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Biomedical subjects

T Mayer

Publications and source records attributed to T Mayer.

At least 55 records · Page 3Linked to original sources
PubMed1998

Managing utilization successfully in 12 not-so-easy steps.

Managing utilization involves managing the processes of care, which requires a system approach that coordinates services, eliminates redundancy in care delivery, and makes use of alternatives to traditional methods of meeting healthcare needs. On the caregiving level, internally developed benchmarks illuminate efficient or unneeded practice patterns, hospitalist programs help contain inpatient costs, and standard protocols and disease state management help to maintain expected measurable outcomes. Wisely managing patient access to care, relying upon case managers to oversee catastrophic care, assessing high-risk senior citizens and promoting their and other patients' relationships with social service agencies, and implementing patient education and prevention programs all can be coordinated within the managed care system.

Benchmarking↗
PubMed1997

Case-control study of exposure to medication and the risk of injurious falls requiring hospitalization among nursing home residents.

The association between injurious falls requiring hospitalization and selected classes of medications was examined in a case-control study of nursing home residents. Information for this study was obtained exclusively from four computerized administrative databases. Over the period from April 1987 to March 1992, a total of 1,560 first injurious falls occurred to 14,744 residents of Manitoba, Canada, nursing homes who were eligible for inclusion in the study. An injurious fall was defined as an injury consequent to a fall that resulted in admission to the hospital for treatment. Medication use was ascertained from prescription information contained in computerized dispensing records from community pharmacies. Three series of single controls were pair-matched to each case, implementing increasing stringent matching on age, sex, level of dependency, duration of residence, and the presence of up to five chronic disorders. Estimates of relative odds obtained from the most stringently matched case-control series identified two medication classes in which a prescription dispensed in the previous 30 days was associated with an elevated risk of injurious fall: antipsychotic agents (odds ratio = 1.31, 95 percent confidence interval 1.06-1.61) and anxiolytics/sedatives/ hypnotics (odds ratio = 1.35, 95 percent confidence interval 1.09-1.68). An unexpected protective effect was associated with the use inotropic agents (odds ratio = 0.69, 95 percent confidence interval 0.54-0.89). These results support the hypothesis that psychotropic medications are an independent risk factor for injurious falls in nursing home settings.

Accidental Falls↗
PubMed1997

Clinical evaluation of Helioseal F fissure sealant.

Unfilled resins are commonly in use as sealant material. In addition, there are filled sealants available. Helioseal F is a newly developed filled material with fluoride release. In this clinical trial, Helioseal F has been evaluated in one lower molar versus Delton opaque as an unfilled control in lower molars. After 12 months there were no significant differences in retention, porosities, and the number of clinically unacceptable margins between the materials. The complete retention was 30 out of 31 examined teeth for Delton and 28 out of 31 for Helioseal F. After 1 year of clinical testing, these results indicate that a sealant containing fluoride-releasing particles did not show a significant difference in retention rate compared to an unfilled conventional sealant. However, long-term results concerning marginal adaptation should be evaluated.

Adolescent↗
PubMed1997

Facial sporotrichoid infection with Mycobacterium marinum.

We report a case of Mycobacterium marinum facial sporotrichoid infection in an otherwise healthy 2-year-old child, probably acquired through contact with pets in an aquarium. The M. marinum isolate was susceptible to clarithromycin, and the child was successfully treated with oral antibiotic therapy. This unusual case emphasizes the importance of a thorough history in the evaluation of a patient with chronic sporotrichoid skin lesions.

Administration, Oral↗
PubMed1997

Microleakage of temporary restorations after thermocycling and mechanical loading.

The marginal seal of four temporary filling materials in endodontic access cavities was examined in vitro after thermocycling and mechanical loading using dye penetration tests and a quantitative marginal analysis of replicas in the SEM. Class I cavities were prepared in 44 extracted human molars and filled either with Cavit, Kalsogen, IRM, or TERM. After setting the reaction and thermocycling procedure, Cavit showed less microleakage in the dye penetration test and fewer marginal crevices in the quantitative marginal analysis. After loading, two Cavit fillings collapsed into the endodontic cavity. The marginal conditions of TERM were comparable to Cavit after thermocycling and mechanical loading. Kalsogen and IRM restorations demonstrated significantly increased microleakage and a higher percentage of marginal crevices after thermocycling and loading. In contrast to dye penetration tests, the effects of different factors on the marginal integrity of temporary fillings can be examined with the replica technique and quantitative marginal analysis.

Calcium Sulfate↗
PubMed1997

A combined surgical and orthodontic treatment of Class III furcations. Report of a case.

Oral hygiene in furcation defects of upper molars is difficult to achieve. In this case report, a combined surgical and orthodontic treatment procedure is presented to facilitate access and plaque control in furcation areas of upper molars with class-III furcation defects. After endodontic treatment and root resection in an upper 1st molar, the remaining mesiobuccal and palatal roots were separated and aligned orthodontically within the dental arch, as one-rooted teeth. The new morphological position of the roots greatly facilitated oral hygiene and may offer a better long-term prognosis.

