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Biomedical subjects

A Allen

Publications and source records attributed to A Allen.

At least 163 records · Page 9Linked to original sources
PubMed1994

A model for rural health care.

Government health care reform initiatives are intended to assure that every American citizen has access to basic health care services and to decrease health care costs at the same time. Cuts in Medicare and Medicaid reimbursements and overall limits on health care services will require careful and efficient management by providers. This article is about how one rural hospital has survived when other small hospitals were forced to close and created an environment for success in the uncertain years ahead.

Delivery of Health Care↗
PubMed1993

Women's health.

Explore the source record for details and available documents.

Female↗
PubMed1993

Effect of cigarette smoking on coronary patency after thrombolytic therapy for myocardial infarction. TEAM-2 Investigators. Second Multicenter Thrombolytic Trials of Eminase in Acute Myocardial Infarction.

Smokers have been reported to have an improved short-term prognosis after myocardial infarction when compared with nonsmokers. This study examines the effect of smoking status on infarct-related artery patency, a determinant of outcome, following thrombolytic therapy for acute myocardial infarction (AMI). To evaluate patency outcome by smoking status, the database of the Second Thrombolytic Trial of Eminase in Acute Myocardial Infarction was reviewed, and baseline characteristics were compared with infarct-related artery patency early (90 to 240 minutes) after thrombolysis in smokers versus nonsmokers. Smokers were younger (mean age 53 vs 59 years, p = 0.0001), more likely to be men (86 vs 73%, p = 0.008), normotensive (74 vs 58%, p = 0.004), to have an inferior infarction (66 vs 51%, p = 0.007), and tended to have higher hematocrits and fibrinogen levels than nonsmokers. Smokers had a significantly greater chance of achieving complete perfusion (Thrombolysis in Myocardial Infarction trial grade 3) (66 vs 51% p = 0.007) than nonsmokers, although the combination of grades 2 and 3 did not differ. After correcting for imbalances in baseline and angiographic variables, multivariate logistic regression identified smoking (odds ratio 1.8, p = 0.01) and infarct location (odds ratio 1.7, p = 0.03) as independent predictors of achieving grade 3 flow. The independent predictive component of smoking for achieving grade 3 patency after thrombolysis suggests the hypothesis that more active thrombogenic mechanisms may be operative in smokers, leading to a larger thrombus component that is more susceptible to lytic therapy.

Anistreplase↗
PubMed1993

Evaluation of the bioequivalence of tablet and capsule formulations of granisetron in patients undergoing cytotoxic chemotherapy for malignant disease.

Granisetron is a novel, highly specific 5-hydroxytryptamine receptor antagonist given prophylactically to patients undergoing chemotherapy. An open, randomized, crossover trial was performed with 37 patients (24 females and 13 males) undergoing cytotoxic chemotherapy for malignant disease to compare an oral tablet (1-mg tablet given twice daily) with a clinical-trial capsule (1-mg capsule given twice daily). Complete pharmacokinetic data were determined for 24 patients (14 females and 10 males). The concentration of granisetron in plasma was measured by HPLC; the limit of quantitation was 0.2 ng/mL. The bioavailability evaluation was based mainly on the area under the curve (AUC) (mean values: 52.1 ng.h/mL for the capsule and 54.2 ng.h/mL for the tablet) and the maximum concentration (Cmax) (mean values: 7.42 ng/mL for the capsule and 8.18 ng/mL for the tablet) measured at the steady state after 7 days of continuous therapy. Wide interpatient variability in plasma granisetron levels after oral administration was observed. The 90% standard confidence interval for the geometric mean ratio overlapped the critical range, 0.8-1.25. Point estimates for AUC and Cmax based on two one-sided t tests and log-transformed data showed that the upper limit of the confidence interval was not within 20% of the mean for the capsule; the corresponding power analysis values for AUC and Cmax were 0.89 and 0.81, respectively. Despite bioequivalence not being proven, any differences that exist between the two formulations are likely to be small. There was no difference in efficacy or safety between the two formulations assessed.

Adolescent↗
PubMed1993

Pigeon breeders' lung; IgG subclasses to pigeon intestinal mucin and IgA antigens.

