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Biomedical subjects

William F Rayburn

Publications and source records attributed to William F Rayburn.

At least 37 records · Page 2Linked to original sources
PubMed2004

Randomized trial between two active labor management protocols in the presence of an unfavorable cervix.

OBJECTIVE: The purpose of this study was to compare the efficacy of two protocols for active management of labor at term in the presence of an unfavorable cervix. STUDY DESIGN: Pregnancies that underwent labor induction at > or =37 weeks of gestation with an unfavorable cervix (Bishop score, < or =6) were randomly assigned to receive vaginally either a single dose of sustained-release dinoprostone (Cervidil) with concurrent low-dose oxytocin or multidosing of misoprostol (25 microg every 4 hours) followed by high-dose oxytocin. The primary outcome was the time interval from induction to vaginal delivery. Other parameters included excess uterine activity and cesarean delivery rates. RESULTS: A total of 151 patients (dinoprostone, 74 patients; misoprostol, 77 patients) were enrolled. The mean time from the initiation of induction to vaginal delivery was the same in the dinoprostone and misoprostol groups (15.7 hours; 95% CI, 13.7-17.7 hours vs 16.0 hours; 95% CI, 14.1-17.8 hours; P=.34), regardless of parity. The dinoprostone and misoprostol groups did not differ statistically in the percent of patients who were delivered vaginally by 12 hours (36.2% vs 29.7%), 18 hours (63.8% vs 56.3%), and 24 hours (81.0% vs 81.3%). Excess uterine activity was not more common in either group, and hyperstimulation syndrome was absent in all cases. Primary cesarean delivery rates were similar (dinoprostone, 21.6%; misoprostol, 16.9%; relative risk, 1.3; 95% CI, 0.7-2.5), with a failed induction that occurred in one case in each group. CONCLUSION: Sustained-release dinoprostone with concurrent low-dose oxytocin and intermittent misoprostol with delayed high-dose oxytocin are effective alternatives for active management of labor with an unfavorable cervix.

Cervical Ripening↗
PubMed2004

Isolated oligohydramnios is not associated with adverse perinatal outcomes.

OBJECTIVE: To examine fetal growth and perinatal outcomes in pregnancies with isolated oligohydramnios. DESIGN: A cohort study. SETTING: Multiple clinics and hospitals. POPULATION: Low risk pregnant women. METHODS: We used data from the multicentre clinical trial of Routine Antenatal Diagnostic Imaging with UltraSound (RADIUS), in which 15,151 low risk pregnant women were randomly assigned to the ultrasound screening group or the control group. Women in the screening group underwent sonographic exams at 15-22 and 31-35 weeks of gestation. Both groups could have clinically indicated sonographic exams at any time. MAIN OUTCOME MEASURES: We used changes of fetal weight z-score to assess whether fetal growth was compromised from the diagnosis of oligohydramnios until delivery, using a repeated-measures regression. We used a combined perinatal index as an indicator of adverse perinatal outcome, which consisted of severe perinatal morbidity and mortality. RESULTS: Oligohydramnios (amniotic fluid index < or =5 cm) was diagnosed in 1.5% (113/7617) of women with ultrasound screening compared with 0.8% (57/7534) among the controls. Approximately half of the oligohydramnios cases in the screening group were isolated with no clearly associated factors (e.g. premature rupture of the fetal membranes, congenital anomalies, diabetes, hypertension, postdate and intrauterine growth restriction). Fetal weight centiles in isolated oligohydramnios cases did not change significantly from diagnosis until delivery. Pregnancies with isolated oligohydramnios had perinatal outcomes similar to pregnancies with a normal amniotic fluid index. CONCLUSION: Isolated oligohydramnios is not associated with impaired fetal growth or an increased risk of adverse perinatal outcomes.

Cohort Studies↗
PubMed2004

Gestational trophoblastic neoplasia in American Indians.

