Faculty Bibliography

Surgical repair of recurrent postmyocardial infarction septal defect is associated with a high mortality rate. We present 2 patients whose recurrent defects were closed percutaneously using an Amplatzer device

OBJECTIVE: There is a rapidly evolving debate on the indications and appropriate duration of therapy for postmenopausal hormone therapy. The objective of this meta-analysis was to examine the specific relationships of postmenopausal estrogen therapy (ET), postmenopausal combined (estrogen-progestogen) hormone therapy (CHT), and the incidence of breast cancer. DESIGN: We performed computerized searches of MEDLINE and CancerLit through September 2003 and reviewed reference lists of retrieved studies and meta-analyses. We included English-language studies that identified noncontraceptive postmenopausal hormone use; reported on the risks of 'current use' of ET and/or CHT and breast cancer incidence; were case-control, cohort, or experimental; and reported either an odds ratio (OR), relative risk (RR), or HR with CIs. Two investigators were involved during all stages of study selection and independently extracted all data selected for inclusion in meta-analyses. RESULTS: Meta-analysis of 13 studies of ET and breast cancer (700,000 women) resulted in an OR of 1.16 (95% confidence limits [CL] 1.06, 1.28), with estimates for less than 5 years use 1.16 (1.02, 1.32) and more than 5 years use 1.20 (1.06, 1.37). Meta-analysis of eight studies of CHT and breast cancer (650,000 women) resulted in an OR of 1.39 (95% CL 1.12, 1.72), with estimates for less than 5 years use 1.35 (1.16, 1.57) and more than 5 years use 1.63 (1.22, 2.18). CONCLUSIONS: Data from observational studies support the association of increased but considerably different risks for breast cancer incidence among current users of ET and CHT. These represent the first pooled estimates for ET. CHT estimates correspond to those from randomized trials

This paper presents the algorithm and technical aspects of an intelligent diagnostic system for the detection of heart murmurs. The purpose of this research is to address the lack of effectively accurate cardiac auscultation present at the primary care physician office by development of an algorithm capable of operating within the hectic environment of the primary care office. The proposed algorithm consists of three main stages. First; denoising of input data (digital recordings of heart sounds), via Wavelet Packet Analysis. Second; input vector preparation through the use of Principal Component Analysis and block processing. Third; classification of the heart sound using an Artificial Neural Network. Initial testing revealed the intelligent diagnostic system can differentiate between normal healthy heart sounds and abnormal heart sounds (e.g., murmurs), with a specificity of 70.5% and a sensitivity of 64.7%

BACKGROUND: Experience with a quality improvement (QI) program undertaken to increase the use of beta-adrenergic blockade in at-risk patients at both a major academic medical center and a community hospital suggests barriers to implementation. METHODS: A retrospective and prospective cohort study was performed to establish the incidence and effectiveness of beta-blockade use pre- and postimplementation of a standardized screening tool and a major education program as part of a QI project. Data gathering involved a baseline phase pre-intervention; 6 weeks postintervention; and 3-6 months postintervention. RESULTS: During phase I (baseline) 56% of eligible received beta-blockers, but targeted measures (a pre-induction heart rate < 70 or a systolic blood pressure [BP] < 110 mmHg) were achieved in only 11% of patients. Phase II saw a significant overall increase in beta-blocker administration (79%) and efficacy (50%). However, during phase III (3-6 months postimplementation), the rate of beta-blocker administration fell to 61% overall, while overall efficacy remained stable at 52%. Significant differences between the academic and community hospitals were observed throughout the study. CONCLUSION: Implementation of a quality program for beta-blockade is significantly affected by the presence or absence of ongoing physician and staff education beyond the study period

At the meeting, Merck presented data from clinical trials supporting reports that its vaccine was nearly 100 percent effective in preventing the two types of HPV that cause most cases of cervical cancer. Merck representatives said the company hoped to receive approval next year for its vaccine, which is given as a series of three shots over six months. The survey on the HPV vaccine initially involved 2,500 members of the American Academy of Pediatrics who care directly for patients more than half of the workweek. Dr. [Nicole Liddon]'s team narrowed the group to 431 pediatricians to get a representative sample of such practitioners. For example, 54 percent said incorrectly that genital warts were caused by the same types of HPV that caused cervical cancer. Twenty-three percent incorrectly said that the incidence of HPV in women was highest among women in their 30's, and 48 percent said they did not know

It also urged that adults ages 19 to 65 have the booster against whooping cough, also called pertussis, 10 years after their last shot against the disease. They could receive the vaccine at the same time as their booster against tetanus and diphtheria, because a newly licensed vaccine -- Adacel, made by Sanofi Pasteur -- offers protection against all three diseases. Using estimates made by the disease centers, the panel said routine hepatitis A immunization would prevent up to 180,000 infections and 30,000 illnesses each year among children and adults, advancing the goal of eliminating the disease in this country. Adverse reactions to the vaccine are reported as rare. In recommending hepatitis A shots for toddlers, the panel cited the success of a vaccination program in 17 states that had had a high incidence of the disease: Alaska, Arizona, Arkansas, California, Colorado, Idaho, Missouri, Montana, Nevada, New Mexico, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington and Wyoming