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Biomedical subjects

D Holmes

Publications and source records attributed to D Holmes.

At least 91 records · Page 5Linked to original sources
PubMed1993

Results of directional coronary atherectomy during multicenter preapproval testing. The US Directional Coronary Atherectomy Investigator Group.

Between 1988 and 1990, clinical testing was performed at 12 US institutions using the Simpson Coronary AtheroCath under an Investigational Device Exemption. Data on 1,069 lesions (873 patients) were analyzed and presented to the Food and Drug Administration (FDA) advisory panel in the summer of 1990, forming the basis for approval of this device in September 1990. Analysis of these preapproval data shows a primary success rate of 85% (defined as tissue removal, > or = 20% reduction in stenosis, < 50% residual stenosis after directional atherectomy, and no major complication), with somewhat higher primary success in prior restenosis and noncalcified lesions. Including the use of conventional angioplasty performed after atherectomy, the overall success rate was 92%. One or more major complications occurred in 4.9% of procedures, and included death (0.5%), nonfatal Q-wave myocardial infarction (0.9%), and emergency bypass surgery (4.0%). These complications were more frequent in right coronary, de novo, and diffuse (> 20-mm length) lesions. Six-month angiography results were available in 384 (77%) of 498 lesions eligible for follow-up when the registry closed and showed a restenosis rate (late stenosis > 50%) of 42%. The restenosis rate in both native vessels (30 vs 46%) and bypass grafts (31 vs 68%) was lower in primary (de novo) lesions compared with lesions that had developed restenosis after a prior intervention. Despite the use of prototype atherectomy catheters and still evolving procedural technique, this preapproval experience provided an important initial indication of the situations in which directional coronary atherectomy was most useful and helped set clear standards for performance of this procedure following FDA approval.

Atherectomy, Coronary↗
PubMed1993

Nonverbal expression in autism of Asperger type.

Short unstructured social interactions between a volunteer interviewer, an adult with autism of Asperger type, and a control subject with a schizoid personality disorder were video-recorded. Asperger subjects tended to look less at the other person, to make more self-stimulatory gestures, and to look at the interviewer significantly less than normal subjects, and substantially less than schizoid subjects, during the periods when the interviewer was vocalizing although there were no such differences when the interviewer was listening. We suggest that the gaze avoidance of autism may in actuality be a lack of expected gaze (e.g., gaze when the other person is talking) rather than an absolute avoidance, and suggest that a lifelong absence of gaze response to social cues including speech could explain a number of the developmental features of autism including lack of joint attention with others, lack of understanding and affective response to others, and poor discrimination of facial expressions.

Adult↗
PubMed1993

An evaluation of the effects of commingling cognitively and noncognitively impaired individuals in long-term care facilities.

A sample of 77 noncognitively impaired individuals residing in integrated long-term care units housing both demented and nondemented residents were assessed in terms of morale and satisfaction with their environment and with life. One third of these individuals lived near and/or shared a bathroom with a cognitively and/or behaviorally impaired individual. Residents placed next to demented individuals had significantly fewer kin contacts, were more likely to be unmarried or never married, and were more dissatisfied with their roommate/living situation.

Aged↗
PubMed1993

A primary care nursing model in long-term care facilities: evaluation of impact on affect, behavior, and socialization.

A primary care model of delivery of nursing aide care was implemented and evaluated in one small, rural nursing home and one large, urban facility. Experimental unit residents received primary care consisting of permanent assignment of nursing aide, a team approach and enhanced communication. The urban experimental residents improved significantly in behavior and affect as measured across several sources, while the comparison group declined or remained the same. Significant improvements in behavior and social activities were observed among the experimental rural nursing home residents as contrasted with the comparison group after implementation of primary care nursing. It was concluded that primary care nursing as applied to nursing attendants in long-term care is beneficial to residents in terms of decreasing disturbed behavior and improved affect.

Affect↗
PubMed1993

Excimer laser coronary angioplasty of aorto-ostial stenoses. Results of the excimer laser coronary angioplasty (ELCA) registry in the first 200 patients.

