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Biomedical subjects

D Nichols

Publications and source records attributed to D Nichols.

70 records · Page 4Linked to original sources
PubMed1980

Determinants of hypoventilation during wakefulness and sleep in diaphragmatic paralysis.

A 45-yr-old man with limb girdle muscular dystrophy, bilateral diaphragmatic paralysis, chronic carbon dioxide retention, and hypersomnolence was studied to determine the causes of hypoventilation during wakefulness and during sleep. Awake hypoventilation was associated with an insufficient inspiratory effort in the presence of inefficient respiratory muscles and a shortened inspiratory time. During sleep, severe hypoventilation and oxygen desaturation occurred only during REM-induced intercostal and accessory muscle inhibition.

Diaphragm↗
PubMed1979

Acute and chronic pulmonary function changes in allergic bronchopulmonary aspergillosis.

Pulmonary functions of patients with allergic bronchopulmonary aspergillosis were studied during an acute episode (n = 6); during a mean follow-up period of 44 months (range four months--14.8 years) (n = 16); and for any correlation between duration of ABPA and asthma with the total lung capacity (helium dilution), 1 second forced expiratory volume (FEV1), vital capacity, 1 second forced expiratory volume-forced vital capacity ratio (FEV1:FVC per cent) and diffusing capacity of carbon monoxide (DL:CO) (single breath) for the entire group (n = 22). All patients were treated with corticosteroids (intermittent or continuous) and bronchodilators. For the 16 patients, slopes using linear regression analysis were determined from the function as per cent predicted versus time in months from diagnosis and then analyzed for significance. Significant functional loss was shown in three of 16 patients for FEV1, two of 16 patients for vital capacity, one of 16 patients for FEV1:FVC per cent, none of 10 patients for DL:CO and one of 10 patients for total lung cital capacity, FEV1:FVC per cent and the duration of asthma or allergic bronchopulmonary aspergillosis was found by multiple regression analysis correcting for age and smoking (mean 4.24 years; range 0.3 to 14.8 years). Roentgenographic criteria and blood eosinophilia were used to define a "flare" of allergic bronchopulmonary aspergillosis. The six patients during a flare showed a significant reduction in total lung capacity (P less than 0.001), vital capacity (P less than 0.05), FEV1 (P less than 0.01) and DL:CO (P less than 0.001) which uniformly returned to baseline values during steroid therapy. The FEV1:FVC per cent remained unaltered. These findings, contrary to suggestions in the literature, indicate that in the majority of our patients there was no significant progressive functional deterioration after diagnosis. However, during acute episodes of allergic bronchopulmonary aspergillosis, transient reduction of volumes and DL:CO were uniformly present.

Adolescent↗
PubMed1978

Relationships between prednisone therapy, disease activity, and the total serum IgE level in allergic bronchopulmonary aspergillosis.

Allergic bronchopulmonary aspergillosis (ABPA) is an unusual syndrome caused by hypersensitivity to Aspergillus spores growing in the bronchii. Previous investigators have suggested that the IgE levels and precipitating antibodies may vary according to disease activity. We have been able to closely follow 12 out of a group of 40 ABPA patients with IgE and serum precipitating antibody measurements. Our results confirm that both the total serum IgE and the precipitin response vary according to ABPA disease activity. In particular the IgE trend appears to mirror the disease activity in that a rising level may portend a flare, while a stable or declining value implies disease remission.

Antibodies, Fungal↗
PubMedDate not supplied

Impact of mobilized blood progenitor cell quality determined by the CFU-GM/CD34+ ratio on rapid engraftment after blood stem cell transplantation.

To find a parameter to predict the quality of collected mobilized CD34+ blood as hemopoietic reconstituting cells, the ratio of CFU-GM to CD34+ cells was examined. One hundred six consecutive patients who underwent blood stem cell transplantation at the University of Rochester from 01/01/99 to 12/31/99 were examined retrospectively for the number of days to reach an absolute neutrophil count of 500 or 1000 cells/microl and an absolute platelet count of 20,000 or 50,000 cells/microl without transfusion support as measures of engraftment. Linear regression analyses were conducted to determine factors influencing engraftment. The number of CD34+ cells/kg and CFU-GM/kg correlated highly with the number of nucleated blood cells/kg. In this population, in which 90% of patients received >2 x 10(6) CD34+ cells/kg, neither the number of CD34+ cells/kg nor the number of CFU-GM/kg correlated with the time to engraftment as judged by neutrophil or platelet levels. In contrast, the lower the ratio of CFU-GM to CD34+ cells, the more rapid the reconstitution of platelets to 20,000/microl (P = 0.03) and 50,000/microl (P = 0.02). Thus, a lower ratio of the CFU-GM/CD34+ appended to reflect a greater number of hematopoietic reconstituting cells in the blood cell collection. The CFU-GM/CD34+ ratio is an apparent predictor of earlier platelet engraftment, suggesting that the ratio reflects the engraftment potential of mobilized donor progenitor cells.

