1.
A History of Quality of Life Measurements - Prutkin, Jordan Matthew
Purpose: To review the origins and early development of quality of life measurements in the medical literature.
Methods: A comprehensive literature review of Medline from 1966-1986 examining articles with quality of life as a subject heading. Studies were included if they were the original article describing a scales development or used scales developed in the social science literature.
Results: The measurements have been derived from two separate sources: a transfer and expansion of medical appraisals for health status, and an application of sociometric and psychometric methods for populational assessment of happiness, well-being, and other affects. Neither source of measurements used the basic...
2.
Effects of Brain Region and Gender on Proton Magnetic Resonance Spectroscopy in Normal Subjects - Pol-Rodriquez, Marlyanne M.
The purpose of this study was to acquire spectra using proton magnetic resonance spectroscopy (MRS) with a long echo time (TE) to measure clinically important brain metabolites in normal subjects. We aimed to determine whether these metabolites vary across brain regions and between men and women. The results of this study will constitute a normative database that will be used as a reference for MRS studies of patients with neurological disease.
Single voxel proton (1H) spectra were acquired in seventy-two subjects ranging in age from twenty to forty-four years. Ten brain regions were examined. Six gray matter sites in the cerebrum...
3.
Demographic Characteristics of Adoptees Presenting to the Yale International Adoption Clinic and the Utility of Pre-Adoption Video Review - Boone, Jon L.
The major purpose of this study was to examine whether the assessment of pre-adoption video (pre-vid) by an experienced pediatrician accurately predicts the post-adoption developmental (post-dev) status of the adoptee on arrival and to examine any difference in the extent of developmental delay between those adoptees with and those without a pre-vid review. As a foundation for the study, an extensive database for all adoptees seen at the Yale International Adoption Clinic was created and their demographic characteristics were analyzed.
The developmental status of 20 children from Russian and Eastern European orphanages was assessed by an experienced pediatrician using a pre-vid...
4.
African-Americans at the Yale University School of Medicine:1810-1960 - Daniels, Daryl Keith
African Americans have had a long and interesting history at the Yale School of Medicine. Through extensive researching of primary and secondary sources this history is documented for the first time. The first African-American known to have graduated from the School was Dr. Courtlandt Van Rensselaer Creed. Because of strong abolitionist sentiment at Yale and in New Haven during the 1850s and his familys prominence in New Haven, Dr. Creed was able to matriculate into the School of Medicine in 1854. He graduated in 1857 and practiced in New Haven. He also served as a surgeon in the Civil War.
Two...
5.
Risk Factors for Delayed Diagnosis of Subarachnoid and Intracerebral Hemorrhage - Oen-Hsiao, Joyce Mey Sian
To identify risk factors for delayed diagnosis of subarachnoid (SAH) or intracerebral (ICH) hemorrhage in younger patients (ages 18 ¨C 49), we performed a subsidiary case-control study among 702 subjects from the Hemorrhagic Stroke Project (HSP). Case subjects were the 54 HSP patients (7.7%) who did not receive an appropriate diagnostic evaluation (brain CT scan, and if CT negative, LP) within 24 hours of consulting a physician for symptoms consistent with hemorrhagic stroke. For each case subject with a delayed diagnosis, we identified two subjects from the HSP with a prompt diagnosis, all successfully matched on recruitment site. We calculated...
6.
Use of SPECT Difference Imaging to Assess Subcortical Blood Flow Changes During Epileptic Seizures - Norden, Andrew D.
Seizures are thought to arise primarily from the cerebral cortex. However, the propagation and behavioral manifestations of seizures involve a network of both cortical and subcortical structures. The medial thalamus and upper brainstem reticular formation are crucial areas for the maintenance of normal consciousness. Bilateral involvement of these structures may be responsible for loss of consciousness during partial seizures. Therefore, we sought to investigate the role of the medial thalamus and brainstem in seizures. We performed SPECT ictal-interictal difference imaging co-registered with high-resolution MRI scans to localize regions of cerebral blood flow changes in patients undergoing inpatient monitoring for epilepsy....
7.
In utero Idnomethacin alters O-2 [oxygen]delivery to the fetal ductus arterious: implications for persistant post-natal patency - Goldbarg, Seth Hamlin
Exposure of the fetus to indomethacin produces constriction of the fetal ductus arteriosus (DA) and hypoxia in the avascular muscle media of the vessel wall. Hypoxia induces cell death, which increases the incidence of patent DA in the newborn period. We used a fetal sheep model to determine the factors that were responsible for indomethacin-induced hypoxia at various degrees of DA constriction. Indomethacin produced DA constriction in all fetuses studied in vivo. Cell death in the DA wall was directly related to the degree of indomethacin-induced DA constriction and was present at both moderate (pressure gradient across DA <16 mmHg)...
