Search PubMed⌕ Search

Biomedical subjects

C A Taylor

Publications and source records attributed to C A Taylor.

At least 55 records · Page 3Linked to original sources
PubMed1994

Residency directors' responses to the concept of a proposed electronic residency application service.

BACKGROUND: In 1992, the Executive Council of the Association of American Medical Colleges (AAMC) recommended that the feasibility of the proposed Electronic Residency Application Service (ERAS) be investigated. This action was based on concerns that the current system was inefficient, costly, and disruptive to students, medical schools, and residency programs. The purpose of this study was to explore residency directors' opinions about the benefits and barriers to the introduction of such a system. METHOD: All directors from family practice and obstetrics-gynecology residency programs were surveyed in early 1993. Three forced-choice and three open-ended questions elicited opinions concerning benefits and potential barriers to the implementation of ERAS. T-tests and chi-square tests for independence were used to examine differences for continuous and categorical variables. RESULTS: Overall, 544 residency directors (81%) responded to the questionnaire: 339 (86%) in family practice, and 205 (75%) in obstetrics-gynecology. Eighty percent of the respondents in family practice and 75% of those in obstetrics-gynecology were in favor of the initiation of ERAS. Perceived benefits included increased "efficiency," "simplicity," "standardization," and "completeness." Concerns included "technical problems," "loss of flexibility," "lack of a personal touch," "costs," and "lack of security." CONCLUSIONS: It is appropriate for the AAMC to take the lead in investigating the computerization of this important process. It is essential, however, to gather data from all three consumers of this potentially valuable service as an important step in the project's development.

Administrative Personnel↗
PubMed1994

Screening patients with traumatic brain injuries for substance abuse.

Substance abuse frequently accompanies and complicates serious traumatic brain injury (TBI). An important prerequisite to providing assistance to TBI patients is the ability to identify substance abuse accurately. The authors prospectively evaluated 10 consecutive admissions to a TBI program using four substance abuse screening tools: the CAGE questions, the Brief Michigan Alcohol Screening Test (BMAST), the Substance Abuse Subtle Screening Inventory, and the Addiction Severity Index. The CAGE questions and the BMAST were found to be easy to administer and very sensitive as well as specific for substance abuse in this population. The authors conclude that all patients with traumatic brain injuries should be screened for substance abuse by using either the CAGE questions or the BMAST.

Adult↗
PubMed1994

Physicians' perceptions of the impact of the reclassification of vaginal antifungal agents.

BACKGROUND: In January 1991, miconazole and clotrimazole were released as nonprescription therapy for vaginal candidiasis. Considering the number of women suffering from vaginal symptoms annually, these new over-the-counter (OTC) products may have a considerable impact on women's health care. METHODS: All 191 family physicians and obstetrician and gynecologist members of the Toledo and Lucas County Academy of Medicine were surveyed in June 1992. The survey instrument was constructed to include questions regarding physician perceptions of the impact of OTC antifungal agents on preventive care; the type of advice they currently give patients concerning the use of OTC antifungal agents; and their estimates of the incidence of misdiagnosis and reported side effects resulting from use of OTC antifungal agents. RESULTS: Of the surveyed physicians, 24% concluded that the reclassification of antifungal agents was a positive change for their female patients, 19% believed it was a negative change, and the remaining 57% noted no impact on their patients' well-being. Over 40% of the physicians indicated that four to six of their patients had delayed treatment for other vaginal conditions because of inappropriate use of an OTC antifungal preparation within the last year. On a positive note, the physicians in favor of the OTC preparations believed their patients were getting faster and more economical care and were in "control of their health care." CONCLUSIONS: Physicians participating in this study reported mixed opinions concerning the reclassification of vaginal antifungal agents and raised several pertinent questions that require further examination.

Antifungal Agents↗
PubMed1993

Extent to which guided-discovery teaching strategies were used by 20 preceptors in family medicine.

