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Biomedical subjects

Robert E Booth

Publications and source records attributed to Robert E Booth.

At least 19 recordsLinked to original sources
PubMed2006

Predictors of HIV sero-status among drug injectors at three Ukraine sites.

OBJECTIVE: To assess the HIV serostatus of injection drug users (IDU) in Ukraine, as well as associations between serostatus and selected demographic and risk factors. DESIGN AND METHODS: IDU were recruited from the streets in Kiev, Odessa and Makeevka/Donesk. Participants were interviewed using an HIV risk behavior assessment and tested for HIV with a finger-stick rapid test. Multiple logistic regression was used to identify determinants of HIV infection. RESULTS: Of the 891 IDUs surveyed, one-third came from each site and 22% were female. Their mean age was 29 years and on average they had been injecting for slightly more than 10 years. Seven hundred and seventy-eight of the total sample did not know their HIV status when first interviewed; they are the participants in this investigation. Overall, 33% tested positive for HIV, including 34% in Kiev, 51% in Odessa and 17% in Makeevka/Donesk. Independent predictors of HIV included injecting a sedative/opiate mixture, female sex, having sex with a person who was HIV positive or whose HIV status was unknown and injecting daily. HIV-negative IDU were significantly younger than those infected, they were more likely to be from Makeevka/Donesk and they were more likely to have been sexually active. CONCLUSIONS: Rates of HIV infection among IDU vary considerably across Ukraine, although even in the site with the lowest rate nearly one in five was infected. The extent of drug and sex-related risk behaviors calls for interventions to reduce the spread of HIV and other infectious diseases.

Adult↗
PubMed2006

What would you do? Case challenges in knee surgery.

Six cases representing a variety of orthopedic issues were presented to a panel of senior surgeons. These included the following: (1) developmental patella baja with degenerative arthritis, (2) high valgus knee with attenuated medial collateral ligament, (3) degenerative arthritis with near-ankylosis, (4) depressed tibial plateau fracture with degenerative arthritis, (5) degenerative arthritis with laterally dislocating patella, and (6) degenerative arthritis with distal femoral malunion.

Aged↗
PubMed2006

Predictors of risky needle use following interventions with injection drug users in Ukraine.

This study was designed to assess factors associated with change in needle-related risk behaviors as well as predictors of continued high-risk behavior following intervention efforts among injection drug users (IDUs) in Ukraine. In each of three locations--Kiev, Odessa, and Makeevka/Donesk--100 IDUs were recruited using modified targeted sampling methods. Following a baseline interview, participants were offered free HIV testing and, over the course of the next 5 months, individualized interventions focusing on reducing HIV-related risk behaviors. Former IDUs conducted interventions through street outreach. The intervention model was based on the Indigenous Leader Outreach Model (ILOM) and stressed assessing an individual's unique risks and developing strategies by which to minimize those risks. Follow-up assessments showed significant reductions in every risk behavior measured. Following the intervention, however, approximately one of four participants reported front- or backloading, using drugs obtained from a common container or injecting with a used needle/syringe. Although the sample as a whole averaged only 28 years of age, those who were younger were significantly more likely to engage in each of these behaviors than those who were older. In light of the overall young age of the Ukrainian IDUs observed in this study, the consistent finding that younger IDUs were at highest risk foreshadows a worsening HIV epidemic in Ukraine.

Adult↗
PubMed2006

Revision of a failed patellofemoral arthroplasty to a total knee arthroplasty.

BACKGROUND: Patellofemoral arthroplasty is an effective treatment for isolated arthritis of the anterior compartment of the knee, but it is unclear whether it compromises the results of total knee arthroplasty if revision is necessary. The purpose of this study was to review the results of total knee arthroplasty after a prior patellofemoral arthroplasty. METHODS: Twelve failed patellofemoral replacements in ten patients were revised to total knee arthroplasties for isolated progressive tibiofemoral arthritis (six knees), isolated patellofemoral catching and maltracking (three), or a combination of both (three). Revisions were performed at a mean of four years after the patellofemoral arthroplasty. A posterior stabilized implant was used in each knee, without a need for stems, augments, or structural bone graft. Patients were assessed by clinical and radiographic follow-up, including Knee Society clinical and functional scores. Baseline preoperative Knee Society scores were obtained at the time of evaluation of the failed patellofemoral arthroplasty. RESULTS: At a mean follow-up of 3.1 years, the mean Knee Society clinical and functional scores had increased from 57 points preoperatively to 96 points and from 51 points preoperatively to 91 points, respectively. At the most recent follow-up, there was no clinical or radiographic evidence of patellofemoral maltracking, loosening, or wear. CONCLUSIONS: On the basis of our experience in this relatively small series with short-term follow-up, the results of total knee arthroplasty do not seem to be compromised after revision of the failed patellofemoral replacement.

