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Biomedical subjects

M J Reeves

Publications and source records attributed to M J Reeves.

At least 19 recordsLinked to original sources
PubMed2006

Quality of hospital care in African American and white patients with ischemic stroke and TIA.

OBJECTIVE: To examine whether differences exist in the in-hospital diagnostic evaluation and treatment of African American and white patients with ischemic stroke (IS) and TIA. METHODS: The authors used a state-wide hospital-based stroke registry prototype designed to measure and track the quality of acute stroke care. Weighted descriptive statistics for each racial group are reported for the following variables, which were deemed to be potential confounders of the association between race and the quality of stroke care: age, gender, insurance status, emergency medical services arrival, functional status on presentation, modified Rankin score at discharge, stroke subtype, neurologist involved in care, and stroke pathway utilization. The magnitude and significance of the associations between race and each quality indicator of in-hospital acute stroke care were determined by separate multiple logistic regression models, adjusting for all potential confounding variables. RESULTS: Among patients admitted with IS and TIA who were alive at discharge (n = 1,837), 340 (18.5%) were African American and 1497 (81.5%) were white. After multivariate analysis, African Americans were less likely to have a door-to-CT time of less than 25 minutes (odds ratio [OR] 0.13 [CI 0.049 to 0.32]), obtain cardiac monitoring (OR 0.54 [CI 0.29 to 1.03]), undergo dysphagia screening (OR 0.69 [CI 0.50 to 0.95]), and receive smoking cessation counseling (OR 0.27 [CI 0.17 to 0.42]). CONCLUSIONS: Quality of hospital care for African American and white patients with acute ischemic stroke and TIA was similar in many respects. However, African Americans were less likely to receive a CT within 25 minutes of arrival, cardiac monitoring, dysphagia screening, and smoking cessation counseling.

Adolescent↗
PubMed2006

IV tissue plasminogen activator use in acute stroke: experience from a statewide registry.

OBJECTIVE: To assess the use of IV recombinant tissue plasminogen activator (rt-PA) in a statewide hospital-based stroke registry and to identify factors associated with its use among eligible patients. METHODS: A modified stratified sampling scheme was used to obtain a representative sample of 16 hospitals. Prospective case ascertainment and data collection were used to identify all acute stroke admissions over a 6-month period. Subjects eligible for IV rt-PA were defined as those who arrived within 3 hours of onset, who had no evidence of hemorrhage on initial brain image, and who had no physician-documented reasons for non-treatment with IV rt-PA. Multivariate logistic regression was used to identify factors associated with IV rt-PA use. RESULTS: Of 2,566 stroke admissions, 330 (12.9%) met the eligibility criteria for rt-PA treatment, and of these 43 (13%) received IV rt-PA treatment. Among 2,236 admissions excluded from consideration, 21% had evidence of hemorrhage on initial imaging, 35% had unknown stroke onset times, 38% had an onset to arrival time >3 hours, and 6% had physician documented contraindications. Among eligible patients, being male, use of emergency medical services, and rapid presentation were associated with increased IV rt-PA use. CONCLUSIONS: Treatment with IV rt-PA was underutilized in this hospital-based stroke registry. The primary reason for nontreatment was delayed presentation. Reducing prehospital and in-hospital response times would help increase IV rt-PA use, as would greater emergency medical services use. Improving the documentation of onset times would help clarify the underlying causes of delayed presentation.

Adult↗
PubMed2001

Blood lipids of young distance runners: distribution and inter-relationships among training volume, peak oxygen consumption, and body fatness.