Sera from all symptomatics with pigeon breeders' lung and many non-symptomatic pigeon breeders react specifically with the pigeon antigens and in particular pigeon intestinal secretions and isolated pigeon intestinal mucin and IgA. In sera from all 82 precipitin-positive pigeon breeders investigated, IgG1 reacted with both IgA and mucin, while IgG2 reacted predominantly with mucin only. Sera from all 32 symptomatic patients with pigeon breeders' lung demonstrated an IgG3 reaction with mucin, but only three sera showed reactivity against IgA and this was very weak. In contrast, only three out of 27 pigeon breeders with pulmonary pathology other than pigeon breeders' lung and only three out of 23 sera from healthy pigeon breeders showed detectable IgG3 reactivity with mucin. IgG4 from eight sera only reacted with mucin (n = 7) or IgA (n = 1) and showed no consistent pattern between subject groups. Precipitin-negative sera from 30 volunteers with no previous pigeon exposure showed no IgG subclass reactivity with either the pigeon intestinal secretions or the isolated mucin and IgA antigens. These results show specific IgG2 and IgG3 subclass reactivity to pigeon intestinal mucin antigen in precipitin-positive sera from pigeon breeders. Further IgG3 subclass reactivity specific to pigeon mucin is strongly associated with sera from patients with the active pigeon breeders' lung disease.

Adolescent↗
PubMed1993

Gastroduodenal mucosal protection.

The barrier that protects the undamaged gastroduodenal mucosa from autodigestion by gastric juice is a dynamic multicomponent system. The major elements of this barrier are the adherent mucus gel layer, which is percolated by the HCO3- secretion from the underlying epithelial cells; the epithelial layer itself, which provides a permeability barrier and can rapidly repair superficial damage by a process of cell migration referred to as reepithelization or restitution; and a specially adapted vasculature, which provides a supply of HCO3- for transcellular transport and/or diffusion into the mucus layer. Passive diffusion of intestinal HCO3- into the lumen is particularly important when there is superficial damage resulting in increased leakiness of the mucosal epithelium. The process of reepithelization occurs by the migration of performed cells from gastric pits or duodenal crypts. This process is quite distinct from the wound healing and associated inflammatory response that accompany more severe injury or chronic damage. The adherent mucus gel acts as a physical barrier against luminal pepsin and provides a stable unstirred layer that supports surface neutralization of acid by mucosal HCO3-. Surface neutralization by mucosal HCO3- provides a major mechanism of protection against acid in the proximal duodenum. In the stomach, where luminal acidity can fall to around pH 1, other mechanisms of protection must exist, since the surface pH gradient is reported to collapse when luminal H+ exceeds approximately 10 mM. This collapse of the surface pH gradients may reflect, at least in part, that such studies have been mostly performed on non-acid-secreting mucosa where the supply of HCO3- to the interstitium from the parietal cells will be reduced. However, because the gastric mucosa can withstand prolonged exposure to acid without apparent damage, this implies an intrinsic resistance of the epithelial apical surface. This is amply illustrated within the gastric glands that do not secrete mucus and HCO3- yet are exposed to undiluted pepsin and an isotonic solution of HCl. Bicarbonate and mucus secretions together with mucosal blood flow are under paracrine, endocrine, and neural control. The rate of reepithelialization will depend on local chemotactic factors, adhesion mechanisms, and the creation of an acid/pepsin/irritant-free environment under a protective gelatinous or mucoid cap. If optimal conditions are met, then the rate of reepithelialization appears to depend primarily on the intrinsic properties of the migrating cells themselves rather than control by exogenous mediators.(ABSTRACT TRUNCATED AT 400 WORDS)

Acids↗
PubMed1993

Issues of consequence.

Rapid advances in scientific knowledge and technology engender ethical and moral concerns. The explosion of new genetic information is bringing about changes that will affect virtually every aspect of our lives. Jeffrey Fisher, MD, author of Rx 2000, reports on health care breakthroughs we will see during the next 40 years. This article touches on just a few of the exciting, innovative, and sometimes troubling possibilities.

Ethics, Nursing↗
PubMed1993

Choosing facts and caution over fear and convenience.

It has been said that fear of becoming infected with the human immunodeficiency virus is limiting the quality of care nurses provide. Concern for personal safety has increased with the appearance of acquired immunodeficiency syndrome as well as outbreaks of some other diseases that were thought to be well controlled. This article provides an overview of these diseases and the requirements for prevention.

Fear↗
PubMed1993

Health care: change versus status quo.

Health care reform efforts have been stalled since the late 1960s when Medicare and Medicaid were established. This article discusses some of the problems that continue to block any substantial measures to cut costs and to assure that all Americans have access to basic health care.

American Medical Association↗
PubMed1993

Caring about the elderly: opportunities and obligations.

