Biomedical subjects

Stephen C Alder

Publications and source records attributed to Stephen C Alder.

At least 19 recordsLinked to original sources

PubMed2006

An internet-based method of selecting control populations for epidemiologic studies.

Identifying control subjects for epidemiologic studies continues to increase in difficulty because of changes in telephone technology such as answering services and machines, caller identification, and cell phones. An Internet-based method for obtaining study subjects that may increase response rates has been developed and is described. This method uses information from two websites that, when combined, provide accurate and complete lists of names, addresses, and listed phone numbers. This method was developed by use of randomly selected streets in a suburb of Salt Lake City, Utah, in June 2005.

Case-Control Studies↗

PubMed2006

Mentor's hand hygiene practices influence student's hand hygiene rates.

BACKGROUND: There were 3 objectives for this prospective quasiexperimental study. The first was to determine the effect of mentor's hand hygiene practices on student's hand hygiene rates during clinical rotations. The second was to assess the difference in hand hygiene rates for students with and without prior medical experience. The third was to assess the student's opinion and beliefs regarding hand hygiene. METHODS: Sixty students enrolled in a certified nursing program were selected to participate in the study. Each study group was observed twice during the 30-day span. The first observational period was conducted on day 1 of clinical rotation. The second observational period was conducted on day 30 of clinical rotation. Students were observed for hand hygiene. Also assessed were medical experience, sex, gloving, age, and mentor's hand hygiene practices. After observational period 2, a brief questionnaire was given to students to determine their opinion and beliefs regarding hand hygiene. The questionnaire was divided into 5 sections: student's commitment to hand hygiene, their perception of hand hygiene inconvenience, the necessity of hand hygiene, the student's ability to perform hand hygiene, and their opinion on the frequency of medical staff's hand hygiene. RESULTS: The mentor's practice of hand hygiene was the strongest predictor of the student's rate of hand hygiene for both observational periods (P < .01). Furthermore, students without prior medical experience had a significant increase in hand hygiene rates when comparing observational period 1 to observational period 2 (P < .01). Glove usage was associated with increased hand hygiene rates by 50% during observational period 1 (P = .01) and 44% during observational period 2 (P < .01). Male students during observational period 1 practiced hand hygiene 30% less often than female students (P < .01); however, during observational period 2, there was no significant difference between hand hygiene rates for males and females (P = .82). Questionnaires were completed by 47 students, who reported a strong commitment to hand hygiene, belief in its necessity, and ability to perform hand hygiene (with scores in the high 90s on a 10 to 100 rating scale). CONCLUSION: Mentor's use of hand hygiene and glove usage was associated with increased hand hygiene among students. Even though students reported strongly positive attitudes toward hand hygiene, students had a low overall rate of hand hygiene.

Adolescent↗

PubMed2006

Differences in pain perception in women using concentric and monopolar needles.

OBJECTIVE: To examine pain perception using concentric needle electrodes and monopolar needle electrodes in an all-female study group without underlying hand or arm pain complaints, using study subjects as their own controls. DESIGN: Prospective randomized study. Two muscles--the biceps and abductor pollicis brevis (APB)--were examined using both a concentric needle electrode and a monopolar needle electrode. SETTING: University community. PARTICIPANTS: Eighty healthy female employees at the University of Utah and Primary Children's Hospital were enrolled. All completed the study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Pain scores. Posttest verbal analog pain scale (0-10) measures were obtained after each muscle was studied. A subset of subjects (n=51) was asked to identify needle preference after completion of the study. RESULTS: There was no significant difference in mean pain scores between the concentric needle electrode and the monopolar needle electrode (3.06 and 3.10, respectively; P=.803). The APB muscle was significantly more painful than the biceps muscle with both needle types (mean pain scores, 3.92 and 2.24, respectively; P<.001). In the subset of subjects asked to identify needle preference after completion of the study, 21 chose a concentric needle electrode and 30 a monopolar needle electrode. This difference was not statistically significant. However, verbal analog pain scores were lower with the needle preferred by each subject (P<.20). CONCLUSIONS: There is no significant difference in mean pain scores reported between a concentric needle electrode and a monopolar needle electrode. Subjects were clear on the needle they preferred, and the pain scores reported for the less painful needle were lower than those for the other needle.

