Hand-searching for systematic reviews.
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Controlled Clinical Trials as Topic↗
Biomedical subjects
C McCarthy
Publications and source records attributed to C McCarthy.
Experience of 'screening' for domestic violence in women's services.
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Attitude of Health Personnel↗
An audit of the application of care aims across the south west Thames region.
Care aims are a means of defining the purpose of intervention of health care. The Malcomess care aims model uses these labels to guide the planning, delivery and outcome measurement of care. Within speech and language therapy (SLT) this involves the use of one of seven labels which clarify and make explicit the purpose of each episode of care undertaken with a client. This relatively simple application has been shown to change the way SLTs work, clarifying expectations of many who use the service. In the South West Thames Region, a project was put in place for SLTs which included undertaking training, audit and support. The outcome of the audit showed that care aims had been adopted across the region in a sufficiently flexible way to meet local needs and offered therapists the tools to reflect on the types of interventions provided to clients.
England↗
Hypergraphia in a patient with multiple medical problems.
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Agraphia↗
Power Doppler ultrasound assessment of rheumatoid hand synovitis.
OBJECTIVE: To evaluate power Doppler ultrasound (PD) as a technique in assessing response to treatment with steroids in rheumatoid hand synovitis. METHODS: Twelve patients with rheumatoid hand synovitis were assessed before and after treatment with steroids. Variables used to assess synovitis activity in each patient included patient visual analog scale (VAS) score for pain, physician assessment score (PAS), erythrocyte sedimentation rate (ESR), and PD of the metacarpophalangeal joints. RESULTS: Nine female and 3 male patients were studied; mean age was 53.3+/-6.5 yrs and mean disease duration 6.5+/-4.5 yrs. All patients had a good clinical response to steroid treatment and there was a significant improvement in the synovitis activity assessments. Wilcoxon signed-rank test using the exact method was applied to the change in disease activity variables. For PD signal, p < 0.002; VAS, p < 0.0016; ESR, p < 0.031; PAS, p < 0.008. CONCLUSION: PD quantifies synovitis and may be a useful adjunct to disease assessment and the response to treatment in RA.
Adult↗
Selective ET(A) antagonists. 5. Discovery and structure-activity relationships of phenoxyphenylacetic acid derivatives.
The fifth paper in this series describes the culmination of our investigations into the development of a potent and selective ET(A) receptor antagonist for the treatment of diseases mediated by ET-1. Receptor site mapping of several ET(A) antagonists prepared previously identified a common cationic binding site which prompted synthesis of phenoxyphenylacetic acid derivative 13a, which showed good in vitro activity (IC(50) 59 nM, rat aortic ET(A)). Optimization of 13a led to the identification of 27b, which exhibited an IC(50) of 4 nM. Although this did not translate into the expected in vivo potency, a compound of comparable in vitro activity, 27a (RPR118031A), showed a far better pharmacokinetic profile and in vivo potency (75 micromol/kg) and was duly proposed and accepted as a development candidate.
Administration, Oral↗
Pain in young children attending an accident and emergency department.
OBJECTIVES: To assess pain in young children presenting to an accident and emergency (A&E) department. To evaluate the use of the toddler-preschooler postoperative pain scale (TPPPS) and the use of analgesia in these children. METHODS: 100 children aged 1-5 years presenting to an A&E department were assessed for pain. Pain assessments were carried out using a modified form of the TPPPS; a visual analogue scale by parents and a numerical scale by nursing staff. RESULTS: The majority of children were assessed as having pain: 60 by the TPPPS, 58 by the nurses and 63 by parents. Only 30 children, however, received analgesia. Children with the highest pain scores as assessed by nursing staff or using the TPPPS all received analgesia. CONCLUSIONS: The pain scale appears suitable for use in young children in A&E departments. The subsequent management of pain in young children could be improved.
Child, Preschool↗
History of 7,093 patients with lower urinary tract symptoms related to benign prostatic hyperplasia treated with alfuzosin in general practice up to 3 years.
