Modification of a commercially available DNA sequencer to increase sample throughput.
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Computer Systems↗
Biomedical subjects
D Williams
Publications and source records attributed to D Williams.
Comparative efficacy of olmesartan, losartan, valsartan, and irbesartan in the control of essential hypertension.
In a multicenter, randomized, double-blind trial, the authors compared the antihypertensive efficacy of once-daily treatment with the new angiotensin II type 1 receptor blocker (ARB) olmesartan (20 mg) with recommended starting doses of losartan (50 mg), valsartan (80 mg), and irbesartan (150 mg) in 588 patients with a cuff diastolic blood pressure (DBP) of greater than or equal to 100 and less than or equal to 115 mm Hg and a mean daytime DBP of greater than or equal to 90 mm Hg and less than 120 mm Hg, as measured by ambulatory blood pressure monitoring. Cuff and ambulatory blood pressures were monitored at baseline and after 8 weeks of treatment. All groups were predominantly white and approximately 62% male, and their mean age was approximately 52 years. In all groups, mean baseline DBP and systolic blood pressure (SBP) were approximately 104 and 157 mm Hg, respectively. The reduction of sitting cuff DBP with olmesartan (11.5 mm Hg), the primary efficacy variable of this study, was significantly greater than with losartan, valsartan, and irbesartan (8.2, 7.9, and 9.9 mm Hg, respectively). Reductions of cuff SBP with the four ARBs ranged from 8.4-11.3 mm Hg and were not significantly different. The reduction in mean 24-hour DBP with olmesartan (8.5 mm Hg) was significantly greater than reductions with losartan and valsartan (6.2 and 5.6 mm Hg, respectively) and showed a trend toward significance when compared to the reduction in DBP with irbesartan (7.4 mm Hg; p=0.087). The reduction in mean 24-hour SBP with olmesartan (12.5 mm Hg) was significantly greater than the reductions with losartan and valsartan (9.0 and 8.1 mm Hg, respectively) and equivalent to the reduction with irbesartan (11.3 mm Hg). All drugs were well tolerated. The authors conclude that olmesartan, at its starting dose, is more effective than the starting doses of the other ARBs tested in reducing cuff DBP in patients with essential hypertension.
Analysis of Variance↗
Declining morbidity and mortality of carotid endarterectomy. The Wake Forest University Medical Center experience.
The 30-day mortality as well as morbidity for stroke and myocardial infarction were determined by review of the charts for every carotid endarterectomy (N = 389 operations on 356 patients) performed at Wake Forest University Medical Center from 1979 through 1983 to ascertain whether the 16% morbidity and 6% mortality documented in our previous report of 1978 had changed over time. For endarterectomies performed on asymptomatic patients (n = 155), major morbidity included 2 myocardial infarctions and 1 stroke (1.9%). There were 3 fatalities--2 myocardial infarctions and 1 stroke (1.9%). For the symptomatic group (n = 234), major morbidity was 2.1%, mortality 2.6%. The combined morbidity for asymptomatic and symptomatic carotid stenosis was 2%, mortality 2.3%. Perioperative stroke rate (morbidity plus mortality) was 2.6%, 9 ipsilateral to the carotid endarterectomy, suggesting distal embolism as its probable cause. We contend that quality control measures implemented to correct the unacceptable rates reported in 1978 have contributed to dramatic and sustained reductions in complication rates.
Academic Medical Centers↗
An analysis of the nurse practitioner role in palliative care.
The purpose of this study was to examine the nature and contribution of the nurse practitioner (NP) role in an oncology palliative clinic. Quantitative and qualitative data were collected from the practice of one NP. Data were obtained on the performance of the NP role functions. the characteristics of the patients seen by the NP, the interventions delivered by the NP, and the outcomes of care. Descriptive and content analyses were used to analyze the data. The results indicate that the NP in an oncology palliative care clinic engages primarily in the clinical component of the role. The emphasis is on symptom management, patient and family education and counseling, coordination of care, and maintaining continuity of care. The method followed in this case study to examine the contribution of the NP role could be used by other NPs to demonstrate the quality, effectiveness, and efficiency of their care.