Adult↗

PubMed2006

A survey of parental views regarding their child's hearing loss: a pilot study.

OBJECTIVE: Assess parental perceptions of their child's sensorineural hearing loss care. METHODS: Families of pediatric patients diagnosed with a sensorineural hearing loss from 2000 to 2004 were sent a survey asking about their experiences with their child's hearing loss. RESULTS: One hundred eight of 389 families surveyed were studied. Thirteen percent did not know the results of the newborn screening. Twenty-two percent of the primary care physicians were not involved in the child's hearing evaluation. Forty percent of the patients underwent 4 or more audiologic tests before a diagnosis. The most common reason for delayed diagnosis was difficulty in obtaining an appointment with an audiologist. Sixty-two percent of families had difficulties obtaining hearing aids, and 58% noted difficulties obtaining cochlear implants. CONCLUSIONS: Families reported multiple obstacles to obtain timely diagnosis and treatment. Otolaryngologists may need to be more involved in the evaluation and treatment of these patients. EBM RATING: C-4.

Audiometry↗

PubMed2006

Crosslinked hydrogels for tympanic membrane repair.

PROBLEM: To provide a less expensive and more convenient protocol for the treatment of tympanic membrane perforations (TMPs). METHODS: Several materials were prepared and compared for TMP repair including Carbylan-SX, Gelatin-DTPH-PEGDA (GX), Carbylan-S/Gelatin-DTPH (Carbylan-GSX) (injectable and sponge), Gelfoam, Epifilm, and crosslinked thiolated chondroitin sulfate (CS-DTPH-PEGDA [CS-SX]). Hartley pigmented guinea pigs (Elm Hill) underwent bilateral myringotomy with 1 ear left as a control and the other treated with one of the previously mentioned materials. RESULTS: Carbylan-GSX (injectable and sponge), Gelfoam with saline, and CS-SX had the shortest time for TMP closure. Epifilm, Carbylan, and gelatin preparations resulted in closure rates similar to controls. CS-SX showed a marked inflammatory reaction compared with controls and other materials based on neutrophil, lymphocyte, epitheloid counts, and degree of fibrosis. CONCLUSIONS: This study shows the validity of Carbylan-GSX compared with Gelfoam as a material to promote TMP closure in an acute TMP guinea pig model.

Animals↗

PubMed2006

Thyroid disease associated with exposure to the Nevada nuclear weapons test site radiation: a reevaluation based on corrected dosimetry and examination data.

BACKGROUND: A study was begun in 1965 to 1966 to determine whether children exposed to radioactive iodine from nuclear weapons testing at the Nevada Test Site from 1951 through 1962 were at higher risk of thyroid disease. In 1993, we reported that among those examined in 1985 to 1986 (Phase II) there was an association between radiation from the Nevada Test Site and thyroid neoplasms. METHODS: We reevaluated the relationship between exposure to Nevada Test Site fallout and thyroid disease using newly corrected dose estimates and disease outcomes from the Phase II study. A prospective cohort of school children 12 to 18 years old living in Utah, Nevada, and Arizona was first examined for thyroid disease in 1965 to 1966 and reexamined in 1985 to 1986. In the Phase II report, 2497 subjects formed the basis for this analysis. Thyroid disease, including thyroid neoplasms and thyroiditis, was expressed as cumulative incidence and risk ratios (RRs) with a dose-response expressed as excess risk ratio (ERR/Gy). RESULTS: The RR between thyroid radiation dose in the highest dose group and thyroid neoplasms increased from 3.4 (in the earlier analysis) to 7.5. The RR for thyroiditis increased from 1.1 to 2.7 with an ERR/Gy of 4.9 (95% confidence interval = 2.0 to 10.0). There were too few malignant thyroid neoplasms to estimate risk. CONCLUSIONS: Persons exposed to radioactive iodine as children have an increased risk of thyroid neoplasms and autoimmune thyroiditis up to 30 years after exposure.

Adolescent↗

PubMed2006

Cross-linked hydrogels for middle ear packing.