8.
The Recognition and Determinants of Depression at a South African Primary Care Clinic - Triant, Virginia Athena
Depression leads to substantial morbidity and mortality on a global scale, but it is frequently underrecognized and inadequately treated in primary care settings. The detection of depression is particularly challenging in under-resourced countries. This study attempts to determine rates of recognition and treatment of depressive disorders at a community clinic in the Cape Flats, South Africa.
The diagnostic instrument PRIME-MD was administered and charts reviewed for a sample of 222 patients presenting to the Lotus River Community Health Centre. Outcomes sought were (1) the prevalence of depressive disorders and (2) rates of detection and treatment as indicated by antidepressant prescription through...
9.
Discussing Prognosis: Documented Communication with Elderly Patients with Cancer at the End of Life - Hallemeier, Anna Gibb
The purposes of this study were to evaluate the frequency of documented prognosis discussions among terminally ill cancer patients, to identify correlates of having documented prognosis discussions, and to describe the content of prognosis discussions as documented in patient medical records. Sample data were collected from the randomly selected medical records of inpatients (n=210) aged 65 years or older and admitted with diagnoses of brain, pancreas, liver, gall bladder, or inoperable lung cancer from six large Connecticut hospitals. A standardized instrument was used to extract data concerning patient demographics, hospital course, prognosis discussions, and evidence of advance care planning. Prognosis...
10.
PATTERNS OF EFAVIRENZ USE AMONG HIV-POSITIVE WOMEN IN URBAN HIV AND HIGH-RISK OBSTETRICS CLINICS - Kronman, Matthew P.
We investigated patterns of efavirenz use among physicians caring for HIV-positive women in the primary HIV and high-risk obstetrics clinics (HROC) of an academic teaching hospital. Efavirenz, a non-nucleoside reverse transcriptase inhibitor approved for HIV treatment, is a potential teratogen. The FDA recommends that women prescribed efavirenz use two forms of birth control and avoid becoming pregnant. We conducted a retrospective analysis of medical records of reproductive-age HIV-positive women seen between September 1998 and December 2002, recording information documented at initial prescription of efavirenz, pregnancies occurring on efavirenz, other antiretroviral medications taken during pregnancy, and fetal malformations noted at birth....
11.
EXPRESSION OF THE EXTRACELLULAR NUCLEOTIDE DIPHOSPHOHYDROLASE, NTPDASE2, IS DOWN-REGULATED IN PRIMARY CHOLANGIOPATHIES - Toure, Joahd
Portal fibroblasts are newly discovered liver cells that may be of particular importance in biliary fibrosis. Recent data indicate that portal fibroblasts express NTPDase2, an ecto-nucleoside triphosphate diphosphohydrolase. Portal fibroblasts exist within the peri-portal regions of rat livers and express NTPDase2 adjacent to the basolateral side of intrahepatic bile ducts. Because extracellular nucleotides regulate secretion via activation of P2Y purinergic receptors, extracellular nucleotide hydrolysis via NTPDase2 makes NTPDase2 a potential regulator of bile ductular secretion. We propose that NTPDase2 expression may be altered in biliary fibrosis, especially in conditions in which bile duct epithelia are the target of disease. To...
12.
UCSF MOUNT ZION: The Closure of a Teaching Hospital and Its Primary Care Residency Program - Teitelbaum, Jennifer
In November 1999, financial losses led the University of California at San Francisco Medical Center (UCSF) to close all inpatient services at Mount Zion Hospital, a community teaching hospital affiliated with UCSF since 1990. As a result of the closure, Mount Zions primary care residency program (MZPC) was merged with UCSFs university-based primary care program. We examined these events in the context of three major currents in U.S. health care: containment of rising health care costs, financial pressures on teaching hospitals, and the shifting priorities in graduate medical education with respect to subspecialty medicine and primary care. As part of...
13.
Do Physicians Have an Ethical Obligation to Care for Patients with AIDS? - Angoff, Nancy Rockmore
This thesis responds to the question: Do physicians have an ethical obligation to care for patients with Acquired Immunodeficiency Syndrome (AIDS)? First, the social and political milieu in which this question arises is sampled. Here we find physicians as well as other members of the community exclaiming an unwillingness to be exposed to people with AIDS. Next, laws, regulations, ethical codes and principles and the history of the practice of medicine are examined, and the literature as it pertains to these areas is reviewed. The obligation to care for patients with AIDS, however, cannot be located in an orientation to...
14.
