Angioinvasive aspergillosis presenting as neutropenic colitis.
Explore the source record for details and available documents.
Adalimumab↗
Biomedical subjects
C Quinn
Publications and source records attributed to C Quinn.
Can the radiologist accurately predict the adequacy of sampling when performing ultrasound-guided core biopsy of BI-RADS category 4 and 5 lesions detected on screening mammography?
AIM: To investigate in mammography screening the correlation between the confidence level of the radiologist, in sampling BI-RADS assessment category 4 and 5 lesions using a single ultrasound-guided 14-gauge needle core biopsy, and the final histological diagnosis. METHODS: In a prospective study, 389 consecutive ultrasound-guided 14-gauge needle core biopsies were performed on 131 BI-RADS assessment category 4 and 5 breast lesions in 126 women. On average, 3 passes were made through each lesion; for each pass, the radiologist rated confidence in adequacy of sampling at <50%, 50% to 90% or >90%. This was compared with the final histological diagnosis. RESULTS: The radiologist was >90% confident in 293 biopsies; diagnostic results were confirmed at histology in 283 (97%). In 70 biopsies the radiologist was 50% to 90% confident; diagnostic results were confirmed in 60 (86%). Of 26 samples where confidence was <50%, 13 were diagnostic (50%) (p<0.0001). CONCLUSION: If, at the time of ultrasound-guided needle core biopsy of BI-RADS assessment category 4 and 5 breast lesions, the radiologist is >90% confident that the lesion has been adequately sampled, a single pass is usually sufficient for diagnosis.
Attitude of Health Personnel↗
Intradermal radioisotope injection optimises sentinel lymph node identification in breast cancer.
AIM: Currently there is no consensus on the optimal technique for sentinel lymph node (SLN) identification in patients with breast cancer. The aim was to compare the efficacy of intraparenchymal and intradermal isotope injection in sentinel lymph node mapping for breast cancer. METHODS: One hundred and twenty-five patients with histologically confirmed invasive breast cancer underwent SLN mapping using radioisotope and isosulphan blue dye followed by a back-up axillary dissection. The first 80 patients had intraparenchymal (IP) injection of radioisotope given in four portions around the tumor. The remaining 45 patients had an intradermal (ID) injection given at a single site over the tumour. Both groups had isosulphan blue dye injected around the tumour. Sentinel node(s) were identified using a combination of lymphoscintigraphy, blue dye and an intra-operative hand held gamma probe. RESULTS: The preoperative lymphoscintigram (LSG) demonstrated a SLN significantly more often in the ID isotope group compared to the IP isotope group (P=0.002). A combination of blue dye and isotope successfully located the SLN in 96% of the intraparenchymal group and 100% of the intradermal group. CONCLUSION: Our results suggest that intradermal isotope injection in combination with intraparenchymal blue dye optimises the localization of the sentinel lymph node in breast cancer.
Axilla↗
Achieving 95% uptake in an immunisation programme--not an impossibility.
This study sought to document uptake rates achieved for vaccinations administered in a School Immunisation Programme in a school year. In a population of 6436 children uptake rates of more than 95% were achieved for all the vaccines administered, except MMR in the 6th class cohort for which 94.7% was the uptake figure. The success of the programme was attributed to the fact that the programme was the responsibility of a dedicated team, which facilitated the active follow-up of all defaulters as identified by the comprehensive database made available by the schools. Avoidance of deferral for minor illness was also a key factor.
Child↗
Clinical results using biochemotherapy as a standard of care in advanced melanoma.
Phase II studies of biochemotherapy in metastatic melanoma patients have reported response rates of 47-63%. Even though these were highly selected patients, we were intrigued by these promising response rates and began using this regimen as standard care in advanced melanoma patients. We report the results of the first 65 patients with AJCC stage IV melanoma (n = 57) or unresectable stage III (n = 8) melanoma treated with concurrent biochemotherapy at Memorial Hospital. Treatment was repeated every 3 weeks and patients were assessed for antitumour effects after every other cycle. The overall response rate among the 63 patients evaluable for response was 29% (three complete responses, 15 partial responses). The median duration of responses was 3.7 months. The response rate among previously treated and previously untreated patients was 6% and 38%, respectively. The estimated median survival for all patients was 8.5 months; the median survival for previously untreated patients was 9.2 months. Tumour response did not correlate with survival. Our experience, which is a retrospective evaluation, does not provide support for the routine use of biochemotherapy as standard treatment. The low response rate among previously treated patients indicates that biochemotherapy is not useful as second-line therapy.