Adult↗
PubMed2006

Blood management in total joint arthroplasty.

Blood loss associated with total joint arthroplasty can be substantial. Various techniques for dealing with such blood loss include allogeneic blood programs, preadmission donation programs, pharmacologic agents, hemodilution, and perioperative blood salvage. This article reviews these techniques as well as the consequences of perioperative anemia. Problems associated with blood transfusions are also outlined.

Arthroplasty, Replacement↗
PubMed2005

Effect of prize-based incentives on outcomes in stimulant abusers in outpatient psychosocial treatment programs: a national drug abuse treatment clinical trials network study.

CONTEXT: Contingency management interventions that provide tangible incentives based on objective indicators of drug abstinence are efficacious in improving outcomes in substance abusers, but these treatments have rarely been implemented in community-based settings. OBJECTIVE: To evaluate the efficacy of an abstinence-based contingency management intervention as an addition to usual care in community treatment settings. DESIGN: Random assignment to usual care or usual care plus abstinence-based incentives for 12 weeks. SETTING: Eight community-based outpatient psychosocial drug abuse treatment programs. PARTICIPANTS: A total of 415 cocaine or methamphetamine users beginning outpatient substance abuse treatment. INTERVENTION: All participants received standard care, and those assigned to the abstinence-based incentive condition also earned chances to win prizes for submitting substance-free urine samples; the chances of winning prizes increased with continuous time abstinent. MAIN OUTCOME MEASURES: Retention, counseling attendance, total number of substance-free samples provided, percentage of stimulant- and alcohol-free samples submitted, and longest duration of confirmed stimulant abstinence. RESULTS: Participants assigned to the abstinence-based incentive condition remained in treatment for a mean +/- SD of 8.0 +/- 4.2 weeks and attended a mean +/- SD of 19.2 +/- 16.8 counseling sessions compared with 6.9 +/- 4.4 weeks and 15.7 +/- 14.4 sessions for those assigned to the usual care condition (P<.02 for all). Participants in the abstinence-based incentive condition also submitted significantly more stimulant- and alcohol-free samples (P<.001). The abstinence-based incentive group was significantly more likely to achieve 4, 8, and 12 weeks of continuous abstinence than the control group, with odds ratios of 2.5, 2.7, and 4.5, respectively. However, the percentage of positive samples submitted was low overall and did not differ between conditions. CONCLUSION: The abstinence-based incentive procedure, which provided a mean of 203 dollars in prizes per participant, was efficacious in improving retention and associated abstinence outcomes.

Adult↗
PubMed2005

The Knee Society system of standardized abbreviations for surgery of the arthritic knee.

A new standardized system of abbreviations has been adopted by the Knee Society to bring clarity and brevity to scientific reports involving the arthritic knee. This system works by using a set of core abbreviations that are modified with prefixes, suffixes, and superscript notations to indicate succinctly the surgical approach, the procedure used, and the type of prosthesis implanted.

Abbreviations as Topic↗
PubMed2005

The Mark Coventry Award: white blood cell gene expression: a new approach toward the study and diagnosis of infection.

UNLABELLED: We introduce a new genomic approach toward the study and diagnosis of infection. Our purpose is to show that synovial fluid white blood cells express a gene expression "signature" that differentiates septic from aseptic inflammation. Synovial fluid was aspirated from patients with acute Staphylococcus aureus infections or acute gout of the knee. Differential cell counts included predominantly neutrophils in all aspirates. Ribonucleic acid was isolated from the synovial-fluid white blood cells and was analyzed on the Affymetrix U133A GeneChip. The neutrophils from a patient whose knee is infected with Staphylococcus aureus can be distinguished from the neutrophils found in gout by nature of their differential gene expression. There are 1615 genes that have an expression level that is significantly different between the groups. The 124 most significant differences are in genes from immune pathways including the interleukin pathway, the tumor necrosis factor pathway, and the antibacterial response. The neutrophils at a site of infection (Staphylococcus aureus) express different genes than the neutrophils at a site of aseptic inflammation (gout). To our knowledge, this is the first in vivo demonstration of this principle. The differences in neutrophil gene expression may be used to develop simple laboratory tests that distinguish the causes of inflammation in a total joint arthroplasty. LEVEL OF EVIDENCE: Diagnostic study, Level II-1. See the Guidelines for Authors for a complete description of levels of evidence.

Acute Disease↗
PubMed2005

Nonsurgical and surgical management of lumbar spinal stenosis.