OBJECTIVES: As we have previously published 4 articles reporting the treatment of 7,093 clinical benign prostatic hyperplasia (BPH) patients treated with alfuzosin in a 3-month open-labelled study which was subsequently extended to 12, 24, and 36 months, the objective of this article is to provide additional data on dropouts, acute urinary retention (AUR), progression to surgery, and safety under the natural conditions of general practice, paying special attention to the predictive factors. METHODS: 7,093 patients were initially enrolled by 1,812 centers for up to 3 months. Subsequently 1,508, 1,325, and 812 general practitioners agreed to extend the study up to 12, 24, and 36 months, respectively, which corresponds to 4 patient populations. RESULTS: The baseline symptom profile of patients who completed the study was identical to that of patients who dropped out (because the center resigned or during treatment). In the 4 patient populations, the percentage of patients per month who dropped out, experienced adverse effects, AUR and surgery were 0. 6-1.6, 0.1-0.5, 0.01-0.03, and 0.1-0.3%, respectively. The classes of symptom severity were not predictive for dropouts: 3.5, 12.6, 20, and 14.3% of the severe patients dropped out during treatment versus 4.2, 13.7, 22.9, and 14.0% of the moderate patients who dropped out up to 3, 12, 24, and 36 months, respectively. Safety was satisfactory regarding the number of adverse events and blood pressure measurement. No retrograde ejaculation was reported. CONCLUSION: Under the natural conditions of general practice the reasons for dropping out were not correlated with symptom severity.
Adrenergic alpha-Antagonists↗
Computer needs assessment based on nursing tasks.
The purpose of this paper was to validate the Nurse Task Computer Use (NTCU) scale as a measure of the impact of computer use on tasks performed by nurses. It was expected that evaluation of a computer system by tasks is a better measure of nursing satisfaction. We used four strategies to accomplish validation. Initially, we used taxonomy of nursing interventions developed by Susan Grobe as a basis for identifying tasks. Next, using factor analysis, the results of the NTCU was compared to two validated user satisfaction scales. The third validation strategy consisted of comparing responses to the survey with interview findings for similarity, additional responses, and reoccurring patterns. Finally, findings from the results of the NTCU were compared to the Computers in Medical Care values survey. Results generally supported the validity and reliability of this instrument.
Attitude of Health Personnel↗
Assessing the implementation process.
A Computerized Patient Record System (CPRS) has many benefits and could improve health care outcomes. Reaping these benefits, however, is dependent on successful implementation of a provider order entry system. The literature supports substantial evidence that even systems that are usable, effective and reliable have not been adopted by the intended users. A successful implementation may be substantially a function of the degree to which the processes of care have changed to adapt to the new system. To ensure successful implementation we suggest monitoring the implementation process itself. The purpose of this paper is to report the methodology we developed for assessing how successfully a provider order entry system is being implemented. We adopt a model of diffusion of information technology developed by Fichman (1994) and expanded by Ash (1997). In this model, diffusion is characterized be three categories, "breadth" (infusion) and "depth" (diffusion) and "quality" (appropriateness of use). In this paper we discuss the typology of diffusion and describe specific measures designed to measure infusion and diffusion of a hospital information system.
Diffusion of Innovation↗
Does user satisfaction relate to adoption behavior?: an exploratory analysis using CPRS implementation.
User satisfaction is commonly assessed in evaluations of information systems as a proxy for user adoption. However few studies actually report directly assessing the relationship between the two constructs. In this study the relationship between four user satisfaction measures and five adoption behaviors were explored in the context of the implementation of the Veteran's Health Administration Computerized Patient Record System 1.0. Findings suggest that the relationship is modest and depends on the measurement system used. Specifically, direct reports of affect and judgements of specific task efficacy related to behavior more often than usability and a general user satisfaction instrument.
Attitude to Computers↗
Influence of microenvironment on mammary epithelial cell survival in primary culture.