Adolescent↗
The developmental acquisition of English grammar as an additional language.
The results are presented here of an investigation into the development of receptive and expressive English grammar when this is acquired as a second language. A cross-sectional survey using standardised assessments was conducted. 103 children were randomly selected from three local primary schools. These children were aged between 5 and 11 years and were acquiring English sequentially. Data relating to the receptive and expressive grammar of English as a second language was collected from each child. Analysis of this data revealed preliminary developmental patterns that appear to be specific to the sequential acquisition of English grammar. This data confirms the importance of not using data pertaining to the acquisition of first language English for English that is acquired as a second language.
Asia↗
Research utilization: a challenge for nursing graduate education to improve patient care.
To improve patient care, hospitals and other health care facilities are looking to improve patient outcomes through examining how nursing care can be changed or modified based on research. The process of applying research results into clinical practice is called research utilization (RU). In this article, a master's level research utilization course is described. The process of research utilization is highlighted along with specifics regarding course development and evaluation methods. Graduate level research courses such as this one can assist students to demonstrate competency in research utilization including: synthesis of research literature, development of practice guidelines based on research, and identification of strategies to carry out RU protocols and evaluate outcomes.
Diffusion of Innovation↗
An estimate of the cost of conducting phase II trials in lung cancer.
OBJECTIVE: Although it is commonly assumed that clinical trials are more costly than standard therapy, there have been no previous studies of the cost of conducting phase II trials in lung cancer. We retrospectively analyzed two National Cancer Institute of Canada phase II trials in previously untreated small cell lung cancer (SCLC) to determine the costs of conducting the trials in a cancer treatment centre. Both studies were clinical trials undertaken as part of the NCIC's Investigational New Drug program: IND 69 and IND 50 evaluated docetaxel (taxotere) and gemcitabine, respectively. METHODS: data management costs in a Canadian cancer treatment centre were determined from the time estimates provided by data managers to complete various protocol related tasks. Nursing and pharmacy personnel measured the time and supplies necessary to prepare and administer the chemotherapy. Physician fees were determined from the type and number of care visits required by the clinical protocols. Laboratory tests and imaging studies were costed according to the Ontario Health Insurance Plan (OHIP) Schedule of Fees and Benefits. To estimate whether phase II trials are more costly than standard treatment, we determined the cost of four cycles of VP-16-cisplatin, a standard treatment for SCLC. RESULTS: The total cost of performing the docetaxel study was $18443 for an average cost per case of $1317 and an average cost per treatment cycle of $683. The gemcitabine study cost more, due to the fact that the drug proved to be active against SCLC and more cycles of therapy were administered to a larger number of patients. Laboratory and administration costs were also higher, because of the drug administration schedule. The total cost of this study was estimated to be $64670 and the average cost per patient entered was $2230 with an average cost per treatment cycle of $898. In comparison, the estimated cost of four cycles of VP-16-cisplatin chemotherapy was $3948 or $987 per treatment cycle. The major cost drivers in the clinical trials were laboratory and imaging tests which made up 17 and 39%, respectively, of the costs of the taxotere study, and 29 and 27%, respectively, for the gemcitabine study. Data management costs contributed 21 and 13% of the total costs, respectively. CONCLUSION: As the main cost drivers in these phase II clinical trials are laboratory and imaging tests, the cost of clinical trials could potentially be reduced by ensuring that only essential tests are required by protocol. Not surprisingly, the cost of conducting a trial of an active agent is greater than for an inactive agent, because more patients are treated and each patient receives more treatment. The implications for the per-case funding of phase II clinical trials are discussed.
Antineoplastic Combined Chemotherapy Protocols↗
Neuroimaging variables related to development of Secondary Attention Deficit Hyperactivity Disorder after closed head injury in children and adolescents.
