Association between SSRIs and upper gastrointestinal bleeding. Coprescription of antiulcer drugs with SSRIs is fairly common.
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Anti-Ulcer Agents↗
Biomedical subjects
D Williams
Publications and source records attributed to D Williams.
Pulmonary artery catheterization and clinical outcomes: National Heart, Lung, and Blood Institute and Food and Drug Administration Workshop Report. Consensus Statement.
OBJECTIVE: The efficacy and safety of the pulmonary artery catheter are under scrutiny because of its association with increased morbidity and mortality in observational studies. In response, the National Heart, Lung, and Blood Institute (NHLBI) and the US Food and Drug Administration (FDA) conducted the Pulmonary Artery Catheterization and Clinical Outcomes workshop in Alexandria, Va, on August 25 and 26, 1997, to develop recommendations regarding actions to improve pulmonary artery catheter utility and safety. PARTICIPANTS: The NHLBI and FDA planning task force selected a workshop chairperson, subcommittee chairs, and participants. Approximately 85 participants were selected for their collective expertise in critical care, pulmonary medicine, cardiovascular medicine and surgery, pediatrics, nursing, biostatistics, and medical economics. The meeting was open to industry representatives and other government and lay observers. This workshop was funded by the NHLBI and the FDA's Division of Devices. EVIDENCE: Published reports relating to the efficacy and safety of the pulmonary artery catheter, especially consensus documents developed by professional societies. CONSENSUS PROCESS: The planning task force disseminated materials, held teleconferences, and developed draft position papers prior to the workshop. These were modified during the workshop and thereafter in the course of several teleconferences, and presented to the entire group for final modifications and approval. CONCLUSIONS: A need exists for collaborative education of physicians and nurses in performing, obtaining, and interpreting information from the use of pulmonary artery catheters. This effort should be led by professional societies, in collaboration with federal agencies, with the purpose of developing and disseminating standardized educational programs. Areas given high priority for clinical trials were pulmonary artery catheter use in persistent/refractory congestive heart failure, acute respiratory distress syndrome, severe sepsis and septic shock, and low-risk coronary artery bypass graft surgery. JAMA. 2000;283:2568-2572
Catheterization, Swan-Ganz↗
Patient education role of a pharmacist on a transplant service.
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Humans↗
Regional and racial differences in response to antihypertensive medication use in a randomized controlled trial of men with hypertension in the United States. Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents.
BACKGROUND: Stroke incidence and mortality rates are higher in the southeastern region of the United States, which is called the "Stroke Belt." We compared the response to antihypertensive medication use in patients from different US regions. METHODS: The short-term and 1-year efficacy of the antihypertensive medications hydrochlorothiazide, atenolol, diltiazem hydrochloride (sustained release), captopril, prazosin hydrochloride, and clonidine was compared by US region in a randomized controlled trial of 1,105 men with hypertension from 15 US Veterans Affairs medical centers. RESULTS: Compared with patients outside the Stroke Belt, patients inside the Stroke Belt achieved significantly lower treatment success rates of diastolic blood pressure control at 1 year with hydrochlorothiazide (63% vs 41%), atenolol (62% vs 46%), captopril (60% vs 30%), and clonidine (69% vs 43%); there were no differences in treatment success rates with diltiazem (70% vs 71%) or prazosin (54% vs 53%). When controlling for race, patients inside the Stroke Belt had significantly lower treatment success rates with hydrochlorothiazide (P = .003) and clonidine (P = .003), and the lower success rate with atenolol approached significance (P = .15). Regardless of region, blacks were less likely than whites to achieve treatment success with atenolol (P = .02) or prazosin (P = .03) and more likely with diltiazem (P = .05). There was a trend for blacks residing inside the Stroke Belt to have a lower treatment success rate than other race-region groups when treated with captopril (P = .07). Many regional and racial differences in diet, lifestyle, and other characteristics were observed. After adjustment for these characteristics by regression analysis, the effect of residing inside the Stroke Belt remained for captopril (P = .01) and clonidine (P = .01) and approached significance for hydrochlorothiazide (P = .10). CONCLUSIONS: Hypertension in patients residing inside the Stroke Belt responded less to the use of several antihypertensive medications and important differences were shown in a number of characteristics that may affect the control of blood pressure, compared with patients residing outside the Stroke Belt.
