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C M Bliss

Publications and source records attributed to C M Bliss.

9 recordsLinked to original sources
PubMed1999

Implementation of on-site screening sigmoidoscopy positively influences utilization by primary care providers.

BACKGROUND & AIMS: Sigmoidoscopy is an effective screening strategy for colorectal cancer that is not widely used by primary care providers. The aim of this study was to assess the impact of "academic detailing" in the form of an outreach educational seminar combined with implementation of on-site sigmoidoscopy services performed by university-based gastroenterologists on provider compliance. METHODS: A controlled trial was initiated at 9 urban neighborhood health centers, including 4 intervention and 5 comparison sites. Baseline data on provider attitudes and practice patterns were collected using a validated questionnaire. Outcome measures included a year 1 follow-up survey of provider attitudes and quarterly review of screening sigmoidoscopy referrals using appointment logs to assess utilization. RESULTS: Overall self-reported compliance rates for screening sigmoidoscopy increased by 36% (baseline, 24%; year 1, 60%) for the intervention group vs. only 7% (baseline, 19%; year 1, 26%) for the comparison group (P = 0. 001). When stratified by site, compliance rates increased at each intervention site (range, 7%-92%) but at only 2 control sites. Use of screening sigmoidoscopy was also significantly greater at the intervention sites (47% vs. 4%; P </= 0.001). CONCLUSIONS: An outreach educational seminar combined with implementation of on-site sigmoidoscopy services is an effective strategy for enhancing provider utilization of screening sigmoidoscopy.

Adult↗
PubMed1998

Helicobacter pylori lipopolysaccharide binds to CD14 and stimulates release of interleukin-8, epithelial neutrophil-activating peptide 78, and monocyte chemotactic protein 1 by human monocytes.

Helicobacter pylori gastritis is characterized by leukocyte infiltration of the gastric mucosa. The aims of this study were to determine whether H. pylori-derived factors stimulate chemokine release from human monocytes and to ascertain whether H. pylori lipopolysaccharide (LPS) may be responsible for this effect. Human peripheral blood monocytes were exposed to an H. pylori water extract (HPE) or to purified H. pylori LPS. Levels of the chemokines interleukin-8 (IL-8), epithelial neutrophil-activating peptide 78 (ENA-78), and monocyte chemotactic protein 1 (MCP-1) were measured by enzyme-linked immunosorbent assay. The contribution of H. pylori LPS to monocyte activation was determined by using the LPS antagonist Rhodobacter sphaeroides lipid A (RSLA) and a blocking monoclonal antibody to CD14 (60bca). HPE increased monocyte secretion of IL-8, ENA-78, and MCP-1. Heat treatment of HPE did not reduce its ability to activate monocytes. Purified H. pylori LPS also stimulated monocyte chemokine production but was 1,000-fold less potent than Salmonella minnesota lipid A. RSLA blocked H. pylori LPS-induced monocyte IL-8 release in a dose-dependent fashion (maximal inhibition 82%, P < 0.001). RSLA also inhibited HPE-induced IL-8 release (by 93%, P < 0.001). The anti-CD14 monoclonal antibody 60bca substantially inhibited IL-8 release from HPE-stimulated monocytes (by 88%, P < 0.01), whereas the nonblocking anti-CD14 monoclonal antibody did not. These experiments with potent and specific LPS inhibitors indicate that the main monocyte-stimulating factor in HPE is LPS. H. pylori LPS, acting through CD14, stimulates human monocytes to release the neutrophil-activating chemokines IL-8 and ENA-78 and the monocyte-activating chemokine MCP-1. Despite its low relative potency, H. pylori LPS may play an important role in the pathogenesis of H. pylori gastritis.

Chemokine CCL2↗
PubMed1991

Geriatric constipation: brief update on a common problem.

Constipation occurs frequently in the elderly and is often multifactorial in origin. A search for an underlying cause is necessary, and can often be found by taking an adequate history and performing a thorough physical examination. A minority of patients require further investigation, guided by the clinical setting. Management should be directed at correcting the underlying cause and providing dietary advice and, less commonly, medication to allow restoration of a normal bowel habit.

Aged↗
PubMed1987

Significance of occult gastrointestinal bleeding during anticoagulation therapy.

A prospective study was undertaken to determine the effect of anticoagulation therapy on the prevalence of occult gastrointestinal bleeding and to ascertain the causes of bleeding. During a six-month period, 256 patients who had received anticoagulants were screened for occult bleeding with guaiac-impregnated cards. Twenty-one (12 percent) of the 175 patients who had received anticoagulants and who voluntarily completed the cards had occult gastrointestinal bleeding compared with only two (3 percent) of 74 control patients who had not received anticoagulants. The mean prothrombin time and partial thromboplastin time did not differ significantly in the patients who had received anticoagulants with and without subsequent bleeding. Fifteen of 16 patients who had received anticoagulants and who underwent diagnostic evaluation had previously undiagnosed lesions in the intestinal tract. These results indicate that occult gastrointestinal bleeding in a patient who has received an anticoagulant should not be attributed to the anticoagulant; instead, such bleeding often indicates the presence of significant intestinal disease.

Adult↗
PubMed1982

Tuberculous abscess of the pancreas.

A patient who presented with a prolonged febrile course was found to have a pancreatic abscess. Routine bacterial cultures of the abscess obtained at laparotomy were negative. The patient was treated with surgical drainage and antibiotics but did poorly. Following a second laparotomy 4 wk later, the tuberculous cause of the pancreatic abscess was recognized. Despite antituberculous therapy, the patient died; autopsy revealed generalized miliary tuberculosis. This case is unique in the accessible literature. We speculate that delayed diagnosis of the tuberculous pancreatic abscess contributed to the final dissemination of tuberculosis in this patient.

Abscess↗