OBJECTIVE: To develop an ideal supportive packing material for ossiculoplasty, tympanoplasty, or other otologic procedures. MATERIALS AND METHODS: Several materials, namely, Carbylan-SX (P-C; Sentrx Surgical, Inc., Salt Lake City, UT), Gelfoam (P-GF; Pharmacia & Upjohn, Kalamazoo, MI), and Merogel (P-MG; Medtronics, Inc., Minneapolis, MN), were prepared and then placed into a Hartley guinea pig's (Elm Hill, Chelmsford, MA) middle ear cavities through a large myringotomy incision. The contralateral ear underwent a large myringotomy without packing material being placed. Preoperative and posteroperative auditory brainstem response studies were performed using Intelligent Hearing system software. The animals were examined weekly. Two weeks after packing placement, the animals were killed, and the temporal bones were harvested. Whole temporal bone sectioning was performed to analyze the presence of implant, surrounding inflammation, presence of osteoneogenesis and fibrosis, or adhesions. RESULTS: All the materials, except the P-MG, were easy to place into the middle ear cavity. The P-MG contains woven strands that are difficult to trim into the small sizes needed for placement. The P-MG group had a smaller average amount of implant present compared with the other groups at 2 weeks. The degree of osteoneogenesis was similar among the P-GF, P-C, and P-MG groups. The P-MG and P-C groups contained the lowest amount of fibrosis between the implant and surrounding middle ear structures. CONCLUSION: This study demonstrates promising results with P-C as a potential supportive packing material for otologic procedures. P-C compares favorably with P-MG and P-GF in a guinea pig model with respect to ease of placement and amount of fibrosis.

Animals↗

PubMed2006

Efficacy of the ketogenic diet as a treatment option for epilepsy: meta-analysis.

The evidence base for the efficacy of the ketogenic diet was assessed among pediatric epileptic patients by application of a rigorous statistical meta-analysis. Nineteen studies from 392 abstracts met the inclusion criteria. The sample size was 1084 patients (mean age at initiation 5.78 +/- 3.43 years). The pooled odds ratio, using a random effects model, of treatment success (> 50% seizure reduction) among patients staying on the diet relative to those discontinuing the diet was 2.25 (95% confidence interval = 1.69-2.98). The reasons for diet discontinuation included < 50% seizure reduction (47.0%), diet restrictiveness (16.4%), and incurrent illness or diet side effects (13.2%). The results indicate that children with generalized seizures and patients who respond with > 50% seizure reduction within 3 months tend to remain on the diet longer. Although no class I or II studies have been published regarding the efficacy of the ketogenic diet, this meta-analysis shows that current observational studies reporting on the therapeutic effect of the ketogenic diet contain valuable statistical data. Future observational studies should aim for long-term follow-up, patient dropout analysis, and improved seizure type characterization.

Adolescent↗

PubMed2005

Mechanisms by which antibiotics promote dissemination of resistant pneumococci in human populations.

Mechanisms by which antimicrobials contribute to dissemination of pneumococcal resistance are incompletely characterized. A serial cross-sectional study of nasopharyngeal pneumococcal carriage in healthy, home-living children <or=6 years of age was conducted in four rural communities-two in Utah (1998-2003) and two in Idaho (2002-2003). Prevalence odds ratios for carriage of resistant pneumococci (OR(res)) and of susceptible pneumococci (OR(sus)) were estimated. Dynamic transmission models were developed to facilitate a mechanistic interpretation of OR(res) and OR(sus) and to compare the population impact of distinct antimicrobial classes. A total of 5,667 cultures were obtained; 25% of the cultures were positive, and 29% of isolates exhibited reduced susceptibility to penicillin. The adjusted OR(res) for recent individual and sibling cephalosporin use was 2.2 (95% confidence interval: 1.4, 3.4) and 1.8 (95% confidence interval: 1.0, 3.3), respectively. Neither individual nor sibling penicillin use was associated with increased OR(res). Rather, recent use of penicillins was associated with decreased carriage of susceptible pneumococci (OR(sus) = 0.2, 95% confidence interval: 0.1, 0.3). In simulations, both types of effects promoted dissemination of resistant pneumococci at the population level. Findings show that oral cephalosporins enhance the risk of acquiring resistant pneumococci. Penicillins accelerate clearance of susceptible strains. The effect of penicillins in increasing resistance is shared equally by treated and untreated members of the population.

