Biomedical subjects
Publications and source records attributed to A Pedersen.
A group of unit-based personnel set about to redesign work in the intensive care unit. Their strategy acknowledged the fiscal reality of the hospital's situation, while maintaining a proactive and positive approach. The implementation process of such a program--establishing a skills mix, redesigning a patient care delivery system and capitalizing on the RNs' career ladder is described.
The staff of one medical/surgical unit defined nine qualities of a winning team, then set about to turn their unit around. The situation faced by the unit nurses, technicians, secretaries and the nurse manager as well as the successful strategies they implemented to enhance teamwork are presented.
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Recurrent aphthous ulceration (RAU) is the most common oral mucosal disease. The etiology is unresolved but several studies have suggested a systemic immunoregulatory imbalance in the patients. The purpose of the present study was to assess possible signs of immunologic deficiency or activation of peripheral blood mononuclear cells in patients with RAU by flow cytometry using three-color immunofluorescent staining which has not previously been employed in this patient category. The population consisted of 13 and 14 otherwise healthy patients with active and inactive RAU, respectively, and 18 healthy volunteers with a negative RAU history served as controls. The most striking observation was an increased fraction of T-cell receptor (TCR)-gamma delta+ cells in patients with active RAU (median percentage 8.5) compared with controls (median percentage 2.8; P < 0.001) and patients with inactive RAU (median percentage 5.0; P < 0.01). The fraction of peripheral TCR-gamma delta cells has not previously been determined in patients with RAU but the increased figures during active disease might reflect an immunologic stimulation during exacerbation. The nature of the stimulus remains to be established, but recent studies suggest that varicella zoster virus and/or cytomegalovirus may be involved. The potential role of TCR-gamma delta cells in RAU lesions has not yet been investigated but appears to be an obvious issue for future studies.
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Natural killer cell activity against K562 target cells was measured during active disease (within 48 hours after symptom debut, day 0), and in remission stages (days 14 and 28) of 10 patients with recurrent aphthous ulceration. Ten healthy sex- and age-matched persons with a negative history of recurrent aphthous ulceration served as controls. Baseline, interferon-alpha- and interleukin-2-boosted natural killer cell activity was not significantly different between patients and controls at any of the three time periods. Furthermore, the percentages of peripheral CD16+, CD56+, and CD14+ cells were at no time significantly different between patients and controls. This study supports other investigations with respect to a systemic T-cell imbalance in which a decreased CD3+ and CD4+ fraction is encountered among patients with recurrent aphthous ulceration; however, the previously reported increase in the CD8+ subsets was not confirmed in the present study. Although no quantitative or nonspecific functional alterations of circulating peripheral natural killer cells were observed in patients with recurrent aphthous ulceration, this does not preclude NK cell involvement in the lesion sites. Furthermore, with recent studies that suggest a possible implication of varicella zoster virus or cytomegalovirus in recurrent aphthous ulceration, studies of varicella zoster virus and cytomegalovirus specific killer activity in this patient population are hereby encouraged.
Very little research exists regarding qualities that characterize an excellent head nurse (HN). Sixteen nurses were asked to tell the researcher about an excellent HN that they had worked with at some point in their career. The excellent HNs could be characterized as having a humanistic management philosophy and being skilled at negotiating and conflict resolution. These leaders have excellent interpersonal skills and are powerful advocates for nurses and patients. They are viewed as highly credible, innovative and even tempered. Generally, these leaders were able to meet the needs of the nurses--be they clinical, professional, or personal.
PURPOSE: To present the diagnosis and management of superwarfarin ingestion, a cause of serious and prolonged coagulopathy. METHODS: Specific identification of the anticoagulant was made by high-pressure liquid chromatography. RESULTS: A 24 month-old child developed bruises and a prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT) after receiving multiple doses of brodifacoum, a superwarfarin rodenticide. The coagulopathy was treated successfully with large doses of parenteral and oral vitamin K1; fresh frozen plasma was administered as a precautionary measure on two occasions. After the first 10 days of the child's hospitalization, the mother was identified as the source of brodifacoum, exemplifying the behavior described as Munchausen syndrome by proxy. Oral vitamin K1 was initiated and continued in an outpatient setting with tapering doses over nine months, using the PT as a guide for therapy. CONCLUSIONS: This report emphasizes the necessity of recognizing rodenticide poisoning and investigating its source. Frequent monitoring of the PT is essential to prevent hemorrhagic complications due to repeat exposure, inadequate vitamin K1 therapy, or noncompliance.
