Evaluation of common urine specimen adulteration indicators.
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Creatinine↗
Biomedical subjects
C Edwards
Publications and source records attributed to C Edwards.
Selection of an appropriate initial test cutoff concentration for workplace drug urinalysis--Cannabis example.
Apparent analyte concentration (equivalent of 11-nor-delta 9-tetrahydrocannabinol-9-carboxylic acid [9-THC-COOH]) obtained by radioimmunoassay (RIA) for cannabinoids using reagents manufactured at four different periods (from the same manufacturer) and specific 9-THC-COOH concentration as determined by GC/MS are examined for the significance of their correlation. The resulting regression equations are then used to estimate the apparent RIA analyte concentrations of reagents manufactured at different time periods that are equivalent to a specific 9-THC-COOH concentration. Correlation coefficients of the regression analysis improve from approximately 0.4 to 0.7 in parallel with the increasing reagent specificity. The apparent RIA analyte concentrations that correspond to 15 ng/mL 9-THC-COOH decrease from about 110 to 50 ng/mL again in parallel with the increasing reagent specificity. These findings empirically demonstrate that reagent specificity is the determining factor of the resulting apparent RIA analyte concentration when testing samples that contain 9-THC-COOH and other metabolites (derived from marijuana exposure). Thus, if the 9-THC-COOH concentration as determined by GC/MS is of primary concern, the initial test cutoff concentration should be adjusted in accordance with the specificity of the reagent used.
Dronabinol↗
High-risk endometrial cancer in young indigent women.
OBJECTIVE: The aim of this study was to evaluate a different prevalence and clinical pattern of high-risk endometrial cancer in an indigent population of young women. METHODS: Charts of 71 consecutive patients, treated for endometrial adenocarcinoma during a 6-year period, were reviewed. The patients were divided into two groups contingent upon age--(i) those who were below 40 years and (ii) those who were over 40. Based on histological type, grade, and stage, both groups were subdivided into a low, intermediate, or high-risk cancer category. RESULTS: Of the 13 (18.3%) patients in the younger age group, five patients (38.4%) had high-risk endometrial cancer, compared to only eight patients (13.8%) in the older age group. CONCLUSION: In contradiction to previous reports, our results show that a higher proportion of young indigent women diagnosed with endometrial cancer have a high-risk cancer. Delay in diagnosis can explain only some of the discrepancies in the special clinical pattern of endometrial cancer among this population. Other possible explanations include nutritional differences, genetic susceptibility, immunological status, and high-risk behavior. More epidemiological studies are needed for complete understanding of the unfavorable outcome of endometrial cancer in these young women.
Adenocarcinoma↗
Increased theophylline clearance during hemofiltration.
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Adult↗
Clinicopathologic analysis of mullerian adenosarcoma: the M.D. Anderson Cancer Center experience.
The records of 41 patients diagnosed with adenosarcoma of the female genital tract between 1982 and 1996 were reviewed. The median age at diagnosis is 51 years (range, 14-84). The most common symptom is vaginal bleeding (71%). Clinical signs at presentation include pelvic mass (37%), uterine polyps (29%), and enlarged uterus (22%). In 71% of patients, the tumor originates from the uterus. Other sites include ovary (15%), pelvis (12%), cervix (2%). A history of thyroid cancer, benign ovarian cyst, and polycystic ovarian disease is found more frequently than expected in this patient population, whereas no relationship to endometriosis is observed. Surgery is the mainstay of treatment, but platin-based chemotherapy given upfront in inoperable patient has definite efficacy. An overall response rate of 92.5% was observed after primary therapy (surgery with or without radiotherapy, and/or chemotherapy), with a median survival of 48 months (range, 1-174). Thirty-eight percent of patients had recurrent disease. The median time to recurrence is 12 months (range, 5-132). Although 60% of patients with recurrence achieved a complete remission after treatment, only 1 (8%) is alive without disease, and 3 (22%), with disease at the time of this analysis. In our series, histologic sarcomatous overgrowth is a predictor of poor prognosis (p<0.03), however myometrial invasion and stage of disease seem to be of less prognostic significance. Adenosarcoma is a tumor with a fair prognosis. Most tumor can be cured with surgery, but recurrence carries a bad prognosis.
Adenosarcoma↗
Competency-based learning for the surgical assistant.
In the first of two articles about the benefits and drawbacks of occupational standards, the authors describe a competency-based programme of continuing education for surgical assistants. The structure and content of the modules offered are discussed and the authors emphasise the validation of the courses by institutions of higher education. Next week's article will examine occupational standards in relation to professional development.
Competency-Based Education↗
MRSA: false economy may lead to dangerous practices.
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Cross Infection↗
Effects of aging and cytokine blockade on inflammatory cachexia.
OBJECTIVE: To evaluate the role of aging and specific cytokine blockade in the etiology of cachexia caused by adjuvant arthritis (AA), a model of cytokine-associated cachexia. METHODS: AA was induced in Lewis rats using CFA. In Experiment 1, severity of AA and inflammatory cachexia was assessed in young (Y, age 2-6 months, n = 132) and old rats (O, age 18-22 months, n = 40). In Experiment 2, young rats were divided into 5 different intervention groups: Saline-injected (n = 66); CFA-injected (n = 78); CFA-injected and treated with IL-1 receptor antagonist (IL-1Ra, n = 18); CFA-injected and treated with soluble TNF receptor type I (sTNFrI, n = 27); and CFA-injected and treated with both IL-1Ra and sTNFrI (both treatments, n = 8). RESULTS: In Experiment 1, young Lewis rats developed more severe arthritis (mean joint score on day 21 = 5.1 +/- 0.3) compared to the old group (0.6 +/- 0.6, p < 0.0001). The young group with AA lost 2.1% of baseline total body weight loss compared to 13.8% total body weight gain in controls (p < 0.0001). In contrast, old rats injected with CFA lost as much weight (-11%) as age-matched saline injected controls (-13%, p > 0.05, n = 18, age 18-22 months). In Experiment 2, mean joint scores in rats treated with IL-1Ra, sTNFrI or both were higher then untreated rats injected with CFA (p < 0.0001). Despite this, rats given both IL-1Ra and sTNFrI lost less weight on day 16 (p < 0.01) and 21 (p < 0.002) than untreated rats or those rats treated with either IL-1Ra or sTNFrI. CONCLUSION: Lewis rats aged 2-6 months are more susceptible to developing AA than older rats (age range 18-22 months). Inhibition of both IL-1 and TNF is needed to mitigate AA-associated weight loss, and this effect is dissociated from the effect of such inhibition on joint inflammation.
