Panic induced by lactate infusion during electroconvulsive therapy?
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Depressive Disorder↗
Biomedical subjects
C M Burns
Publications and source records attributed to C M Burns.
Toward Healthy People 2000: the role of the nurse practitioner and health promotion.
The central purpose of Healthy People 2000 is to increase the proportion of Americans who live long and healthy lives. The best health promotion strategies are those related to individual lifestyle, and include personal choices made in a social context that have a significant influence over one's health. The primary lifestyle activities include: physical activity; nutrition; alcohol, tobacco, and other drug use; family planning; and violent and abusive behavior. Nurse practitioners play a significant role in promoting healthy lifestyle behaviors in their patients. This article presents an innovative teaching strategy used to teach health promotion concepts and intervention strategies to nurse practitioner students. The course design follows a clinical protocol format, which facilitates translation to clinical practice.
Adolescent↗
Early detection and intervention for the hidden alcoholic: assessment guideline for the clinical nurse specialist.
Among hospitalized patients, it is estimated that between 20% and 35% have significant alcohol problems that remain largely undetected. Alcohol abuse is a risk factor for a variety of disorders, including diabetes mellitus, gastrointestinal problems, hypertension, liver disease, and stroke. In an era of health care cost containment, early detection, intervention, and referral of alcohol-abusing or -dependent patients by the CNS may significantly impact the cost effectiveness of hospital care. In this article, a guideline is described that can be used by the CNS relative to the assessment, intervention, and referral of alcohol-abusing or -dependent patients in the general hospital setting.
Alcoholism↗
Electroconvulsive therapy and Parkinson's disease: the case for further study.
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Electroconvulsive Therapy↗
Stimulus dose-titration in ECT: a 2-year clinical experience.
One hundred and thirty-four patients referred for electroconvulsive therapy (ECT) over a 2-year period underwent standardized stimulus dose-titration. No significant adverse events were associated with the dose-titration procedure. Our data demonstrate that seizure threshold increases with age (p = 0.0001) and is higher with bilateral electrode placement (p = 0.0001). Contrary to other studies, our data show the effect of gender is not statistically significant (p = 0.54). If consensus regarding optimal dosing strategies relative to seizure threshold can be achieved, dose-titration may be adopted as a clinically useful step in optimizing ECT technique.
Adult↗
The prevalence of obstructive sleep apnoea in an obese female population.
Obstructive sleep apnoea (OSA) has been estimated to affect between 1 and 4% of the total population. OSA may be more frequent among women than studies based on subjects presenting for treatment would indicate. The aim of this study was to determine the prevalence of OSA in an obese female population (BMI > 30 kg/m2, age > 18 years) who presented to a hospital-based obesity clinic. The women were screened by an overnight ambulatory sleep study (MESAM) to detect OSA. Subjective sleep quality and sleep disturbance were assessed by a 19-item questionnaire, the Pittsburg sleep quality index (PSQI). From a population of 108 women, 29 were screened by MESAM. OSA was determined on the basis of respiratory disturbance index (RDI). The prevalence of OSA, defined as five or more respiratory disturbances per hour, was 37.9%. The mean age of the women was 43.6 +/- 2.57 years (mean +/- s.e.m.) and they had a mean BMI of 40.7 +/- 1.40 kg/m2. There was a significant positive correlation for RDI and BMI (r = 0.71; P < 0.001). Our findings indicate that over one third of women had OSA, yet they did not complain of symptoms even though the PSQI questionnaire indicated that they were poor sleepers. Non-specific symptomatology of OSA may be important diagnostically, particularly in women, and obese women should be considered at risk of OSA.
Adult↗
Regulation of TCR signaling by CD45 lacking transmembrane and extracellular domains.
The CD45 protein is a transmembrane tyrosine phosphatase that is required for normal T cell receptor (TCR)-mediated signaling. A chimeric complementary DNA encoding the intracellular enzymatically active portion of murine CD45 preceded by a short amino-terminal sequence from p60c-src was transfected into CD45- T cells. Expression of this chimeric protein corrected most of the TCR signaling abnormalities observed in the absence of CD45, including TCR-mediated enhancement of tyrosine kinase activity and Ca2+ flux. Thus, the enzymatically active intracellular portion of CD45 is sufficient to allow TCR transmembrane signaling.