OBJECTIVE: To analyze gestational trophoblastic neoplasia (GTN) trends among American Indians (AI) using population-based data. STUDY DESIGN: GTN incidence, by race and age, was calculated using data collected by the New Mexico Tumor Registry over 29 years (1973-2001). Live birth, pregnancy and women at risk were tabulated using data derived from the state's vital record annual reports and from the registry. Statistical methods included trends analysis and Poisson regression. There is no national registry in the United States for all GTN. Therefore, the Surveillance, Epidemiology and End Results (SEER) database was used to identify choriocarcinoma cases in American Indians between 1973 and 1999. RESULTS: Within New Mexico, 1,082 cases of GTN were identified among 752,374 live births and 904,831 pregnancies, with ratios of 1:695 and 1:836, respectively, affecting 234 AI, 355 non-Hispanic whites (NHW), 463 Hispanic whites (HW) and 30 other nonwhites. Ratios per live births (pregnancy), respectively, were significantly higher in AI (AI 1:439 [1:487], NHW 1:739 [1:949], HW 1:783 [1:903]), as was age-adjusted incidence per 100,000 woman-years (AI 10.62, NHW 3.53, HW 5.15; all P<.0001). Using Poisson models with live birth and woman-year denominators, AI were found to be at increased risk for all GTN histologic subsets (complete, partial and invasive hydatidiform mole and choriocarcinoma). Of 524 total gestational choriocarcinoma cases identified within SEER, 8 (1.8%) affected American Indians; of them, 7 were from New Mexico. CONCLUSION: In New Mexico, AI continue to be at higher risk of GTN than are other groups. Given the rarity of choriocarcinoma within SEER, especially among AI, the New Mexico dataset provides the best available estimate of trends in U.S. AI GTN risk.

Black or African American↗
PubMed2004

Selecting an external light source for fetal biophysical testing.

OBJECTIVE: To select the most intense light source that penetrates tissues and is safe for fetal biophysical testing STUDY DESIGN: A 3-step series of experiments was undertaken using a digital light meter (Extech Light Probe Meter, Extech Instruments, Waltham, Massachusetts). First, the density of light through a light filter was compared between the sun and 4 commercially available light sources. Second, penetration of light through the abdominal subcutaneous tissue (3-4 cm thick) of 6 pigs was compared between these light sources. Last, the skin reaction to the preferred light source and the distance in penetrating the uterine cavity were assessed in 50 pregnant women. RESULTS: Light emitted from a halogen bulb was significantly more intense than from a photographic flash, krypton bulb or penlight. Maximal intensity was gained with the light source placed against the skin. The halogen bulb penetrated a pig's abdominal wall more than the photographic flash or krypton bulb. The thickness of a pig's abdominal wall is similar to the distance in pregnant humans near term from the skin to the uterine cavity. No thermal injury or discomfort to the skin was observed for exposures <10 seconds. CONCLUSION: The halogen bulb was safe, penetrated tissues most effectively and was the best light source for fetal biophysical testing.

Abdomen↗
PubMed2004

Choosing abdominal incision and closure techniques: a review.

This review summarizes contemporary concepts of abdominal surgical incision creation and closure. The Ovid computerized database was searched for articles published in English from 1996 to 2003 using keywords pertaining to the specific topic of interest (e.g., suture, drain, surgical technique, fascia). Human prospective, randomized trials; meta-analyses; and evidence-based-focused reviews were assessed and data abstracted. Several earlier and animal-based studies on specific issues were included. The data indicate that: (1) the direction of the incision should be based upon obtaining adequate exposure; (2) hair should either be left in place or clipped at the time of surgery; (3) a single dose of prophylactic antibiotics should be given 30 minutes prior to surgery; (4) using a "deep" scalpel is unnecessary; (5) a scalpel and electrocautery are comparable for deepening the incision; (6) minimal peritoneal lavage with non-antibiotic containing solutions is adequate; (7) the peritoneum should not be routinely closed; (8) the fascia should be loosely approximated by a continuous mass closure using a slowly absorbable, monofilament suture with the smallest possible caliber and a suture:wound length ratio of at least 4:1; (9) retention sutures, subcutaenous sutures and drains do not appear to reduce the risk of wound complications; and (10) the skin may be closed in a variety of methods, but a semiocclusive dressing should be applied. As scientific evidence accumulates to refute traditional dogma, management of the surgical patient has undergone substantial changes. Surgeons should now be able to create and close an abdominal wound based upon sound scientific principles rather than simply "doing what I always do."