OBJECTIVE: To characterize children who develop Secondary Attention Deficit Hyperactivity Disorder (S-ADHD) after severe and moderate closed head injury (CHI) according to neuroimaging variables. METHOD: Ninety-nine children from 4-19 years who suffered severe and moderate CHI were prospectively followed for a year after injury. Premorbid psychiatric status was determined by administration to the parent of a structured psychiatric interview. This interview was readministered 1 year after injury to determine the presence of post-closed head injury S-ADHD. An MRI was performed 3 months after injury to define lesion locations and volumes. RESULTS: A set of multiple logistic regression models determined that the odds of developing S-ADHD were 3.64 times higher among children with thalamus injury, and 3.15 times higher among children with basal ganglia injury. There was no significant difference in lesion volumes in any of the locations of interest between the group who developed S-ADHD and the group who did not develop S-ADHD. CONCLUSION: The data support an association between S-ADHD and injury in either or both the thalamus and basal ganglia, but they do not definitively demonstrate whether injury in either structure has an effect on S-ADHD in the absence of injury in the other.
Adolescent↗
Taking seriously victims of unethical experiments: Susan Brison's conception of the self and its relevance to bioethics.
Explore the source record for details and available documents.
Biomedical Research↗
A guide for diagnosis of patients with arterial and venous thrombosis.
Inasmuch as coagulation laboratories are involved in providing a diagnosis for underlying causes of venous and arterial thrombosis, we present a comprehensive review of the biological properties and functions of the components of the hemostatic system as they relate to the diagnosis of arterial and venous thrombosis. Moreover, as coagulation laboratories are necessary to evaluate the success of initial treatment modalities and to provide guidance for supplemental therapeutic intervention, we include information on antiplatelet and antithrombotic therapy. Included in clinical coagulation testing are assays that evaluate the potential of blood to form clots and tests for platelet numbers and platelet functions. Clot-based assays directly detect the biological activity of procoagulant factors and fibrinogen; chromogenic substrate assays evaluate proteolytic activities of clotting as well as fibrinolysis enzymes; and specific antibodies measure the concentrations of coagulation and fibrinolysis enzymes in plasma. Genetic testing is rapidly becoming incorporated into the clinical routine. The prothrombin time (PT), activated partial prothrombin time (APTT), and thrombin time (TT) are screening assays that measure the clotting times of recalcified whole blood or platelet-poor plasma. In addition to their function as screening assays, PT, APTT, and TT are the backbone of all the specialized clot-based assays for factor activities and for the indirect measurement of inhibitory antithrombin and protein C activities. Molecular markers related to hemostasis and fibrinolysis consist of proteins or peptides that indicate an ongoing physiological or abnormal process related to clot formation, thrombosis, vascular damage, or drug effect. Molecular markers are currently identified by means of specific antibodies prepared against them. The list of hemostatic molecular markers is rapidly growing. Most of the assays developed for molecular marker measurement, with the notable exception of the d-dimer assay, are typically used in clinical research.
Antifibrinolytic Agents↗
Resistance of rheumatoid synovial dendritic cells to the immunosuppressive effects of IL-10.
IL-10 down-regulates the APC function of many dendritic cells (DC), including human peripheral blood (PB) DC. In rheumatoid arthritis (RA), synovial fluid (SF) DC express markers of differentiation and are effective APC despite abundant synovial IL-10. The regulation of DC responsiveness to IL-10 was therefore examined by comparing the effect of IL-10 on normal PB and RA SF DC. Whereas IL-10 down-modulated APC function and MHC class II and B7 expression of PB DC, IL-10 had no such effect on SF DC. Since SF DC have differentiated in vivo in the presence of proinflammatory cytokines, PB DC were cocultured in the presence of IL-10 and either GM-CSF, IL-1beta, TNF-alpha, IL-6, or TGF-beta. GM-CSF, IL-1beta, and TNF-alpha were all able to restore APC function. Whereas the effects of IL-10 on PB DC were shown to be mediated by IL-10R1, neither PB nor RA SF DC constitutively expressed IL-10R1 mRNA or detectable surface protein. In contrast, IL-10R1 protein was demonstrated in PB and SF DC whole cell lysates, suggestive of predominant intracellular localization of the receptor. Thus, DC responsiveness to IL-10 may be regulated through modulation of cell surface IL-10R1 expression or signaling.
Antigen Presentation↗
Storing methadone in babies' bottles puts young children at risk.
Explore the source record for details and available documents.
Bottle Feeding↗
The transition to managed care has to be seen as at least bittersweet.
Explore the source record for details and available documents.
Humans↗
Infusion devices: a bleeding vein of clinical negligence?