Animals↗
Field trial of four cowside antibiotic-residue screening tests.
Four commercially available screening tests for antibiotic residues in milk were evaluated for their ability to correctly identify the antibiotic status of cows. A field trial, which included 199 cows from 2 herds, was conducted. Sensitivity, specificity, and likelihood ratios for a positive test result were calculated by using the Bacillus stearothermophilus var calidolactis disk assay as the reference test. The relationship of risk factors to the probability of a false-positive result for each screening test was modeled by use of unconditional logistic regression. The risk factors evaluated in these models were loge somatic cell count (scc), intramammary infection, herd, milk appearance, time milk sample frozen before tested, days in lactation, parity, and manufacturer's lot number. The risk factors log(e) scc and intramammary infection were forced into all models. The overall specificities for the 4 tests ranged from 0.78 to 0.95, whereas likelihood ratios for a positive test result ranged from 4.54 to 20.0. When the confounding of cofactors was controlled in the logistic model, there was a positive effect of log(e) scc on the probability of a false-positive result for 3 of the screening tests, that is, for incremental increases in log(e) scc, there was an increasing likelihood for a false-positive result. In some of the tests, parity and intramammary infection also influenced the likelihood of a false-positive result. The goal of cowside testing is to assist in the production of high-quality, antibiotic residue-free milk from dairies.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
T-cell activation: ZAPping the T-cell receptor.
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Journal Article↗
Hepatotoxicity associated with angiotensin-converting enzyme inhibitors.
OBJECTIVE: To review published reports of hepatotoxicity associated with angiotensin-converting enzyme (ACE) inhibitors and to explore possible mechanisms of injury. DATA SOURCES: Published reports of hepatotoxicity associated with use of ACE inhibitors and investigations that suggest potential mechanisms of injury. DATA SYNTHESIS: Nineteen cases of ACE-inhibitor-associated hepatotoxicity are presented. Early theories regarding mechanisms are reviewed. Laboratory investigations of hepatic effects of eicosanoids on hepatic function are reviewed and a novel mechanism by which ACE inhibitors may cause hepatic injury is postulated. CONCLUSIONS: Hepatotoxicity, usually cholestatic in nature, has been reported with captopril, enalapril, and lisinopril use. Apparent cross-reactivity has been reported twice. Potential mechanisms of injury include idiopathic hypersensitivity and modulation of eicosanoid metabolism by inhibition of kininase II and subsequent increased hepatic bradykinin activity. Mediation via altered eicosanoid metabolism provides a plausible explanation for cross-reactivity among ACE inhibitors. Hepatotoxicity resolves if ACE inhibitors are stopped but may progress to liver failure if treatment is continued.
Angiotensin-Converting Enzyme Inhibitors↗
Assessment and screening for substance abuse: guidelines for the primary care nurse practitioner.
In ambulatory care settings, NPs can expect to encounter numerous patients who have had or currently have an alcohol and/or other drug problem. In addition, a large number of patients are estimated to have an undetected or undiagnosed problem. This article presents guidelines for the assessment and screening of patients abusing alcohol and other drugs. History-taking, screening instruments, physical examination, and commonly used biological markers/laboratory tests are described. Brief intervention techniques and referral resources are also discussed.
Decision Trees↗
The CD45 tyrosine phosphatase regulates phosphotyrosine homeostasis and its loss reveals a novel pattern of late T cell receptor-induced Ca2+ oscillations.
