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Biomedical subjects

John T Queenan

Publications and source records attributed to John T Queenan.

17 recordsLinked to original sources
PubMed2003

Total versus subtotal hysterectomy: a survey of gynecologists.

OBJECTIVE: To estimate the attitudes and practice of gynecologists in the Washington, DC, Maryland, and Virginia area regarding total versus subtotal abdominal hysterectomy. METHODS: A questionnaire with 18 questions on physicians' attitudes and practice regarding total versus subtotal hysterectomy was mailed to 1647 gynecologists in Washington, Maryland, and Virginia. RESULTS: The corrected response rate was 51.2%. Forty-five percent of respondents stated that they always removed the cervix. The most common reason cited was to eliminate the risk of cervical cancer. The most common reason for subtotal hysterectomy was surgical difficulty leading to an intraoperative change of procedure. Only 17.8% of respondents always counseled women regarding the advantages and disadvantages of both total and subtotal hysterectomy; 63% rarely or never did. Nineteen percent always offered women a choice between the procedures; 61% rarely or never did. Eighty-eight percent of respondents felt that the risk of cancer in the cervical stump was small or negligible. Gender of the physicians or year of completion of residency made no significant impact on patients being counseled about both procedures or being offered a choice between the two. CONCLUSION: Most gynecologists surveyed favor total abdominal hysterectomy over subtotal hysterectomy. Few counsel women regarding the options of total and subtotal hysterectomy or offer a choice between the procedures. Given that there are no convincing data proving the superiority of either procedure over the other, it may be reasonable to discuss the potential advantages and disadvantages of both procedures with women undergoing hysterectomy for benign disease and to offer them a choice.

Adult↗
PubMed2003

Evaluating the efficacy of intervention.

The standard for reaching a verdict in civil trials is "the preponderance of the evidence." This is a valid standard to apply to evaluating the medical literature as well. Every published report should be given weight based on physicians' judgment of its reliability. Larger-scale studies should be weighted more heavily than smaller-scale studies, randomized trials more heavily than observation studies, rigorously designed trials more heavily than studies that may be biased. If there seems to be a relationship between a factor and an outcome, this does not necessarily imply that the factor caused the outcome. The association could be a result of chance variation between individuals. Statistical testing allows researchers to exclude chance as a likely cause of the relationship, but this is the only explanation ruled out by a significance test. The relationship could be a result of bias: bias in the selection of individuals for the study, bias in measurement of the factor or the outcome, or bias in differential loss to follow-up. A thorough analysis of the data is necessary to identify and exclude other possible explanations of the association. A government agency dealing with environmental regulations experimented with replacing administrative law judges with scientists. It was believed that scientists were better qualified to make the necessary technical evaluations. The experiment was not considered successful because, as one observer remarked, "Judges are used to having to reach a verdict within a short period of time based on whatever evidence is presented--scientists just can't seem to make decisions." This illustrates a similar difference between the role of the researcher and the role of the physician. The physician must decide the best treatment for each patient based only on whatever evidence is available. There is little question, however, what the patient would decide if allowed to choose between receiving the standard therapy today or waiting 5 years until conclusive scientific evidence has been obtained about whether an alternative treatment is better. Few patients would choose to wait. Yet the decisions a physician makes today will be criticized in 5 years, especially by those who never have had to make similar decisions themselves. Some decisions will turn out to be wrong when additional data are available, but physicians must make choices based on the best data currently available. The choice of medicine as a profession implies the acceptance of a life sentence to jury duty: the evidence will never stop accumulating, and the verdict must be continually reevaluated.

Data Interpretation, Statistical↗
PubMed2002

Fertilisation involving ageing gametes, major birth defects, and Down's syndrome.

For many years, ageing of gametes as a result of prolonged retention in the female reproductive tract before fertilisation has been circumstantially associated with major birth defects. To assess this association, we studied pregnant women who had recorded the timing, with regard to presumed ovulation, of the coital event leading to conception. We found major anomalies in 11 (2.7%) of 400 infants born to women with optimally timed conceptions (on the day of or 1 day before ovulation), compared with 14 (2.5%) of 538 infants of women with non-optimally timed conceptions (odds ratio 0.94, 95% CI 0.43-2.06). The numbers of infants with Down's syndrome were two (0.5%) of 400, and four (0.7%) of 538, respectively (1.48, 0.27-8.06). There is no association between ageing gametes and major birth defects, including Down's syndrome.

Abortion, Spontaneous↗
PubMed2002

The risk takers.

Explore the source record for details and available documents.

Humans↗
PubMed2002

Age and resting follicle number predict response to gonadotropin stimulation in in vitro fertilization cycles.

OBJECTIVE: The purpose of this study was to assess whether age, resting follicle number, intraovarian blood flow, and/or ovarian volume are predictive of follicular response and oocyte quality in patients with in vitro fertilization. STUDY DESIGN: A retrospective chart review was done on 90 in vitro fertilization cycles that were completed in a university setting. Multiple linear regression analysis was used to assess the predictive value of age, resting follicle number, pretreatment ovarian volume, and peak systolic velocity for response to gonadotropin stimulation. RESULTS: Age was predictive (P <.05) for the number of oocytes retrieved, the number that reached two pronuclei, and the number of embryos that reached > or = 4 cells by day 3 after insemination. Resting follicle number was also predictive of follicular response and subsequent embryonic development. Peak systolic velocity and ovarian volume were both found to be of no value. CONCLUSION: Age and resting follicle number can be used as additional parameters to support patient counseling before in vitro fertilization stimulation.

Adult↗
PubMed2002

Timing of initiation of the preovulatory luteinizing hormone surge and its relationship with the circadian cortisol rhythm in the human.

The relationship between the hypothalamo-pituitary-gonadal (HPG) axis and the hypothalamo-pituitary-adrenal (HPA) axis has been well documented in the rat. In most cases, a negative coupling was observed and an inhibitory effect of the HPA axis upon the HPG was shown. In the female rat, a marked circadian rhythm of corticosterone plasma values is observed during each day of the estrous cycle, with maximal values around 08:00 p.m. The preovulatory luteinizing hormone (LH) surge also occurs at 08:00 p.m. on the day of proestrus. Here we measured circadian variations of plasma cortisol in humans in relation with the time of initiation of the preovulatory LH surge. Blood samples were taken at 08:00 a.m., 12:00 a.m., 04:00 p.m., 08:00 p.m., 12:00 p.m., and 04:00 a.m. from 19 subjects for 4 consecutive days, once 17beta-estradiol (E(2)) values reached 125 pg/ml (days 7-10 of the menstrual cycle). Serum E(2) and LH determinations were performed by microparticle enzyme immunoassays. Serum progesterone and plasma cortisol determinations were made using RIA methods. For plasma cortisol values, a marked circadian rhythm, with 2- to 3-fold higher values during the morning than during the afternoon, was almost identical before, during and after the LH surge. However, values were generally higher during the follicular phase than during the luteal phase. Maximum cortisol values occurred between 04:00 and 08:00 a.m. and minimal cortisol values between 04:00 and 08:00 p.m. Initiation of the LH surge (50% over the mean of previous values) occurred at 04:00 a.m. (20% of the cases) or at 08:00 a.m. (80% of the cases). There was a strong coupling between the onset of the surge and the acrophase of the cortisol circadian rhythm: maximal cortisol plasma values were seen at 04:00 a.m. when the LH preovulatory surge started at 04:00 a.m. and 08:00 a.m. when it started at 08:00 a.m. The present results show that the positive coupling documented in the female rat between the HPA and the HPG axis at the time of preovulatory LH surge is also present during the menstrual cycle in the human.

Adult↗