AIM: This article explores the impact of technology and potential clinical negligence claims on nursing practice. BACKGROUND: Sophisticated procedures and techniques have led to the development of many types of medical device. Many device functions have moved from being one of supporting clinical practice to that of being an integral requirement in treatment delivery. Clinical negligence claims against National Health Service (NHS) Trusts are also likely to spiral significantly over the next 5 years. The Medical Devices Agency cite inadequate training as a main contributing factor to the yearly increase in adverse incident reports they receive. It is these incidents that will potentially provide 'rich pickings' for the ever increasing litigation conscious Great British public, and their lawyers. KEY ISSUES: The challenge for management is how can staff be trained when they are under pressure to maintain a service in the face of staff and skills shortages and increased activity. CONCLUSION: Investment in training schemes that address and minimize the many areas of clinical negligence risk should be explored and introduced as a matter of urgency. The management of infusion systems and a training scheme which is designed to lead staff through a comprehensive competency based generic training in the use of infusion devices is discussed.
Equipment Failure↗
A comparison among animal models of acute lung injury.
OBJECTIVES: To compare four widely used animal models of acute lung injury and to determine the changes in physiologic variables associated with each model. DESIGN: A prospective, controlled animal study. SETTING: An animal laboratory of a university-affiliated children's hospital. SUBJECTS: Four groups of anesthetized, paralyzed, and ventilated young Yorkshire pigs, weighing 35 to 45 kg. INTERVENTIONS: Acute lung injury was generated by four different methods: a) intrapulmonary arterial infusion of endotoxin of Escherichia colt; b) bronchoalveolar instillation of 0.05N of hydrochloric acid; c) repeated bronchoalveolar warm saline lavage; and d) intrapulmonary arterial infusion of oleic acid. After each acute lung injury procedure, the temporal changes in various physiologic variables were measured, starting at 60 mins and at 15-min intervals thereafter for a total of 165 mins. Systemic and mixed venous serum immunoreactive tumor necrosis factor (TNF)-alpha concentrations were also measured at the same time points. Analysis of variance for repeated measures was employed to determine the absolute and relative significance of the changes observed. MEASUREMENTS AND MAIN RESULTS: Systemic and mixed venous immunoreactive TNF-alpha did not change following any of the acute lung injury procedures. The animals' heart rates and systemic vascular resistances also did not change. Hydrochloric acid instillation as well as bronchoalveolar lavage resulted in significant hypoxemia with no other hemodynamic effects. Endotoxin infusion did not result in hypoxemia but caused significant increases in mean pulmonary arterial pressure and pulmonary vascular resistance and decreases in mean arterial pressure and cardiac output. Oleic acid infusion resulted in a marked hypoxemia with a pronounced increase in mean pulmonary arterial pressure and pulmonary vascular resistance. It also markedly reduced the mean arterial pressure, cardiac output, and the mixed venous PO2. CONCLUSIONS: The surfactant depletion and hydrochloric acid instillation models produce acute hypoxemia in an otherwise hemodynamically stable animal. A brief endotoxin infusion provides a model for cardiovascular instability and pulmonary hypertension but fails to produce hypoxemia in the pig. The oleic acid infusion creates a model of marked cardiovascular instability, pulmonary hypertension, and profound hypoxemia. However, none of the acute lung injury models described was associated with the production of tumor necrosis factor.
Animals↗
Blood glucose and glucoregulatory hormone responses to solid and liquid carbohydrate ingestion during exercise.
This study was conducted to compare blood glucose and glucoregulatory hormone responses to the ingestion of solid and liquid carbohydrate (CHO) during prolonged cycling, followed by 30 min of isokinetic cycling. Eight male cyclists randomly completed three cycling trials (LC = liquid CHO, SCE = solid CHO with water equal to LC, SCA = solid CHO + ad libitum water). Each subject cycled for 120 min at 65% of VO2max with CHO ingestion (0.6 g CHO/ kg/hr) at 0, 30, 60, 90, and 120 min. Subjects then completed a 30-min maximal isokinetic ride at 90 rpm. There was no significant (p < .05) difference between the trials for plasma glucose, insulin, glucagon, glycerol, lactate, RER, HR, VO2, RPE, and total work performed during the isokinetic ride. However, serum glucose was significantly lower in the SCE and SCA trials compared to LC at 80 min. The ingestion of a solid food containing CHO, protein, and fat with added water produced similar blood glucose, metabolic, glucoregulatory hormone, and exercise performance responses to those seen with the ingestion of liquid CHO.
Adult↗