Abdomen↗
PubMed2003

Trends in gestational choriocarcinoma: a 27-year perspective.

OBJECTIVE: To evaluate trends in incidence and survival rates for gestational choriocarcinoma with the use of population-based data. METHODS: Overall and 5-year average age-adjusted incidence rates were computed with the Surveillance, Epidemiology, and End Results program public-use database. Differences by age at diagnosis, race, stage, registry, and over calendar time were compared by Poisson regression, and survival censored for deaths other than choriocarcinoma by log-rank tests and Cox's proportional hazard ratios. RESULTS: Between 1973 and 1999, 450 cases were recorded. The annualized age-adjusted incidence rate for choriocarcinoma was 0.133 per 100,000 woman-years and decreased by 49.7% (2.8% per year). By race (whites, blacks, and others), incidence rates declined by 62.3%, 27.2%, and 54.3%, respectively. In the Poisson model evaluating incidence rates, age, race, registry, and stage were significant main effects. Compared with whites, the relative risk was higher for blacks (2.14, 95% confidence interval [CI] 1.60, 2.86) and others (2.30, 95% CI 1.67, 3.18). Rates were highest in Utah and lowest in Iowa. By age at diagnosis, rates were higher in 20-39-year-olds. The 5-year relative survival rate was 89.5%. Censored survival was significantly lower among blacks (whites 92.4%, blacks 84.9%, others 87.1%, P = .045), for advanced disease (localized 94.5%, regional 92.9%, distant 87.1%, P = .02), and with increasing age at diagnosis (P = .017). Age and calendar time significantly influenced censored survival independent of stage and registry. CONCLUSION: Gestational choriocarcinoma incidence rates have declined and survivals have improved, but blacks continue to have higher incidence and lower survival rates.

Adolescent↗
PubMed2003

Substance use disorders in women: special considerations during pregnancy.

Care of substance-using pregnant women is complex, difficult, and often demanding. Women's care providers must be aware of these women's unique psychologic and social needs and the related legal and ethical ramifications surrounding pregnancy. In addition, relating specific substances to perinatal outcome is difficult, because concurrent use of multiple substances is frequent and many pregnant abusers are members of economically disadvantaged segments of society in which unfavorable perinatal outcomes are more common. It is also difficult to follow up outcomes in such pregnancies prospectively and to analyze research data. This article discusses various issues related to pregnancies complicated by substance use, including perinatal pharmacology and teratogenic risks, identification of substance abuse, treatment approaches, and comprehensive perinatal management.

Adolescent↗
PubMed2003

Ethnic differences at risk for gestational trophoblastic disease in New Mexico: A 25-year population-based study.

OBJECTIVE: The purpose of this study was to compare gestational trophoblastic disease incidence rates with the use of population-based data. STUDY DESIGN: All incident cases between 1973 and 1997 and live birth, pregnancy, and women at risk were tabulated with the use of data that were derived from the New Mexico Tumor Registry and Vital Records and Health Statistics Annual Reports. Statistical methods included trends analyses, odds ratios, and Poisson regression. RESULTS: Of 939 total cases, 312 non-Hispanic white women, 399 Hispanic white women, 201 American Indian women, and 27 other women were affected. Age-adjusted incidence rates were significantly higher for American Indian women (11.16%) compared with non-Hispanic (3.57%) or Hispanic white women (5.32%); the probability value was <.001. When live birth (1:438 women) and pregnancy (1:486 women) denominators were considered, American Indian women alone were at increased risk, and the ratio increased by 56% over 25 years. American Indian women were also at increased risk for partial mole (relative risk, 4.03; 95% CI, 2.57-6.31), invasive mole (relative risk, 26.7; 95% CI, 7.81-93.14), and choriocarcinoma (relative risk, 6.29; 95% CI, 1.81-22.66) variants. CONCLUSION: American Indians are at increased risk relative to the other predominant ethnic groups in New Mexico. Age-adjusted standardization provided a reproducible measurement that may be applicable across other registries.