Anti-Bacterial Agents↗

PubMed2005

Women and postfertilization effects of birth control: consistency of beliefs, intentions and reported use.

BACKGROUND: This study assesses the consistency of responses among women regarding their beliefs about the mechanisms of actions of birth control methods, beliefs about when human life begins, the intention to use or not use birth control methods that they believe may act after fertilization or implantation, and their reported use of specific methods. METHODS: A questionnaire was administered in family practice and obstetrics and gynecology clinics in Salt Lake City, Utah, and Tulsa, Oklahoma. Participants included women ages 18-50 presenting for any reason and women under age 18 presenting for family planning or pregnancy care. Analyses were based on key questions addressing beliefs about whether specific birth control methods may act after fertilization, beliefs about when human life begins, intention to use a method that may act after fertilization, and reported use of specific methods. The questionnaire contained no information about the mechanism of action of any method of birth control. Responses were considered inconsistent if actual use contradicted intentions, if one intention contradicted another, or if intentions contradicted beliefs. RESULTS: Of all respondents, 38% gave consistent responses about intention to not use or to stop use of any birth control method that acted after fertilization, while 4% gave inconsistent responses. The corresponding percentages for birth control methods that work after implantation were 64% consistent and 2% inconsistent. Of all respondents, 34% reported they believed that life begins at fertilization and would not use any birth control method that acts after fertilization (a consistent response), while 3% reported they believed that life begins at fertilization but would use a birth control method that acts after fertilization (inconsistent). For specific methods of birth control, less than 1% of women gave inconsistent responses. A majority of women (68% or greater) responded accurately about the mechanism of action of condoms, abstinence, sterilization, and abortion, but a substantial percentage of women (between 19% and 57%) were uncertain about the mechanisms of action of oral contraceptives, intrauterine devices (IUDs), Depo-Provera, or natural family planning. CONCLUSION: Women who believe that life begins at fertilization may not intend to use a birth control method that could have postfertilization effects. More research is needed to understand the relative importance of postfertilization effects for women in other populations, and in relation to other properties of and priorities for birth control methods. However, many women were uncertain about the mechanisms of action of specific methods. To respect the principles of informed consent, some women may need more education about what is known and not known about the mechanisms of action of birth control methods.

Journal Article↗

PubMed2005

Clinical decision support and appropriateness of antimicrobial prescribing: a randomized trial.

CONTEXT: The impact of clinical decision support systems (CDSS) on antimicrobial prescribing in ambulatory settings has not previously been evaluated. OBJECTIVE: To measure the added value of CDSS when coupled with a community intervention to reduce inappropriate prescribing of antimicrobial drugs for acute respiratory tract infections. DESIGN, PARTICIPANTS AND SETTING: Cluster randomized trial that included 407,460 inhabitants and 334 primary care clinicians in 12 rural communities in Utah and Idaho (6 with 1 shared characteristic and 6 with another), and a third group of 6 communities that served as nonstudy controls. The preintervention period was January to December 2001 and the postintervention period was January 2002 to September 2003. Acute respiratory tract infection diagnoses were classified into groups based on indication for antimicrobial use. Multilevel regression methods were applied to account for the clustered design. INTERVENTION: Six communities received a community intervention alone and 6 communities received community intervention plus CDSS that were targeted toward primary care clinicians. The CDSS comprised decision support tools on paper and a handheld computer to guide diagnosis and management of acute respiratory tract infection. MAIN OUTCOME MEASURE: Community-wide antimicrobial usage was assessed using retail pharmacy data. Diagnosis-specific antimicrobial use was compared by chart review. RESULTS: Within CDSS communities, 71% of primary care clinicians participated in the use of CDSS. The prescribing rate decreased from 84.1 to 75.3 per 100 person-years in the CDSS arm vs 84.3 to 85.2 in community intervention alone, and remained stable in the other communities (P = .03). A total of 13,081 acute respiratory tract infection visits were abstracted. The relative decrease in antimicrobial prescribing for visits in the antibiotics "never-indicated" category during the post-intervention period was 32% in CDSS communities and 5% in community intervention-alone communities (P = .03). Use of macrolides decreased significantly in CDSS communities but not in community intervention-alone communities. CONCLUSION: CDSS implemented in rural primary care settings reduced overall antimicrobial use and improved appropriateness of antimicrobial selection for acute respiratory tract infections. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00235703.