BACKGROUND: Percutaneous transluminal coronary angioplasty (PTCA) of aorto-ostial stenosis has been associated with a lower rate of acute success, a high risk of vessel closure, and late restenosis. The purpose of this report is to document a prospective multicenter trial of excimer laser coronary angioplasty (ELCA) of aorto-ostial stenosis involving the coronary arteries and saphenous vein grafts. METHODS AND RESULTS: Between December 1989 and May 1992, 206 aorto-ostial ELCA procedures were performed on 209 stenoses in 200 patients. Canadian Cardiovascular Society class III or IV angina was present in 76%. The distribution of stenosis locations was left main coronary (LM) in 26 (12%), right coronary (RCA) in 124 (59%), and vein grafts (VG) in 59 (28%). Adjunctive PTCA was performed in 72%. Procedure success defined as < or = 50% diameter stenosis without major complications was achieved in 90% (LM, 92%; RCA, 89%, VG, 90%). Quantitative angiographic analysis documented an improvement in stenosis diameter from 0.8 +/- 0.5 mm or 76 +/- 14% at baseline to 2.1 +/- 0.6 mm or 36 +/- 15% at completion (P < .01). The majority of the acute gain in diameter (1.0 +/- 0.6 mm) resulted from ELCA. A major complication during hospitalization occurred in 3.9% (death, 0%; Q-wave myocardial infarction, 0.5%; bypass surgery, 3.4%). The only logistic regression univariate and multivariate predictor of procedure failure was female gender. Six-month angiographic follow-up, available in 51% of eligible patients, documented an average lumen diameter of 1.7 +/- 1.0 mm and mean diameter stenosis of 46 +/- 26%. Restenosis (> 50% diameter stenosis) occurred in 39% (LM, 64%; RCA, 35%; VG, 35%). Restenosis was less likely when residual stenosis was < or = 35% (28% versus 53%, P < .05). Clinical events at follow-up were death, 2.7%; bypass surgery, 6.5%; myocardial infarction, 2.2%; and repeat angioplasty, 16.2%. Of the remainder, 78% were asymptomatic, class I or II for anginal symptoms. An adverse event during follow-up was more than twice as likely in the group with LM (50.0% versus 21.1%, P < .02). CONCLUSIONS: ELCA is acutely effective and safe therapy in patients with aorto-ostial stenosis. Six-month restenosis, adverse-event rates were higher and functional status was poorer in the group with LM stenosis. ELCA may be considered as an alternative to bypass surgery in carefully selected patients with isolated aorto-ostial stenosis of the RCA and saphenous vein grafts.

Adult↗
PubMed1993

Serendipity and pseudoscience. A look at health-related program evaluation.

This article presents a discussion of the pitfalls of sloppy science as it is applied to the evaluation of human service programs. The differences are examined between use of the scientific method and trial-and-error approaches to assessment. The major requirements for sound research are presented, as are the pitfalls and shortcomings associated with a less rigorous approach.

Health Services Research↗
PubMed1992

Special care units in nursing homes: prevalence in five states.

As part of a five-state study of the impact of special care units for demented residents, the authors surveyed (with telephone follow-up) nursing homes to identify those facilities that maintained some form of special care unit. The estimated prevalence was 11%; this finding suggests that special care units are far more numerous than had previously been reported. This difference is due in part to definitional considerations: many facilities maintain "cluster units" that do not differ appreciably from segregated units. However, more often than not, facilities did not regard these units as special care units.

Activities of Daily Living↗
PubMed1992

Limited joint mobility in subjects with insulin dependent diabetes mellitus: relationship with eye and kidney complications.

Three hundred and fifty seven subjects (178 males and 179 females) with insulin dependent diabetes mellitus were evaluated for the presence of limited joint mobility of the interphalangeal joints. Sixty six subjects (19%) had stage 1 and 26 subjects (7%) had stage 2 involvement of their interphalangeal joints. The presence of contractures was significantly related to mean longitudinal glycated haemoglobin (HbA1) concentrations, duration of diabetes, age of onset, mean longitudinal cholesterol concentrations and blood pressure. Limited joint mobility was also significantly associated with early diabetic retinopathy and raised albumin excretion rates. Limited joint mobility remained a significant factor in the logistic regression model for albuminuria and grade of retinopathy when controlled for smoking, cholesterol concentrations, duration of diabetes, age, gender, and blood pressure. However, limited joint mobility was only significantly associated with diabetic retinopathy when the effect of HbA1 concentrations was included in the multivariate model.