The etiology of the most common intraoral mucosal disease, recurrent aphthous ulceration (RAU), remains obscure. Here, attempts were made to diagnose reactivation of varicella zoster (VZV), cytomegalovirus (CMV), Epstein-Barr (EBV) and human hepes virus 6 (HHV-6) infections from paired sera in association with RAU recurrences. The first sample was obtained within 3 days after a new recurrence (1) and the second 10-14 days later (2). The study initially comprised 18 otherwise healthy RAU patients (gr A) and 17 sex- and age-matched healthy non-RAU individuals. Values of specific antibody subclasses (IgM, IgG, IgA) were determined by ELISA (VZV, CMV, EBV) and IFA (HHV-6). Patients and controls exhibited differences in parameters on specific VZV IgM and CMV IgM. In order to substantiate these findings, specific VZV IgM and CMV IgM were subsequently also evaluated in 17 other RAU patients (gr B). Ten patients in gr A and 11 in gr B were IgM seropositive for either VZV and/or CMV in at least one of the serum samples, whereas in the controls only one was VZV IgM positive and none CMV IgM positive. Evaluated as groups, optometric density (OD) antibody levels of VZV IgM were significantly higher in the patients (gr A (1,2) vs controls: p < 0.0001; gr B (1,2) vs controls: p < 0.001). CMV OD IgM antibody values were significantly higher in gr B only (1,2 vs controls: p < 0.01). The study lends support for reactivation of VZV and/or CMV infection associated with RAU recurrences.
The present study was undertaken to examine for varicella-zoster virus (VZV) constituents in recurrent aphthous ulcers (RAU). Smears and biopsies of ulcers 0-3 days old were obtained from 20 otherwise healthy minor/major RAU patients and from two patients with Behçet's syndrome. VZV could not be cultivated from any of the biopsies, all smears were negative for VZV antigen, and in situ hybridization on the five samples tested was negative for VZV nucleic acid. DNA extracted from biopsies, however, yielded positive polymerase chain reaction (PCR) products in all cases with one primer set of the protein kinase 66 (PK66). Ten control biopsies from non-RAU subjects yielded no PCR products apart from the sample from AP, who obtained the biopsies, and from HOM, who performed the PCR, suggesting that the DNA had been passed on from the patients. Other parts of the PK66 gene and of thymidine kinase 36 yielded no products. Although the consistent presence of VZV DNA in RAU might suggest a pathogenetic implication, the potential presence and possible pathogenetic importance of other herpesviruses cannot be excluded.
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Whether or not the factor VII Gla-domain is involved in the high-affinity interaction of factor VII and tissue factor via calcium-dependent interactions with surrounding phospholipids is unknown. To investigate this, we have purified the factor VII Gla-peptide (FVII-GP) from digested recombinant human factor VIIa and assessed its effect on factor VII:tissue factor interactions. FVII-GP inhibited the activation of factor X by factor VIIa in the presence of either soluble or cell surface tissue factor half-maximally at 0.5 microM and 2.7 microM, respectively. However, FVII-GP failed to inhibit the specific binding of factor VIIa to cell-surface tissue factor, and did not inhibit the ability of tissue factor to stimulate the amidolytic activity of factor VIIa. Unrelipidated tissue factor apoprotein stimulated the amidolytic activity of factor VIIa to the same extent as relipidated tissue factor apoprotein. These findings suggest that the factor VII Gla-domain does not directly interact with tissue factor, but rather is important for calcium binding and concomitant expression of other factor VII epitopes necessary for tissue factor recognition and binding. To test this hypothesis, we have prepared a monoclonal antibody against a putative factor VII epitope that participates in the interaction of factor VII with cell-surface tissue factor (peptide 195-206) and assessed its ability to bind to factor VII in the presence and absence of calcium. Binding of this monoclonal antibody (PW-4) to intact factor VIIa was calcium-dependent and could be inhibited in a dose-dependent manner by peptide 195-206.(ABSTRACT TRUNCATED AT 250 WORDS)
In the present study, the proportion of mononuclear cells and percentages of CD4+ (OKT4+) and CD8+ (OKT8+) were determined in clinically healthy buccal mucosa in patients with recurrent minor aphthous ulceration (RAU) (n = 43) during active and inactive disease as compared with RAU-free controls (n = 15). In lamina propria, the total number of mononuclear cells and subset percentages were determined histologically and immunohistochemically. Mononuclear cell counts in patient specimens were significantly lower than in the control group. CD4+ percentages were not significantly different between controls and patients. CD8+ percentages of the patients were significantly increased during active RAU, but not during inactive RAU as compared with controls. In proportion to the total number of mononuclear cells, CD4+ and CD8+ cell counts per 0.25 mm2 were significantly lower in the patients during both active and inactive disease as compared with controls. Thus, RAU seems characterized by reduced numbers of mononuclear cells, including T-lymphocytopenia in the oral mucosa as such, features that appear more pronounced during active disease than during quiescence.
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LongoVital (LV) (DK. reg. no. 5178/75) is a herbal based tablet enriched with recommended doses of vitamins. The present study was undertaken to investigate prevention of recurrent aphthous ulceration (RAU) during daily intake of LV for six months as compared with placebo in a double-blind, randomised clinical, cross-over 1-year study. The population comprised 29 otherwise healthy minor RAU patients (18F, 11M) mean age 36 (18-67), with an estimated average number of recurrences the previous year of 12.8 (3-30). The number of recurrences was significantly reduced on treatment with LV during the latter four of the six months (p less than 0.01) where 31% were totally free of recurrences. Subjective all-over evaluation of treatment period was significantly in favour of LV. LV induced no adverse reactions and is the first harmless systemic treatment which has proved better than placebo in the prevention of RAU.