Acute Disease↗

PubMed2005

Effect of grand multiparity on intrapartum and newborn complications in young women.

OBJECTIVE: To examine the effect of high parity on complications in young women, aged 18-34 years. METHODS: Seven years of Utah birth certificate data were reviewed (1995-2001). Young nulliparas and primiparas were compared with young grand and great grand multi-paras by using logistic regression. Young grand multiparas were compared with older grand multiparas. RESULTS: Young grand multiparas were more likely to have a preterm delivery and less likely to experience fetal distress, instrumented delivery, cesarean delivery, and any intrapartum complication than young nulliparas or primiparas. Young grand multiparas were less likely to experience many complications than their older counterparts. CONCLUSION: Among young women, grand and great grand multiparity does not increase the risk for most intrapartum and newborn complications. Young grand and great grand multiparas are at significantly decreased risk for many complications when compared with young women of lower parity and older grand and great grand multiparas. LEVEL OF EVIDENCE: II-2.

Adult↗

PubMed2004

Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones.

BACKGROUND AND AIMS: Endoscopic retrograde cholangiopancreatography is commonly performed to remove bile duct stones. The aim of this study was to determine short-term outcomes of endoscopic balloon dilation of the sphincter of Oddi compared with sphincterotomy for stone extraction. METHODS: A randomized, controlled multicenter study of 117 patients assigned to dilation and 120 to sphincterotomy was performed in a spectrum of clinical and academic practices. RESULTS: Characteristics of the patients, procedures, and endoscopists were similar except that dilation patients were younger. Procedures were successful in 97.4% and 92.5% of the dilation and sphincterotomy patients, respectively. Overall morbidity occurred in 17.9% and 3.3% ( P < .001; difference, 14.6; 95% confidence interval, 7-22.3) and severe morbidity, including 2 deaths, in 6.8% and 0%( P < .004; difference, 6.8; 95% confidence interval, 2.3-11.4) for dilation and sphincterotomy, respectively. Complications for dilation and sphincterotomy, respectively, included: pancreatitis, 15.4% and .8% ( P < .001; difference, 14.6; 95% confidence interval, 7.8-21.3); cystic duct fistula, 1.7% and 0%; cholangitis, .9% and .8%; perforation, 0% and .8%; and cholecystitis, 0% and .8%. There were 2 deaths (1.7%) due to pancreatitis following dilation and none with sphincterotomy. The study was terminated at the first interim analysis. Dilation patients required significantly more invasive procedures, longer hospital stays, and longer time off from normal activities. CONCLUSIONS: In a broad spectrum of patients and practices, endoscopic balloon dilation compared with sphincterotomy for biliary stone extraction is associated with increased short-term morbidity rates and death due to pancreatitis. Balloon dilation of the sphincter of Oddi for stone extraction should be avoided in routine practice.

Bile Ducts↗

PubMed2004

Associations between body-mass index and surgery for rotator cuff tendinitis.

BACKGROUND: Rotator cuff tendinopathy is a common entity. We hypothesized that obesity, because of biomechanical and systemic risk factors, increases the risks of rotator cuff tendinitis, tears, and related surgical procedures. METHODS: A frequency-matched case-control study was conducted. Three hundred and eleven patients who were fifty-three to seventy-seven years old and who underwent rotator cuff repair, arthroscopy, and/or other repair of the shoulder in a large hospital from 1992 to 2000 were included in the study. These surgical procedures were used as proxies for the risk of rotator cuff tendinitis. These patients were age and frequency-matched to 933 controls, who were randomly drawn from a pool of 10,943 potential controls consisting of Utah state residents who were enrolled in a large cancer-screening trial. Age-adjusted odds ratios were calculated with use of the International Classification of Diseases, Ninth Revision procedural codes and body-mass-index groups. The data were stratified according to gender and age. Multiple linear regression analyses also were performed. RESULTS: There was an association between increasing body-mass index and shoulder repair surgery. The highest odds ratios for both men (odds ratio = 3.13; 95% confidence interval = 1.29 to 7.61) and women (odds ratio = 3.51; 95% confidence interval = 1.80 to 6.85) were for individuals with a body-mass index of > or =35.0 kg/m(2). Tests for trend also were highly significant for both men (p = 0.002) and women (p < or = 0.001). Multiple linear regression analysis also indicated a significant association between increasing body-mass index and shoulder surgery (beta = 1.57; 95% confidence interval = 0.97 to 2.17; p < or = 0.001). CONCLUSIONS: There is an association between obesity and shoulder repair surgery in men and women who are fifty-three to seventy-seven years of age. The results of the present study suggest that increasing body-mass index is a risk factor for rotator cuff tendinitis and related conditions.