Ambulatory Care↗
An overview of proteinase inhibitors.
Proteinase inhibitors are proteins in the body that regulate the catalytic activity of proteinases. They are important in a large variety of physiologic processes including coagulation, digestion, tumor metastasis and immunity. Proteinase inhibitors are categorized as either nonspecific proteinase inhibitors or class-specific proteinase inhibitors. Nonspecific proteinase inhibitors are comprised soley of the alpha macroglobulins, most notably alpha2-macroglobulin. Class-specific proteinase inhibitors are subcategorized as serine proteinase inhibitors, aspartic proteinase inhibitors, metalloproteinase inhibitors, and cysteine proteinase inhibitors. Each subcategory is made up of numerous inhibitors. As the roles of individual proteinase inhibitors are determined, the therapeutic use of natural and synthetic proteinase inhibitors is also being investigated. The purpose of this article is to review the history and classification of proteinase inhibitors and their relevance to veterinary medicine.
Animal Diseases↗
Alpha1-proteinase inhibitor deficiency and Bartonella infection in association with panniculitis, polyarthritis, and meningitis in a dog.
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Animals↗
Tympanometric screening in elementary school children.
The revised ASHA (American Speech Language Hearing Association, 1990) hearing screening guidelines were developed to decrease over-referrals for middle ear disorders through amended tympanometric measurements. These guidelines also recommended a large-scale normative study be done with tympanometric measures to further reduce the over-referral rate. Seven hundred and fifty ears from 392 kindergarten through third-grade children were tested. Normative values of Peak Ytm and tympanometric width were calculated by grade. For increasing grade level, there was an orderly increase in the mean Peak Ytm and a decrease in the mean tympanometric width. Sensitivity and specificity were calculated at 65 and 80% respectively, with a prevalence of 11%. Suggestions for improving sensitivity and specificity are discussed.
Acoustic Impedance Tests↗
Visual benefit of correcting higher order aberrations of the eye.
There is currently considerable debate concerning the visual impact of correcting the higher order aberrations of the eye. We describe new measurements of a large population of human eyes and compute the visual benefit of correcting higher order aberrations. We also describe the increase in contrast sensitivity when higher order aberrations are corrected with an adaptive optics system. All these results suggest that many, though not all, observers with normal vision would receive worthwhile improvements in spatial vision from customized vision correction, at least over a range of viewing distances and particularly when the pupils are large. Keratoconic patients or patients suffering from spherical aberration as a result of laser refractive surgery as it is presently performed would especially benefit. These results encourage the development of methods to correct higher order aberrations.
Contrast Sensitivity↗
Atrial fibrillation and flutter with left bundle branch block aberration referred as ventricular tachycardia.
Five patients were referred for electrophysiologic evaluation of nonsustained or sustained ventricular tachycardia. In each patient, the clinical rhythm disturbance was reproduced and identified as atrial fibrillation or flutter with left bundle branch block aberrancy. All five patients demonstrated enhanced or accelerated atrioventricular conduction through the normal atrioventricular nodal-His Purkinje pathway. This rapid conduction created an electrophysiologic substrate suitable to the preferential development of this less common form of aberration. Four of five patients responded well (ventricular rate control or reversion to sinus rhythm) to verapamil therapy. Electrocardiographic criteria for differentiating supraventricular tachycardia with aberration from ventricular tachycardia exist. Nevertheless, misdiagnosis of wide complex tachycardia remains common. Electrophysiologic testing plays an important role in correctly identifying these rhythms, assessing long-term prognosis, and choosing effective therapy.
Adult↗
Hospital use by Olympic athletes during the 1996 Atlanta Olympic Games.
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Adolescent↗
Preceptorship: is it a workable concept?
