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Biomedical subjects

D Terry

Publications and source records attributed to D Terry.

At least 19 recordsLinked to original sources
PubMed2006

Non-invasive metabolic monitoring of patients under anaesthesia by continuous indirect calorimetry--an in vivo trial of a new method.

BACKGROUND: Oxygen uptake is an important form of metabolic monitoring for patients under anaesthesia. In critically ill patients oxygen uptake has been shown to provide valuable clinical information in directed therapy and acts as a useful monitor of cardiovascular dysfunction. A new method of continuous real time monitoring of metabolic gas exchange was tested in patients during anaesthesia. METHODS: Using a standard anaesthetic machine with attached semi-closed circle absorber system, oxygen uptake was measured continuously throughout surgery in 30 patients undergoing cardiopulmonary bypass surgery and compared with paired measurements made with the reverse Fick method. The method is an indirect calorimetry technique which uses fresh gas rotameters for control, regulation and measurement of the gas flows into the system, with continuous sampling of mixed exhaust gas. RESULTS: When compared with the reverse Fick method the oxygen uptake showed a mean difference (and sd) of 20.7 ml min(-1) or 12.1% (25.3 ml min(-1)) pre-bypass and 13.9 ml min(-1) or 8.1% (27.0 ml min(-1)) post-bypass. This bias is consistent with previous studies comparing oxygen uptake measured at the mouth against oxygen uptake by reverse Fick, which have shown a difference of approximately 10-15% accounted for by the consumption of oxygen by lung tissue. CONCLUSIONS: As the method allows continuous measurement of gas exchange and can be adapted to a modern anaesthetic workstation it is an attractive method for use in clinical setting.

Aged↗
PubMed2004

A phase II study of carboplatin and paclitaxel in esophageal cancer.

BACKGROUND: This study was conducted to evaluate the efficacy and toxicity of combination carboplatin and paclitaxel in patients with esophageal cancer. MATERIALS AND METHODS: Thirty-five patients were enrolled. Patients were treated with paclitaxel 200 mg/m(2) intravenously (i.v.) over 3 h and carboplatin i.v. at an AUC of 5 mg/h/ml. Thirty-three patients were assessable for toxicity and objective response. RESULTS: A total of 166 treatment courses were administered with a median of five courses per patient. The objective response rate was 43% [90% confidence interval (CI) 0.3-0.58] by the intention-to-treat analysis. The median response duration was 2.8 months (90% CI 2.1-5.4). The median survival time was 9 months (90% CI 7-13.8) and the 1-year survival rate was 43% (90% CI 0.29-0.57). The major grade 3-4 toxicity observed was neutropenia, occurring in 17 patients (52%). There were no treatment-related deaths. CONCLUSIONS: The combination of carboplatin and paclitaxel is an moderately active and tolerable regimen in advanced esophageal cancer.

Adenocarcinoma↗
PubMed2000

Effects of megakaryocyte growth and development factor on platelet production, platelet life span, and platelet function in healthy human volunteers.

The effects of thrombopoietic stimulation on megakaryocytopoiesis, platelet production, and platelet viability and function were examined in normal volunteers randomized to receive single bolus subcutaneous injections of 3 microg/kg pegylated recombinant megakaryocyte growth and development factor (PEG-rHuMGDF) or placebo in a 3:1 ratio. PEG-rHuMGDF transiently doubled circulating platelet counts, from 237 +/- 41 x 10(3)/microL to 522 +/- 90 x 10(3)/microL (P <.0001), peaking on day 12. Baseline and day-12 samples showed no differences in responsiveness of platelets to adenosine diphosphate or thrombin receptor agonist peptide (P >.4 in all cases); expression of platelet ligand-induced binding sites or annexin V binding sites (P >.6 in both cases); or density of platelet TPO-receptors (P >.5). Platelet counts normalized by day 28. The life span of autologous (111)In-labeled platelets increased from 205 +/- 18 hours (baseline) to 226 +/- 22 hours (P <.01) on day 8. Platelet life span decreased from 226 +/- 22 hours (day 8) to 178 +/- 53 hours (P <.05) on day 18. The theoretical basis for senescent changes in mean platelet life span was illustrated by biomathematical modeling. Platelet turnover increased from 43.9 +/- 11.9 x 10(3) platelets/microL/d (baseline) to 101 +/- 27.6 x 10(3) platelets/microL/d (P =.0009), and marrow megakaryocyte mass expanded from 37.4 +/- 18.5 fL/kg to 62 +/- 17 x 10(10) fL/kg (P =. 015). Although PEG-rHuMGDF initially increased megakaryocyte volume and ploidy, subsequently ploidy showed a transient reciprocal decrease when the platelet counts exceeded placebo values. In healthy human volunteers PEG-rHuMGDF transiently increases megakaryocytopoiesis 2-fold. Additionally, peripheral platelets expand correspondingly and exhibit normal function and viability during the ensuing 10 days. The induced perturbation in steady state thrombopoiesis resolves by 4 weeks. (Blood. 2000;95:2514-2522)

Blood Platelets↗
PubMed1999

Effective employee relations in reengineered organizations.

