Biomedical subjects

Joseph Jaeger

Publications and source records attributed to Joseph Jaeger.

5 recordsLinked to original sources

PubMed2005

Inaccuracy of stated versus measured parental heights.

Routine measurement of children's height is essential in monitoring for deviations in normal growth velocity. Target adult height of children is estimated by determining an adjusted midparental height. Such determinations are dependent on the accurate acquisition of parental height. Incorrect assessment of parental height will result in inaccurate expectations for the child's height. To observe the difference between stated and measured parental heights within a United States subspecialty setting, prospective acquisition of parental stated and measured heights during the summer months of 2000 and 2001 was examined. Two hundred and thirty-eight parents, 185 mothers and 53 fathers, were measured. The mean values of the stated heights for mothers and fathers were 163.7 cm +/- 6.3 cm and 177.1 cm +/- 8.6 cm, respectively. The corresponding measured heights were 163.0 cm +/- 5.9 cm and 175.2 cm +/- 6.6 cm, respectively. The mean height difference for mothers was 0.69 cm (p<0.001) while the mean height difference for fathers was 1.90 cm (p<0.001). Parents significantly overestimate their height in a clinical setting. Fathers overestimate to a greater degree than mothers. These findings emphasize the need to obtain height measurement of parents along with that of their children in assessing for linear growth delay.

Body Height↗

PubMed2004

Cardiovascular complications after GI endoscopy: occurrence and risks in a large hospital system.

BACKGROUND: There is limited information concerning the risks for, and occurrence of, cardiovascular complications because of GI endoscopy. Published data are based on questionnaire surveys, which have a potential for bias. Moreover, available studies pertain exclusively to out-patients. METHODS: In-patients and day-stay patients who incurred charges for endoscopy with endoscopic procedure coding from 1999 through 2001 were identified from a financial database for all 9 hospitals in a large health care system. From these patients, those considered "at risk" for cardiovascular complications were selected based on charges for cardioactive medications, cardiac enzyme determinations, or intensive care services on the day of or the day after endoscopy. Medical records were reviewed for 25% of these patients, selected at random, noting demographics, history, and a modified Goldman score in patients with cardiovascular complications (defined as arrhythmia, chest pain or anginal equivalent, hypotension or myocardial infarction occurring within 24 hours after endoscopy). Identical information was obtained from a random sample of 0.5% of the chart records for all patients undergoing endoscopy. RESULTS: Patients who underwent endoscopy were not reliably identified for one hospital. This hospital was omitted from the calculation of the extrapolated rate of complication occurrence, but patients identified through chart review as having or not having a complication after endoscopy were included in the risk analysis. The extrapolated rate of occurrence of cardiovascular complications was 308: 95% CI [197, 457] per 100,000 procedures. Independent risk factors were: male gender, modified Goldman score, and use of propofol. CONCLUSIONS: In this study of patients undergoing hospital-based GI endoscopy, the risk of procedure-related cardiovascular complications was 2 to 70 times higher than previously reported. This finding may be ascribed to differences in the populations sampled and to a case-finding method that minimized reporting and ascertainment biases.

Aged↗

PubMed2004

Assessment of a 360-degree instrument to evaluate residents' competency in interpersonal and communication skills.

OBJECTIVE: To test the reliability of the 360-degree evaluation instrument for assessing residents' competency in interpersonal and communication skills. METHOD: Ten-item questionnaires were distributed to residents and evaluators at Monmouth Medical Center in Long Branch, New Jersey, in March/April, 2002. The scoring scale was 1-5; the highest score was 50. Data were maintained strictly confidential; each resident was assigned a code. Completed data sheets were collated by category and entered into a spreadsheet. The total and mean scores by each category of evaluator were calculated for each resident and a rank order list created. Shrout-Fleiss (model 2) intraclass correlation coefficients measured reliability of ratings within each group of evaluators. Reliability/reproducibility among evaluators' scores were tested by the Pearson correlation coefficient (p <.05). RESULTS: Intraclass correlation coefficients showed a narrow range, from.85-.54. The highest ranked resident overall ranked high and the lowest was low with most evaluators. The rank order among fellow residents was markedly different from other evaluator categories. Pearson correlation coefficients showed significant correlation between faculty and ancillary staff, (p =.002). Patients as evaluators did show intraclass correlation, but did not correlate significantly with other categories. Scores from colleagues correlated negatively with all other categories of evaluators. CONCLUSIONS: The 360-degree instrument appears to be reliable to evaluate residents' competency in interpersonal and communication skills. Information from the assessment may provide feedback to residents. Areas of improvement identified by the scores would suggest areas for improvement and further ongoing assessment.

Clinical Competence↗

PubMed2003

A randomized trial of initial warfarin dosing based on simple clinical criteria.

Warfarin induction is accomplished by titrating dosage to coagulation test results. Algorithms can guide this process but not identify the starting dose. We hypothesized that an initial warfarin dose approximating the maintenance value would safely enhance rapidity of induction. In a randomized trial we compared a fixed-dose to a maintenance-dose strategy for beginning warfarin therapy. To predict the maintenance dose among patients with differing warfarin requirements we performed regression analysis on clinical factors derived from chart review. Four community hospitals supplied records for retrospective analysis. The prospective trial was conducted in one, a 350-bed teaching institution. A sample of inpatients anticoagulated during 1998 formed the development set for retrospective study; a 1999 sample formed the validation set. A one year trial recruited consecutive eligible inpatients initiated on warfarin. We randomly assigned patients to a first warfarin dose calculated using our regression formula or fixed at 5 mg. All patients' subsequent doses were determined (as a percentage of initial) from coagulation testing. We compared days to anticoagulation, hospitalized hours, complications, and activity of factor II and protein C in a patient sample at intervals after induction. Weight, age, serum albumin, and presence of malignancy explained 25-30% of variance in maintenance dose. Ninety patients (44 calculated-dose and 46 standard-dose) evaluated in the clinical trial. Mean time to anticoagulation (among patients achieving anticoagulation) was 4.2 and 5.0 days, respectively (p = 0.007). We observed no significant differences in other endpoints. Individualized initial dosing may safely hasten warfarin induction.

Adult↗

PubMedDate not supplied

Can computerized cost data substitute for chart review?

Identification of alternatives to manual chart review might improve efficiency in quality improvement work. This study at a large community teaching hospital in central New Jersey considered whether selected charges from a patient-level costs database could identify compliance with Sixth Scope of Work indicators in congestive heart failure (CHF). Charges resulting from specific tests, from test outcomes, and from prescribed treatments were identified from among 75 randomly chosen patients with CHF. In the sample 65% (as determined by database analysis) and 69% (as determined by chart review) complied with the principal peer review organization criterion. This difference was less than that found between review and re-review of study charts.

Adrenergic beta-Antagonists↗