Dental Plaque↗
PubMed1997

Dentinal adhesion and histomorphology of two dentinal bonding agents under the influence of eugenol.

This study examined the influence of eugenol on the dentinal adhesion of an enamel-dentin bonding agent that removes the smear layer (total-etch technique) and a system that partially dissolves the smear layer (self-conditioning adhesive system). The tensile bond strength was measured on flat, dentinal surfaces after application and removal of pure eugenol for 15 minutes and a eugenol-containing temporary luting agent for 24 hours. In addition, the resin-dentin interface was evaluated with confocal laser scanning microscopy. Dentinal adhesion was found to be significantly reduced after the application of eugenol when a dentin bonding agent that dissolves the smear layer was used. Under confocal laser scanning microscopy, the resin-dentin interdiffusion zone of both adhesive was found to be changed, not only after application of eugenol but also after application of a eugenol-containing temporary luting agent.

Adhesiveness↗
PubMed1996

Transport between cis and medial Golgi cisternae requires the function of the Ras-related protein Rab6.

The small GTP-binding protein Rab6, a member of the Ras superfamily, is localized on the membranes of the Golgi apparatus and the trans Golgi network. Recent studies revealed that the Rab6 protein might be involved in the transit of proteins through the Golgi complex. In this report we demonstrate the essential function of the Rab6 protein in a distinct step of reconstituted Golgi transport. Polyclonal antibodies and Fab fragments directed against the C-terminal part of the Rab6 protein inhibit transport between the cis and the medial Golgi cisternae. Inhibition also occurred when a trans-dominant mutant form of the Rab6 protein (N126I) was added to the reconstituted transport. Furthermore, Rab6 antibodies inhibit uncoupled fusion of Golgi membranes. From these data we conclude that Rab6 is involved in a process related to membrane fusion at the cisternal membranes of the Golgi apparatus and therefore is needed for the consumption of Golgi-derived vesicles by their target membranes.

Amino Acid Sequence↗
PubMed1996

Recurrent or new injury outcomes after return to work in chronic disabling spinal disorders. Tertiary prevention efficacy of functional restoration treatment.

STUDY DESIGN: A large prospective longitudinal cohort study (n = 1204) to identify prevalence of new or recurrent injury and risk factors in a rehabilitated chronic disabling spinal disorder patient group with matched control subjects. OBJECTIVES: To evaluate prevalence and risk factors for new or recurrent injury on a chronic disabling spinal disorder population. SUMMARY OF BACKGROUND DATA: The rate of symptom recurrence after acute low back pain, like the rate of initial back pain episodes, is extremely high (40-70%). However, although the incidence of recurrent back pain after chronic disabling spinal disorder represents a small subcomponent of these cases, there is a large socioeconomic impact. An individual attempting to return to work after a chronic disabling spinal disorder episode usually bears a stigma of "high risk" for recurrent injury and related work disability that may result in barriers to reemployment or work retention. Before the present research, no large scale studies had been conducted to evaluate whether recurrent spine injuries or new injuries to other musculoskeletal areas could be prevented by medical treatment. In addition, no studies had emerged to evaluate physical and psychologic risk factors of injury recurrence in this context to facilitate design of prevention programs. METHODS: The present study assessed the incidence of claimed recurrent spinal and new musculoskeletal injuries in a population of 1204 workers. A subgroup of 5.3% (n = 64) of treated patients with a new injury claim in the ensuing 12 months was matched for gender, age, race, length of disability, workers' compensation venue, previous surgery, and litigation status to an identically sized control group who did not report new or recurrent injuries. Demographic, physical, and psychologic measures were obtained prospectively on all patients, before and after treatment, to be analyzed as risk factors. RESULTS: During the year after treatment, 1.3% (n = 16) of patients reported another injury to the same spinal area, with only a 0.9% (n = 11) recurrent disability rate. A new injury to a different musculoskeletal area was reported by 4.0% (n = 48) of patients. Only 3.4% of the whole cohort, or 64.1% (n = 41) of the sample reporting reinjuries after returning to work, experienced lost work time (i.e., disability) after the reinjury. Only a modest predictive association was found between risk for new or recurrent injury and two self-report indices. CONCLUSIONS: The present study suggests that even a sample of the most severe chronic disabling spinal disorder workers' compensation patients who complete a tertiary functional restoration program are at relatively low risk for either a recurrent spinal disorder or new musculoskeletal injury claim (with or without disability). No major physical or psychologic risk factors for recurrent injury could be identified in this large cohort. These findings argue powerfully against employer bias in not rehiring employees with previous chronic disabling spinal disorder or discriminating in pre- or reemployment on the basis of putative reinjury risk factors after an appropriate rehabilitation program. Literature review documents a surprising paucity of quality studies examining variables predictive of this important socioeconomic outcome variable.

Adult↗
PubMed1996

[High resolution computerized tomography of middle ear abnormalities].