This study describes the distribution of blood lipid concentrations and examines relationships among training volume (TV, kilometers per week), peak oxygen consumption (VO2peak), body fatness, and blood lipid concentrations in 48 male and 22 female distance runners, aged 10-19 years. Comparisons were made to a current reference sample and clinical cut-off points. Relationships were assessed by partial correlations allowing for age and sexual maturity. Compared to reference median values, mean concentrations of total cholesterol (P=0.07) and low density lipoprotein-cholesterol (P<0.005) were higher, while high density lipoprotein-cholesterol (HDL-C; P=0.24) was comparable in male distance runners. Blood lipid concentrations in female distance runners were comparable to reference median values. Although some subjects had dyslipidemic values, most possessed clinically normal concentrations of blood lipids. The TV was weakly correlated with blood lipid concentrations, but may have been indirectly related with HDL-C through its relationship with VO2peak in males runners (r=0.32). In female runners, correlations between sum of skinfolds (SSF), the trunk-to-extremity ratio (TER) and blood lipid concentrations were low (r=0.16 to -0.27), with one exception (TER and HDL-C, r=-0.60). The most consistent relationships existed among TV, VO2peak, SSF, and HDL-C with partial correlations ranging from low (r=0.10 TV) to moderate (r=0.37 SSF, r=0.41 VO2peak). The correlation between VO2peak and HDL-C remained significant after allowing for age and SSF, while the partial correlation between SSF and HDL-C, allowing for age and VO2peak, was reduced and not significant (r=-0.19, P=0.20). In female runners, the correlation between VO2peak and HDL-C was r=0.32, whereas the partial correlation between SSF and HDLC, allowing for age and VO2peak, was r=0.00. Blood lipid concentrations of young male distance runners were not, on average, different to the general population of the youth of the United States. The young distance runners showed considerable heterogeneity in blood lipid phenotypes, including dyslipidemic values. The results highlight the complex relationships among TV, VO2peak, body fat and HDL-C, and indicate the unique contribution of VO2peak as an important predictor of HDL-C in young distance runners.

Adolescent↗
PubMed2001

Blood lipids in young distance runners.

PURPOSE: The purpose of this study was to examine the age-and sex-associated variation in blood lipids among young athletes. METHODS: A mixed-longitudinal design was used to examine the development of blood lipids in competitive young distance runners followed from 1982 to 1985. Serial data included 99 annual measurements for 27 male subjects and 84 annual measurements for 27 female subjects aged 9-18 yr. Total cholesterol (TC), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), and triglycerides (TG) were determined by standard procedures. RESULTS: In general, cross-sectional age group means showed that TC and LDL-C remained stable and HDL-C declined with age, especially in male subjects. TG increased with age. Age-related trends were statistically significant for HDL-C and TG in boys only (P < 0.05). TC and LDL-C were slightly greater in boys at all ages except 11, 15, and 17 yr (P > 0.05). HDL-C was similar between the sexes until 13 yr when values became greater in girls (3.2-13.8 mg.dL(-1)) (P < 0.05 in 17+ yr). No clear pattern of sex differences emerged for TG. Compared with the general population, blood lipids of young distance runners showed the following trends: 1) TC was above reference medians, 2) LDL-C tended to approximate or to be slightly above reference medians, 3) TG fluctuated about the reference medians, and 4) HDL-C was higher in distance runners compared to the reference medians before age 14 yr, but in the older age groups, especially male subjects, HDL-C either approximated or fell slightly below the reference medians. There was considerable variability in blood lipid levels among the runners. In 21 male and 18 female subjects with serial data for 3-5 yr, HDL-C declined 22.4 and 18.3 mg.dL(-1) (P < 0.05), whereas TG increased 18.0 and 14.0 mg.dL(-1)(P < 0.05 in female subjects only) in male and female subjects, respectively. Tracking coefficients over intervals of 3-5 yr were moderate to high (0.48-0.90), except for TG in male subjects (0.08). CONCLUSIONS: The results indicate that the development of blood lipids in young distance runners is similar to youth in the general population. In contrast to observations in adult endurance athletes, young distance runners did not possess a superior blood lipid profile except for HDL-C in the younger age groups.

Adolescent↗
PubMed1999

Use of patient reminder letters to promote cancer screening services in women: A population-based study in Wisconsin.

BACKGROUND: Patient reminder letters are an effective method of promoting cancer screening services in women; however, information on their actual use in a population setting is lacking. METHODS: Data were obtained from a population-based, random digit dial telephone survey of 896 adult women living in Wisconsin. Respondents were asked if they had received a reminder letter for Pap or mammography screening within the past year. RESULTS: Among women aged >/=18 years, 12.9% (95% confidence interval [95% CI] = 10.1-15. 6) received a Pap test reminder within the past year, while 13.0% (95% CI = 9.3-16.7) of women aged >/=40 years received a mammography reminder. Women without health care coverage were unlikely to receive either type of reminder. Current compliance with screening recommendations was greater among those women who received a reminder letter for Pap tests (94.3 versus 78.1%, P < 0.0001) and for mammography (81.7 versus 59.4%, P < 0.001). In contrast to the infrequent use of cancer screening reminders, 54.2% (95% CI = 50. 1-58.3) and 72.7% (95% CI = 67.6-77.8) of women reported receiving a reminder letter from their dentist or veterinarian, respectively. CONCLUSIONS: Reminder letters for cancer screening services were rarely utilized in this study population. Receipt of a reminder letter was associated with greater compliance with current screening recommendations.

