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P E Gates

Publications and source records attributed to P E Gates.

10 recordsLinked to original sources
PubMed1999

Left ventricular morphology and function in endurance-trained female athletes.

In this study, we investigated resting left ventricular dimensions and function in trained female rowers, canoeists and cyclists. In male populations, such athletes have demonstrated the largest left ventricular wall thicknesses and cavity dimensions. Echocardiograms were analysed from 24 athletes (rowers and canoeists, n = 12; cyclists, n = 12) and 21 age-matched controls to measure left ventricular end-diastolic dimension and volume, and septal (ST) and posterior wall (PWT) thicknesses. Left ventricular mass was calculated from M-mode data. Systolic and diastolic function were calculated from M-mode and Doppler echocardiography, respectively. Height, body mass, body surface area and fat-free mass were determined anthropometrically. The athletes were well matched with the controls for all anthropometric variables except fat-free mass (rowers and canoeists 49.7+/-3.6 kg, cyclists 48.0+/-3.8 kg, controls 45.0+/-5.4 kg; P < 0.05). The left ventricular end-diastolic dimension, mass and volume, and septal and posterior wall thicknesses, were all significantly greater in the athletes than the controls (P < 0.05). These differences persisted (except for left ventricular end-diastolic dimension) even after allometric adjustment for group differences in fat-free mass. Stroke volume was larger (rowers and canoeists 102+/-13 ml, cyclists 103+/-16 ml, controls 80+/-15 ml; P < 0.05) in both groups of athletes but all other functional data were similar between groups. As in male athletes, female rowers, canoeists and cyclists displayed significantly larger left ventricular cavity dimensions and wall thicknesses than controls.

Adipose Tissue↗
PubMed1999

Echocardiographic examination of cardiac structure and function in elite cross trained male and female Alpine skiers.

OBJECTIVE: To assess cardiac structure and function in elite cross-trained male and female athletes (Alpine skiers). METHODS: Sixteen athletes (10 male, six female) and 19 healthy sedentary control subjects (12 male, seven female) volunteered to take part in the study. Basic anthropometry determined height, body mass, body surface area, and fat free mass. Cardiac dimensions and function were determined by two dimensional, M mode, and Doppler echocardiography. Absolute data and data corrected for body size (allometrically determined) were compared by two way analysis of variance and post hoc Scheffé tests. RESULTS: Absolute left ventricular internal dimension in diastole (LVIDd), septal and posterior wall thickness and left ventricular mass were larger in athletes than controls (p < 0.05) and also increased in the men (p < 0.05) compared with women (except for septal thickness in controls). An increased LVIDd, septal thickness, posterior wall thickness, and left ventricular mass in athletes persisted after correction for body size except when LVIDd was scaled by fat free mass. Cardiac dimensions did not differ between the sexes after correction for body size. All functional indices were similar between groups. CONCLUSION: There is evidence of both left ventricular chamber dilatation and wall enlargement in cross trained athletes compared with controls. Differences in absolute cardiac dimensions between the sexes were primarily due to greater body dimensions in the men.

Adult↗
PubMed1995

Think globally, act locally: an approach to implementation of clinical practice guidelines.

BACKGROUND: In an environment of concern about the rising costs of medical care, the Vermont Program for Quality in Health Care (VPQHC; the program) was incorporated in 1988 as a nonprofit organization and in 1989 was made a peer review organization by the state legislature. The program acts a resource center for health care in Vermont, coordinating three functions: implementation and maintenance of a statewide database for healthcare quality; training for health care providers in continuous quality improvement (CQI) methods and support for their CQI projects; and focusing clinical study group work on specific diagnoses or procedures. METHODS: The program uses a seven-step process for implementing CQI: pick a process (modify a nationally developed guideline or develop a new guideline); select a team of people involved in doing the work; establish goals and key quality factors; document the clinical process; determine what and how to measure; measure and analyze data; and modify the process to improve. GUIDELINE: This article describes the implementation of a guideline from the American College of Obstetricians and Gynecologists (ACOG) on cesarean section (C-section). Except for a few specific contraindications, the ACOG paper states that it is reasonable to encourage vaginal birth after C-section. A related set of criteria from ACOG states that the benchmark for emergency C-section should be 30 minutes from the decision to proceed with an emergency C-section until the baby is born. CASE STUDY: State C-section rates from 1985-1990 showed wide variation by hospital. Such wide variation is based as much on practice style as on sound science. C-section rates (primary and repeated) were measured, plotted, and shared with Vermont hospitals. Successful vaginal birth after C-section (VBAC) rates from the statewide data-base also were shared. Based on these data, one hospital, Hospital A, developed a plan to lower its repeated C-section rate and improve its VBAC rate. Hospital A collected and reviewed local data, which showed interesting variations. The time from decision to birth became the focus of the overall project; Hospital A designed its project to study events during the time from decision to birth. RESULTS: Most recent data (1992-1993) from Hospital A shows improvement in three areas. First, 89% of patients having emergency C-sections met the goal of a 30-minute time frame from decision to incision. Second, the VBAC success rate for the same time period increased to 85.7% from 69% in the previous year, and from a mere 7% before the implementation of the project. Third, the percentage of total C-sections that were repeat C-sections fell to 36% from a high of 51%. In a follow-up evaluation, one-third of the C-section performed from October 1, 1993, to July 31, 1994 were performed because of patient refusal to attempt VBAC, suggesting that there is a communitywide culture that influences behavior. A major effort at patient education on VBAC is underway. CONCLUSIONS: Think globally, act locally, might be the motto for the program. Implementing guidelines starts with obtaining national guidelines and literature but needs the use of local data to sharpen the focus on narrow areas to address. Specifically, it is unrealistic to tackle the entire problem at once. Success comes from finding specific opportunities for improvement.

Cesarean Section↗
PubMed1993

Clinical quality improvement: getting physicians involved.

Through support from the Robert Wood Johnson Foundation through its program, "Improving the Quality of Hospital Care," the Vermont Program for Quality in Health Care (VPQHC) has developed a quality improvement model that hastens learning through knowledge sharing. Using guidelines and other quality improvement techniques, VPQHC works with hospitals and practitioners to improve not only hospital processes of care but also clinical management. This article describes the concepts driving the program, using an example, and describes the program's success in involving physicians in the process.

Clinical Medicine↗
PubMed1980

Visceral Kaposi's sarcoma presenting with gingival lesions.

This is the first reported case of fatal visceral Kaposi's sarcoma which presented with oral lesions and in which skin lesions were absent throughout the course of the disease. Both clinical and histologic recognition may be difficult because of the similarity of the lesions to pyogenic granuloma.

Diagnosis, Differential↗
PubMedDate not supplied

Wound healing in orthopaedic procedures for Klippel-Trenaunay syndrome.

Klippel-Trenaunay syndrome is a triad of cutaneous hemangiomas, varicose veins, and hypertrophy of soft tissue and bone; when combined with arteriovenous fistulas, the syndrome is known as Klippel-Trenaunay-Weber syndrome. Orthopaedic surgical management of localized limb-length discrepancy or hypertrophy in these conditions is frequently indicated, especially in the lower limb. Forty orthopaedic procedures in 21 patients were retrospectively reviewed. Nine (22.5%) wound complications were identified in this study group. All the complications were associated with transverse amputations. All required significant further treatment and extension of hospital stay. Wound complications should be anticipated in patients with Klippel-Trenaunay syndrome having orthopaedic surgical procedures, especially terminal amputations.

Amputation, Surgical↗