BACKGROUND: The aim of this study was to analyze malformed petrous bones with computed tomography and to develop a radiologic score which can help to judge the indication for operative reconstructions. METHODS: One hundred forty-two petrous bones in 71 patients with unilateral or bilateral microtia, atresia of the external auditory canal, and malformations of the middle ear were evaluated with high-resolution CT. RESULTS: In 97% of patients with severe auricular dysplasia, there was dysplasia of the middle ear ossicles; in 70% the stapes was malformed. In 32% the oval window was occluded, and in 7% the round window. In 75%, the canal of the facial nerve was displaced, and 16% also showed abnormalities of the labyrinth. A close correlation between the malformation of the auricle and of the middle ear was not found. CONCLUSIONS: High-resolution CT is necessary for the evaluation of malformed middle ears. Based on the abnormalities described, we propose a radiologic score for the assessment of malformed petrous bones. This consists of the following criteria: external auditory meatus, pneumatization of the mastoid and of the tympanic space, size of the tympanic space, facial nerve, vessels, malleus and incus, stapes, oval and round window. The graded points of each structure are added up to the score, which might range between 0 and 28. This score can help to judge the indication for reconstruction of the middle ear. In bilateral malformation we suggest a middle ear reconstruction of the better hearing ear if the score is greater than or equal to 15, and in unilateral malformation if it is at least 20. In patients with lower scores, we only suggest hearing aids.

Adolescent↗
PubMed1996

A method to monitor dental demineralisation in vitro.

This paper presents an in vitro method for monitoring the progression of dental hard tissue demineralisation using consecutive, standardised radiographs. Reliability and factors affecting the reproducibility of this method were established by replicate measurements and comparison to histological evaluation. Whereas assessment of the extent of the lesions by measuring linear distances was highly reproducible, reproducibility of measurements of the central depth of a lesion is affected by the superficial extension and the surrounding hard tissue. Radiographic imaging underestimates the extent of demineralisation as compared to histological analysis.

Disease Progression↗
PubMed1996

Continuity of pediatric ambulatory care in a universally insured population.

OBJECTIVE: To describe the prevalence of continuity of care over a 5-year period in a complete cohort of urban children universally insured for medical care provided under fee-for-service reimbursement. METHOD: All children enrolled in the study were born to women living in metropolitan Winnipeg between July 1, 1987 and December 31, 1988 (N = 12,590). All ambulatory physician services for this group were enumerated from computerized administrative databases for the period from birth through 60 months. Continuity of care, defined as the proportion of total care provided by the most frequently seen physician or physician practice over time, was calculated for each child. Descriptive analyses include an examination of maternal and household characteristics associated with children receiving 80% or more of total ambulatory care from a single provider source. RESULTS: From birth to 24 months, 51% of children received at least 80% of ambulatory visits from a single provider practice. This proportion of the children declined to 28% at 25 through 60 months. Children living in low-income neighborhoods had poorer continuity profiles. Other household factors associated with poor continuity included young maternal age, single maternal marital status, residential mobility, and inadequate maternal use of prenatal medical care. Households affiliated with pediatric practices had better continuity profiles than households affiliated with general medical practices. CONCLUSION: Despite universal medical insurance, barriers to a longitudinally continuous relationship with a primary care provider remain in this setting. Although this study has emphasized the description of those barriers associated with household characteristics, there is evidence that factors related to the organization and delivery of medical care are also relevant.

Adult↗
PubMed1996

[Occupational exposure to enflurane and laughing gas in operating rooms].

Current scientific evidence suggests that chronic exposure to trace concentrations of anaesthetic gases may result in various forms of untoward health responses in operating room personnel. Although there are no clear dose-effect-relationships, in Germany threshold values (MAK-values) exist for nitrous oxide of 100 ppm and for enflurane of 20 ppm. Aim of this investigation was, to determine the exposure of the operating room personnel under modern working conditions using a standardized anaesthetic procedure. By means of a direct-reading, high sensitive gas monitor trace concentrations of nitrous oxide and enflurane were measured at three personnel-related (surgeon, anaesthetist, auxiliary nurse) and a potential leakage source (patient's mouth). The calculation and assessment of the measured concentrations followed the prescriptions of the technical rules for hazardous substances 402 and 403 (TRGS 402 and 403). The personnel-related concentrations were clearly under the MAK-values of 100 ppm nitrous oxide and/or 20 ppm enflurane. The time weighted averages were for the personnel-related measurement points, indicated in ppm for nitrous oxide and enflurane, respectively: "surgeon" 28.3/0.25, "anaesthetist" 39.3/0.34 and "auxiliary nurse" 64.6/0.57. At the leakage source "patient's mouth" time weighted averages of 317 ppm nitrous oxide and 3.79 ppm enflurane were measured. Under air-conditioning with a high air change rate, a central scavenging system and low leakage anaesthesia machine low trace concentrations of anaesthetic gases were measured. Despite an average contamination of approx. 300 ppm nitrous oxide at the "patient's mouth" personnel-related values remained clearly under the MAK-values. Outside the mainstream of the air-conditioning system the group "auxiliary nurse" had an approximately 30% higher exposure than the other groups. Under the described conditions, the working environment "operating room" can be classified as a low exposure working area.

Air Pollutants, Occupational↗