Aged↗

PubMed2002

Vitamin A in the cerebrospinal fluid of patients with and without idiopathic intracranial hypertension.

We quantified vitamin A in the cerebrospinal fluid of patients with idiopathic intracranial hypertension, elevated intracranial pressure of other causes and normal intracranial pressure. Vitamin A could be detected by high-pressure liquid chromatography in most of the specimens. There was a significantly higher level of vitamin A in the cerebrospinal fluid of some patients with idiopathic intracranial hypertension. Vitamin A toxicity may play a role in the pathogenesis of idiopathic intracranial hypertension.

Adult↗

PubMed2002

Incision of recurrent distal esophageal (Schatzki) ring after dilation.

BACKGROUND: Distal esophageal (Schatzki) ring is a frequent cause of dysphagia. Bougienage is generally effective but relapse is common. Outcomes for patients treated by endoscopic incision of distal esophageal rings after symptomatic relapses after bougienage are described. METHODS: Eleven patients (2 women, 9 men; median age 61 years; range 24 to 81 years) with recurrent dysphagia after bougienage with large caliber bougies underwent 17 sessions of endoscopic incision of the rings. Follow-up was by standardized interview at a median of 55 months (range, 7 to 84 months) after the initial incision procedure. RESULTS: A median of 3 dilation sessions (range, 1 to >25) were performed prior to incision. All patients noted complete resolution of dysphagia immediately thereafter. Seven required subsequent incision or dilation and 4 did not. The mean dysphagia score was significantly improved from that before incision to that during follow-up. There was a significant increase in the mean duration of improvement in dysphagia after the initial incision compared with that after preincision dilation (respectively, 17 months [range, 2 to 72 months] vs. 5 months [range, 0.5 to 28 months]; p = 0.034). CONCLUSIONS: Endoscopic incision of distal esophageal rings that cause recurrent dysphagia after bougienage improves dysphagia and provides a longer dysphagia-free interval compared with repeated bougienage.

Adult↗

PubMed2002

Topical versus retrobulbar anesthesia for combined phacotrabeculectomy: prospective randomized study.

PURPOSE: To compare the safety and efficacy of topical and retrobulbar anesthesia for combined phacotrabeculectomy. SETTING: Tertiary-care university hospital ambulatory surgical center. METHODS: In this prospective study, 40 consecutive patients having combined phacotrabeculectomy were randomized to receive topical (n = 20) or retrobulbar (n = 20) anesthesia. Operating conditions, patient comfort, and surgical outcome were evaluated. RESULTS: There was no significant between-group difference in operating conditions (P =.56), pain during (P =.41) or after (P =.23) surgery, or supplemental anesthesia required (P =.49). Few patients in either group were bothered by tissue manipulation or the microscope light, although more patients in the topical group were slightly bothered by touch sensation (P =.05). Chemosis, subconjunctival hemorrhage, and eyelid hematoma were seen almost exclusively in the retrobulbar group (P <.05). Inadvertent eye movement was present more frequently in the topical group (P =.04), although this did not pose a problem to the surgeon. CONCLUSION: Topical anesthesia is a safe and effective alternative to retrobulbar anesthesia for combined phacotrabeculectomy.

Administration, Topical↗

PubMedDate not supplied

Physician preparedness for bioterrorism recognition and response: a Utah-based needs assessment.

The medical community accepts that they have a need to be prepared to recognize and respond to bioterrorism events. A needs assessment conducted among physicians throughout the state of Utah provided insights into their perceived training needs and preferred methods of learning. Physicians have many competing demands on their time and tailored educational offering can increase the intended audience's acceptance and learning.

Bioterrorism↗