Adolescent↗
PubMed2003

Systemic administration of betamethasone delays endotoxin-induced preterm labor in the murine model.

OBJECTIVE: The purpose of this study was to determine whether the administration of betamethasone decreases the endotoxin-induced preterm parturition rate and inhibits the risk of cytokines in the murine model. STUDY DESIGN: Endotoxin was administered intraperitoneally at gestational day 15 (75% of gestation). In phase I, the duration of gestation was measured in 36 gravid C3H/HeOu mice that were equally divided into four treatment groups: control, endotoxin only, and two different dose regimens of betamethasone followed by endotoxin. In phase II, maternal serum and amniotic fluid concentrations of cytokines (interleukin-1alpha, tumor necrosis factor-alpha, and interleukin-6) were measured at 4 hours after endotoxin injection in 44 gravid mice divided equally in the four treatment groups. RESULTS: The group that was exposed only to endotoxin was delivered at a significantly earlier gestational age compared with the control group (16.2 +/- 0.4 days vs 19.6 +/- 0.2 days; P <.01). The two groups that were pretreated with betamethasone before the endotoxin were delivered at gestational ages similar to the control group. There was a marked increase of tumor necrosis factor-alpha and interleukin-6 levels in amniotic fluid of mice that were treated with endotoxin only compared with the control group (P <.001). No difference in cytokine levels was found in those mice that were premedicated with betamethasone compared with the control group. CONCLUSION: Antenatal administration of betamethasone to mice delayed preterm parturition that was induced by endotoxin. Elevations of amniotic fluid cytokine concentrations that were observed with endotoxin were not observed with pretreatment with betamethasone.

Amniotic Fluid↗
PubMed2003

Effects from prenatal exposure to alprazolam on the social behavior of mice offspring.

OBJECTIVE: The purpose of this study was to conduct, in a randomized placebo-controlled manner, social behavior testing on mice offspring that were exposed prenatally to alprazolam. STUDY DESIGN: A previously described, clinically relevant dose of 0.32 mg/kg of alprazolam (n=8 mice) or a placebo (n=9 mice) was given to gravid C57BL/6 mice by gavage on gestational day 18. Social play, sleep/wake patterns, and male aggression of the exposed offspring were assessed during prejuvenile, juvenile, and adult periods. RESULTS: Alprazolam did not produce treatment differences in pregnancy outcomes or in dam-pup interactions. Compared with the placebo group, alprazolam-exposed offspring demonstrated less desire to escape (P<.01), more desire to remain alone (P<.02), and shorter periods of being awake (P<.03) on PND 17. Alprazolam-exposed male offspring exhibited more aggression on food restriction (P<.01) and on cage changing (P<.01). CONCLUSION: Mice offspring that were exposed prenatally to alprazolam demonstrated more individual rather than group activities, avoidance of open areas, and aggression in males. Correlation of these findings in humans is encouraged.

Aggression↗
PubMed2003

What medical students value most during their clinical clerkships from department chairs.

OBJECTIVE: The purpose of this study was to evaluate the qualities that medical students value most in department chairs during clinical clerkships. STUDY DESIGN: All fourth-year students were asked to complete an anonymous survey voluntarily. The students ranked nine qualities of a chair using a visual analog scale that ranged from "strongly disagree" to "strongly agree." Also assessed was the student's level of contact with each department chair during the six core clerkships. RESULTS: Sixty-seven of 73 students (91.8%) completed the survey. Almost two thirds of the students (63%) had minimal or no contact with clinical chairs. The most desirable qualities of the department chair included advocating teaching by the residents and faculty, meeting with students (if possible, at the beginning, middle, and end of the clerkship), and participating in teaching in the classroom or clinic settings. Least important qualities involved knowing the student as a person and displaying an air of authority. The most common theme of written comments was that the department chair sets the tone for the department by advocating teaching and by encouraging respect for students. CONCLUSION: Medical students want clinical chairs to be visibly proactive toward teaching, meet with them periodically, and participate in teaching.

