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Biomedical subjects

A Cochran

Publications and source records attributed to A Cochran.

18 recordsLinked to original sources
PubMed2000

Don't ask, don't tell: the incontinence conspiracy.

Don't ask, don't tell is the attitude of both patients and doctors toward symptoms of urinary incontinence (UI). This has serious fiscal implications for managed care, because the consequences of not treating the condition increase the annual cost of care by an estimated $3,941 per individual. Behavioral treatments have clinical efficacy of 87 percent, and should be tried first, according to the clinical practice guidelines published by the Agency for Health Care Policy and Research. Attitudes about the condition, and historical and current interventions, are discussed.

Adult↗
PubMed1999

Current management of AIDS and related opportunistic infections.

Significant changes in acquired immunodeficiency syndrome (AIDS) epidemiology and AIDS treatment strategies have emerged in the 17 years since the first case of this disease was reported. In the United States, the human immunodeficiency virus (HIV) is now primarily acquired through heterosexual relationships and intravenous drug use. As a result, dramatic increases in the number of AIDS cases in the female, African American, and Hispanic populations are evident. Treatment strategies now focus on maximal viral suppression and preventing drug resistance. Advances in anti-retroviral therapy and chemoprophylaxis of opportunistic infections have increased the long-term survival of AIDS patients by 10 to 20 years. However, despite abundant research and advances in medical care, AIDS continues to be a devastating epidemic worldwide.

AIDS-Related Opportunistic Infections↗
PubMed1998

Response to urinary incontinence by older persons living in the community.

PURPOSE: To investigate the responses to urinary incontinence (UI) of older persons living in the community. DESIGN: Detailed interviews were completed on a sample of 42 independent, community-dwelling persons who were at least 60 years of age. Nineteen participants reported UI, and their experiences are reported in detail. SETTING AND SUBJECTS: Subjects were recruited from 3 sources: volunteers who acknowledged having UI, those with known UI who were invited by their doctors to participate, and those who selected "Loss of bladder control" in a 20-card sort of common ailments. All interviews were conducted in a private setting at a seniors center or at participants' church or home. INSTRUMENTS: Twenty cards with a common ailment printed in large type and an interview schedule with questions relating to the ailment selected as having the most impact were used; demographic data were collected on a standardized form. METHODS: Interviews were recorded on audiotape and lasted from 20 to 60 minutes. These recordings were analyzed for themes with use of Ethnography software. MAIN OUTCOME MEASURES: Demographic and other data from the interview schedule were tabulated. The communication style of the 19 subjects with UI was analyzed to determine how freely they spoke about problems with bladder control to family and friends and their sources of information for managing urinary leakage. Analysis was done both by the researcher and a faculty member; an interrater reliability of 1.00 was achieved. RESULTS: There was little difference in the self-rating of health for those with or without UI. Subjects recruited by letters sent to doctors' patients ranked the impact of loss of bladder control higher than other subjects did. Of the 19 subjects with UI, 10 spoke freely to family and friends, but 9 seldom discussed the subject--and then only to a family member. Four of the 9 with a closed communication style reported no current source of information about UI or its management. CONCLUSION: Though UI had a major effect on the lives of these subjects, they were more willing to admit having "loss of bladder control" than "urinary incontinence." Communication style is related to prior sources of information about UI, but not its perceived impact on health. This relationship helps to determine the teaching methods that are most likely to influence elderly persons with UI who have either on open or closed communication style.

Activities of Daily Living↗
PubMed1998

Dampening of the cortisol response to handling at 3 months in human infants and its relation to sleep, circadian cortisol activity, and behavioral distress.

The decrease in responsiveness of the hypothalamic-pituitary-adrenocortical (HPA) system is marked over the first months of life. Seventy-eight healthy infants (44 girls), 7 to 15 weeks old, were given a laboratory mock physical examination. Salivary cortisol samples were collected pre- and postexamination and at home. Behavioral state during the examination and home sleep/wake activity were measured. Subjects younger than 11 weeks showed an increase in pre- to postexamination cortisol, while older subjects did not. Further, there was no decrease in behavioral distress to the examination with age. Infants who showed an early- morning peak (EMP) in home cortisol levels were significantly older and were likely to be those who slept through the night. However, the presence of an EMP was not associated with a lack of cortisol response to the examination. The decrease in cortisol responsiveness witnessed around the age of 3 months is presumably due to other processes associated with age, and not with the expression of the day-night rhythm in basal cortisol.

Arousal↗
PubMed1997

Developing careers despite an environment of downsizing: what worked for one nurse.

My patients are achieving a higher level of success, now that I have used these steps. My compensation is better than when, like a piano teacher, I was going to people's homes to give lessons. And because continence includes related health issues, I am doing the health education I have always enjoyed but seldom had time to do when working in acute care settings. Although this application dealt with urinary incontinence, the steps can be applied to many other health conditions and their management. What would you really like to do professionally? Write down everything you can think of, and circle the most likely, or use "right brain clustering," and you will be surprised what you can come up with. It might even be something you can get paid well for doing.

Career Mobility↗
PubMed1993

Intraoperative lymphatic mapping and selective cervical lymphadenectomy for early-stage melanomas of the head and neck.

