Biomedical subjects
Publications and source records attributed to B L Thompson.
Abuse of elders is a widespread but largely invisible problem in the United States. This problem and its detection, management, and prevention are described. Specific attention is directed toward risk factors for abuse and toward suggestive signs and symptoms. Texas laws and the physician's responsibility for reporting and intervening in cases of elder abuse are discussed. Strategies for intervention and prevention are outlined.
A survey was conducted of programs which reported requiring a third-year clerkship in family medicine in the 1988-89 AAMC Curriculum Directory to determine the characteristics of these 36 programs. The program characteristics were compared to those outlined by the STFM Task Force on Predoctoral Education in the 1981 monograph, Predoctoral Education in Family Medicine. Only one third of schools nationwide had a required family medicine clerkship; for 36 schools it was scheduled in the third year. Based on the information provided by the 25 (72%) of these 36 programs which responded, the third-year clerkship was likely to be a stand-alone, decentralized six- or eight-week rotation. The curricula were based on a set of "common problems" and emphasized those areas which separate family practice from other specialties. Students were most likely to be graded by faculty rating and a multiple choice examination. The curricula of the programs reviewed did reflect the recommendations of the Task Force, but there was great variability across programs.
The need for long-term planning and efficient usage of resources in the health care field necessitates approaching the elderly patient from a biopsychosocial point of view, facilitating a more complete approach to patient care. This article critiques tools available for the comprehensive functional evaluation of older patients, and identifies their effectiveness in improving specific aspects of patient outcomes. The Comprehensive Older Persons' Evaluation tool is described and compared with two other tools that evaluate a patient's functional and instrumental activities of daily living, as well as the medical, social and psychological aspects of the patient.
We recently showed that phosphatidylinositol trisphosphate (PIP3) was present in a unique lipid fraction generated in neutrophils during activation. Here, we demonstrate that the band containing this fraction isolated from thin layer chromatography consists primarily of PIP3 and that only small amounts of radiolabeled PIP3 exist prior to activation. In addition, high performance liquid chromatography of deacylated phospholipids from stimulated cells reveals an increase in a fraction eluting ahead of glycerophosphoinositol 4,5-P2. After removal of the glycerol we found that it coeluted with inositol 1,3,4-P3 when resubjected to high performance liquid chromatography. Thus, we have detected a second, novel form of phosphatidylinositol bisphosphate in activated neutrophils, PI-(3,4)P2. The elevation of PIP3 through the formyl peptide receptor is blocked by pretreatment with pertussis toxin, implicating mediation of the increase in PIP3 by a guanosine triphosphate-binding (G) protein. The rise in PIP3 is not secondary to calcium elevation. Buffering the rise in intracellular calcium did not diminish the increase in PIP3. The elevation of PIP3 appears to occur during activation with physiological agonists, its level varying with the degree of activation. Leukotriene B4, which elicits many of the same responses as stimulation of the formyl peptide receptor but with minimal oxidant production, stimulates a much attenuated rise in PIP3. Isoproterenol, which inhibits oxidant production also reduces the rise in PIP3. Hence formation of PI(3,4)P2 and PIP3 (presumed to be PI(3,4,5)P3) correlates closely with the early events of neutrophil activation.
Inositol (1,4,5)triphosphate (InsP3) and tetrakisphosphate (InsP4) have been observed in a variety of cell types and have been proposed to play roles in the receptor-mediated rise in intracellular Ca2+ (refs 2, 3). Recently, they have been shown to act synergistically in the activation of a Ca2+-dependent K+ channel in lacrimal acinar cells. InsP3 is the product of phospholipase C (PLC) action on phosphatidylinositol 4,5-bisphosphate (PtdInsP2) whereas InsP4 is believed to arise from phosphorylation of InsP3 by a cytosolic kinase. Although sought as a source for InsP4, PtdInsP3 has not been identified in any specific cell type. There were early reports of InsP4-containing phospholipids in crude extract from bovine brain, but this finding was later withdrawn. Recently, however, a membrane-bound enzyme (Type 1 PI kinase) which adds phosphate onto the 3 position of inositol phospholipids has been identified and the phosphatidylinositol-3-phosphate (PtdIns(3)P) product characterized. This suggests that several forms of phosphoinositides may exist and could be precursors for some of the variety of soluble inositol phosphate products which have been reported in recent years. Here we report the appearance of another novel phosphoinositide containing four phosphates, phosphatidylinositol trisphosphate (PtdInsP3) which we find only in activated but not in unstimulated neutrophils from human donors.
The cutaneous application of antiviral agents was studied by iontophoresis, a process that increases penetration of most drugs 20- to 60-fold. Twenty-seven subjects with vesicular orolabial herpes were treated one time in a double-blind, placebo-controlled clinical study: nine received vidarabine monophosphate (ara-AMP), nine received acyclovir (ACV), and nine received NaCl. Ara-AMP-treated lesions yielded lower titers of virus after 24 hr compared with lesions treated with NaCl or ACV (P less than .05). Ara-AMP significantly decreased the duration of shedding of virus (P less than .05) and time to dry crust (P less than .05) compared with the other two agents. There was a trend toward decreased healing time after ara-AMP treatment.
Melanoma most often occurs on the leg in women and on the head or neck in men. The appearance of the lesion should suggest the diagnosis, but pathologic examination and classification based on depth of skin penetration are essential for optimal therapy. Wide surgical excision should be followed by lymph node dissection, chemotherapy and/or immunotherapy depending on classification.
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Literature of Mexican-American folk medicine and on Mexican-American utilization of conventional medical services suggests that folk medicine and utilization of conventional medical services are related. This study reports on interviews with 40 Mexican-American families randomly selected from the community. The results indicate that choice of conventional medical care and/or folk medicine is dependent upon the symptom, that families often use both folk and conventional medicine, that they are more likely to seek medical help for anxiety than for depression, and that knowledge of folk medicine is best acquired by asking about specific folk diseases. These findings have application in family practice.
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A new synthesis is described for 10alpha-methoxy-delta8,9-lysergaldehyde involving the oxidation of elymoclavine with manganese dioxide in methanol. Lysergol and agroclavine provide no reaction under the same conditions.
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BACKGROUND: The reported incidence of congenital syphilis in the United States rose dramatically during the 1980s. Although lack of prenatal care has been associated with congenital syphilis, little has been published regarding missed opportunities for prenatal intervention. GOAL OF THIS STUDY: To determine whether congenital syphilis increases in Maryland between 1989 and 1991 resulted from a true increase in congenital syphilis incidence or a change in the surveillance case definition, and to describe missed opportunities for prenatal intervention. STUDY DESIGN: This was a retrospective cohort study. RESULTS: When the revised case definition was used, a 473% increase in the number of cases was seen. Among infants who met the revised definition, 45% of mothers had received no prenatal care. Among those whose mothers had received prenatal care, opportunities to intervene were missed for 53%. CONCLUSIONS: Although a true increase in congenital syphilis incidence occurred before 1990, the increase reported in Maryland between 1989 and 1991 was primarily due to the change in case definition. Many cases of congenital syphilis could have been prevented with early and adequate prenatal care.