Adolescent↗
PubMedDate not supplied

Repetitive strain injury in computer keyboard users: pathomechanics and treatment principles in individual and group intervention.

Computer users experience high rates of injury and disability, broadly termed repetitive strain injury (RSI). With more than 60 million Americans using computers in offices and homes, the potential magnitude of the RSI problem indicates a need for increased attention to prevention and treatment. The purpose of this article is to: 1) present a conceptual model of RSI as a kinetic-chain, multifactorial disorder; 2) outline the salient features of the clinical evaluation of the RSI patient; 3) describe the role of postural deviation in the pathogenesis of RSI; 4) present the principles of individual manual therapy; and 5) discuss the rationale, admission criteria, educational principles, and outcome of a multidisciplinary group intervention.

Biomechanical Phenomena↗
PubMedDate not supplied

Evaluation of a new radioimmunoassay for urinary albumin.

We have evaluated a new commercially available radioimmunoassay kit for albumin determination in urine. The assay is precise; within-run precision (CV) in the clinically significant ranges is 1.8-3.5%, between-run, 1.2-8.5%. The minimum detection limit was 0.6 micrograms/ml. Analytic recovery of different concentrations of albumin added to urine ranged from 98% to 103%. Samples, stored in plastic containers, were stable at room temperature for periods up to 7 days. Mean albumin excretion rates, measured in 20 normal volunteers for 3-h and 24-h periods during the same day were similar (7.1 +/- 4.6 [SD] versus 6.5 +/- 5.0 micrograms/min). In 8 normal subjects, 3-h excretion rates measured daily for 5 days showed no significant variability. In eight insulin-dependent diabetic subjects, albumin excretion measured in short periods of urine collection (3 h) were also in close agreement with 24-h collections (24.7 +/- 28.9 versus 17.6 +/- 18 micrograms/min). From these results it appears that this commercially available kit is suitable for conveniently monitoring microalbuminuria in large numbers of patients in research studies as well as for office practice. Such widespread use should make it possible to better determine the clinical usefulness of this test in the management of diabetic patients.

Adult↗
PubMedDate not supplied

Quantitative analysis of a new marker for common acute lymphoblastic leukemia detected by two-dimensional electrophoresis.

A major subtype of childhood lymphoblastic leukemia has been previously defined on the basis of expression of a cell surface marker referred to as the common acute lymphoblastic leukemia antigen. In this study we provide evidence that leukemic cells from most of the patients with common acute lymphoblastic leukemia contain a cytosolic polypeptide designated L4, the occurrence of which is strongly correlated with the expression of the common acute lymphoblastic leukemia antigen. The detection and quantitation of L4 was accomplished by analysis of cellular polypeptides resolved by two-dimensional polyacrylamide gel electrophoresis. This approach provides a powerful tool for the delineation of distinct polypeptides corresponding to different types of leukemia and complements immunological analysis of the cell surface marker phenotype.

Antigens, Differentiation↗
PubMedDate not supplied

Sexual behavior, contraceptive practice, and reproductive health among Liberian adolescents.

This paper reports on a survey that was aimed at obtaining information for use in designing programs to reduce the incidence of adolescent pregnancy in Liberia. The sample of 1,488 never-married adolescents aged 14-21 was divided into subgroups based on age, sex, student status, and (for non-students) level of education. Although 57-93 percent of respondents claimed to have received information on reproductive health, only 2-21 percent could identify the monthly fertile period. Thirty to 49 percent of females ages 14-17 years have sexual relations at least once a month; over 80 percent of female non-students ages 18-21 years are sexually active. Highest levels of current contraceptive use were reported for 18-21-year-old female students (51 percent). Never-use of contraception among sexually active respondents was 97 percent for 14-17-year-old non-student females with a low educational level. Insufficient information about family planning methods and inaccessibility were the main reasons cited for non-use. Half of females ages 14-21 years who are currently attending school have been pregnant, as have 67 percent of those not in school. These results indicate a substantial unmet need on the part of Liberian adolescents with respect to reproductive health knowledge, information, and access to contraceptive methods.