BACKGROUND: Learners learn more and are able to categorize problems at higher levels when their teachers use guided-discovery strategies (e.g., questions and advice to investigate relationships between concepts), as opposed to directly telling learners the answers. This study examines the extent to which clinician preceptors of residents use guided-discovery strategies when faced with a diagnostic problem-solving situation. METHOD: Twenty family medicine preceptors from four residencies volunteered in 1991-92 to role-play with a simulated first-year resident on a single standardized case. Judges coded the preceptors' verbal behaviors by type (question, statement, or advice) and by category. The categories were teacher, i.e., behaviors relating to more than the present case (hence exemplifying guided-discovery strategies), and consultant, i.e., behaviors relating to the successful disposition of the case (without overt concern for the education of the resident). RESULTS: Of the preceptors' 846 verbal behaviors, 602 (71%) were coded as teacher behaviors, but only 329 (39%) were teacher behaviors that were of the specific types (high-level advice or questions promoting reflectivity, i.e., mindfulness) described in the literature as being most likely to promote learners' reflectivity and transfer of knowledge and skills from a lower level of abstraction to a higher level. CONCLUSION: The results suggest that the 20 perceptors were aware of the importance of "getting residents to think" and did use teaching strategies known to promote transfer. However, their repertoire of strategies was limited.

Family Practice↗
PubMed1993

Effects of supplementation on intake, growth rate, and fleece production by female Angora kid goats grazing rangeland.

Ninety-eight and 88 female Angora kid goats (6 mo of age) were grazed/browsed on Edwards Plateau rangeland in 92- and 88-d trials in 1989 and 1990, respectively. The goats were either not supplemented (negative control, NC) or fed isoenergetic amounts of corn (C), a corn/cottonseed meal/molasses mixture (C/CSM), or a corn/cottonseed meal/fish meal/molasses mixture (C/CSM/FM). The C/CSM and C/CSM/FM supplements provided equal CP but different amounts of ruminally undegraded protein (UDP). The goats were allowed to graze/browse in a common pasture and were separated into treatment groups three times each week for feeding. Intakes of supplement and forage were measured using a dual-marker technique. Forage intake was not increased with supplemental feeding (P = .21), but tended (P = .08) to be greater with high-protein supplements than with C. Total digestible DMI was greater (P < .01) for supplemented goats and was not affected by supplement type. Supplemental feeding increased BW gain (P < .01) and clean fleece weight (CFW; P < .01). High-protein supplements increased BW gain (P < .01), CFW (P = .07), fiber diameter (FD; P < .01), and staple length (P < .01) compared with C. Greater amounts of UDP (C/CSM/FM) did not increase BW gain (P = .99) but tended to increase CFW (P = .12) and FD (P = .15). Supplemental feeding increased total digestible DMI by partial substitution (corn) for forage or addition (high-protein supplements) to forage, and both energy and protein increased BW gain and CFW and influenced mohair traits.

Animal Feed↗
PubMed1993

Combined effects of stocking rate and supplemental feeding level on adult beef cows grazing native rangeland in Texas.

A grazing study was conducted over 4 yr to determine the effects of stocking rate and supplemental feeding levels on intake, and BW and body condition changes by adult beef cows. Stocking rates were 12.3, 16.5, and 24.7 animal units/(100 ha.yr). Supplemental feed treatments included a negative control (NC) and 300 g/(cow.d) of CP with either 2 (L), 4 (M), or 8 (H) Mcal/(cow.d) of DE from early December to late March. Groups fed supplements (L, M, and H) lost less BW from fall to spring (P < .01) and reciprocally gained less BW from spring to weaning (P < .01) than NC cows. The L cows tended (P = .14) to lose less BW between fall and spring than M and H cows. Treatment effects on condition score were similar to those for BW change. Forage intake, estimated by measurements of fecal output, was greater by supplemented cows (P = .02); L was greater than M and H (P = .004). Increased stocking rate correlated with increased fall-to-spring BW losses (P < .002), spring-to-weaning BW gains (P < .0001), and decreased winter forage intake (P < .005). These data provide quantitative bases for the effects of stocking rate and supplemental feeding on BW and condition dynamics. Low-level feeding of a high-protein supplement can increase intake of dormant range forage, thereby increasing nutrient intake. High-level feeding of low-protein supplements seems to increase nutrient status primarily by providing supplemental nutrients. Increasing stocking rate to the reported extremes decreased forage intake and resulted in unfavorable BW and condition changes.

Animal Feed↗
PubMed1992

Predictors of outcome after percutaneous endoscopic gastrostomy: a community-based study.