Adult↗
Crypt-restricted metallothionein immunopositivity in murine colon: validation of a model for studies of somatic stem cell mutation.
The ability to visualize the cellular effects of a somatic mutation is relevant to studies of cell kinetics and carcinogenesis. In the colon, mutagen administration leads to scattered crypt-restricted loss of activity of the X-linked enzyme glucose-6-phosphate dehydrogenase (G6PD); it has been shown that this is due to somatic mutation in the G6PD gene. Mutagen-induced crypt-restricted immunopositivity for metallothionein (MT) has been reported in one study in the mouse colon; if this is also due to somatic mutation, it provides a simple method for studying the phenomenon which could be carried out on paraffin sections. This study shows that, as in the G6PD model, the frequency of crypt-restricted immunopositivity for MT is very low in untreated animals, but increases proportionately with the dose of mutagen administered. There is a good overall correlation of a range of MT-positive crypt frequencies with those derived from studies using G6PD. As with the G6PD model, the MT-positive crypt phenotype evolves over time after mutagen administration; initially individual crypts include both positive and negative phenotype cells, but later almost all involved crypts are composed entirely of MT-positive cells. The frequency of MT-positive crypts stabilizes after a few weeks and remains at the same level 6 months later. All these observations are qualitatively identical to those found using the G6PD model and provide strong evidence that stable, crypt-restricted immunopositivity for MT results from a mutation affecting expression of the metallothionein gene in a colonic stem cell. This model will provide a useful tool to study factors influencing stem cell mutation frequency and cell kinetics in the colon.
Animals↗
Analysis of N-acetylated hexosamine monosaccharides by ferrocenyl boronation and tandem electrospray ionization mass spectrometry.
A tandem electrospray mass spectrometric (MS(n)) technique for the analysis of N-acetylated hexose carbohydrates using ferrocene boronate (F(c)Bor) derivatization was developed. The biologically important N-acetyl hexosamines can be readily distinguished utilizing this technique. The analysis is made possible by utilizing the inherent electrochemical properties of the electrospray device to produce oxidized, pre-formed single-electron ferrocenyl ions in a non-aqueous solvent system. The electrospray device was modified using a custom built cell consisting of concentric stainless steel tubes, which produced an enhanced signal for the molecular ion of each analyte species. The MS(2) spectra derived from isomeric populations of ferrocenyl boronic esters of these carbohydrates when generated under the same conditions possessed features unique to each sugar allowing easy differentiation between a number of N-acetyl hexosamine isomers.
Acetylation↗
Oligosaccharide profiling: the facile detection of mono-, di- and oligosaccharides by electrospray orthogonal time-of-flight mass spectrometry using 3-aminophenylboronic acid derivatization.
Monosaccharides, disaccharides and larger carbohydrates can be derivatized using 3-aminophenylboronic acid (3-APBA). This procedure is carried out at low pH (2.7-3.0) and allows the use of positive ion mode electrospray orthogonal time-of-flight mass spectrometry (ES-OTOFMS) to analyze the resulting boronate complexes. A carbohydrate profile map of a complex carbohydrate mixture, honey, was prepared which displayed superior sensitivity when compared with lithium ion cationization. Complexes formed using simple mono- and disaccharides show that facile in situ derivatization leads to an equilibrium mixture; which is reproducible for a specific set of electrospray conditions. D-Glucose could be detected at 5 microM concentration using the standard instrument spray interface. Lower detection levels of approximately 500 nM could be achieved using a nanospray device. The 3-APBA complexes are observed on instruments employing a low temperature interface (140-150 degrees C) which allows formation of the boronate species while still promoting efficient desolvation of the ions. The spectral identification of 3-APBA complexed carbohydrates in complex mixtures is facilitated by the easily observed 1 mass unit separated peak pair bearing the 1:4 ratio resulting from the natural isotopic abundance of (10)B and (11)B.
