Pronase improves detection of HLA antibodies in flow crossmatches.
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B-Lymphocytes↗
Biomedical subjects
D Stewart
Publications and source records attributed to D Stewart.
Postoperative anisocoria in a patient undergoing endoscopic sinus surgery.
OBJECTIVE: Anisocoria after sinus surgery can be related to serious complications such as intraorbital hematoma or increased intracranial pressure secondary to an expanding hematoma. CASE REPORT: A 51-year-old man underwent endoscopic surgery of sinuses, and developed anisocoria; likely a result of the local spread of cocaine used to provide local anesthesia and vasoconstriction. The localized effect of this anesthetic agent produced a typical picture of nasociliary ganglion block that subsided in a few hours. In the results, the nasociliary nerve block was noticed on recovery from anesthesia with no other neurologic deficit. Ophthalmologic examination demonstrated a short-lasting anisocoria with loss of accommodation and sensory block over the tip of the nose. CONCLUSION: The central spread of the local anesthetics should be considered as a differential diagnosis of unexplained anisocoria, especially when it is associated with loss of corneal reflex.
Anesthetics, Local↗
Health care professionals referred for treatment of alcohol and drug problems.
This study reports on 62 health care professionals referred to a specialist drug and alcohol treatment service. Most patients used more than one type of substance. Health problems were common, but were seldom reasons for referral. Self-referral was infrequent. Referral was often subsequent to intoxication at work or persistent absenteeism. Just over half of admissions completed treatment. Multiple drug use was a poor prognostic indicator with fewer multiple drug users engaging with, or completing, treatment.
Adult↗
Sleep apnea in end-stage renal disease patients on hemodialysis and continuous ambulatory peritoneal dialysis.
Fifteen unselected end-stage renal disease patients (nine hemodialysis [HD] and six continuous ambulatory peritoneal dialysis [CAPD]) were randomly selected from four Sydney metropolitan dialysis centers for sleep assessment by full polysomnography. Four of six CAPD patients and eight of nine HD patients were found to have clinically significant obstructive sleep apnea. An additional 21 unselected patients (10 CAPD and 11 HD patients) were assessed using overnight home monitoring of nasal airflow and arterial oxygen saturation. Of these, 8 of the 11 HD and 7 of the 10 CAPD patients were found to have obstructive sleep apnea. These data confirm the high incidence of obstructive sleep apnea in the end-stage renal disease population at large. Screening for obstructive sleep apnea should become a routine part of the management of these patients.
Adolescent↗
Readiness to perform cardiopulmonary resuscitation: an emerging strategy against sudden cardiac death.
OBJECTIVES: This investigation assessed motivational factors and psychosocial barriers that affect individual readiness to perform cardiopulmonary resuscitation (CPR). This is the first study to use the Transtheoretical model in assessing readiness to perform CPR. METHODS: A sample of 786 subjects, > or = 45 years of age and who resided in a private residence, were randomly selected to participate in a structured telephone interview. Data on motivational readiness, emotional state, perceived psychosocial barriers, and perceived efficacy in performing CPR were collected using dichotomous and Likert-type ratings. RESULTS: Subjects with greater motivational readiness expected to experience significantly fewer symptoms of emotional distress during a cardiac emergency and to encounter fewer psychosocial barriers. This group also reported greater efficacy in their ability to perform CPR. These findings were independent of gender, medical history, age, and educational level. CONCLUSIONS: Meaningful differences are apparent in individual readiness to perform CPR. These findings provide additional support for the need to tailor CPR training strategies using behavioral methods that enhance motivational readiness and decrease apprehension about anticipated emotional distress and psychosocial barriers.
Adaptation, Psychological↗
Richter's hernia at site of insertion of laparoscope.
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Hernia↗
Effect of hyperthermia on cisplatin sensitivity in human glioma and ovarian carcinoma cell lines resistant and sensitive to cisplatin treatment.
Two pairs of human tumour-cell lines consisting of a cisplatin sensitive and resistant line from glioma and ovarian carcinoma were tested to determine the effect of hyperthermia on cisplatin sensitization. Both cisplatin resistant lines were more sensitive to 42 degrees C heating than their cisplatin sensitive counterparts. The cisplatin response was dependent on cell growth phase, with plateau phase cells more sensitive than exponentially growing cells. The difference in cisplatin response between resistant and sensitive lines was also growth phase dependent and was opposite for the two cell line pairs. Hyperthermia caused about the same thermal sensitization in the plateau phase cisplatin sensitive cell lines and in the resistant lines but this too was growth-phase dependent. In exponentially growing cells hyperthermia-cisplatin sensitization was greater in the sensitive cell lines. Hyperthermia at 42 degrees C did not completely overcome cisplatin resistance but could be useful as a sensitizer in cisplatin resistant tumour cells.
Antineoplastic Agents↗
Conjunctival swabs: assessment of value.
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Conjunctiva↗
A winning game plan for QI.
Authors Robert L. Boyle, Jr., M.P.H., FACMPE, James G. Shaw, M.B.A., and Diane Stewart describe how to put a quality improvement program into practice by identifying key internal processes, selecting an improvement program, identifying what to improve and developing a review method. They also present results from the first year of their quality improvement process.