Administrative Personnel↗
PubMed2003

Nuchal cord encirclements and birth weight.

OBJECTIVE: To determine if the presence of a single or multiple nuchal cord encirclement has a negative effect on fetal growth. STUDY DESIGN: Data were retrieved from consecutive deliveries at our institution between January 1991 and December 1996. Our computerized database included live-born single and multiple births with a birth weight of > or = 300 g. ANOVA and multiple linear regression were used for statistical analysis. RESULTS: Among the 13,256 deliveries, a single nuchal cord encirclement was observed in 3,250 (24.5%), and multiple encirclements were present in 504 (3.8%). There was no association between the diagnosis of growth restriction and the presence of a cord encirclement. The mean birth weight was no different in the presence of a single or multiple nuchal cord encirclement than with no encirclement (3,206 g or 3.135 g vs. 3,252 g; F = .08, P = .7). After controlling for substance abuse, medical or obstetric complications, race, infant sex, congenital anomalies and gestational age, there was no effect of a single or multiple cord encirclement on mean birth weight. CONCLUSION: Birth weight is unaffected by a single or multiple nuchal cord encirclement.

Adult↗
PubMed2003

New contraceptive methods.

OBJECTIVE: To provide an update on the current trend toward increasing use of emergency postcoital contraception, continuous (or "extended-use") oral contraceptives (OCs) and longer-acting contraceptive delivery systems. DATA SOURCES: This review is based largely upon patient care-oriented clinical experience data, including some original work submitted to the U.S. Food and Drug Administration by the primary investigators of these novel methods, supplemented, when appropriate, with basic pharmacologic and pharmacokinetic information. METHODS OF STUDY SELECTION: This review is a distillation based on an exhaustive literature search of each of the following topics: emergency postcoital contraception, continuous (extended-use) oral contraception, the weekly patch, the monthly vaginal ring and the monthly injectable. The issue of OC formulations recently begun to be marketed in this country was excluded since they have been extensively reviewed elsewhere. RESULTS: Emergency postcoital contraception is highly effective, though not as effective as available proactive methods of hormonal contraception. Of the popular regimens available, all have similar efficacy; those without estrogen are associated with less nausea and vomiting. The prophylactic administration of an antiemetic 1 hour prior to the first contraceptive dose can mitigate this adverse side effect. Continuous (or "extended" use) of OCs has become increasingly popular. This can decrease or eliminate menstruation as well as several menstruation-related complaints (e.g., dysmenorrhea, menstrual migraines and premenstrual symptoms). Despite the fact that combination OC regimens offer highly reliable contraception as well as several noncontraceptive health benefits, they are limited by the issue of daily compliance. To address this limitation, several longer-acting delivery systems were recently developed. The weekly patch, monthly vaginal ring and monthly injectable have efficacy and side effect profiles similar to those of comparable OC formulations. They offer the advantages of longer action and lower and more steady steroid levels and are free of the challenges associated with daily compliance. CONCLUSION: We need to continue to develop new and highly effective means of contraception that offer women ease of use and minimal side effects, hence leading to successful and effective use.

Administration, Cutaneous↗
PubMed2003

Reported medication errors in obstetric inpatients in 1 hospital.

OBJECTIVE: To describe reported medication errors in the obstetric inpatients in 1 hospital. STUDY DESIGN: We analyzed all errors, reported voluntarily in a nonpunitive manner, from December 1996 to November 2001. RESULTS: The 164 medication errors led to 154 class 1 (no harm), 10 class 2 (additional therapy but no additional harm) and 0 class 3 (permanent harm) adverse drug events. Omissions and incorrect timing of drug administration were the most common reasons. The rate of class 1 adverse drug events was lower in labor and delivery than on the ward (0.8 versus 1.4 per 1,000 patient days; P < .05). Excess dosing with intravenous magnesium sulfate was the most common class 2 event. CONCLUSION: Reported medication errors on 1 inpatient obstetric service were very rare and not associated with permanent harm. Reporting these errors may identify system improvements and avoid recurrences.