The degree to which a healthcare organization can effectively respond to changes that are brought about by managed care is often the result of how well the organization engages the workforce in the changes. The goal of a process-centered healthcare organization is to deliver service that is truly patient-centered. Successful organizations understand that the actualization of this goal begins with the decision to engage in an employee-guided approach to reengineering. This article describes issues of effective employee relations in the postreengineering era. Strategies for dealing effectively with labor unions or for preventing unionization are also discussed.

Attitude of Health Personnel↗
PubMed1995

Quality of life in chronic fatigue syndrome.

Whilst the debilitating fatigue experienced in patients suffering from Chronic Fatigue Syndrome (CFS) results in a subjective marked impairment in functioning, little research has investigated the impact of this disorder on quality of life. Forty-seven subjects with a confirmed diagnosis of CFS and 30 healthy controls were compared using the Sickness Impact Profile (SIP). A subgroup of subjects were interviewed regarding the impact CFS has had on their social and family relationships, work and recreational activities. Results from both the SIP and the interview revealed that CFS subjects had significantly impaired quality of life, especially in areas of social functioning. These findings highlight the importance of addressing the social isolation and loss of role functioning experienced by CFS sufferers.

Adaptation, Psychological↗
PubMed1994

Shunt dysfunction and constipation: could there be a link?

A ventriculoperitoneal (VP) shunt is the treatment of choice for hydrocephalus, functioning by means of a pressure differential between the ventricular system and peritoneal cavity. Constipation is frequently a concomitant problem in children with VP shunts. A case study is reported in which signs and symptoms of shunt dysfunction appear to have developed as a result of constipation. Nurses and physicians must address the need for preventing constipation much more aggressively in the population requiring shunts.

Child, Preschool↗
PubMed1994

Ventriculoperitoneal shunt dysfunction and constipation: a chart review.

Children treated for hydrocephalus frequently experience chronic constipation. A retrospective chart review was conducted to determine if there is a population of children with ventriculoperitoneal (VP) shunt dysfunction in whom constipation might be a factor in the shunt dysfunction. Of 51 cases reviewed, 19 had documented constipation, such as no bowel movement for 2 or more days, small hard ball-like stools or fullness of the colon noted on physical examination or abdominal radiographs. In 6 cases, a bowel cleansing was performed and signs and symptoms of shunt dysfunction resolved without shunt revision. This review suggests that constipation may affect the fluid or pressure dynamics of the VP shunt and contribute to shunt dysfunction.

Adolescent↗
PubMed1994

Integrated health care in California's managed care capital.

Sacramento, California's capital, represents the nation's most competitive managed care marketplace. The Sutter Health organization represents a significant force in this marketplace and surrounding regions of Northern California. Sutter has created an integrated regional health care network capable of delivering a full continuum of care through appropriate community-based facilities, a variety of physician relationships, and both owned and aligned managed care structures. The overall Sutter Health strategy that incorporates facilities, physician partnerships, and patient care financing is described. The article identifies six key lessons learned during this period of growth.

California↗
PubMed1991

Nursing care of the child with external ventricular drainage.

External ventricular drainage (EVD) is used in children who have hydrocephalus, usually for shunt infection. Several complications, including increased intracranial pressure, hemorrhage, brain injury and infection, can occur in children with EVD. Nursing care for these children involves interventions to prevent complications and promote the well-being of children and their families.

Cerebrospinal Fluid Shunts↗
PubMed1991

Use of low-dose trimethoprim-sulfamethoxazole thrice weekly for primary and secondary prophylaxis of Pneumocystis carinii pneumonia in human immunodeficiency virus-infected patients.

We conducted an open prospective clinical trial to evaluate the efficacy and toxicity of trimethoprim-sulfamethoxazole given as one double-strength tablet thrice weekly for primary and secondary prophylaxis of Pneumocystis carinii pneumonia (PCP) in human immunodeficiency virus-infected (HIV+) patients. A total of 104 HIV+ patients were evaluated, with 74 being in the primary prophylaxis group and 30 being in the secondary prophylaxis group. All except six patients received concomitant zidovudine; five patients on primary prophylaxis and one patient on secondary prophylaxis refused zidovudine. There were 70 patients evaluated for the efficacy of primary prophylaxis. The mean CD4 count was 124.4 +/- 110.1 cells per microliter. The mean follow-up time was 11.8 +/- 5.8 months (median, 12 months; range, 1 to 32 months). Two noncompliant patients developed PCP after 1 and 3 months of chemoprophylaxis. The failure rate (under the intention to treat principle) was 2 of 70 patients (2.9%; 95% confidence interval, 0.35 to 10%), or 1 per 413 patient-months of observation. There were 27 patients evaluated for the efficacy of secondary prophylaxis. The mean follow-up time was 12.4 +/- 7.2 months (median, 11 months; range, 1 to 29 months). Two patients, one of whom was noncompliant, were treatment failures, developing PCP after 14 and 15 months of chemoprophylaxis; this gave a failure rate of 2 of 27 patients (7.4%; 95% confidence interval, 0.9 to 24.3%), or 1 per 167 patient-months of observation. Adverse reactions sufficient to permanently terminate therapy occurred in 9 of 104 patients (8.7%; 95% confidence interval, 4 to 15.7%) overall. The serum trimethoprim, sulfamethoxazole, and N4-acetyl-sulfamethoxazole concentrations measured by high-pressure liquid chromatography were uniformly low. One double-strength tablet of trimethoprim-sulfamethoxazole taken weekly on Monday, Wednesday, and Friday appeared to be well tolerated and efficacious for the prophylaxis of PCP in HIV+ patients at high risk and deserves further investigation.