Percutaneous endoscopic gastrostomy (PEG) is used to provide nutrition for patients who are unable to eat but have a functionally intact gut. Clinical guidelines for PEG are uncertain and have been derived mainly from referral practices. We performed a population-based cohort study in 97 residents of Olmsted County, Minnesota, referred for PEG between January 1982 and December 1988 to determine complications, duration of tube feeding, and survival. Follow-up continued until death or February 1990. Inpatient and outpatient records were reviewed to determine indications, comorbid conditions, level of consciousness, and limitations in activities of daily living. Outcomes determined after referral for PEG included type and number of complications, tube removal, and survival. Statistical methods used included Kaplan-Meier and proportional hazards regression analyses. PEG placement was successful in 94% of patients. Although complications occurred in 70% of patients, they usually were minor (88%) and most occurred within 3 months. In 24 patients, tubes were removed because eating was resumed. The probability of surviving 30 days, 1.5 years, and 4 years after referral for PEG was 78%, 35%, and 27%, respectively. The major causes of death within and after 30 days were pneumonia, heart disease, and vascular disease of the central nervous system. An increased risk of death after referral for PEG placement was associated with older age, male gender, diabetes, and specific indications for PEG. If validated in other population-based studies, these predictors of survival after referral for PEG placement could be used to identify patients with a low probability of survival who may not benefit from PEG.

Adolescent↗
PubMed1992

Prospective assessment of early fetal loss using an immunoenzymometric screening assay for detection of urinary human chorionic gonadotropin.

OBJECTIVE: To develop an economical, nonradiometric immunoenzymometric assay (IEMA) for the detection of urinary human chorionic gonadotropin (hCG) in studies of early fetal loss. To be effective, the IEMA must have a sensitivity equal to the standard immunoradiometric assay (IRMA) and sufficient specificity to eliminate the need for screening most nonconceptive cycles with the expensive and labor-intensive IRMA. DESIGN: Two different assays were used to measure hCG in daily early morning urine samples from potential conceptive cycles. SETTING: Women undergoing donor artificial insemination (AI) were evaluated in a prospective study. PATIENTS, PARTICIPANTS: Ninety-two women volunteers were selected on the basis of apparent normal reproductive health. INTERVENTIONS: Artificial insemination with nonfrozen donor semen was performed by cervical cup twice each menstrual cycle at 48-hour intervals, and daily urine samples were self-collected throughout the menstrual cycle. MAIN OUTCOME MEASURES: An IEMA was developed to detect urinary hCG using the same antibodies as in the standard IRMA; a study was designed to determine whether this nonradiometric assay could successfully detect the early fetal loss that was detected by the IRMA. RESULTS: Of 224 menstrual cycles analyzed by both assays, a total of six early fetal losses were detected by the IRMA. When the tentative screening rule was set to allow all six of these losses and 95% of future losses to be detected by the IEMA, an additional 34 false-positive results were detected by the IEMA. The specificity of the IEMA with this rule was calculated to be 84%. CONCLUSION: An IEMA based on the same antibodies used for the standard IRMA can serve as an efficient screening assay for the detection of early fetal loss. When the IEMA is used in this manner, nearly 80% of screened menstrual cycles can be eliminated without further testing by the IRMA.

Abortion, Spontaneous↗
PubMed1991

Scanning electron microscopic examination of ultrasonic and effervescent methods of surface contaminant removal from complete dentures.

Dentures were examined by scanning electron microscopy to evaluate removal of surface contaminants such as plaque, calculus, microflora, and cigarette smoke. Ten complete dentures were obtained during patient appointments and prepared for SEM examination. Samples from 10 control surfaces, 10 surfaces cleaned with effervescent cleansers, and 10 surfaces ultrasonically cleaned were photographed at x5000. One photograph of each sample was evaluated in random order by five judges for a total of 150 observations. Photographs were compared with one of a clean denture sample. Statistical analysis of the results validated the superiority of the ultrasonic method for cleaning dentures.

Bacteria↗
PubMed1991

An electron microscopy study of urinary sediment: relationship between myeloid body excretion and gentamicin nephrotoxicity in the rat.

