis-I features were analyzed statistically. Age, racial composition, and gender of the three groups were similar. No significant differences were found (P less than or equal to .01) between maternal affected, paternal affected, and sporadic cases in terms of overall severity, probability of reaching advanced severity as a function of age, indications of possible prenatal influence (eg, congenital neurofibromas, tibial pseudarthrosis), or other neurofibromatosis features. These results demonstrate that the nature and severity of neurofibromatosis for maternal affected cases are essentially the same as for paternal affected and sporadic cases.

Adolescent↗