Abortion, Induced↗
PubMedDate not supplied

Sexual behavior, contraceptive practice, and reproductive health among Nigerian adolescents.

In the context of a high and increasing incidence of unwanted pregnancy among Nigerian adolescents, a sample survey of never-married residents of the Ibadan area, aged 14 to 25 years, was conducted in 1982 to learn about their perceptions and practices relating to reproductive health. A substantial proportion of the young unmarried population is sexually active, and despite comparatively high contraceptive prevalence among that proportion, many are still engaging in sexual relations without benefit of contraceptive protection. Nearly half of the female students interviewed at both the secondary and university levels have been pregnant, as have two-thirds of those not currently enrolled in school. Among those respondents who had been pregnant, almost all reported that they voluntarily terminated their pregnancies. Existing and needed contraceptive services for the adolescent population are discussed.

Abortion, Illegal↗
PubMedDate not supplied

Vanguard family planning acceptors in Senegal.

This study examines contraceptive use among clients at the three clinics providing family planning services in Dakar, Senegal in early 1983. Most clients first became interested in family planning following the birth of a child, and most are interested in spacing future pregnancies, although one-third state that they want no more children. The clinic itself was found to be an important determinant of the type of contraceptive used, with only the government-operated clinic providing a balance between IUDs, oral contraceptives, and barrier methods. Nearly half of the clients interviewed said that a lack of knowledge about contraception is the reason for the low contraceptive prevalence rates among Senegalese women; another frequently cited reason was the opposition of the husband. Most clients reported the broadcast media to be the best means of providing family planning information to potential acceptors.

Contraceptive Devices, Male↗
PubMedDate not supplied

Episodic acute care costs: linking inpatient and home care.

STUDY OBJECTIVE: To develop a measure of an acute care "episode of care" that incorporates hospital and home care portions of care, and to measure the costs of such episodes. DESIGN: Patient level data from a home care program and an acute care hospital were linked using patient health insurance identification numbers. The linked database contained information on inpatient case mix, home care patient classification (i.e., type of care) and cost data for both settings. Data by patient classification were analyzed. MAIN RESULTS: Patterns of resource use were very different for medical and surgical cases, home care costs being 25% of a medical episode and only 5% of a surgical episode. For surgical cases, the marginal cost of an extra surgical day is about equal to the marginal cost of an extra short-term home care case (i.e., a one-day reduction in a surgical inpatient length of stay would cover the cost of a home care stay). Medical cases would require a three-day reduction in inpatient cost.

Acute Disease↗
PubMedDate not supplied

Knowledge, behavior, and fears concerning breast and cervical cancer among older low-income Mexican-American women.

INTRODUCTION: Although recent studies have documented the low participation level of Hispanic women in cancer screening, few have examined their predisposing knowledge and attitudes concerning cancer. We documented the knowledge and fears concerning cancer of an older population of Mexican-American women and how these factors relate to screening behavior and sociodemographic characteristics. METHODS: The data are from baseline surveys conducted before the start of a community cancer awareness and prevention program. Nine hundred twenty-three Mexican-American women were interviewed in-person about their knowledge, attitudes, and Pap smear and mammogram screening practices. RESULTS: Knowledge and attitude about cancer varied with age, education, type of health insurance, ability to speak English, and place of birth. Women 65 years of age and older were least knowledgeable of cancer-detection methods and screening guidelines. Those with only Medicare or Medicaid knew far less even compared to uninsured women. Women who did not speak English well were more likely not to know the cancer signs and symptoms, risk factors, and screening guidelines. Women who had knowledge of guidelines and detection methods were more likely to have had a recent screening. Older Mexican-American women with more fatalistic and fearful attitudes toward cancer were less likely to have had a recent Pap smear. CONCLUSIONS: The low screening participation among Mexican-American women may be due to their limited awareness and knowledge about breast and cervical cancer screening examinations. Our study highlights the need for wide-scale cancer screening interventions consistent with Mexican-American beliefs.

Adult↗
PubMedDate not supplied

Care coordination. A new role in a customer-focused healthcare system.

In the current healthcare environment, all healthcare providers are challenged to provide quality patient care in an efficient, cost-effective manner. Managed care organizations and third-party payors actively collect data related to cost, length of stay, resource use, and patient outcomes for use in affiliating and contracting with healthcare facilities and providers. The authors, in this article, outline one organization's evolution from a "utilization review"-based discharge planning process to a proactive "utilization management" approach to care coordination.

Case Management↗