We studied renal function, urinary enzymes, urinary sediment, and renal histopathology in Fischer 344 rats that were treated with one dose of mercuric chloride (HgCl2) alone, HgCl2 followed by gentamicin, gentamicin alone, or gentamicin, followed by HgCl2. HgCl2 was administered intraperitoneally at 1 mg/kg body weight. Gentamicin was injected subcutaneously at 40 mg/kg body weight. Renal function was assessed by creatinine clearance. Urinary sediment was examined using transmission electron microscopy; particular attention was given to the numbers by myeloid bodies in the urinary sediment. Renal tissue was assessed using light microscopy for acute tubular necrosis (ATN). In either HgCl2- or saline-treated rats urinary sediment showed no myeloid bodies, and renal morphology was essentially normal. The rats given HgCl2 48 h prior to initiation of gentamicin therapy showed significant decrease of myeloid bodies excretion. This was accompanied by significantly less impairment of renal function, mild renal lesion, and no necrotic tubule cells in urinary sediment. The rats treated with either gentamicin alone or gentamicin followed by HgCl2 developed significant impairment of renal function in association with marked elevation of the urinary enzymes, and variable extent of ATN. In both of these groups, urinary sediment showed a profusion of free myeloid bodies and many necrotic renal tubule cells. The urinary sediment findings, however, did not aid in distinguishing between these two treatment groups. From these data we conclude that (1) a tentative relationship exists between the concentration of the urinary myeloid bodies and severity of gentamicin nephrotoxicity; (2) prior treatment with compound(s) analogous to HgCl2 which could minimize urinary excretion of the myeloid bodies might be useful in the mitigation of gentamicin nephrotoxicity.

Animals↗
PubMed1991

Erythrocyte deformation in ischemic acute tubular necrosis and amelioration by splenectomy in the dog.

Bilateral renal artery occlusion (RAO) for 120 minutes in dogs results in acute tubular necrosis (ATN) and peritubular capillary (PTC) congestion with rapidly deteriorating renal function. We have shown that prior splenectomy minimizes RAO-induced renal functional and histopathologic changes. The purpose of this study was to examine whether this renal protection is due to prevention of red blood cell echinocyte formation and resultant renal PTC congestion. Echinocytes (burr cells) are poorly deformable, impart high viscosity to the blood, and may hinder reperfusion by increasing resistance to renal capillary blood flow. Splenectomized (SPLX) or sham-SPLX dogs were treated with bilateral RAO for 120 minutes. After RAO, renal function and renal blood flow were monitored, and peripheral blood red blood cells were examined at 1 hour and at 24-hour intervals for 96 hours. Renal biopsies were taken 1 hour after RAO and the kidneys removed 96 hours after RAO. The RBCs and renal tissues were studied using scanning electron microscopy. Renal function was assessed by endogenous creatinine clearance. Sham-SPLX animals showed a marked and sustained decrease in creatinine clearance, consistently elevated serum creatinine levels and fractional excretion of sodium, and diffuse ATN and PTC congestion with echinocytes. These animals had a peak in circulating echinocytes 1 hour after RAO (p less than 0.05), which showed an excellent negative correlation with creatinine clearance (r = -0.999; p less than 0.001). On the contrary, SPLX animals had essentially no change in serum creatinine or fractional excretion of sodium, minimal tubular changes, no PTC congestion, and no rise in circulating echinocytes during the 96-hour observation. In vitro treatment of the postischemic red blood cells from sham animals with adenosine-inosine or fresh postischemic plasma from the SPLX animals showed almost complete reversal to discocytes (normal red blood cells), whereas in vitro treatment of postischemic red blood cells from the SPLX animals with fresh postischemic plasma from the sham animals resulted in a marked echinocytic response. We conclude that 1) a marked echinocyte response in the immediate postischemic period is an important mechanism in initiating ischemic ATN, 2) an echinocyte inducing factor may reside in the plasma of spleen-intact animals, and 3) mitigation of ATN and PTC congestion by splenectomy is, at least in part, consequential to attenuated echinocytic response in the immediate postischemic period.

Animals↗
PubMed1991

POEMS syndrome with idiopathic flushing mimicking carcinoid syndrome.

POEMS syndrome, a rare multisystem disease, is a variant of osteosclerotic myeloma and is characterized by polyneuropathy, organomegaly, endocrinopathy, monoclonal proteins, and skin changes. Presented herein is a case of POEMS syndrome with flushing. The flushing was intermittent, involving the face and upper third of the trunk, and was associated with hypotension and bronchospasm. Final diagnosis was made by biopsy examination of an axillary lymph node, which showed angiofollicular hyperplasia that stained strongly and selectively for lambda light chains. The patient had most of the typical features of POEMS syndrome but was unique in that her most striking finding was carcinoid-like flushing. The flushing improved with steroid therapy, as did some of the other clinical features of her disease. This case suggests that idiopathic flushing can be added to the skin changes observed in POEMS syndrome.