Aging↗
T-cell functions in ovarian cancer patients treated with viral oncolysates: I. Increased helper activity to immunoglobulins production.
We investigated the humoral and cellular responses of ovarian cancer patients treated with viral oncolysates (VO) tumor vaccines. All patients treated with VO developed tumor cell surface-reacting antibodies and anti-hemagglutinin antibodies. Furthermore, PBMC from these patients developed cellular proliferative responses to the cellular oncolysates (CO). The in vitro proliferating population consisted mainly of CD4+ cells, as demonstrated by depletion experiments using the corresponding monoclonal antibodies and complement and by examination of the phenotype of the cells stimulated in culture with VO or cellular oncolysates. Furthermore, in the patients treated with VO we observed an increased helper activity to immunoglobulin production by PBMC collected post-VO treatment in the PWM-driven differentiation system. The helper activity was much higher in patients treated with IL-2 plus VO than IL-2 alone.
Adenocarcinoma↗
Management. Neighbourhood networks.
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Communication↗
Radiation protection for dental professionals.
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Adolescent↗
The Crib-O-Gram in the NICU: an evaluation based on brain stem electric response audiometry.
This study evaluated the Crib-O-Gram as a screening test for hearing loss in NICU infants using Brain Stem Electric Response Audiometry (BERA) as the standard. Two Crib-O-Gram tests were administered to 280 babies within 48 hours of BERA testing. An additional 26 babies received BERA and one Crib-O-Gram test. Correlation coefficients for the two Crib-O-Gram scalar scores were calculated separately for a group of preterm (31 to 37 weeks) and a group of full term and older (38 to 54 weeks) infants, with values of 0.36 and 0.52, respectively. This indicates that the Crib-O-Gram has poor reliability for a screening test, particularly for preterm babies. Approximately one-third of babies with normal BERA thresholds failed Crib-O-Gram screening. The identification of hearing loss by Crib-O-Gram increased with the severity of the loss. Crib-O-Gram was able to identify moderately severe hearing losses in full term and older babies.
Acoustic Stimulation↗
Social support in smoking cessation among black women in Chicago public housing.
To accomplish significant reductions in smoking by the year 2000, special populations with relatively low rates of smoking cessation must be reached and helped to quit smoking. These populations are most often groups in which traditional approaches to smoking cessation have not been successful. Focus groups were conducted with black women who were residents of Chicago public housing developments. The purposes were to assess factors related to smoking and the women's willingness to participate in cessation programs. The findings reveal several barriers to smoking cessation. These barriers are linked to the difficult daily existence and environment of these women and to a lack of social support that would help them to achieve smoking cessation. The barriers include (a) managing their lives in highly stressful environments, (b) major isolation within these environments, (c) smoking as a pleasure attainable with very limited financial resources, (d) perceived minimal health risks of smoking, (e) commonality of smoking in their communities, (f) scarcity of information about the process of cessation available to them, and (g) belief that all they need is the determination to quit on their own. The women emphasized that smoking cessation would be more relevant to them if part of broader social support efforts geared to improve their lives. The public health system may need to consider such strategies to engage this group of women.
Black or African American↗
Effect of subcutaneous granulocyte colony-stimulating factor injectate volume on drug efficacy, site complications, and client comfort.
PURPOSE/OBJECTIVES: To determine the effect of administering 1.6 ml (480 mcg) of granulocyte colony-stimulating factor (G-CSF) in one subcutaneous injection or two injections of 0.8 ml each. DESIGN: Experimental. SETTING: 27-bed bone marrow transplant intensive care unit of a metropolitan, university medical center in the southwestern United States. SAMPLE: Nonprobability; 76 women who received high-dose chemotherapy for breast cancer followed by hemopoietic rescue. METHODS: Subjects were randomized into an experimental group that received one injection per 480 mcg dose and a control group that received two injections per 480 mcg dose administered by research associates using a standardized injection technique. MAIN RESEARCH VARIABLES: Injectate volume. The number of days post-transplant until the absolute neutrophil count (ANC) returned to 1,000/mm3, the incidence and surface area in mm2 of site complications, and scores on Tursky's Quantified Pain Descriptor immediately following the injection(s). FINDINGS: No significant difference existed between the two groups in ANC recovery time, frequency or size of site complications, or intensity, reaction, or sensation of discomfort reported. CONCLUSIONS: Administering 1.6 ml doses of G-CSF in one injection instead of two does not result in slower ANC recovery, induration, more frequent or larger bruises or areas of erythema, or greater client discomfort. IMPLICATIONS FOR NURSING PRACTICE: Administering one injection instead of two may decrease patients' anxiety, the nursing time needed for preparation and administration of injections, patient instruction for self-administration, the potential for contamination of vials or loss of dose, and the cost of supplies.
Adult↗