CD45 is a transmembrane tyrosine phosphatase implicated in T cell antigen receptor (TCR)-mediated activation. In T cell variants expressing progressively lower levels of CD45 (from normal to undetectable), CD45 expression was inversely related to spontaneous tyrosine phosphorylation of multiple proteins, including the TCR zeta chain, and was directly correlated with TCR-driven phosphoinositide hydrolysis. The Ca2+ response in these cells was altered in an unexpected fashion. Unlike wild-type cells, stimulated CD45- cell populations did not manifest an early increase in intracellular Ca2+, but did exhibit a delayed and gradual increase in mean intracellular Ca2+. Computer-aided fluorescence imaging of individual cells revealed that CD45- cells experienced late Ca2+ oscillations that were not blocked by removal of extracellular Ca2+. CD45 revertants had the signaling properties of wild-type cells. Thus, CD45 has a profound influence on both TCR-mediated signaling and phosphotyrosine homeostasis, and its loss reveals a novel role for this tyrosine phosphatase in Ca2+ regulation.
Animals↗
Human equivalent of canine acral lick.
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Adult↗
High percentage of CD8+, Leu-7+ cells in rheumatoid arthritis synovial fluid.
OBJECTIVE: While analyzing the phenotype of the synovial fluid mononuclear cells (SFMC) clustered about dendritic cells in rheumatoid arthritis (RA) joint effusions, it was noted that most of the clustering cells were CD8+ and coexpressed Leu-7. Therefore, the present study was conducted to investigate the frequency of CD8+, Leu-7+ cells in RA SF: METHODS: SFMC from 13 patients with RA and from 12 patients with non-RA inflammatory arthritides were examined for CD8 and Leu-7 expression using 2-color immunofluorescence flow cytometry. RESULTS: RA SFMC had statistically significantly greater percentages of total CD8+ cells, total Leu-7+ cells, and CD8+, Leu-7+ cells, compared with SFMC from the non-RA patients. These RA CD8+, Leu-7+ SFMC had a distinctive electron microscopic appearance compared with CD8+, Leu-7- SFMC. When peripheral blood mononuclear cells (PBMC) from 31 RA patients (including 7 from the SFMC group) were compared with PBMC from 15 normal controls, the percentage of CD8+, Leu-7+ cells was not significantly greater in the RA patients. However, the combination of a modest increase in CD8+, Leu-7+ cells and a decrease in total CD8 cells in RA PBMC altered the composition of the RA CD8 population compared with normal PBMC, such that over 40% of RA peripheral blood CD8 cells coexpressed Leu-7. CONCLUSION: The increased frequency of CD8+, Leu-7+ cells in RA SFMC may arise from the fact that a high percentage of the CD8+ PBMC in RA patients are also Leu-7+. This altered composition of CD8 cells in RA SF may have a role in the pathogenesis of the disease.
Antigens, Differentiation↗
Safe administration of ECT in a patient with a calcified frontal mass.
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Aged↗
Nursing care in electroconvulsive therapy.
Psychiatric nursing care for the electroconvulsive therapy (ECT) patient has evolved from a traditional supportive and adjunctive practice to the current practice of independent and collaborative nursing actions. The nurse's multifaceted role is enacted by providing education and support, performing pretreatment assessments, monitoring the procedure, and observing and interpreting posttreatment patient responses. Areas of future nursing education and research should include the expansion of nursing practice with the ECT patient in the provision of quality nursing care.
Electroconvulsive Therapy↗
Diagnostic peritoneal lavage as an indicator for therapeutic surgery.
Diagnostic peritoneal lavage (DPL) has been reported to be extremely accurate in identifying intra-abdominal injury. Many studies, however, fail to indicate clearly if the procedure is helpful in determining which patients require truly therapeutic surgical intervention, because not all injuries need such surgery. In this study the authors reviewed the charts of 174 patients with blunt abdominal trauma and, by applying strict criteria to define a therapeutic laparotomy, sought to determine, retrospectively, whether DPL was useful for indicating the need for therapeutic surgery. Although 94% of patients with positive findings from DPL underwent a laparotomy, only 65% underwent one that was clearly of therapeutic value. Although other factors may have partially contributed to the discrepancy between these results and those generally referred to in the trauma literature, this study suggests that criteria providing a strict definition of a therapeutic laparotomy must be universally applied when analysing the value of DPL.
Abdominal Injuries↗