Boronic Acids↗
Analysis of neutral isomeric low molecular weight carbohydrates using ferrocenyl boronate derivatization and tandem electrospray mass spectrometry.
A new analytical technique for small carbohydrates utilizing the cyclic ferrocenyl boronic esters (FcBors) of several neutral mono- and disaccharides is demonstrated. Distinction between the diastereomers of mono- and disaccharides is obtained. Analysis is by tandem electrospray-mass spectrometry (ES-MS) using a modified ion-source that promotes the preformation of ions. Selection of the molecular ion produced during single-electron oxidation of the ferrocene moiety of a specific population of saccharide isomers permits a variety of collisionally induced dissociation (CID) experiments. The resultant MS2/MS3 spectra reflect the ensemble of possible cyclic esters in equilibrium. An array of stable cross pyranose ring fragment ions representing sequential carbon loss as 30 u is observed. Consequently, the system provides an information-rich set of MSn spectra containing large amounts of structural information. Identification of D-glucose (D-Glc), its two commonly found epimers (D-mannose and D-galactose), and the two major L-diastereomers of 6-dideoxymonosaccharides, L-fucose (L-Fuc) and L-rhamnose (L-Rhm), are demonstrated. Selected pairs of disaccharides can be distinguished in terms of their anomeric linkage by reference to their MS3 spectra.
Carbohydrate Sequence↗
Social inequalities, stressors and self reported health status among African American and white women in the Detroit metropolitan area.
This article examines the cumulative effects of multiple stressors on women's health, by race and area of residence. Specifically, we examine socioeconomic status, experiences of unfair treatment and acute life events by race and residential location, and their cumulative effects on the health status of African American and white women living within the city of Detroit and in the surrounding metropolitan area. African American women, regardless of whether they live inside or outside the city, report more frequent encounters with everyday unfair treatment than white women. African American women who live in the city report a greater number of acute life events than white women who live outside the city. Regression analyses used to examine the cumulative effects of exposure to these stressors by race and area of residence show that: (1) socioeconomic status, everyday experiences with unfair treatment and acute life events each make a significant contribution to differences in health status; and (2) the contribution of each of these variables to explaining variations in health status varies by area of residence. We suggest that differences in socioeconomic status, exposure to unfair treatment or discrimination and experiences of acute life events make significant contributions to racial differences in women's health status.
Adolescent↗
A comparison between BMI and Conicity index on predicting coronary heart disease: the Framingham Heart Study.
PURPOSE: This study examined the relationship of mortality and morbidity of coronary heart disease with body mass index (BMI) and Conicity index (CI). METHODS: Among 5209 Framingham Heart Study participants, 1882 men and 2373 women had waist and weight measurement at the 4th examination period and height measured on the 5th visit. These were used for BMI and CI. RESULTS: During a 24-year follow-up, 597 men and 468 women developed CHD and 248 men and 150 women died from CHD associated causes. In men the relative risks (RR) (95% confidence interval) adjusted for age, hypertension, diabetes, smoking status, and total cholesterol for CHD incidence in 2nd, 3rd, and 4th quartiles of BMI were 1.28 (1.0, 1.65), 1.45 (1.13, 1.86), and 1.53 (1.19, 1.96). The RR for CHD incidence in the 4th quartile of BMI in women was 1.56 (1.16, 2.08). No CI quartiles were risk factors for CHD incidence. There was 86% higher risk of CHD related death in the 4th quartile of BMI than the 1st quartile of BMI in women. In men no significantly higher risks of death were found across the quartiles of BMI. No associations were found between CI quartiles and CHD mortality. CONCLUSIONS: Obesity as measured by BMI is an important risk factor for CHD incidence in men and women and for CHD mortality in women. CI was not associated with an increase in CHD incidence or mortality. Thus, BMI is a better marker than CI for predicting CHD incidence and mortality.
Adult↗
Specific language impairment with or without hyperactivity: neuropsychological evidence for frontostriatal dysfunction.
