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Biomedical subjects

J Wayne

Publications and source records attributed to J Wayne.

29 records · Page 2Linked to original sources
PubMed1993

New therapeutic possibilities in primary invasive breast cancer.

OBJECTIVE: Current therapy for small invasive breast cancer, particularly when discovered mammographically, was re-examined. Axillary dissection may be avoided when lymph node metastases incidence is low (< 10%) or when primary cancer features determine adjuvant therapy. Radiation therapy may be avoided when risk of recurrence is very low. SUMMARY BACKGROUND DATA: Recent studies by the Surveillance, Epidemiology, and End Results program (SEER) have shown increases in small invasive breast cancers (< 1 cm) attributable to mammographic screening. The incidence of axillary metastases in mammographically discovered small cancers (< 1 cm) may be less than 10%. Follow-up data from the Breast Cancer Detection Demonstration Project (BCDDP) indicate a disease-free survival rate exceeding 95% at 8 years if the cancer was discovered mammographically. METHODS: Maximum diameter and lymph node metastases of invasive breast cancer diagnosed between 1969 and 1988 were analyzed and compared to cases diagnosed between 1929 and 1968. One hundred thirty patients have been treated without either axillary dissection or radiation therapy since 1980. RESULTS: The mean and median diameters of invasive breast cancers decreased to 2.31 and 2.0 cm, respectively, between 1984 and 1988; 13% were less than 1 cm in diameter. Only 13% of patients had axillary metastases if the primary cancer was 1 cm or less in diameter in the last 10 years; 71% had only 1 or 2 nodes involved. Isolated local recurrence, total local recurrence, and distant metastases were unchanged when radiated and nonirradiated patients were compared. Axillary nodal recurrence was decreased in irradiated patients because the lower half of the axilla was treated. CONCLUSION: In selected patients with very small invasive breast cancers detected by mammography, breast conservation without axillary dissection or radiation therapy may be used. Entirely outpatient treatment markedly reduces morbidity and cost, and furthers the gains from screening programs.

Axilla↗
PubMed1986

The cost of burn care and implications for the future on quality of care.

The high cost of health care has become a nationwide concern and there are several national initiatives under way to reduce the rate of increase of these costs. Among the most recent initiatives has been the introduction of Medicare reimbursement based upon Diagnostic Related Groups (DRGs). This paper presents a retrospective analysis of the costs of care of burned patients admitted to the University of Alabama at Birmingham Burn Center and a profile of the financial impact of DRGs. Costs for burned patients were twice as high as for the average patient in the hospital and increased at a faster rate. Since 1977 the proportion of indigent patients and patients with very poor third-party coverage has greatly increased and those with good or excellent third-party coverage has decreased. If the care for Medicare patients had been reimbursed on the bases of DRG rates in 1982, payments would have exceeded costs by $2,981 but would have been $88,399 less than charges. In 1983, if the care for Medicare patients had been reimbursed on the bases of DRG rates, the payment would have been $409,629 less than costs and $634,583 less than charges. This very unfavorable reimbursement is because DRG reimbursement is essentially a flat rate and for long lengths of stay costs are much greater than reimbursements. Specific policies on methods to correct this discrepancy are suggested.

Burn Units↗
PubMed1984

Survival of infants with low birth weight and early gestational age, 1979 to 1981.

A chart for displaying neonatal survival data regarding low birth weight and early gestational age is presented. Survival data at two institutions for infants with low birth weight and early gestational age are compared. This format is useful for student and resident teaching, for counseling parents-to-be about potential outcomes, for consulting with out-of-hospital physicians who request advice about maternal-fetal transport, and most important, for helping to make the crucial decisions necessary during the management of labor and delivery of infants with low birth weight and early gestational age.

Black or African American↗
PubMed1982

The variability of viability: the effect of physicians' perceptions of viability on the survival of very low--birth weight infants.

Physicians who deliver babies in Alabama were surveyed to determine their level of knowledge about the survival of low--birth weight/early gestational age infants. These estimates of neonatal survival were compared to the actual neonatal survival rates at local hospitals and at the regional perinatal centers in Alabama. In addition, the physicians' knowledge of survival rates was correlated with their management decisions in hypothetical cases of premature labor. Our findings indicate that physicians who perform deliveries tended to underestimate the potential for neonatal survival in premature infants. Equally as important, the range of responses varied markedly. In the hypothetical cases, management decisions often appeared to be based on incorrect information about neonatal survival. These decisions, including not electronically monitoring fetuses, not performing a cesarean section for fetal distress, and not transferring women in premature labor to a perinatal center, if made in actual cases, would result in potentially viable fetuses receiving less than optimal management.

Adult↗
PubMedDate not supplied

5-year followup of the effect on optometrists of continuing education about hypertension.

All 319 participants of an intensive continuing education course on optometric hypertension screening at the University of Alabama at Birmingham were surveyed 5 years after completion of the course. Almost 85 percent of 211 responding optometrists reported that they were continuing to screen for hypertension in their practices. They estimated that 24 percent of their patients had hypertension and that of these 11 percent were previously undetected. The criteria used by these optometrists for tentative diagnosis and referral were consistent with currently accepted guidelines. Hypertension screening by optometrists is cost-effective, and this survey suggests that continuing education courses providing intensive didactic and clinical instruction may be an effective method for changing clinicians' behavior. For most optometrists who participated in this continuing education program, the program appears to have positively changed their clinical behavior.

Adult↗