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Biomedical subjects

S Broste

Publications and source records attributed to S Broste.

7 recordsLinked to original sources
PubMed1996

The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators.

OBJECTIVE: To examine the association between the use of right heart catheterization (RHC) during the first 24 hours of care in the intensive care unit (ICU) and subsequent survival, length of stay, intensity of care, and cost of care. DESIGN: Prospective cohort study. SETTING: Five US teaching hospitals between 1989 and 1994. SUBJECTS: A total of 5735 critically ill adult patients receiving care in an ICU for 1 of 9 prespecified disease categories. MAIN OUTCOME MEASURES: Survival time, cost of care, intensity of care, and length of stay in the ICU and hospital, determined from the clinical record and from the National Death Index. A propensity score for RHC was constructed using multivariable logistic regression. Case-matching and multivariable regression modeling techniques were used to estimate the association of RHC with specific outcomes after adjusting for treatment selection using the propensity score. Sensitivity analysis was used to estimate the potential effect of an unidentified or missing covariate on the results. RESULTS: By case-matching analysis, patients with RHC had an increased 30-day mortality (odds ratio, 1.24; 95% confidence interval, 1.03-1.49). The mean cost (25th, 50th, 75th percentiles) per hospital stay was $49 300 ($17 000, $30 500, $56 600) with RHC and $35 700 ($11 300, $20 600, $39 200) without RHC. Mean length of stay in the ICU was 14.8 (5, 9, 17) days with RHC and 13.0 (4, 7, 14) days without RHC. These findings were all confirmed by multivariable modeling techniques. Subgroup analysis did not reveal any patient group or site for which RHC was associated with improved outcomes. Patients with higher baseline probability of surviving 2 months had the highest relative risk of death following RHC. Sensitivity analysis suggested that a missing covariate would have to increase the risk of death 6-fold and the risk of RHC 6-fold for a true beneficial effect of RHC to be misrepresented as harmful. CONCLUSION: In this observational study of critically ill patients, after adjustment for treatment selection bias, RHC was associated with increased mortality and increased utilization of resources. The cause of this apparent lack of benefit is unclear. The results of this analysis should be confirmed in other observational studies. These findings justify reconsideration of a randomized controlled trial of RHC and may guide patient selection for such a study.

APACHE↗
PubMed1996

The changing radiographic presentation of bronchogenic carcinoma with reference to cell types.

OBJECTIVE: To analyze chest radiographic patterns of lung cancer at presentation by cell type. This current series is compared with historic published data. DESIGN: Retrospective, using a tumor registry. SETTING: Large, rural multispecialty clinic. PATIENTS: Three hundred forty-five patients with newly diagnosed lung cancers presenting between October 1990 and August 1992. METHODS: Radiographs were interpreted by two radiologists blinded to cell type. Our results were compared statistically to published data from Mayo Clinic patients in the 1950s and 1960s. RESULTS: (1) Adenocarcinoma: Decreased presentation as a peripheral tumor in current series (49%) compared with historic control at Mayo (72%); (2) squamous cell: increased presentation as peripheral tumor in current series (43%) compared with historic control (31%); and (3) no statistically significant difference between adenocarcinoma (49%) and squamous (43%) for a presentation as a peripheral mass, or between adenocarcinoma (46%) and squamous (52%) for central origin in the current series of cases. CONCLUSION: As adenocarcinoma has increased in relative frequency among lung cancers, the percent of cases with peripheral primary tumors is decreased while central tumors have increased. Squamous carcinoma has had a relative increase in peripheral mass presentation. There is now no significant difference between these two cell types in percent presenting as a peripheral mass or central tumor on chest radiograph.

Adenocarcinoma↗
PubMed1992

Hip involvement in juvenile rheumatoid arthritis.

We followed 386 children who met the criteria for juvenile rheumatoid arthritis (JRA) an average of 89 months. Hip involvement in JRA results in poor functional capacity. The prognosis for the pauciarticular group is good, but patients with onset at age greater than 6 years appear to do worse than those aged less than 6 years. In the polyarticular group, age of onset did not change the prognosis, whereas the systemic-onset group aged less than 6 years had a worse prognosis and more frequent radiographic changes than the older group.

Adolescent↗
PubMed1991

High-dose carmustine and autologous bone marrow reinfusion in the treatment of refractory or relapsed small cell lung carcinoma.

Fourteen patients with small cell carcinoma of the lung in relapse or with disease refractory to chemotherapy were treated with carmustine (BCNU) at doses of 600 to 1000 mg/m2 intravenously followed by autologous bone marrow transplantation. All patients previously were treated with cyclophosphamide, doxorubicin, vincristine, and etoposide. Seven of the 14 patients responded to the high-dose BCNU (50% response with 95% confidence limits ranging from 23% to 77%). Three patients had a complete response, and four had a partial response. Regrowth of tumor occurred within 60 days of treatment in the responding patients. Death occurred in six patients before the recovery of the platelet count to 50,000 cells/microliters. Although the response rate was high, the toxicity was excessive. In the dosage range of 600 to 1000 mg/m2 in heavily pretreated patients, BCNU is not recommended, but additional investigation may be warranted in patients with central nervous system metastases who previously were treated with radiation therapy.

Adult↗
PubMed1990

Eye movement patterns in REM sleep.

Eye movements in 6 healthy men and women were studied for recurrent patterns during REM sleep. The REM periods of nocturnal polysomnograms, on 2 consecutive nights, were analyzed in each subject. A discrete scale from 1 to 8 was used to record each eye position. The total number of recorded eye positions for the 2 nights of testing varied from 1314 to 3006. The distributions of eye movement were similar for males and females, for both nights of testing for each subject, among individual REM periods, and between subjects. This was in spite of marked differences in the number and length of REM periods, and in the number of eye movements per minute of REM sleep. In 5 of 6 subjects there was a marked tendency for the eyes to move between the 2 opposite lateral positions. Regardless of the eye position, the opposite movement was generally most likely, with an underlying tendency to return to the most opposite of the two lateral positions. In the remaining subject the opposite movement was also favored, but in this subject eye movements were more likely to be vertical rather than horizontal. Our data suggest that eye movements in REM sleep are organized in complex recurring patterns, with marked similarities between subjects. The significance of these patterns and the significance of deviations from these patterns require further study.

Adult↗
PubMed1986

Risk factors, exercise fitness and electrocardiographic response to exercise in 12,866 men at high risk of symptomatic coronary heart disease.

The association between coronary heart disease (CAD) risk factors with submaximal exercise performance was examined among 12,866 men at high risk in the Multiple Risk Factor Intervention Trial (MRFIT). Men were selected from a risk score based on serum cholesterol level, diastolic blood pressure and number of cigarettes smoked per day. Multivariate analysis using exercise ST depression as the dependent variable showed age, diastolic blood pressure and serum cholesterol level were significant positive predictors of ST depression and cigarettes per day, body mass index and heart rate at rest were significant negative predictors of ST depression. Similarly, multivariate analysis, using exercise duration as the dependent variable, revealed that age, cholesterol level, body mass index and heart rate at rest were significant negative predictors of exercise duration, whereas cigarettes per day and leisure-time physical activity were significant positive predictors. Some of these relationships with exercise performance are consistent with established epidemiologic CAD risk factor associations and others are not. The MRFIT selection process, which resulted in smokers who were significantly younger and who had significantly lower levels of other CAD risk factors than nonsmokers, was partially responsible.

Adult↗