Mammary epithelial cells cultured on Engelbreth-Holm-Swarm (EHS) matrix form multicellular structures termed mammospheres, in which cells and matrix become arranged around a central luminal space. In the presence of lactogenic hormones, cells within mammospheres become polarized, form tight intercellular junctions, and secrete milk proteins vectorially into the luminal space. This study examined the mechanism of lumen formation. Histological examination of developing mammospheres showed that cavitation was associated spatially and temporally with the appearance of fragmented nuclear material in apoptotic bodies, and with the presence of cells positively labeled by terminal deoxynucleotide transferase-mediated deoxyuridine nick end-labeling (TUNEL). Analysis of [(32)P]-deoxynucleotide end-labeled genomic DNA by electrophoresis and autoradiography showed DNA laddering indicative of apoptosis. A transient increase in laddering coincided with both lumen formation and the presence of TUNEL-positive cells. Lumen formation, DNA laddering, and detection of TUNEL-positive cells were all accelerated when matrix composition was altered. They were also impaired coordinately when caspase inhibitor was present during the first two days of culture. Therefore, lumen formation in mammosphere cultures is due to selective apoptosis of centrally located cells. Mammosphere cavitation was accompanied by redistribution of matrix constituents to the mammosphere periphery. Western blotting and Western ligand blotting of culture medium showed that lumen formation was also associated with a transient increase in insulin-like growth factor binding protein-5 (IGFBP5), a factor implicated in mammary apoptosis in vivo. We propose that epithelial cell survival during mammosphere development is induced selectively through stabilization by basement membrane constituents, which may act directly on the epithelial cell or confer protection against autocrine apoptotic factors.
Animals↗
Selective endothelin A receptor antagonists. 3. Discovery and structure-activity relationships of a series of 4-phenoxybutanoic acid derivatives.
The third in this series of papers describes our further progress into the discovery of a potent and selective endothelin A (ETA) receptor antagonist for the potential treatment of diseases in which a pathophysiological role for endothelin has been implicated. These include hypertension, ischemic diseases, and atherosclerosis. In earlier publications we have outlined the discovery and structure-activity relations of two moderately potent series of nonpeptide ETA receptor antagonists. In this paper, we describe how a pharmacophore model for ETA receptor binding was developed which enabled these two series of compounds to be merged into a single class of 4-phenoxybutanoic acid derivatives. The subsequent optimization of in vitro activity against the ETA receptor led to the discovery of (R)-4-[2-cyano-5-(3-pyridylmethoxy)phenoxy]-4-(2-methylphenyl)b utanoi c acid (12m). This compound exhibits low-nanomolar binding to the ETA receptor and a greater than 1000-fold selectivity over the ETB receptor. Data are presented to demonstrate that 12m is orally bioavailable in the rat and is a functional antagonist in vitro and in vivo of ET-1-induced vasoconstriction.
Administration, Oral↗
Selective endothelin A receptor antagonists. 4. Discovery and structure-activity relationships of stilbene acid and alcohol derivatives.
This publication describes the synthesis and optimization of a novel series of stilbene endothelin antagonists. Analysis of the SAR established for previous papers in this series prompted the design and synthesis of (Z)-4-phenyl-5-(3-benzyloxyphenyl)pent-4-enoic acid 3 which was found to be a moderately active inhibitor of the binding of [125I]ET-1 to ETA receptors with an IC50 of 6 microM. More interestingly, the intermediate compound (E)-2-phenyl-3-(3-benzyloxyphenyl)propenoic acid 5 was equiactive with 3. Optimization of 5 resulted in the preparation of (E)-2-phenyl-3-(2-cyano-5-(thien-3-ylmethoxy))phenylprope noic acid 18 (RPR111723) which had an IC50 in the binding assay of 80 nM on the ETA receptor and a pKB of 6.5 in the functional assay, measured on rat aortic strips. Reduction of the acid group of 5 gave the first nonacidic ETA antagonist in our series, (E)-2-phenyl-3-(3-benzyloxyphenoxy)prop2-enol 6 with an IC50 of 20 microM. Optimization of 6 resulted in the preparation of 2-(2-methylphenyl)-3-(2-cyano-5-(thien-3-ylmethyl)phenyl)pro p-2-enol 33 with an IC50 of 300 nM on the ETA receptor.
