PubMed Health⌕ Search

Biomedical subjects

Jonathan D Norton

Publications and source records attributed to Jonathan D Norton.

4 recordsLinked to original sources
PubMed2006

Absorbing and transferring risk: assessing the impact of a statewide high-risk-pregnancy telemedical program on VLBW maternal transports.

BACKGROUND: Prior research has shown that resources have an impact on birth outcomes. In this paper we ask how combinations of telemedical and hospital-level resources impact transports of mothers expecting very low birth weight (VLBW) babies in Arkansas. METHODS: Using de-identified birth certificate data from the Arkansas Department of Health, data were gathered on transports of women carrying VLBW babies for two six-month periods: a period just before the start of ANGELS (12/02-05/03), a telemedical outreach program for high-risk pregnancies, and a period after the program had been running for six months (12/03-05/04). For each maternal transport, the following information was recorded: maternal race-ethnicity, maternal age, and the birth weight of the infant. Logistic regression was used to assess the relationship between the predictors (telemedicine, hospital level, maternal characteristics) and the probability of a transport. RESULTS: Having a telemedical site available increases the probability of a mother carrying a VLBW baby being transported to a level III facility either before or during birth. Having at least a level II nursery also increases the chance of a maternal transport. Where both level II nurseries and telemedical access are available, the odds of VLBW maternal transports are only modestly increased in comparison to the case where neither is present. At the individual level, Hispanic mothers were less likely to be transported than other mothers, and teenaged mothers were more likely to be transported than those 18 and over. A mother's being Black or being over 35 did not have an impact on the odds of being transported to a level III facility. CONCLUSION: Combinations of resources have an impact on physician decisions regarding VLBW transports and are interpretable in terms of the capacity to diagnose and absorb risk. We suggest a collegial review of transport patterns and birth outcomes from areas with different levels of resources as a vehicle for moving the entire system of care forward over time. With such an evidence-based review in place, the collegial relations among level III specialists and obstetricians from around the state can, over time, develop workable protocols for when and how level III facilities should be involved.

Journal Article↗
PubMed2006

A two-period assessment of changes in specialist contact in a high-risk pregnancy telemedical program.

The purpose was to examine the organizational impact of a state-wide high-risk pregnancy telemedical system, Antenatal and Neonatal Guidelines, Education and Learning System (ANGELS), after the first year of its roll out. The focus is on several aspects of system organization, including the volume and diversity of patient-based telemedical consultations and weekly telemedical case discussions, telephone consultations, and changes in the pattern of birth-related patient transports. Individual data on patient transports and associated hospital days, provider-specialist telephone calls, and telemedical consultations were collected for two time periods: December 2002-May 2003 (prior to initiation of ANGELS), and December 2003-May 2004 (postinitiation of ANGELS). Different statistical tests were constructed to compare the two periods as appropriate. Significant increases were observed in the volume and geographic diversity of telemedical consultations and the volume of telephone consultations. There was a moderate, but nonsignificant decrease in the number of maternal transports to University of Arkansas School of Medical Sciences (UAMS), and the average length of stay decreased. The type of specialist-provider and specialist-patient contact has changed as the ANGELS high-risk pregnancy telemedical system has evolved over the first year. We conclude that the rollout of the ANGELS program is changing the shape of high-risk patient care in Arkansas, and we attribute that to an evolving collegial network between specialists and generalists.

Female↗
PubMed2004

A simple wavelet-based test for evoked responses.

Statistically valid detection of evoked responses from magnetoencephalographic (MEG) sensors is complicated by temporal autocorrelation. By decorrelating time series and transforming them toward normality, the discrete wavelet transform (DWT) allows the analyst to test for an association between stimulus and sensor time series with appropriate degrees of freedom. Eswaran et al. (Neurosci. Lett. 2002a;331:128-32) used a 151-channel fetal MEG system to obtain serial recordings from 10 pregnant subjects. There were 3-8 recordings per subject. In each recording session, the fetus was stimulated by 500Hz and 1KHz tones with a relative frequency of 80-20%, respectively. In this new analysis of the same data, the fetal MEG signals were compared to two different stimulus waveforms: the frequent tone and the Novel stimulus, defined as a change in pitch. WaveDetect was developed to determine whether there was a significant association between the stimuli and the MEG traces. This test is performed by taking the DWT of each series and then computing the Spearman correlation between the wavelet coefficients for an appropriate scale. A significant response (i.e., correlated stimulus-sensor pair) was detected from each patient. This result suggests that the combination of serial recordings and WaveDetect may ensure reliable detection of auditory evoked responses.

Acoustic Stimulation↗