The number of people age 60 and older worldwide is expected to increase to 612 million by the year 2000. As a whole these individuals are much healthier and lead more active, independent lives than their ancestors. Health care for this growing population presents many challenges, opportunities, and obligations. Nurses who care about the elderly may be lacking the current information and specific educational preparation needed to care for them. The author discusses some important aspects of home care for elderly patients in the ambulatory surgery unit.

Aged↗
PubMed1993

Looking, feeling, watching, and seeing.

In today's hospital environment we often rely on technology for vital information about the status of our clients. This article is about looking and feeling (something technology cannot do for us). It is about simplicity and appreciating differences.

Empathy↗
PubMed1992

Malignant myositis ossificans. A case report.

A patient presented with an ossifying thigh mass suggestive of myositis ossificans. He had no antecedent trauma to the area. The mass was found to be an ossifying soft tissue metastasis from an occult gastric adenocarcinoma primary. Malignancy, and especially metastatic malignancy, is rarely considered in the differential diagnosis of a radiographic presentation of myositis ossificans.

Adenocarcinoma, Mucinous↗
PubMed1992

Phase II evaluation of piroxantrone in renal cell carcinoma. A Southwest Oncology Group Study.

The Southwest Oncology Group (SWOG) studied the response rate and toxicity of piroxantrone (150 mg/m2 q 21 days) in patients with advanced metastatic renal cell carcinoma. Among 32 eligible patients, there were no partial nor complete responses. There were two mixed responses. Significant white cell toxicity, anemia, nausea, and vomiting were observed. Mild or moderate degrees of fever, malaise, and stomatitis occurred. No significant cardiac toxicity was noted. Piroxantrone does not have significant activity as a single agent in advanced renal cell carcinoma.

Adult↗
PubMed1992

Retrospective search for bleeding diathesis among premature newborn infants with pulmonary hemorrhage after synthetic surfactant treatment. The American Exosurf Neonatal Study Group I, and the Canadian Exosurf Neonatal Study Group.

In an across study analysis of five multicenter, placebo-controlled trials of the synthetic surfactant, Exosurf Neonatal, involving infants with birth weights 700 gm or greater the incidence of clinical pulmonary hemorrhage was 1.9% in treated infants and 1.0% in control infants. To determine whether this apparent increase in pulmonary hemorrhage was the result of a bleeding diathesis, we retrospectively reviewed charts for 39 of 41 infants with clinical pulmonary hemorrhage. The incidence of nonpulmonary bleeding was the same in control- and surfactant-treated infants. Platelet counts, hematocrit values, and the number of transfusions with platelets or red blood cells did not differ between the two groups. There was no evidence that surfactant treatment was specifically associated with a generalized bleeding diathesis.

Double-Blind Method↗
PubMed1992

The relationship between paroxetine and the sparteine oxidation polymorphism.

The relationship between the selective serotonin reuptake inhibitor paroxetine and the sparteine oxidation polymorphism was investigated in a combined single-dose (30 mg) and steady-state (30 mg/day for 2 weeks) study including a panel of nine extensive metabolizers and eight poor metabolizers of sparteine. The median area under the plasma concentration-time curve (AUC) after the first paroxetine dose was about seven times higher in poor metabolizers than in extensive metabolizers (3910 versus 550 nmol.hr/L), whereas at steady state the median AUCss tau interphenotype difference was only twofold (4410 versus 2550 nmol.hr/L). Plasma half-life and steady-state plasma concentration were significantly longer and higher, respectively, in poor metabolizers than in extensive metabolizers (41 versus 16 hours and 151 versus 81 nmol/L). Paroxetine pharmacokinetics were linear in poor metabolizers and nonlinear only in extensive metabolizers. Sparteine metabolic ratio (MR = 12 hour urinary ratio of sparteine/dehydrosparteine), increased during treatment with paroxetine in subjects who were extensive metabolizers, and after 14 days treatment two extensive metabolizers were phenotyped as poor metabolizers and the remaining extensive metabolizers were changed into extremely slow extensive metabolizers with sparteine MRs of 5.7 to 16.5. The inhibition of sparteine metabolism was rapidly reversed after cessation of paroxetine administration. In the poor metabolizers there were no significant changes in MRs during the study. It is concluded that paroxetine and sparteine metabolism cosegregates, but the interphenotype difference in metabolism was less prominent at steady state than after a single dose, presumably because of saturation of the sparteine oxygenase (CYP2D6) in subjects who were extensive metabolizers. Paroxetine is a potent inhibitor of sparteine oxidation by CYP2D6 in vivo.

Adult↗