Evaluation of the clinical performance of high-risk human papillomavirus testing for primary screening: a retrospective review of the Southern California Permanente Medical Group experience.

Objective: We investigated the potential impact of using the high-risk human papillomavirus (HPV) test as a primary screening tool for the detection of cervical cancer and its precursor lesions.

Materials And Methods: From October 2005 to March 2006, conventional cervical cytological samples and Hybrid Capture II HPV tests were cocollected from all patients. Human papillomavirus tests were processed in all women aged 30 years and older and women younger than 30 years with a cytological finding of atypical squamous cells of undetermined significance.

Managing type I diabetes in pregnancy: how near normal is necessary?

Objective: This was a feasibility study to determine if pregnant women with type I diabetes managed with liberal target glucose values will have a decreased frequency of hypoglycemia with no differences in adverse outcomes compared with tightly controlled subjects.

Study Design: Twenty-two women who had type I diabetes were randomized in first trimester to 'rigid' and 'less rigid' groups. Participants recorded blood glucose results and symptoms of hypoglycemia on memory-based meters.

What proportion of birth weight is attributable to maternal glucose among infants of diabetic women?

Objective: This study was undertaken to determine the proportion of birth weight attributable to glucose concentrations of diabetic mothers.

Study Design: Data of diabetic women who used insulin were eligible for analysis if the women had been treated during pregnancy for at least 12 weeks, and had recorded at least 50% of 4 daily glucose checks (fasting and 1-hour postprandial) until the last office visit before delivery. The independent association between maternal glucose values and demographics and birth weight percentiles for gestational age and gender were analyzed by multiple regression methods.

Restenosis in Intervened Coronaries with Hyperhomocysteinemia (RICH).

Background: Controversy exists regarding the contribution made by elevated serum homocysteine evels in raising the risk of restenosis after percutaneous coronary interventions. The objective of this study was to determine whether elevated homocysteine evels increase the risk of restenosis.

Methods: Two hundred and two consecutive patients undergoing percutaneous coronary intervention with stents on previously nonintervened native coronary arteries were eligible for enrollment in the study.

Fasting plasma glucose test at the first prenatal visit as a screen for gestational diabetes.

Objective: To determine whether the fasting plasma glucose test administered at the first prenatal visit could serve as an efficient screen for gestational diabetes.

Methods: A total of 5557 women not known to have diabetes were offered a fasting plasma glucose test at their first prenatal visit. Results less than 100 mg/dL were blinded.

Triage of atypical squamous cells of undetermined significance with hybrid capture II: colposcopy and histologic human papillomavirus correlation.

Objective: To estimate the effectiveness of Hybrid Capture II to predict high-grade cervical intraepithelial neoplasia (CIN) from a cytological cervical sample. Evidence of high-risk human papillomavirus (HPV) was also determined from biopsy samples using the polymerase chain reaction (PCR) for women referred with atypical squamous cells of undetermined significance (ASCUS) Papanicolaou smears.

Methods: We screened 8170 women with Papanicolaou smears, of whom 278 (3.

When is fasting really fasting? The influence of time of day, interval after a meal, and maternal body mass on maternal glycemia in gestational diabetes.

Objective: The object of the study was to determine whether time of day, interval after a standard meal, and maternal body mass influence plasma glucose concentrations in women with gestational diabetes mellitus.

Study Design: Identical mixed meals were administered on 2 separate occasions 1 week apart to 30 women with dietarily treated gestational diabetes and pregnancies between 28 and 38 weeks' gestation. One meal was administered at 7 AM (morning meal) and the other was administered at 9 PM (evening meal), each after a fast of >/=5 hours.

[Criteria of Rigiscan normalcy in aged men].

Purpose: To define the changes in penile tumescence and rigidity in normally potent older men before a nerve-sparing radical retropubic prostatectomy (NS-RRP) and to establish a base-line for investigating erectile dysfunction in that age group.

Material And Methods: 75 patients used the Rigiscan for 2-3 nights before undergoing a NS-RRP procedure. Rigiscan data were analyzed visually using Kaneko & Bradley criteria, and by computerized analysis.

Critical care transport: outcome evaluation after interfacility transfer and hospitalization.