Adult↗
PubMed1998

Evaluation of bovine viral diarrhea virus control using a mathematical model of infection dynamics.

A mathematical model for infection with bovine viral diarrhea virus (BVDV) was created comprising a series of coupled differential equations. The model architecture is a development of the traditional model framework using susceptible, infectious and removed animals (the SIR model). The model predicts 1.2% persistent infection (within the range of field estimates) and is fairly insensitive to alterations of structure or parameter values. This model allows us to draw important conclusions regarding the control of BVD, particularly with respect to the importance of persistently infected (PI) animals in maintaining BVD as an endemic entity in the herd. Herds without PI animals are likely to experience episodic reproductive losses at intervals of two to three years, unlike herds with PI animals which will not see such marked episodic manifestations of infection. Instead, these herds will experience an initial peak of disease which will settle to low-level chronic reproductive losses. The model indicates that vaccine coverage for herd immunity (to avoid episodic manifestations of disease) need be only 57% without PI animals, although 97% coverage is required when PI animals are present. Analysis of model behavior suggests a program of detection and removal of PI animals may enhance the effectiveness of a vaccine program provided these animals are in the herd for 10 days or less. The best results would be seen with PI animals in the herd for 5 or fewer days.

Animals↗
PubMed1997

Chronic disease mortality among Wisconsin Native American Indians, 1984-1993.

Premature chronic disease mortality continues to be a problem among American Indian populations. To document the chronic disease burden in the Wisconsin American Indian population, age- and sex-specific incidence-density mortality rates for ten chronic diseases (ischemic heart disease, stroke, diabetes, chronic obstructive pulmonary disease, cirrhosis, and cancer of the breast, cervix, lung, colorectum and prostate) were estimated for a 10-year period (1984-1993) and compared with the Wisconsin non-Hispanic white population. Compared with whites, American Indians had markedly higher mortality rates from diabetes and cirrhosis in all age- and sex-specific groups. Ischemic heart disease mortality was significantly greater in both American Indian men and women 45-64 years of age (Rate Ratio [RR] = 1.7 and 2.1, respectively) compared to whites of the same age, but was lower in American Indians 65 years of age or older (RR = 0.9 for both sexes). Overall, these ten chronic diseases were responsible for a significant excess number of deaths in middle-aged American Indian men and women (i.e., 45-64 years of age), whereas the chronic disease mortality experience of older American Indian men and women (i.e., > or = 65 years of age) was similar to that of the older white population. Diabetes and cirrhosis were the most important causes of increased mortality overall; however, ischemic heart disease was responsible for a large number of excess deaths in middle-aged American Indian men and women.

Aged↗
PubMed1996

Body mass and breast cancer. Relationship between method of detection and stage of disease.

BACKGROUND: Obesity is associated with advanced stage breast cancer at diagnosis and a poorer prognosis. Stage of breast cancer at diagnosis is also strongly influenced by the method of cancer detection. The objective of this study was to determine the relationship between body mass index (BMI) and breast cancer disease stage, taking into account the method of cancer detection (i.e., self-detection, screening mammography, and clinical breast examination [CBE]). METHODS: From 1988 to 1990, 2863 patients with invasive breast cancer were identified through a statewide, population-based, cancer reporting system and were interviewed as part of a larger study of breast cancer etiology. Stage of disease was classified as either localized or nonlocalized (regional and distant disease combined). The relation between BMI and disease stage was examined by using multiple logistic regression adjusting for age, education, race, year of diagnosis, and prior mammography use. RESULTS: Thirty-eight percent (1092 of 2863) of the women had nonlocalized breast cancer. A strong dose-response relationship was observed between increased BMI and the likelihood of nonlocalized disease (P < 0.001). However, this association was present only among the 55% of women (1585 of 2863) who self-detected their tumors. The odds ratios for nonlocalized cancer increased from 1.0 for the lowest quintile of BMI to 1.3, 1.6, 1.7, and 1.8 for the second through fifth quintiles, respectively, for this group. CONCLUSIONS: Greater body mass was associated with nonlocalized breast cancer; however, this association was restricted to women who detected their own cancer. No association was found between BMI and stage of disease among cases detected by either mammography or CBE.