PURPOSE: We developed intraoperative lymphatic mapping with selective lymphadenectomy (SLND) to identify micrometastatic spread of cutaneous melanoma to regional lymph nodes. This study was undertaken to assess the sensitivity and specificity of our technique in patients with clinical stage I (CS-I) melanoma of the head or neck. PATIENTS AND METHODS: Seventy-two CS-I melanoma patients underwent intraoperative lymphatic mapping of primary cutaneous melanomas located on the head, neck, or upper chest/back draining to the neck. Key (sentinel) cervical lymph nodes in the regional lymphatic drainage basin were identified, selectively excised during SLND, and examined for microscopic evidence of tumor cells. If these sentinel nodes were tumor-negative, the surgery was concluded; if the sentinel nodes were tumor-positive, all nodes in the drainage basin were removed during en bloc lymphadenectomy (LND). RESULTS: Intraoperative lymphatic mapping identified sentinel nodes in 90% of the regional drainage basins. Fifteen percent of these nodes were tumor-positive, indicating the need for LND. There were no false-negative sentinel nodes, and extended follow-up showed no local nodal recurrences in patients whose sentinel-node histology did not indicate the need for LND. CONCLUSION: Intraoperative lymphatic mapping and SLND is a minimally invasive and highly accurate screening technique for determining which patients with CS-I head and neck melanomas have subclinical node metastases and therefore might benefit from cervical LND.

Adolescent↗
PubMed1987

Reactivity of neoplastic cells of hairy cell leukemia with antisera to S-100 protein.

Rabbit antibodies to bovine S-100 protein were tested by immunoperoxidase technics against fresh hairy cell leukemia (HCL) cells obtained from nine patients (peripheral blood in six and spleen in three), as well as lymphoblastoid cell lines derived from three patients with HCL. Peripheral mononuclear cells from three normal persons and two patients with chronic lymphocytic leukemia (CLL) and cells from two melanoma lines were used as controls. The melanoma cell lines, cell lines derived from patients with HCL, and fresh HCL cells displayed cytoplasmic and nuclear positivity after exposure to anti-S-100 protein sera. By contrast, normal peripheral blood lymphocytes and CLL cells were negative for S-100 protein. Additional studies were performed by immunoperoxidase technics on representative sections of formalin-fixed splenic tissues from eight patients who had splenectomies. The cause of splenectomy was HCL in three, traumatic rupture in one, CLL in one, Hodgkin's disease in one, and hypersplenism in two patients. Sections from all three HCL patients showed moderate to marked positivity with antisera to S-100 protein. These results strongly suggest the presence of S-100 protein in HCL cells.

Animals↗
PubMed1981

S100 protein: a marker for human malignant melanomas?

S100 protein is a nervous-system-specific cytoplasmic protein which is also present in human malignant melanoma cell lines. To test for its tumour specificity, biopsy specimens from normal tissue and a wide variety of tumours were tested for S100 by complement fixation and immunofluorescence tests. S100 was present in all of thirteen samples of malignant melanoma tissue and absent from nineteen samples of non-melanocytic tumours, and from normal skin and normal lymph nodes. S100 levels did not correlate with tyrosinase activity in the tissues examined. Detection and measurement of S100 protein may help distinguish poorly differentiated amelanotic malignant melanoma from tumours of obscure histological origin; they may also aid the detection of micrometastatic disease in the lymph nodes and other tissues of melanoma patients.

Complement Fixation Tests↗
PubMed1980

Difficulties encountered in the application of Clark classification and the Breslow thickness measurement in cutaneous malignant melanoma.

The purpose of this study was to analyse the reproducibility of Clark's classification and Breslow's measure of tumor thickness to determine if there is general agreement among pathologists regarding these parameters and whether these pathologists reach consistent conclusions concerning each slide. Three successive workshops including a panel of pathologists were held at Amsterdam, in May 1977; at Villejuif in June 1977, followed by circulation of slides and at Villejuif again, in June 1978, followed by slide projection. This was necessary because of the great divergencies of opinion noted at the first meeting at Amsterdam. These sessions gave a better understanding of the divergencies and finally indicated that general agreement could only be reached by slide presentation followed by discussion. Regarding histogenesis, agreement between pathologists was improved after discussion from 6/11 cases to 11/13 cases. Regarding the level, no initial agreement was reached (Amsterdam). At the second meeting an agreement was obtained in 4/13 cases and finally in 11/13 cases (Villejuif). Clark's classification is more difficult to use than Breslow's because it depends on a discontinuous variable, the choice of the infiltration level. Breslow's classification, on the other hand, is based on a continuous variable. Because of frequent discrepancies, the classification of patients into various therapeutic groups according to Clark's level and Breslow's thickness necessitates that all cases including in therapeutic trials be reviewed by a panel of pathologists.

Histological Techniques↗
PubMedDate not supplied

Sumatriptan suppositories for the acute treatment of migraine. S2B351 Study Group.

A randomised, double-blind, parallel-group, placebo-controlled trial was undertaken to assess the efficacy and tolerability of the sumatriptan suppository in 184 patients with acute migraine. Patients used a sumatriptan suppository (12.5 mg or 25 mg) or placebo at home for the treatment of a moderate or severe migraine attack and those who experienced headache recurrence within 24 hours of dosing had the option to repeat the dose. By 2 hours post-dose, 68% of patients in the sumatriptan 25 mg group and 47% of patients in the sumatriptan 12.5 mg group compared with 25% of placebo patients achieved headache relief. Relief rates 2 hours post-dose for nausea, vomiting, photophobia and phonophobia were similar to those reported 2 hours post-dose for headache. Post hoc review of the recurrence data showed that administration of a second suppository was effective in alleviating recurrent headache in over 80% of the sumatriptan-treated patients experiencing recurrence. No serious or unusual adverse events were reported, and the pattern and incidence of adverse events did not vary as a function of dose. These data demonstrate that the sumatriptan suppository is a well-tolerated, effective treatment for the acute treatment of migraine pain and its associated symptoms.

Administration, Rectal↗