The symptoms associated with lumbar spinal stenosis can decrease quality of life and may cause patients to seek treatment. Except in rare cases of rapid neurologic progression or cauda equina syndrome, nonsurgical modalities should be the initial treatment choice. Activity modification, a variety of medications, epidural steroid injections, and other methods are recommended for pain reduction. A formal physical therapy program, which focuses on flexion-based exercises, may lead to improved patientfunction. Surgery is indicated in patients who remain symptomatic despite a course of nonsurgical therapy and who have advanced imaging studies that correspond to existing .symptoms. Adequate decompression of the neural elements and maintenance of bony stability are necessary for a good surgical outcome for patients with spinal stenosis. Laminectomy has long been the method of choice for thorough lumbar decompression. Preserving at least the lateral half of the facet joints bilaterally and bone in the area of the pars interarticularis minimizes the potential for iatrogenic instability. Numerous other decompression techniques have been described, including multilevel laminotomies, fenestration, distraction laminoplasty, and microscopic decompression. Arthrodesis, either with or without instrumentation, is also indicated in some patients. Several studies report that surgical treatment produces better outcomes than nonsurgical treatment in the short term; however, the results tend to deteriorate with time. Lumbar decompressive surgery can be complicated by epidural hematoma, deep venous thrombosis, dural tear, infection, nerve root injury, and recurrence of symptoms.

Decompression, Surgical↗
PubMed2004

Factors associated with methadone maintenance treatment retention among street-recruited injection drug users.

This study examined factors associated with methadone maintenance retention, defined as remaining in treatment for a minimum of 90 days, among street recruited injection drug users (IDUs). Targeted sampling methods were used to establish recruitment quotas in Denver census tracks. A total of 577 IDUs were randomly assigned to either a risk reduction intervention, focusing on safer injection and sex behaviors, or motivational interviewing, addressing more sweeping lifestyle changes including drug treatment. All subjects who wanted treatment were provided transportation, rapid intake and a waiver of the intake fee. In addition, 50% were randomly assigned a coupon for 90 days of free treatment. Overall, 33% entered treatment and of these, 60% remained for at least 90 days. Factors associated with retention included higher methadone dose, free treatment, greater contacts with the clinic and counselor rating of patient cooperation. Although desire for treatment, or motivation, was associated in univariate analyses with greater retention, there were no differences observed between the motivational interviewing and risk reduction interventions.

Adult↗
PubMed2004

Predictors of self-reported HIV infection among drug injectors in Ukraine.

OBJECTIVE: To identify characteristics, including current high-risk drug and sex behaviors, associated with self-reported HIV infection among injection drug users (IDUs) in Ukraine. DESIGN: Targeted sampling of IDUs from Kiev, Odessa, and Makeevka/Donetsk, Ukraine. METHODS: From June through August 2002, 100 IDUs from each site were recruited through street outreach, including 212 who had previously been tested for HIV and knew their serostatus. Subjects were administered a standardized computer-assisted interview assessing HIV-related drug and sex risk behaviors and history of HIV testing. RESULTS: Twenty six percent of the 212 participants reported they were HIV-positive. Univariate followed by multiple logistic regression analyses were used to identify factors associated with HIV infection. In the 30-day period before their interview, HIV-infected IDUs were significantly more likely to have injected with a needle previously used by another injector without disinfecting, frontloaded and/or backloaded, and shared the drug solution from a common container. In addition, they had higher prevalence rates for hepatitis B virus and hepatitis C virus than those not infected with HIV. On the other hand, they were more likely to have reported no sex partners and, if sexually active, more likely to have used a condom. CONCLUSION: The high HIV seroprevalence among IDUs in Ukraine, combined with their continued engagement in needle-related risk behaviors, assures the continuance of the epidemic in this region, a region that is the epicenter of HIV in Europe.

Adult↗
PubMed2004

Embolization of traumatic pseudoaneurysms after total knee arthroplasty.

We report on 2 cases of traumatic pseudoaneurysm after total knee arthroplasty. In one patient, a hemarthrosis and a pulsatile antecubital mass developed 1 month after arthroplasty, prompting angiography. In the second patient, evacuation of a large hemarthrosis was performed before angiography and embolization. In both patients, the pseudoaneurysm was successfully treated without the need for surgical repair, using percutaneous thrombin injection or transcatheter embolization. No recurrence of hemarthrosis was seen in either patient at up to 24 months of follow-up evaluation. These cases show the use of angiography in reconstructed joints when acute or delayed hemarthrosis occurs, and the role of embolization techniques in this setting.

Aged↗
PubMed2004

Arthroscopy before arthroplasty: a con or a comfort?

The proliferation of arthroscopic procedures in the United States has called into question the efficacy of this technique in the presence of degenerative arthritis of the knee. Appropriate filters such as a history of mechanical rather than inflammatory symptoms, the presence or absence of a joint space on weight-bearing radiographs, and the exhaustion of other less invasive measures are not only increasingly appropriate, but may soon be mandated by Medicare and other third-party payers. It is important that orthopedic surgeons lead and modulate this debate in the interest of their patients and the quality of their surgeries.

Arthroplasty, Replacement, Knee↗