Study Objective: To test the hypothesis that interfacility transfer is not associated with increased mortality, duration of stay, or readmission within 7 days.

Methods: We matched 3,298 patients who were hospitalized for chest pain or related complaints in Kaiser Permanente medical centers after transfer from the emergency department of a nonplan hospital (transported patients) with 3,298 patients of the same gender and age (+/-5 years) and with the same principal diagnosis who were hospitalized within 6 months without transfer in the same Kaiser Permanente medical center (directly admitted patients). Patients were compared in terms of outcome measures: in-hospital deaths, continued care in another facility, readmission within 7 days, in-patient length of stay (LOS), and LOS in special care units.

Should the same glucose values be targeted for type 1 as for type 2 diabetics in pregnancy?

Objective: Our purpose was to determine whether the same maternal glycemic control is necessary to achieve similar perinatal outcomes for type 1 as for type 2 diabetics.

Study Design: The subjects were all women with pregestational diabetes mellitus delivered of live-born singletons. Glycemic control was achieved with diet and insulin.

Predictors of perceived health in hospitalized older persons: a cross-sectional and longitudinal study.

Objectives: To identify the predictors of perceived health and predictors of changes in perceived health in frail hospitalized older persons during the year after hospitalization.

Design: Both cross-sectional and longitudinal multivariate analysis of data from a cohort followed for 1 year.

Setting: Six hospital in a group practice model health maintenance organization (HMO) in Southern California.

Efficacy of functional electrical stimulation in treating genuine stress incontinence: a randomized clinical trial.

Our objective was to determine the efficacy of functional electrical stimulation as a stand-alone therapy for female stress incontinence. The study was conducted as a prospective, double-blind, randomized controlled trial using subjective and objective outcome criteria. Patients enrolled in this study had stress incontinence consistent with International Continence Society criteria.

Looking inside the black box of comprehensive geriatric assessment: a classification system for problems, recommendations, and implementation strategies.

Objective: To develop and test the inter-rater reliability of a coding system for geriatric problems identified through Comprehensive Geriatric Assessment (CGA) of hospitalized older persons, recommendations generated by the assessment, and implementation strategies for these recommendations.

Design: Validation study.

Setting: A health maintenance organization and a geriatrics academic program.

Spontaneous regression of restenosis: an angiographic study.

Objectives: This study was designed to examine the possibility that spontaneous regression in stenosis severity occurs over time in patients with restenosis after percutaneous transluminal coronary angioplasty.

Background: The underlying mechanisms of restenosis are intimal hyperplasia and smooth muscle cell proliferation in response to vascular injury. We hypothesized that the initial hyperplastic response is followed by dynamic remodeling and eventual spontaneous regression, leading to stabilization or a reduction in stenosis severity.

Alternative prenatal care. Impact of reduced visit frequency, focused visits and continuity of care.

Objective: To investigate the impact of an alternative prenatal care program for low-risk patients.

Study Design: Five hundred forty-nine low-risk pregnant women were allocated to the study and control groups. The study group received, on average, eight visits, all of them with one of nine study providers.

A randomized trial of comprehensive geriatric assessment in the care of hospitalized patients.

Background: Although many studies describe benefits from the comprehensive assessment of elderly patients by an interdisciplinary team (comprehensive geriatric assessment), the most supportive evidence for the process has come from programs that rely on specialized inpatient units and long hospital stays. We examined whether an inpatient geriatric consultation service might also be beneficial in a trial involving four medical centers of a group-practice health maintenance organization (HMO).

Methods: We conducted a randomized clinical trial with 2353 hospitalized patients 65 years of age or older in whom at least 1 of 13 screening criteria were present: stroke, immobility, impairment in any basic activity of daily living, malnutrition, incontinence, confusion or dementia, prolonged bed rest, recent falls, depression, social or family problems, an unplanned readmission to the hospital within three months of a previous hospital stay, a new fracture, and age of 80 years or older.

Low-grade Papanicolaou smears and the Bethesda system: a prospective cytohistopathologic analysis.

Objective: To examine the clinical usefulness of the Bethesda classification system of low-grade cervicovaginal cytology as it relates to predicting underlying histology and aiding in triage to colposcopy.