Adult↗
PubMed1996

A new concept for implementation of a required general surgery clerkship.

BACKGROUND: Two years ago our institution abbreviated the junior internal medicine and general surgery clerkships to accommodate a 4-week family practice clerkship and a 4-week elective clerkship. As a consequence, 1-month mandatory internal medicine and general surgery clerkships were placed in the senior year. METHODS: The surgical disorders most commonly encountered by the generalist are discussed. The senior students spend 4 weeks with a community-based surgeon. All lectures are presented by full-time faculty and adhere to the student manual, which is designed to coincide with examination material. Three histories and physicals are reviewed by the course director to determine utilization of critical thinking skills. The development of healthy interpersonal and professional relationships is addressed by a 2-hour module on the essentials of integrity, compassion, humility, and self-knowledge. A faculty development seminar provides an awareness of course objectives and logistics. Student grades are determined by the preceptor's evaluation (50%), an in-house written examination (50%), and submission of adequate history and physicals. RESULTS: Subjective reviews by students (n = 115) reveal that although only 27% of the students care to pursue a surgical practice, 85% feel that their time was effectively spent and 83% feel that the clerkship should be offered to future fourth year medical students. Seventy percent of submitted history and physicals (n = 420) exhibit appropriate critical thinking skills. CONCLUSIONS: We are currently in the midst of our third year of implementation. The students are receiving insight into a surgical approach to common disease processes. History and physical examination skills and healthy interpersonal relationships are reinforced. Although change is often difficult to accomplish and accept, the positive response to the newly formatted senior curriculum has exceeded expectations.

Clinical Clerkship↗
PubMed1996

Nonsteroidal anti-inflammatory drug use and protection against colorectal cancer in women.

Several epidemiological studies have identified an association between nonsteroidal anti-inflammatory drug (NSAID) use and colorectal cancer risk in women. We examined this association in a population-based case-control study in Wisconsin women. Between 1991 and 1992, 184 women ages 40-74 years with colorectal cancer were identified through the statewide cancer registry and 293 population-based control women were randomly selected via telephone. Regular NSAID use was defined as at least twice weekly for 12 months or longer. After adjusting the data for age, controls were more likely than cases to report regular NSAID use (38 versus 27%). Following adjustment for age, prior sigmoidoscopy use, family history of large bowel cancer, and body mass index, women who regularly used NSAIDs were approximately one-third less likely to be diagnosed with colorectal cancer compared to women who did not use NSAIDs [odds ratio (OR), 0.65; 95% confidence interval (CI), 0.40-1.03]. A statistically significant effect of duration of use was identified, although the ORs did not show a consistent trend. No significant effect of frequency of NSAID use was observed. When the type of NSAID used was examined (aspirin or nonaspirin), subjects who used nonaspirin compounds had a statistically significantly lower risk of colorectal cancer (OR, 0.43; 95% CI, 0.20-0.89), compared to nonusers, whereas aspirin users had only a small, nonsignificant reduction in cancer risk (OR, 0.79; 95% CI, 0.46-1.36). These data add support to the hypothesis that regular NSAID use is associated with lower colorectal cancer risk in women and suggest that the type of NSAID used may be important.

Adult↗
PubMed1995

Sternothyrohyoideus myectomy or staphylectomy for treatment of intermittent dorsal displacement of the soft palate in racehorses: 209 cases (1986-1991).