Animals↗
Detection of coronary artery disease using dobutamine stress echocardiography in patients with an abnormal resting electrocardiograph.
PURPOSE: We assessed the value of dobutamine stress echocardiography for the detection of coronary artery disease in patients with chest pain and an abnormal resting electrocardiograph (ECG). METHODS: Dobutamine stress echocardiography was performed in a standard fashion. Significant coronary artery disease was defined as a >50% luminal diameter stenosis on coronary angiography. RESULTS: The sensitivity, specificity, positive and negative predictive value of dobutamine stress echocardiography for the detection of coronary artery disease in 218 patients were 89, 50, 95 and 32%, respectively. The sensitivity for detection of multi-, double- and single vessel disease were 97, 82 and 81%, respectively. The sensitivity for the detection of coronary artery disease in a subgroup of 69 patients by treadmill exercise testing was 37%. CONCLUSION: Dobutamine stress echocardiography is better than exercise ECG for the detection of significant coronary artery disease. The negative predictive value of dobutamine stress echocardiography in this patient group is low.
Aged↗
AHA 100th anniversary. McCarthy broke ground. Interview by Deanna Bellandi.
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Administrative Personnel↗
[Quality of life of women with stress urinary incontinence with or without pollakiuria].
OBJECTIVES: Assess improvement in quality of life using a validated scale in women with urge incontinence or pollakiuria treated with oxybutynine. PATIENTS AND METHODS: A prospective open multicentric trial was conducted in 1701 women aged 20 to 60 years (mean 47.6) with the last 2 months. Quality of life was assessed on the Ditrovie scale before and after a 3-month treatment with oxybutynin (7.5 to 15 mg/day). RESULTS: Patient compliance was good (97%) and side effects rare (8%) (mainly dry mouth). There was a significant symptom improvement (p < or = 0.0001) between day 0 and day 90 after treatment: 48% of the women no longer had incontinence with a safety interval of more than 15 minutes compared with 0.2% prior to treatment; urge incontinence disappeared in 75% of the 81% affected women; 82% of the women had an intermictional interval longer than 2 hours after treatment compared with 33% prior to treatment. There was a significant improvement in the quality of life scores after treatment (p < 0.0001), as assessed by the overall score and subscores (daily life, emotional impact, self-image, sleep, well-being). CONCLUSION: These findings demonstrate the efficacy of oxybutynine in improving urge incontinence and pollakiuria in women, both in terms of symptom relief and quality of life.
Adult↗
Correlation of myocardial histologic changes in hibernating myocardium with dobutamine stress echocardiographic findings.
OBJECTIVE: The objective of this study was to correlate histologic changes in hibernating myocardium with dobutamine stress echocardiography (DSE). METHODS: Patients (n = 8) with anterior regional wall motion abnormalities in the seven echocardiographic segments representing the territory supplied by a significantly stenosed left anterior descending coronary artery had preoperative DSE performed (yielding 56 segments for analysis). Two transmural biopsy specimens were taken from the anterior wall of the left ventricle during coronary artery bypass grafting. RESULTS: Morphometric histologic analysis of biopsy specimens showed significantly less fibrosis in segments demonstrating inotropic reserve (p < 0.05) and significantly less fibrosis in segments demonstrating improvement in wall motion on echocardiography 3 months after revascularization (p < 0.05). DSE had a sensitivity of 100% and a specificity of 62% for detection of hibernating myocardial segments. Percent fibrosis was inversely correlated with percent nucleated cells (r = 0.66, p < 0.01) and directly correlated with cytoplasmic clearance (r = 0.76, p < 0.01). CONCLUSION: Inotropic response during DSE correlates with histologic evidence of hibernating myocardium.
Cardiotonic Agents↗