Biopsy↗
PubMed1990

Calcium, collagen dose, gender and fasting affect the response of rat platelet thromboxane formation to extremes in dietary linoleate.

Platelet thromboxane synthesis in response to supplemental linoleate in the diet has been very inconsistent. The objective of this study was to investigate potential confounding factors known to affect platelet thromboxane synthesis. Citrated whole blood was recalcified with varying Ca2+ concentrations and challenged with low or high dose collagen preparations to induce extreme ranges of thromboxane synthesis from endogenous arachidonate pools by rat platelets. Male and female weanling rats were fed 0.0, 1.0 or 23 energy percent linoleate for 11 to 13 weeks. Fasting tended to enhance thromboxane synthesis. Both fasted and fed females showed slightly faster rates of thromboxane synthesis than males. Essential fatty acid deficiency depressed (P less than 0.01) thromboxane synthesis; the degree of this depression was inversely related to the level of recalcification (68% for 0.0 mM Ca2+, 36% for 2.5 mM Ca2+ and 20% for 5.0 mM Ca2+) when challenged with the high dose collagen. Essential fatty acid deficiency depressed platelet phospholipid arachidonate concentration 26%. Only blood from fed females stimulated with a mild challenge responded to excess dietary linoleate, and a 62% (not statistically significant) depression in TX synthesis was observed and this was associated with a decrease in platelet phospholipid arachidonate concentration.

Animals↗
PubMed1990

Relaxin in the peri-implantation period.

The time of appearance of relaxin in peripheral blood was determined in conceptive and non-conceptive cycles using a sensitive and specific double-antibody enzyme-linked immunoassay for human relaxin. For study of relaxin in early pregnancy, daily plasma samples were collected from women receiving artificial insemination of donor semen. The day of ovulation was determined by daily LH monitoring and ultrasound observation. In three conceptive cycles, relaxin was significantly elevated over baseline 9-10 days following the LH peak. Relaxin concentrations quickly rose over the next 15 days of observation to over 800 pg/ml. Relaxin was observed to increase 1 to 2 days prior to the first detectable increase in plasma hCG as measured by enzyme-linked immunosorbent assay. To compare the relaxin profile in conceptive cycles with normal luteal phase concentrations, relaxin was also measured in daily plasma samples collected from women contracepting with barrier methods, bilateral tubal ligation, or abstinence. A small but consistent rise in relaxin in the late luteal phase was observed in nine of eleven women, which began 6-9 days after the LH peak, averaged approximately 50 pg/ml, and was declining by the next menses. It is concluded that a small but measurable rise in plasma relaxin is associated with the normal luteal phase and that relaxin secretion is accelerated around the time that hCG is first detected in conceptive cycles. This acceleration of relaxin secretion which is associated with the onset of hCG may provide additional evidence for identification of transient early pregnancy.

Chorionic Gonadotropin↗
PubMed1990

Evaluation of a rapid monitoring system to study heparin pharmacokinetics and pharmacodynamics.

The pharmacokinetic and pharmacodynamic characteristics of heparin were studied in 10 healthy volunteers using the Hepcon/System B-10. This coagulation-monitoring system uses each patient's body weight, height, baseline activated clotting time (ACT), and heparin dose response values to determine initial heparin doses. We administered a calculated mean +/- SD heparin doses of 85 +/- 14 U/kg to 10 subjects to achieve a mean +/- SD target ACT of 364 +/- 29 seconds. This dose produced a mean +/- SD measured peak ACT of 337 +/- 53 seconds from a mean +/- SD baseline of 121 +/- 10 seconds. The measured peak ACT values resulting from the individualized heparin doses were within 20% of the desired peak in 9 (90%) of the subjects. Using the ACT values, the average mean residence time for heparin effect was 1.2 hours and half-life was 0.8 +/- 0.2 hours, with all the subjects' values returning to within 10% of baseline by 4 hours after the dose. Using the protamine-derived heparin concentrations, heparin total-body clearance ranged from 43 to 99 ml/hr/kg (mean +/- SD 73.3 +/- 14.5 ml/hr/kg). A linear relationship was found between heparin concentration and change in ACT that was described by delta ACT = 16.85 + 136.7.(heparin concentration). We conclude that this method is easy to perform and accurate for determining initial heparin dosage requirements, and could be an important improvement over existing approaches. In addition, it is a valuable research tool for studying heparin pharmacodynamics and pharmacokinetics.

Adult↗