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Biomedical subjects

M Deutchman

Publications and source records attributed to M Deutchman.

16 recordsLinked to original sources
PubMed1991

Advances in the diagnosis of first-trimester pregnancy problems.

Prompt diagnosis of problems in the first trimester of pregnancy is facilitated by ultrasound scanning and quantitative serum human chorionic gonadotropin and progesterone testing. When used appropriately, these tests can determine whether a patient has a normal early pregnancy, a miscarriage, a missed abortion, an ectopic pregnancy or a hydatidiform mole.

Chorionic Gonadotropin↗
PubMed1989

The problematic first-trimester pregnancy.

The first-trimester obstetric patient who is experiencing pain or bleeding may have a normal intrauterine pregnancy, a threatened miscarriage, an ectopic pregnancy, a blighted ovum or trophoblastic disease. Correlation of clinical findings, quantitative human chorionic gonadotropin levels and diagnostic ultrasound findings can maximize the efficiency of the work-up, provide a definitive prognosis and identify early ectopic pregnancy.

Abortion, Spontaneous↗
PubMed1988

The effects of 1% pyrophosphate and 0.02% sodium fluoride on artificial caries lesions in vivo.

We evaluated the potential of a pyrophosphate-fluoride solution to affect the remineralizing-demineralizing equilibrium, i.e., caries-inhibiting/-promoting effects on enamel in vivo. Fifteen subjects carried dentin blocks and enamel thin sections with artificial caries lesions in removable partial dentures for periods of two weeks, during which time they rinsed twice daily in a double-blind, randomized cross-over design with solutions containing (a) 90 ppm F, (b) 90 ppm F and 1% pyrophosphate, or (c) no active agents (placebo). A severe cariogenic challenge provided to the lesions by plaque under a stainless steel mesh cover resulted in the placebo-treated lesions losing 70.2% +/- 72.1% mineral. The pyrophosphate rinse with fluoride held the mineral loss to only 28.1 +/- 52.8%, while the fluoride rinse without pyrophosphate held the loss to 24.2 +/- 50.1%. The differences between the fluoride and placebo results were significant (p less than 0.01), but the difference between the two fluoride groups was not. A large amount of fluoride was deposited in the dentin lesions. In the surface layer, the concentration was increased from 1000 ppm F to more than 2300 ppm F by both fluoride treatments. The concentration of fluoride in both groups of fluoride-treated lesions further increased to more than 3500 ppm F in the approximate center of the lesion before declining in deeper layers toward the level found in the placebo-treated group. The findings from both mineral change and fluoride uptake phases of this study show that in the presence of 90 ppm F, 1% pyrophosphate did not promote demineralization of artificial caries lesions.

Adult↗
PubMed1986

Effects of two fluoride gels on fluoride uptake and phosphorus loss during artificial caries formation.

Blocks of human enamel were cycled through a demineralization--F-treatment-remineralization procedure and then analyzed for fluoride and the presence of caries-like lesions. Treatments with a sodium fluoride gel (5000 ppm F) increased the enamel fluoride concentration to 6500 ppm F, whereas a stannous fluoride gel (1000 ppm F) increased enamel fluoride to about 1200 ppm F. Although a control treatment (water) allowed caries-like lesions to form, as observed by microradiography, no lesions were found in either of the fluoride-treated groups. When the experiment was repeated with radioactive teeth, mineral loss, as determined by release of 32P, was again greatest in the water-treated control group, but some loss was observed in the fluoride treatment groups. The least loss was found in the sodium fluoride group. It was concluded that the fluoride treatments not only increased enamel resistance but also enhanced remineralization so that calcium phosphate was replaced during the subsequent remineralization phase. Because of the probability that stannous ions were deposited during the stannous fluoride treatments, some of the apparent calcium phosphate re-deposition in this group was probably stannous compounds.

Absorptiometry, Photon↗
PubMedDate not supplied

Is reimbursement for childhood immunizations adequate? evidence from two rural areas in colorado.

OBJECTIVE: To assess adequacy of reimbursement for childhood vaccinations in two rural regions in Colorado, the authors measured medical practice costs of providing childhood vaccinations and compared them with reimbursement. METHODS: A "time-motion" method was used to measure labor costs of providing vaccinations in 13 private and public practices. Practices reported non-labor costs. The authors determined reimbursement by record review. RESULTS: The average vaccine delivery cost per dose (excluding vaccine cost) ranged from $4.69 for community health centers to $5.60 for private practices. Average reimbursement exceeded average delivery costs for all vaccines and contributed to overhead in private practices. Average reimbursement was less than total cost (vaccine-delivery costs + overhead) in private practices for most vaccines in one region with significant managed care penetration. Reimbursement to public providers was less than the average vaccine delivery costs. CONCLUSIONS: Current reimbursement may not be adequate to induce private practices to provide childhood vaccinations, particularly in areas with substantial managed care penetration.

Child↗
PubMedDate not supplied

Outcomes from use of an evidence-based practice guideline.

The aim of evidence-based guidelines is primarily to improve patient outcomes without adding to the existing cost of care because both payers and policymakers want to identify health care costs that do not result in benefit to the patient. The purpose of the reported project was to generate a practice guideline for the treatment of uncomplicated acute cystitis in a female population, to determine the extent to which the guideline would be used by providers and to measure the cost and quality of outcomes from its use. A retrospective chart review was used to gather pre-guideline practice and cost data. Measurements included the type, frequency, and duration of antibiotic therapy and the use of urine cultures and both complications and routine followup visits. The implementation of an outpatient practice guideline resulted in a significant change in antibiotic prescribing and a trend toward a change in ordering cultures and clinic followup. There was also a significant decrease in treatment costs.

Acute Disease↗
PubMedDate not supplied

Outcomes of cesarean sections performed by family physicians and the training they received: a 15-year retrospective study.

BACKGROUND: Family physicians are the major or sole providers of Cesarean section services in many communities. Approximately 2800 family physicians provide Cesarean section services in communities of all sizes across the country. METHODS: The outcomes of all Cesarean sections performed at two rural hospitals during a 10- to 15-year period were examined and compared with standard quality-outcome criteria published in the medical literature. Outcome criteria included rates of various surgical complications, use of blood transfusion, infant Apgar scores, and length of postoperative hospital stay. Other descriptive data were examined including patient demographics, operating time, anesthesia type, and choice of incision. Statistical analysis consisted of chi-squares, odds ratios, and stepwise multiple regression. RESULTS: Five hundred sixty-three Cesarean sections were performed by 12 residency-trained family physicians, 68 by general practitioners, 70 by general surgeons, and 9 by obstetrician-gynecologists. Family physicians met or surpassed the referenced standards in all measures examined. The number of Cesarean sections each physician performed while in residency training was also examined. The average number of in-training Cesarean sections was 46, ranging from 25 to 100. CONCLUSIONS: The results of this study support the ability of family physicians to provide Cesarean section services based on a wide range of training backgrounds and variable numbers of procedures done in training.

Cesarean Section↗