Adolescent↗
PubMed1992

Clinical equivalence of once-daily administration of a modified-release formulation of isradipine and twice-daily administration of the standard formulation. Multicentre Study Group.

In a double-blind, parallel-group comparative study, once-daily administration of a modified-release formulation of isradipine (Im, n = 189) was compared with twice-daily administration of the standard formulation (Is, n = 191). Following a 3- to 5-week placebo period, patients with a sitting diastolic blood pressure (sDBP) of greater than or equal to 100 mm Hg but less than or equal to 120 mm Hg were randomized to receive either Im at 5 mg once daily or Is at 2.5 mg twice daily for 6 weeks. A double-dummy technique was used to maintain blindness and no dosage titration was made. Blood pressure was always recorded in the morning before drug administration (12 h after the previous administration of Is or 24 h after the previous administration of Im). The mean sDBP was reduced significantly (p less than 0.001) and equally in both groups, and the normalization rate (sDBP less than or equal to 90 mm Hg) was 54% with Im and 55% with Is. Adverse events were slightly less frequent overall in the patients receiving Im than Is (23 vs. 28%, respectively) as was the incidence of typical dihydropyridine side effects such as flushing and headache. The results show that once-daily administration of 5 mg of Im is as effective and better tolerated than 2.5 mg twice daily of Is while providing adequate blood pressure control at the end of the 24-h dosing interval.

Adult↗
PubMed1992

Pregnancy tumor in a 16-year-old: case report and treatment considerations.

A sixteen-year-old female in the third trimester of pregnancy was evaluated for treatment of a pregnancy granuloma. No surgical treatment was rendered. The patient was given a thorough dental prophylaxis and oral hygiene instructions. The tumor was noted to have decreased in size four weeks post partum. Observation of such lesions in conjunction with standard oral hygiene procedures is warranted in lieu of surgical removal.

Adolescent↗
PubMed1991

Gene expression of type I phospholipase A2 in pancreatic beta cells. Regulation of mRNA levels by starvation or glucose excess.

Messenger RNA from intact rat pancreatic islets, or from transformed hamster beta (HIT) cells, hybridized with the cDNA probe for type I (but not type II) phospholipase A2. The levels of phospholipase A2 mRNA increased in islets from fasted rats; they decreased in islets cultured in a high glucose concentration (control values at 5.5 mM glucose = 150 +/- 6% of those at 22 mM) which impaired subsequent insulin secretion (reduction in second-phase release = 70 +/- 11%). These studies uniquely demonstrate that type I phospholipase A2 is expressed specifically in beta cells and that nutrient availability modulates transcript levels, an effect which could that nutrient availability modulates transcript levels, an effect which could contribute to the detrimental influence of prolonged hyperglycemia on islet function.

Animals↗
PubMed1991

Steady state pharmacokinetics of hydrolysed bopindolol in young and elderly men.

Steady-state pharmacokinetic parameters of the new, long-acting beta-adrenoceptor blocker bopindolol have been measured in 17 young and 20 elderly healthy men. The t 1/2 beta and the AUC(0----24 h) of hydrolysed bopindolol (the active metabolite) were both increased (40% and 26%, respectively) in the elderly subjects but tmax, Cmax and CL/f were not altered. However, after adjusting the parameters to allow for the different average body weights of the two groups, Cmax and CL/f became significantly different (+29% and -30%, respectively). AUC(0----24 h) was increased by 41%. The changes of up to 41% in pharmacokinetic parameters were smaller than the alterations of 50-100% usually seen when titrating doses of antihypertensive drugs. The clinical relevance of the effects was not examined, but similar changes have been reported for other beta-blockers which did not appear to be clinically relevant and did not affect the dosage required to treat hypertension.

Adolescent↗