The efficacy of sternothyrohyoideus myectomy (SM) and staphylectomy as treatments for intermittent dorsal displacement of the soft palate was evaluated in 209 racehorses (126 Thoroughbreds, 83 Standardbreds). The 2 most common complaints were respiratory tract noise (75% of horses) and exercise intolerance (51% of horses). Stopping, defined as the inability to finish the race at racing speed, was reported in 40% of the horses. Endoscopy at rest revealed evidence of abnormal epiglottic anatomy (hypoplasia or flaccidity) in 51% of the horses and abnormal soft palate function in 36% of the horses. Race records were available for 149 (77 Thoroughbreds, 72 Standardbreds) horses. The sex distribution consisted of 38% sexually intact males, 20% geldings, and 42% females, with a mean age of 3.4 years. Sixty-nine horses underwent staphylectomy, with a mean of 16 weeks to first stage after surgery. Eighty horses underwent SM, with a mean of 10 weeks to first start. Sternothyrohyoideus myectomy was performed on significantly more (P < 0.05). Thoroughbreds than Standardbreds, and staphylectomy was performed on significantly (P < 0.0001; chi 2 = 39.56) more Standardbreds than Thoroughbreds. After surgery, most horses (74%) had no change in class; however, more moved up in class (17%) than down (9%). On the basis of comparison of earnings for 3 starts before surgery with that for 3 starts after surgery, successful outcome was obtained in 60% of the horses (35 Thoroughbreds, 13 Standardbreds) that received SM and in 59% of the horses (11 Thoroughbreds, 30 Standardbreds) that received a staphylectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

Determinants of breast cancer detection among Wisconsin (United States) women, 1988-90.

Early detection is advocated widely as the best method to reduce the high rate of breast cancer mortality in women. The purpose of this study was to describe the detection histories of women with breast cancer and to identify factors related to the method of detection. During the period 1988-90, 3,197 women with invasive breast cancer, identified through the Wisconsin (United States) tumor registry, were interviewed. The method of cancer detection (classified as self, screening mammography, or clinical breast examination [CBE]) was analyzed using polychotomous logistic regression. Fifty-five percent (1,754/3,197) of the women found their own cancers, while 35 percent (1,122/3,197) were detected by screening mammography. Compared with self-detection, the likelihood of non-localized disease was significantly lower for tumors detected by mammography (odds ratio [OR] = 0.3, 95 percent confidence interval [CI] = 0.2-0.4) and CBE (OR = 0.6, CI = 0.4-0.7). The likelihood of cancer being detected by screening mammography increased with increasing age, education, number of prior mammograms, family history, and body mass index (weight/height2) (BMI). Women in the highest BMI quintile were 2.3 times (CI = 1.7-3.0) more likely than women in the lowest BMI quintile to have their cancers diagnosed by mammography. This association most likely results from breast tumors being more difficult to palpate in heavier women.

Adult↗
PubMed1995

Epidemiology and the veterinary oncologist--evaluation and critical appraisal of the scientific oncology literature: how to read the clinical literature.

Even in the most specialized areas of veterinary medicine, few clinicians or researchers can keep up with the volumes of scientific literature currently published. Faced with this onslaught, most clinicians would benefit from a systematic approach for selecting articles to read and evaluating their scientific merit.

Data Interpretation, Statistical↗
PubMed1991

Reciprocal apparatus dysfunction as a cause of severe hind limb lameness in a horse.

A 2-year-old Appaloosa mare was admitted because of acute, severe hind limb lameness (grade 4 of 5). The hock could be flexed or extended without influencing the position of the stifle joint, and the fetlock and proximal interphalangeal joints could be extended while the hock was maintained in flexion. The diagnosis was functional loss of the reciprocal apparatus. The differential diagnoses for functional loss of the reciprocal apparatus include disruption of the common calcaneal tendon, the gastrocnemius muscle, the peroneus tertius, or the superficial digital flexor muscle. In this horse, the diagnosis was disruption of the superficial digital flexor muscle. The horse made an excellent recovery following 5 months of stall confinement.

Acute Disease↗
PubMed1991

Tarsocrural joint luxation in a horse.

A 14-year-old Quarter Horse x Thoroughbred gelding was admitted to the teaching hospital because of inability to bear weight on its right hind limb, associated with a severe deviation of the tarsus. The provisional diagnosis was tarsal joint luxation or fracture. Radiography revealed complete luxation of the tarsocrural joint. The luxation was reduced, using minimal force. The horse was confined to a box stall and was maintained in a full-length hind-limb cast for 33 days. Box stall confinement was continued for 3 months after removal of the cast. On reexamination 18 months after the injury, the horse had only mild lameness (grade 1 of 5), but had marked reduction in the range of motion of the tarsus. Radiography revealed extensive changes indicative of severe degenerative joint disease. The horse was still used occasionally as a light pleasure riding horse and maintained itself on pasture well.

Animals↗