Methods: We evaluated 1454 women with abnormal cytologic screening results: 782 with atypical squamous cells of uncertain significance (atypia), 355 with low-grade squamous intraepithelial lesions (SIL) determined by the presence of human papillomavirus (HPV) alone, and 317 with low-grade SIL determined by the presence of cytologic evidence of mild dysplasia (cervical intraepithelial neoplasia [CIN] I) devoid of HPV cytopathologic features. All women underwent colposcopy, directed-punch biopsy or loop electrosurgical excision, and/or endocervical curettage (ECC), as indicated.

Toward universal criteria for gestational diabetes: the 75-gram glucose tolerance test in pregnancy.

Objectives: The purpose of this study was to determine the distribution of values for the 75 gm glucose tolerance test in pregnancy and to define glucose intolerance by the relationship between maternal glucose values and neonatal macrosomia.

Study Design: A total 3505 unselected pregnant women were given a 75 gm, 2-hour glucose tolerance test. Diet or insulin therapy was offered only to patients with a fasting plasma glucose level > or = 105 mg/dl or a 2-hour post-glucose-load value > or = 200 mg/dl.

The urban church and cancer control: a source of social influence in minority communities.

A study was conducted to examine the efficacy of a church-based model of social influence in improving access to and participation of underserved minority women in a cervical cancer control program. The model expanded on strategies used in previous hypertension control and health promotion research. A total of 24 churches, stratified by faith tradition, were randomly selected to participate in the cancer control program from a pool of 63 churches in a defined geographic area of Los Angeles County, CA.

Elective repeat cesarean delivery versus trial of labor: a prospective multicenter study.

Objective: To report a prospective multicenter comparison of outcomes of patients who attempted trial of labor and those who underwent elective repeat cesarean.

Methods: During the study interval, all pregnant women with previous cesarean delivery cared for at Kaiser Permanente Hospitals in Southern California were studied regardless of whether trial of labor or elective repeat cesarean was planned.

Results: Of 7229 study patients, 5022 (70%) had a trial of labor and 2207 had elective repeat cesarean operations.

Rationale and design of a multi-center randomized trial of comprehensive geriatric assessment consultation for hospitalized patients in an HMO.

Objective: To describe the evaluation of an interdisciplinary comprehensive geriatric assessment (CGA) consultation program for targeted hospitalized patients.

Design: Multi-center randomized clinical trial (RCT) at four hospitals where patients were randomly assigned to CGA consultation or usual care by the attending physician, and a non-equivalent control group (NCG) at two hospitals.

Setting: Six hospitals in a multi-specialty group practice model health maintenance organization (HMO).

CD8+ lymphocyte counts and the risk of death in advanced HIV infection.

Background: Mortality related to human immunodeficiency virus (HIV) infection occurs predominantly in patients with CD4+ lymphocyte counts of less than 50 cells/mm3. We followed 133 HIV-infected patients with enrollment CD4 counts of less than 50 cells/mm3 to determine if the risk of death during a 1-year period could be predicted by a single enrollment CD8+ lymphocyte count.

Methods: Enrollment data including age, sex, T-cell subset counts, p24 antigen status, antiretroviral use, and preexisting HIV-related illnesses were collected on a cohort of 133 consecutive patients with enrollment CD4 counts of less than 50 cells/mm3.

[Transurethral incision of the prostate: an objective and subjective evaluation of long-term efficacy].

The emergence of less invasive therapies has demanded the reassessment of surgical procedures for the treatment of benign prostatic hyperplasia. This study was designed to evaluate the long term efficacy of transurethral incision of the prostate (TUIP) using objective (urodynamic), and subjective (symptom score and assessment of satisfaction) parameters, and investigate sexual function. Forty one men after TUIP (mean age of 63.

Transurethral incision of the prostate: an objective and subjective evaluation of long-term efficacy.

The emergence of less invasive therapies has demanded the reassessment of surgical procedures for the treatment of benign prostatic hyperplasia. This study was designed to evaluate the long-term efficacy of transurethral incision of the prostate using objective (urodynamic) and subjective (symptom score and assessment of satisfaction) parameters, and investigate sexual function. The results of transurethral incision of the prostate in 41 men (mean age 63.