Thomas Nesbitt - Profile on Academia.edu (original) (raw)
Papers by Thomas Nesbitt
Obstetrics & Gynecology, 1999
Objective: To examine pregnancy outcomes in women age 40 or older. Methods: We used data from the... more Objective: To examine pregnancy outcomes in women age 40 or older. Methods: We used data from the California Health Information for Policy Project, which consists of linked records from the birth certificate and the hospital discharge record of both mother and newborn of all births that occurred in acute care civilian hospitals in California between January 1, 1992, and December 31, 1993. The study population consisted of all women who delivered at age 40 or over. The control population was women who delivered between age 20 and 29 years during this 2-year period. We reviewed gestational age at delivery, birth weight, mode and type of delivery, discharge summary and birth certificate demographics, birth outcome, pregnancy, and delivery data. Results: Approximately 1,160,000 women delivered during the study period, and 24,032 (2%) of these women were age 40 or older. Of this latter group, 4777 (20%) were nulliparous. The cesarean delivery rate for nulliparous women in the study population was 47.0%, and the rate for multiparous patients in this group was 29.6%. The cesarean delivery rate was 22.5% for nulliparous and 17.8% for multiparous women in the control group. In the older group, the operative vaginal delivery rate (forceps and vacuum) was 14.2% for nulliparous women and 6.3% for multiparous women. Rates of birth asphyxia, fetal growth restriction, malpresentation, and gestational diabetes were significantly higher among older nulliparas (6, 2.5, 11, and 7%, respectively) compared with rates among control nulliparas (4, 1.4, 6, and 1.7%, respectively), and there were similar significant increases among older multiparas (3.4, 1.4, 6.9, and 7.8%, respectively), compared with younger multiparous controls (2.4, 1, 3.7, and 1.6%, respectively). Mean (؎ ؎ ؎ standard error) birth weight of infants delivered by older nulliparous women was 3201 ؎ ؎ ؎ 10 g, significantly lower than that among nulliparous controls (3317 ؎ ؎ ؎ 1 g), whereas mean birth weight in the group of older multiparas (3381 ؎ ؎ ؎ 5 g) was no different than that among younger multiparous controls (3387 ؎ ؎ ؎ 1 g). Gestational age at delivery was significantly lower among older nulliparas (273.4 ؎ ؎ ؎ 0.4 days), compared with nulliparous controls (278.5 ؎ ؎ ؎ 0.05 days), and similarly lower among older multiparous women (274.0 ؎ ؎ ؎ 0.2 days), compared with
Telemedicine and e-Health, 2009
Telemedicine technology embodies the electronic acquisition, processing, dissemination, storage, ... more Telemedicine technology embodies the electronic acquisition, processing, dissemination, storage, retrieval, and exchange of information for the purpose of promoting health, preventing disease, treating the sick, managing chronic illness, rehabilitating the disabled, and protecting public health and safety. Telemedicine systems consist of collaborative health networks, facilities, and organizations dedicated to these objectives. Over the past several decades, telemedicine systems have demonstrated the capacity to do the following:
Obstetrics & Gynecology, 1999
Methods: A computerized data set containing records from hospital discharge summaries of mothers ... more Methods: A computerized data set containing records from hospital discharge summaries of mothers and infants and birth certificates was examined. The deliveries took place in more than 300 civilian acute care hospitals in California between January 1, 1994, and December 31, 1995. Cases of brachial plexus injury were evaluated for additional diagnoses and procedures of pregnancy, such as mode of delivery, gestational diabetes, and shoulder dystocia. Those complications were stratified by birth weight and analyzed, using bivariate and multivariate techniques to identify specific risk factors.
Obstetrics & Gynecology, 1999
Objective: To examine pregnancy outcomes in women age 40 or older. Methods: We used data from the... more Objective: To examine pregnancy outcomes in women age 40 or older. Methods: We used data from the California Health Information for Policy Project, which consists of linked records from the birth certificate and the hospital discharge record of both mother and newborn of all births that occurred in acute care civilian hospitals in California between January 1, 1992, and December 31, 1993. The study population consisted of all women who delivered at age 40 or over. The control population was women who delivered between age 20 and 29 years during this 2-year period. We reviewed gestational age at delivery, birth weight, mode and type of delivery, discharge summary and birth certificate demographics, birth outcome, pregnancy, and delivery data. Results: Approximately 1,160,000 women delivered during the study period, and 24,032 (2%) of these women were age 40 or older. Of this latter group, 4777 (20%) were nulliparous. The cesarean delivery rate for nulliparous women in the study population was 47.0%, and the rate for multiparous patients in this group was 29.6%. The cesarean delivery rate was 22.5% for nulliparous and 17.8% for multiparous women in the control group. In the older group, the operative vaginal delivery rate (forceps and vacuum) was 14.2% for nulliparous women and 6.3% for multiparous women. Rates of birth asphyxia, fetal growth restriction, malpresentation, and gestational diabetes were significantly higher among older nulliparas (6, 2.5, 11, and 7%, respectively) compared with rates among control nulliparas (4, 1.4, 6, and 1.7%, respectively), and there were similar significant increases among older multiparas (3.4, 1.4, 6.9, and 7.8%, respectively), compared with younger multiparous controls (2.4, 1, 3.7, and 1.6%, respectively). Mean (؎ ؎ ؎ standard error) birth weight of infants delivered by older nulliparous women was 3201 ؎ ؎ ؎ 10 g, significantly lower than that among nulliparous controls (3317 ؎ ؎ ؎ 1 g), whereas mean birth weight in the group of older multiparas (3381 ؎ ؎ ؎ 5 g) was no different than that among younger multiparous controls (3387 ؎ ؎ ؎ 1 g). Gestational age at delivery was significantly lower among older nulliparas (273.4 ؎ ؎ ؎ 0.4 days), compared with nulliparous controls (278.5 ؎ ؎ ؎ 0.05 days), and similarly lower among older multiparous women (274.0 ؎ ؎ ؎ 0.2 days), compared with
Telemedicine and e-Health, 2009
Telemedicine technology embodies the electronic acquisition, processing, dissemination, storage, ... more Telemedicine technology embodies the electronic acquisition, processing, dissemination, storage, retrieval, and exchange of information for the purpose of promoting health, preventing disease, treating the sick, managing chronic illness, rehabilitating the disabled, and protecting public health and safety. Telemedicine systems consist of collaborative health networks, facilities, and organizations dedicated to these objectives. Over the past several decades, telemedicine systems have demonstrated the capacity to do the following:
Obstetrics & Gynecology, 1999
Methods: A computerized data set containing records from hospital discharge summaries of mothers ... more Methods: A computerized data set containing records from hospital discharge summaries of mothers and infants and birth certificates was examined. The deliveries took place in more than 300 civilian acute care hospitals in California between January 1, 1994, and December 31, 1995. Cases of brachial plexus injury were evaluated for additional diagnoses and procedures of pregnancy, such as mode of delivery, gestational diabetes, and shoulder dystocia. Those complications were stratified by birth weight and analyzed, using bivariate and multivariate techniques to identify specific risk factors.