Preceptorship has many advantages to offer newly graduated nurses. The author of this article warns, however, that the mistakes made in mentorship should be heeded and its use in practice evaluated thoroughly before it is adopted without question.
Education, Nursing↗
Setting up a cardiovascular clinic in primary care.
This article describes what nurses need to know about setting up a cardiovascular clinic in primary care. The author provides practical advice from personal experience of running such a clinic. Areas covered include: identifying patients; how to contact patients; what equipment to include; the consultation; follow up appointments and referrals.
Aftercare↗
A trial of structured implicit review of randomly selected peer review organization cases.
OBJECTIVE: In order to learn more about peer review's acceptability, efficiency, and reliability, we performed structured implicit review with and without use of a structured case review form on a random selection of peer review organization cases. METHODS: We compared the results between methods and with previously obtained review results. Twenty-five charts with physician review completed during the Health Care Financing Administration's Third Scope of Work were randomly selected for rereview. Eight physician advisors, none of whom had seen any of these charts previously, were divided into two groups. Both groups received identical formal instruction in the structured implicit review method. Half of the physicians used a structured review form when performing chart review. The other half did not use this form but completed their reviews using the previously used reporting form. Participating physicians were instructed in the structured review method as described by Rand Corporation. The review process was examined regarding acceptability and efficiency. Review results were analyzed for reliability regarding identification of adverse and potential adverse effects and identification of the source of quality concerns. RESULTS: Instructions regarding structured implicit review methods were understood easily and accepted by physician advisors. Use of the structured review form was less efficient, averaging 50% longer per review. There was no difference in the rate at which adverse events were detected. Potentially serious adverse events were found less often using structured review than in the original review. There was greater agreement among reviewers using the structured form than among those using the historic worksheet, but structured review using the Rand form identified fewer potentially significant adverse events than did the reviewers using the historic worksheets. CONCLUSIONS: Application of structured implicit review methods is clearly feasible for peer review organization case review. Use of a simple worksheet was more time efficient than use of a highly structured form. There was not only less variation in review results but also identification of fewer potentially significant adverse events when the highly structured form was used. Teaching the structured approach to chart review may be more important to obtaining good results than using a structured review form.
Efficiency, Organizational↗
Biomimetic surfaces: how man-made becomes man-like.
Biomaterials are usually synthetic or man-made substances that possess one or more properties that are suitable for use in devices that come into contact with living tissues. Living tissues are most content to be in contact with other tissues, especially those of their own kind. Biomimicry takes this observation and turns it into a practical solution to some problems of biocompatibility. It involves transforming traditional materials into tissue-like materials so that they may then be able to convince their host that it is in contact with one of its kind.
Biocompatible Materials↗
Silicon, silicone, and silica: the importance of the right ending.
Although organic polymers based on carbon have revolutionized the use of commodity materials during the latter half of the twentieth century, polymers based on silicon have also had a remarkable impact in certain speciality areas, especially in medical technology. This article clarifies some of the chemical uncertainties associated with these materials.
Equipment and Supplies↗
Meatless diets: are they right for your menu plan?
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Diet, Vegetarian↗
Objectivity in the evaluation of biological safety of medical devices and biomaterials.
This article attempts to present the current situation with respect to the evaluation of biological safety and biocompatibility where imitations in the methodology and validity are apparent. The introduction of procedures that facilitate the quantitative determination of the parameters of the biological performance of materials, and their objective analysis, should considerably enhance our ability to specify safety and describe biocompatibility.
Consumer Product Safety↗
Where have all the implants gone? The need for surveillance and tracking.
This article examines the issues involved in the recent, widely publicized failures of some implants. It is important that the health care industry and patients have realistic expectations of implants. The limitations as well as the benefits of current technology and practices must be acknowledged, so that the industry can continue to be innovative and sustain the confidence of patients. The author suggests that an important element in achieving this is for the industry to take the initiative in formulating an effective tracking and assessment system.
Equipment Design↗