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Biomedical subjects

C Bell

Publications and source records attributed to C Bell.

At least 361 records · Page 20Linked to original sources
PubMedDate not supplied

A comparison of diagnostic peritoneal lavage and computed tomography (CT scan) in evaluation of the hemodynamically stable patient with blunt abdominal trauma.

The diagnosis of intraabdominal injury in the patient who is victim of blunt trauma is often problematic. Currently, two procedures, diagnostic peritoneal lavage (DPL) and computed tomography (CT scan) are used to evaluate patients with possible intraabdominal injuries after blunt trauma. Controversy exists as to which of these modalities is more efficacious in this setting. There are advantages and disadvantages of both procedures, however, present evidence suggests that the clinician should not rely on the results of the CT scan. The DPL, on the other hand is a sensitive and specific modality in evaluating the patient with blunt abdominal trauma.

Abdominal Injuries↗
PubMedDate not supplied

The effect of intravenous dextrose infusion on postbypass hyperglycemia in pediatric patients undergoing cardiac operations.

STUDY OBJECTIVE: To determine whether elimination of intraoperative dextrose-containing infusions affects post-cardiopulmonary bypass hyperglycemia in pediatric patients. DESIGN: Randomized, unblinded, saline-controlled study of perioperative glucose infusions in children undergoing cardiac surgery. SETTING: Cardiac surgery suite and pediatric intensive care unit (ICU) of a university medical center. PATIENTS: 33 consecutive, nondiabetic children undergoing cardiac surgery with deep hypothermia over an 8-month period. INTERVENTIONS: Group A (n = 16) received only normal saline infusions intraoperatively, and Group B (n = 17) received 5% dextrose and lactated Ringer's solution exclusively. Blood glucose was sampled immediately after induction of anesthesia, prior to cardiopulmonary bypass (CPB), after separation from CPB, on arrival in the ICU, and the morning of the first postoperative day. Data were analyzed using Student's t-test for independent samples, paired t-test, and analysis of variance, with p < 0.05 considered significant. MEASUREMENTS AND MAIN RESULTS: Although moderate elevations in blood glucose (mean less than 165 mg/dl) after CPB were present in Group A, significantly higher levels (mean greater than 250 mg/dl) were noted in Group B. No children were hypoglycemic (glucose less than 40 mg/dl). Glucose levels were normal in both groups on the morning of the first postoperative day despite patients' having received continuous dextrose infusions in the ICU and the presumed stress of emergence from anesthesia. CONCLUSIONS: Extreme postbypass hyperglycemia can be controlled by eliminating intraoperative dextrose infusions. Hypoglycemia, an unlikely event, can easily be avoided by regular blood sampling, which is facilitated by the routine placement of arterial catheters.

Cardiac Surgical Procedures↗
PubMedDate not supplied

Liposome-anchored vascular endothelial growth factor aptamers.

Nuclease-resistant aptamers identified from randomized nucleic acid libraries represent a novel class of drug candidates. Aptamers are synthesized chemically and therefore can be readily modified with functional groups that modulate their properties. We report here on the preparation, initial characterization, and functional properties of a nuclease-resistant vascular endothelial growth factor (VEGF) aptamer anchored in liposome bilayers through a lipid group on the aptamer. While the high-affinity binding to VEGF is maintained, the plasma residence time of the liposome-anchored aptamer is considerably improved compared with that of the free aptamer. The lipid group attachment and/or liposome anchoring leads to a dramatic improvement in inhibitory activity of the aptamer toward VEGF-induced endothelial cell proliferation in vitro and vascular permeability increase and angiogenesis in vivo.

Animals↗
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Trauma and dissociation: treatment perspectives.

TOPIC: How advanced practice nurses can work with trauma survivors to decrease dissociation as a needed coping mechanism. PURPOSE: To review the literature on trauma and dissociation as well as current treatment perspectives. SOURCES: Review of the literature and authors' clinical experience. CONCLUSIONS: Advanced practice nurses can use knowledge of selected psychopharmacological medications and Erikson's stages of psychosocial development to plan treatment for posttrauma clients.

Combined Modality Therapy↗
PubMedDate not supplied

A comprehensive league table of cost-utility ratios and a sub-table of "panel-worthy" studies.

OBJECTIVES: The authors compiled a comprehensive league table of cost/QALY ratios, and a standardized table of analyses satisfying selected Reference Case criteria from the USPHS Panel on Cost-Effectiveness in Health and Medicine. METHODS: They identified 228 cost-utility analyses (CUAs) through literature searches, and abstracted data on methods and cost-utility ratios. The subset of "Panel-worthy" analyses used: a societal or broad health-care perspective, community or patient preference weights, net costs, incremental comparisons, and discounting of costs and QALYs. RESULTS: The 228 CUAs included ratios for 647 interventions, ranging from cost-saving to $52,000,000/QALY (median = $12,000/QALY). The standardized table presents 112 ratios that met the "Panel-worthy" criteria, with articles published in recent years more likely to meet all of the criteria. CONCLUSIONS: The comprehensive league table (available on the Web) provides a useful reference, but ratios may not be comparable because of methodologic variations. The standardized table focuses on studies meeting basic methodologic criteria, potentially allowing for better comparison with future Reference Case analyses. Future studies should investigate the quality of analyses' underlying assumptions in addition to whether certain key procedural protocols were met.

Adolescent↗
PubMedDate not supplied

A review of 100 applications of section 5(4) Mental Health Act.

Section 5(4) of the Mental Health Act (1983) allows nurses to detain a psychiatric inpatient for up to six hours before a doctor arrives. This article reviews the use of Section 5(4) in 100 cases in North Cheshire between 1985 and 1992. Doctors supported every nurse's decision to detain a patient. Patients detained under Section 5(4) were more likely to be converted to other sections. This suggests that the nurse's decision to detain the patient is a useful predictor of outcome.

Adolescent↗
PubMedDate not supplied

Successful implementation of Medicare risk contracting.

With the information resources available today, groups can better determine whether they possess the ingredients for success with regard to risk contracting, write Molly Zelley, M.P.A., and Christy Bell. For those that do, Medicare risk contracting can be a vehicle for developing comprehensive, cost-effective new approaches for attracting and providing health care to this increasingly significant segment of the population.

Aged↗
PubMedDate not supplied

The Timed Get-up-and-Go test revisited: measurement of the component tasks.

The "Timed Get-up-and-Go" (TGUG) test measures the overall time to complete a series of functionally important tasks. In the "Expanded Timed Get-up-and-Go" (ETGUG) test, times for the component tasks are measured using a multimemory stopwatch. Results from the ETGUG test were compared to those from the TGUG test on three groups of subjects: nonimpaired young, nonimpaired elderly, and elderly subjects at risk of falling. Significant differences were found between the two control groups and the at-risk group for all components of the test. Walking speed was the only measurement found to be significantly different between the young and elderly controls. The ETGUG test is a sensitive and objective assessment of function that requires minimal equipment, training, or expense. It better isolates functional deficits, thereby aiding the clinician in devising prevention strategies and guiding both treatment and further testing.

Adult↗