Patient age, number and type of clinical encounters, and provider advice to quit smoking. BRFSS 2000 - Lucan, Sean C
The purpose of this study was to determine how often smoking patients receive quit advice and if patient age, and number and type of clinical encounters are associated with odds of receipt. Behavioral Risk Factor Surveillance System (BRFSS) 2000 data were used to study 10,582 smokers (aged ³ 18) having ³ 1 of three types of clinical encounters in the past year: routine checkups, other physician encounters, or dental visits. Multivariate-adjusted odds ratios (ORs) for quit advice by patient age, encounter type, and number of doctor's visits were calculated. Almost 55% of patients were advised to quit smoking. There was...
15.
Thinking beyond health to motivate dietary change: piloting a vegan healthy eating program for obesity management - Berman, Mark Alan
This pilot study assessed the feasibility, acceptability and efficacy of a novel approach to facilitating dietary change and weight loss in obese adults by presenting vegan environmental, health and farm animal treatment information in a 6 week, group-based, educational nutrition program (called a vegan healthy eating program). Twenty-nine (29) medically stable, obese adults were recruited from 3 ambulatory care clinics at UCSF and enrolled using partial randomization into one of two serially occurring intervention groups (Group 1 n=14, followed by Group 2 n=15). A delayed intervention control group (n=9) was used, consisting of participants enrolled in Group 2 who were...
16.
Pathogenesis oF Intracranial Aneurysms - Nahed, Brian Vala
Introduction:
Intracranial aneurysms (IA) are a common neurological problem, the rupture of which
frequently constitutes a catastrophic neurological event. While the pathogenesis is largely
unknown, it is believed that both genetic and environmental factors work in concert to
some degree within patients. Our goal was to take a comprehensive approach to
understanding the pathogenesis of IA by identifying factors leading to the formation,
growth and rupture of IA.
Methods:
Since 1994, we have recruited patients and families with IA into the Yale Brain
Aneurysm Database. Information regarding aneurysm characteristics (size, location,
number), patient characteristics (age, medical, and social history), and family history
were recorded. We analyzed this database for environmental factors...
17.
Alcohol and injury: an analysis of at risk drinkers presenting to the Yale-New Haven Hospital emergency room - Ryder, Hilary Furste
Compared with the population at-large, the Emergency Department (ED) population sees a high percentage of people with alcohol use and abuse problems. Therefore, the ED is well suited for the implementation of alcohol screening and interventions. It is important to be able to identify at risk drinkers who come to the ED for treatment for injury or other medical problems so that interventions may occur. Project ED Health conducted intensive interviews with harmful and hazardous drinkers presenting to the ED for treatment of injury or medical problem. The data was entered into a database and analyzed to find differences between...
18.
Dose Threshold for Clinical Success in Coronary brachytherapy: a nested case-control study - Singh, Harsimran S
Intravascular brachytherapy is the primary treatment for coronary in-stent restenosis. We hypothesized that differences in dose delivered to target may contribute to treatment failures. We compared dose distribution between arteries that developed recurrent restenosis (treatment failures) and those that remained patent at nine-months (treatment success). A cohort of 207 patients receiving brachytherapy for coronary in-stent restenosis with four radiation delivery devices was followed to identify treatment failures and successes. This cohort was examined to establish which patient and lesion characteristics had an effect on outcome. A nested case-control construct was then used in which treatment failures (n=14) were compared 1:2...
19.
Development and assessment of an innovative video to introduce concepts of adherence in Soweto, South Africa - Wong, Ilene
ISSUES: The widening availability of antiretroviral therapy but dearth of medication taking experience among rural South Africans has raised concerns about adequate adherence to these medications. Interventions to improve adherence have been limited in development and evaluation and are often not culturally appropriate to patients in resource poor settings. It is hypothesized that a culturally-sensitive audio-visual patient education program may be of significant use in increasing patient understanding of concepts of resistance and medication taking skills, particularly in areas with low literacy rates.
METHODS: After focus groups with health care providers and HIV-positive adherence counselors, a 15 minute educational video was...
20.
The Role of Connective Tissue Growth Factor (CTGF) in Fibrosis Associated With Intestinal Neuroendocrine Tumors - Shapiro, Michael David
Carcinoid tumors of the small bowel often present with fibrosis in the peritumoral tissues, distant in the heart or lungs, and locally in the peritoneal cavity. The mechanism of the fibroblastic lesions in patients with small bowel carcinoids is unclear and their timely diagnosis impossible. There exists no test to determine the risk of fibrosis, detect its presence, or monitor its progression once discovered. Furthermore, no current therapy protects against such fibrosis. We have proposed that CTGF, a mediator of the profibrotic activities of TGFâ1 (a known regulator of fibrosis)is directly involved in the genesis of ileal carcinoid-related fibrosis. The...
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