Adult↗
PubMed1990

Alcohol intoxication, injuries, and dangerous behaviors--and the revolving emergency department door.

Suicides, homicides, motor vehicle crashes, and other violent deaths and injuries are linked inextricably to alcoholism. The association of injury and alcoholism should be particularly obvious to Emergency Department (ED) physicians. We sought to determine the extent to which intoxicated patients in an ED were properly diagnosed, counselled, and referred for substance abuse care. We reviewed the charts of 153 consecutive patients seen in a teaching hospital ED who had blood alcohol levels above 100 mg%. Most were male (70%), white (62%), young (mean age, 34 years) and severely intoxicated (mean BAL, 245; range, 109-558 mg%). Forty-six per cent of visits were for trauma; half of the patients were victims of violent assaults. The intoxicated patients received extensive medical and surgical management: an average of five tests or X-rays were performed per patient; 75% received at least one medication; at discharge 48% were referred for followup to medical or surgical clinics. In contrast, few patients were evaluated for dangerous behaviors or referred for treatment of alcoholism: only 19 patients (12.5%) were asked about depression, suicide, or homicide; 15% were advised to stop drinking; 13% received a referral to a psychiatrist, mental health worker, or alcohol rehabilitation facility. Forty-seven per cent of patients received "stat" intravenous thiamine (although the Wernicke-Korsakoff syndrome is rare). In contrast, only 16% received a stat on-site psychiatric consultation (although dangerous behaviors are common in alcoholics). There was a strong, statistically significant negative association between the occurrence of an injury and the decision to initiate treatment and referrals for alcoholism.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Antigenic analysis of household dust samples.

Household dust samples from the homes of 106 allergy clinic patients in Baltimore were analyzed for specific allergen content. Dust mite antigen content was determined by enzyme-linked immunosorbent assays (ELISA) specific for the major allergens of Dermatophagoides pteronyssinus, D. farinae, and D. microceras. Cat and dog antigen content were determined by ELISA using antisera for Fel d 1 (formerly cat allergen 1) and dog allergens 3 and 13, respectively. Mold content was assessed by culture with microscopic identification. Dust mite antigen was detected in 99% of homes (D. farinae, 95%; D. pteronyssinus, 88%; D. microceras, 31%), with total antigen content ranging from 50 ng/g dust (the lower limit of detection) to 30,170 ng/g (median, 1,123 ng/g). Animal allergens were found in 100% of samples (cat: range, 2 to 130,000 ng Fel d 1/g; median, 90 ng/g; dog: range, 112.5 to 585,000 IU/g; median, 2,719.5 IU/g). Although there were highly significant differences in antigen content (p less than 0.001) between homes with and without a particular pet in residence, many homes without pets contained pet allergens at high concentrations. Molds were also detected in 100% of homes (range, 4 to 761 colonies/30 mg dust; median, 72 colonies/30 mg). No correlation was demonstrated between antigen content and skin test results, a history of asthma, symptoms on allergen exposure, or the age of the home (except for molds) for any of the allergens detected. We conclude that dust mite allergens, cat and dog allergens, and molds are virtually ubiquitous in Baltimore homes and that our ability to predict the presence and relative quantities of these allergens on clinical grounds is very limited.

Adolescent↗
PubMed1980

Affinity chromatography of sn-glycerol-3-phosphate dehydrogenase on immobilized NAD.

Three types of potential affinity chromatography columns have been examined for the purification of sn-glycerol-4-phosphate dehydrogenase (EC 1.1.1.8) from rabbit tissues. Each column contained nicotinamide adenine dinucleotide (NAD) covalently attached to an agarose matrix with a different mode of attachment for each column. The most effective column was one in which the NAD was linked to the agarose via the C-8 position of the adenine moiety. Release of the bound enzyme from this column was accomplished by elution with NADH or NAD. The enzymes from brain, heart, kidney, muscle and liver were purified using this procedure with nearly quantitative yields and up to a 90-fold purification. The binding capacity and elution profiles were dependent upon pH, ionic strength and temperature. The capacity was lowest at pH 7 and increased at higher and lower values. Increasing ionic strength and higher temperatures decreased the binding capacities.

Animals↗
PubMed1980

A potent contact allergen of Phacelia (Hydrophyllaceae).

The major contact allergen of Phacelia crenulata (Hydrophyllaceae) has been identified as geranylhydroquinone. A maximization test of geranylhydroquinone showed this to be a potent sensitizer comparable in degree to poison oak/ivy urushiol. Comparative patch testing on humans with urushiol established that the phacelia allergen does not cross-react with poison oak or ivy.

Allergens↗