Female↗
PubMed2002

Rising rates of labor induction: present concerns and future strategies.

The rate of labor induction nationwide increased gradually from 9.5% to 19.4% between 1990 and 1998. Reasons for this doubling of inductions relate to widespread availability of cervical ripening agents, pressure from patients, conveniences to physicians, and litigious constraints. The increase in medically indicated inductions was slower than the overall increase, suggesting that induction for marginal or elective reasons has risen more rapidly. Data to support or refute the benefits of marginal or elective inductions are limited. Many trials of inductions for marginal indications are either nonexistent or retrospective with small sample sizes, thereby limiting definitive conclusions. Until prospective clinical trials can better validate reasons for the liberal use of labor induction, it would seem prudent to maintain a cautious approach, especially among nulliparous women. Strategies are proposed for developing evidence-based guidelines to reduce the presumed increase in health care costs, risk of cesarean delivery for nulliparas, and overscheduling in labor and delivery.

Adult↗
PubMed2002

Randomized trial of concurrent oxytocin with a sustained-release dinoprostone vaginal insert for labor induction at term.

OBJECTIVE: The purpose of this study was to determine whether the concurrent administration of oxytocin with sustained-release dinoprostone results in shorter induction times when compared with oxytocin after the removal of the dinoprostone insert. STUDY DESIGN: Women with singleton pregnancies at > or = 36 weeks, vertex presentations, reactive nonstress tests, no prior uterine scar, intact membranes, and Bishop scores of < or = 6 were randomly assigned to receive oxytocin either immediately after placement of a sustained-release dinoprostone insert (immediate) or 30 minutes after its removal (delayed). The primary outcome was the time interval from induction to delivery. RESULTS: Seventy-one patients were enrolled (immediate, 34 patients; delayed, 37 patients). There were no differences between treatment groups in non-reassuring fetal heart tracings, excess uterine activity, and epidural use. The mean time from dinoprostone placement until delivery was 544 minutes, shorter in the immediate group (972 vs 1516 minutes; P =.001). The proportion of deliveries within 24 hours was higher (90% vs 53%; P =.002) in the immediate group. Cesarean delivery rates were similar between the immediate and delayed groups (16% vs 13%; P =.73). No adverse maternal or neonatal outcomes were observed with concurrent therapy. CONCLUSION: Oxytocin that is administered concurrently with sustained-release dinoprostone significantly shortens induction-to-delivery times and results in a higher proportion of vaginal deliveries of < or = 24 hours with no apparent adverse effects.

Administration, Intravaginal↗
PubMed2002

Neurobehavior effects in four strains of mice offspring exposed prenatally to alprazolam.

OBJECTIVE: This study was performed to determine whether prenatal exposure to alprazolam affects offspring behavior in different strains of mice. STUDY DESIGN: Eight to 11 gravid mice of the C3H/He, C57BL/6, A/J, and DBA/2 strains were given either an anxiolytic dose of alprazolam (0.32 mg/kg) or a placebo by gavage on day 18 of an anticipated 19- to 21-day gestation. Neurobehavior tasks were conducted to assess anxiety, learning and memory, and social interaction. Data were analyzed by analysis of variance or a Fisher exact probability test. RESULTS: Anxiety in alprazolam-exposed offspring was reduced in C3H/He (P <.05) and A/J (P <.05) newborn infants by separation vocalization but may be increased in the C3H/He adult strain on the plus maze task. Learning was slower among C57BL/6 mice exposed to alprazolam (P <.01), whereas memory was reduced in exposed A/J and DBA/2 offspring (P <.05). Alprazolam exposure was associated with more aggression among C3H/He and C57BL/6 male offspring (P <.01) and with less group activity by C57BL/6 offspring (P <.05). CONCLUSION: Altered behaviors in several mouse strains after prenatal exposure to alprazolam suggests a vulnerability of GABA-benozdiazepine receptor formation in fetal brain development.

Aggression↗