California↗
Treatment outcomes of stimulant misusers: one year follow-up results from the national treatment outcome research study (NTORS).
There are substantial gaps in knowledge about treatment outcomes for stimulant misuse. This paper investigates patterns of stimulant use and outcomes of stimulant misusers one year after starting treatment at 54 agencies within United Kingdom national services. In a prospective, longitudinal cohort study of 1,075 drug misusers, 637 were current users of stimulant drugs at intake to treatment. Most of the clients were multiple drug users. Stimulants were the main problem drug for 13% of the sample. The two most frequently used drugs were crack cocaine and amphetamine sulphate. The most frequently reported pattern of stimulant use was among heroin dependent clients who also used stimulants. The clients for whom stimulants were the main problem drug were most likely to approach residential rehabilitation programs for treatment. Overall, the stimulant users showed satisfactory outcomes with marked reductions in substance use and other problem behaviors at follow-up. Many clients with stimulant misuse problems were able to achieve substantial improvements after treatment within existing services.
Adult↗
Utilization, patient satisfaction, and cost implications of acupuncture, massage, and naturopathic medicine offered as covered health benefits: a comparison of two delivery models.
CONTEXT: Increasing numbers of health plans in the United States offer complementary and alternative medicine (CAM) benefits despite limited information. OBJECTIVE: To determine the utilization rates and costs associated with providing CAM services in 2 benefit designs, and to determine the satisfaction of patients in both plans. DESIGN: Two health plans were identified: a traditional indemnity plan offered through a defined preferred provider organization (PPO) of CAM providers and a health maintenance organization (HMO). Costs and utilization rates for CAM services were compared during a 1-year period of coverage beginning November 1, 1996. SETTING AND PARTICIPANTS: 1091 patients in both plans who used CAM services during the month of May 1997 in Washington state. RESULTS: Only 1% of all patients covered for CAM accessed these services during the study period. A significantly higher percentage of patients in the PPO plan (1.2%) used CAM services compared to the HMO plan (0.6%) (P < .001). However, the average total cost of annual CAM services (plan benefit + user contribution) was similar ($347 in the HMO and $376 in the PPO), and the price per member per month was nearly identical ($0.20 in the HMO and $0.19 in the PPO). Most users perceived these services as helpful. CONCLUSIONS: Utilization of CAM services and per member per month costs were lower than expected given the high interest in CAM services reported in consumer surveys. The high level of satisfaction with CAM services and self-reported decrease in the use of pain medications suggests the need for prospective studies examining the effect of CAM treatments.
Acupuncture Therapy↗
Monitoring of patients undergoing intravenous midazolam/methohexital.
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Anesthesia, Dental↗
Evaluation of cisplatin response in three radiation resistant and three radiation sensitive cell lines.
The cisplatin response was studied in three radiation sensitive mutant cell lines each paired with normally responding or radiation resistant cell lines of parental or similar origin. The radiation sensitive cell lines V3 (CHO), AT5BI (human fibroblast) and HT144 (melanoma) also showed reduced or lack of ability to repair sublethal radiation damage. Also, V3 did not repair radiation induced DNA double strand breaks and AT5BI was excision repair deficient. None of these cell lines show any cross sensitivity to cisplatin treatment. Instead the response was more like the paired normally radiation responding cell lines, except for AT5BI which showed cisplatin resistance. Thus the mechanisms causing radiation sensitivity in the three cell lines are not involved in cisplatin sensitivity.
Animals↗
Five conversations: reflections of stakeholders on the impact of the ethnocultural communities facing AIDS study.
This paper reports on issues identified in conversations held between one of the Ethnocultural Communities Facing AIDS Study (ECFA) investigators and five stakeholders associated with this experiment in collaborative and participatory research. The stakeholders reflect on their experiences in partnering with university-based researchers, resistance in ethnocultural communities to being researched, and the next steps implicated by the research in question. The problem of HIV/AIDS in ethnocultural communities in Canada is, relative to the mainstream, also viewed as a symbol of disadvantage in these communities. The stakeholders suggest that to address these deeper concerns, there must be vital, dynamic, and enduring communication between researchers, community representatives, and government at all levels, in the process of identifying solutions and implementing them in the present.
Acquired Immunodeficiency Syndrome↗
Specificity of the BAX polymerase chain reaction system for detection of the foodborne pathogen Listeria monocytogenes.
The polymerase chain reaction (PCR) can be used for rapid and specific detection of foodborne pathogens. One commercial kit, the Qualicon BAX system uses PCR to detect Listeria monocytogenes in enrichment cultures derived from food and environmental samples. The specificity and sensitivity of the BAX system for detecting L. monocytogenes were characterized by using both pure and mixed cell cultures, and optimal conditions for production of cell lysates were determined. The BAX system was highly specific for L. monocytogenes, and no interference was seen in the presence of either other Listeria species or microbes from other genera. The assay detected L. monocytogenes at 10(5)-10(6) colony-forming units/mL. This sensitivity is adequate for detecting viable cells after enrichment but prevents false-positive signals from nonviable cells.
Electrophoresis, Polyacrylamide Gel↗