A neuropsychological investigation of the association between specific language impairment (SLI) and hyperactivity was conducted on four groups of 6-year-old children. The groups, each consisting of five boys and five girls, were: children with SLI alone, hyperactivity alone, both SLI and hyperactivity, and neither disorder (controls). Cognitive functioning was examined using selected non-verbal tests from the Cambridge Neuropsychological Test Automated Battery. SLI was not associated with significantly reduced performance on any of the neuropsychological measures. However, hyperactivity was associated with deficits on a test of attentional set shifting previously demonstrated to be sensitive to frontostriatal dysfunction. Further, hyperactive children showed significantly reduced spatial spans on a test of spatial working memory thought to measure parietal lobe functioning. There were no substantial differences between the groups on tests of frontal lobe function except for reduced performance on a task of attention in the hyperactive group. There were no significant interactions between hyperactivity and SLI on any of the neuropsychological measures. The pattern of neuropsychological deficits shown by children with attention-deficit-hyperactivity disorder (ADHD) suggests relatively specific problems in inhibitory control of attentional selection. This cognitive deficit implicates brain areas including basal ganglia and ventro-lateral prefrontal cortical areas in ADHD, thus providing evidence for disruption of frontostriatal functional loops. SLI and hyperactivity can occur as comorbid syndromes or symptom complexes and this should be noted when interpreting results of tests measuring cognitive performance. The findings suggest that these two groups of disorders have different cognitive correlates.
Analysis of Variance↗
Cricothyroidotomy comments.
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Cricoid Cartilage↗
Drug interactions avoided-a useful indicator of good prescribing practice.
AIMS: To develop an index of quality prescribing in general practice by investigating the incidence of potential drug interactions when medicines were coprescribed within the State supported General Medical Services (GMS) in Ireland. METHODS: We determined an odds ratio (OR), as a measure of the relative risk of being exposed to a potential interaction, comparing the use of the H2-receptor antagonist, cimetidine, with that of the noninteracting agents ranitidine, famotidine and nizatidine in users and nonusers of warfarin, phenytoin and theophylline. RESULTS AND CONCLUSIONS: In 86 510 prescriptions for the H2-receptor antagonists potentially interacting drugs were dispensed to 8188 (9%) patients in the Eastern Health Board Region of the GMS. We found that prescribers were significantly less likely to use cimetidine (OR = 0.20,95% CI 0. 17-0.21, P < 0.001) in those patients who were coprescribed warfarin, suggesting good prescribing practice within the GMS. Similarly there was preferential use of the noninteracting H2-receptor antagonists in patients receiving phenytoin or theophylline and the extent of this selective prescribing was in keeping with the rank order of severity of interaction with these drugs. This novel pharmacological index may be a sensitive marker of good prescribing practice.
Anticoagulants↗
EUS to detect evidence of pancreatic disease in patients with persistent or nonspecific dyspepsia.
BACKGROUND: Mild chronic pancreatitis is difficult to diagnose and the diagnosis is therefore not sought routinely in patients with dyspepsia. The aim of our study was to compare the prevalence of endosonographic pancreatic abnormalities in patients with dyspepsia and control subjects. METHODS: The number of endosonographic abnormalities was compared prospectively in patients with dyspepsia and control patients. Patients in whom there was any suspicion of pancreatic disease were analyzed separately. RESULTS: Between November 1998 and January 1999, 156 patients with dyspepsia were compared with 27 control patients. The groups were similar except that control patients were significantly older and more likely to be men. The mean number of endosonographic abnormalities was higher in dyspeptic patients than in control patients (mean number of abnormalities 3.3: 95% CI [2.9, 3.6] vs. 1.9: 95% CI [0.3, 1.7]). The strongest independent predictors of severe endosonographic abnormalities (defined as 5 or more abnormalities) were the presence of suspected pancreatic disease (odds ratio 7.29: 95% CI [2.03, 26. 14]) and dyspepsia (odds ratio 7.21: 95% CI [1.99, 26.26]). In the dyspepsia group, no clinical variables were significant predictors of severe abnormalities. However, most patients had nonspecific-type dyspepsia or persistent symptoms after therapeutic trials of acid suppression. CONCLUSIONS: Dyspepsia may be an atypical presentation of pancreatic disease in patients with persistent or nonspecific symptoms. Endosonography may be useful to screen for pancreatic disease in patients with persistent dyspepsia.
Adult↗
The effect of home visiting programmes on uptake of childhood immunization: a systematic review and meta-analysis.
BACKGROUND: The aim of the study was to evaluate the effectiveness of home visiting programmes on the uptake of childhood immunization. METHODS: A systematic review was carried out of the literature of controlled studies evaluating home visiting programmes involving at least one post-natal visit, which included tasks within the remit of British health visiting and reporting outcomes relevant to British health visiting. Eleven studies were considered, nine of which used socio-economically disadvantaged families. The outcome measure was uptake of a range of childhood immunizations. RESULTS: Eleven studies reported uptake of immunization. Effect sizes from nine studies were included in the meta-analysis. Fixed effects models demonstrated a significant effect of home visiting for all studies and also for several subgroups of studies, but with significant heterogeneity of effect sizes. A random effects model failed to demonstrate an effect of home visiting. CONCLUSIONS: Home visiting programmes have not been shown to be effective in increasing the uptake of immunization. Other methods of increasing uptake and reducing inequalities in uptake will need to be explored.
Child, Preschool↗
Automatic pace-sense polarity switch as an indicator of early lead corrosion: the usefulness of impedance trend graphing.
A rate responsive dual chamber pacemaker system (Medtronic Inc.) was implanted without complications. At 6-week postimplantation a routine pacemaker check showed a spontaneous switch from programmed bipolar pace-sense to unipolar pace-sense on the atrial and ventricular leads. Pacing and sensing thresholds were not significantly changed from implantation. The atrial and ventricular lead impedances increased from 680 and 720 ohms at implantation to 1,290 and 2,400 ohms, respectively. The device was reprogrammed to bipolar pace-sense and the continuous lead telemetry trend option was programmed On. Evaluation of the system 1 month later revealed a decrease in atrial and ventricular lead impedances, 680 and 2,100 ohms, without a change in pace-sense polarity. One month later, the lead polarity had again switched from programmed bipolar to unipolar pace-sense. The lead trend data revealed stable atrial impedances with sporadic increases in the ventricular lead impedance to values > 3,000 ohms. The pacemaker lead system was invasively investigated and visible gross corrosion of the ventricular lead distal connector pin was discovered.
Corrosion↗
Comparison of human papillomavirus detection and typing by cycle sequencing, line blotting, and hybrid capture.
We compared the results of human papillomavirus (HPV) detection and typing from 781 cervical samples assayed by three methods: L1 consensus PCR followed by cycle sequencing, L1 consensus PCR with biotinylated primers followed by hybridization to a line blot, and Hybrid Capture assay. Both PCR assays used L1 consensus PCR with primers MY09 and MY11. We evaluated the amplification efficiencies of both PCR assays and also compared the specific HPV types detected by each method. The samples positive by the Hybrid Capture assay were compared to the specific types detected by the PCR-based assays. The concordance between the two PCR assays in producing an HPV amplicon visible by gel electrophoresis or in detecting any HPV type was moderate: kappa values were 0.61 (95% confidence interval [CI] = 0.56 to 0.67) and 0.51 (95% CI = 0.46 to 0.58), respectively. The McNemar test for correlated proportions indicated that biotinylated PCR was less likely to produce a band (P = 0.001) and to detect an HPV type (P = 0.001) than the other PCR assay. In comparing the Hybrid Capture assay results with the HPV types detected by the PCR-based assays, we found that positivity by the Hybrid Capture assay for a number of samples may be due to cross-hybridization with HPV types not included in the Hybrid Capture assay probe cocktails.
Biotinylation↗
Does home visiting improve parenting and the quality of the home environment? A systematic review and meta analysis.
AIMS: To evaluate the effectiveness of home visiting programmes on parenting and quality of the home environment. DESIGN: Systematic review of the literature of randomised controlled trials and quasi-experimental studies evaluating home visiting programmes involving at least one postnatal visit. SUBJECTS: Thirty four studies reported relevant outcomes; 26 used participants considered to be at risk of adverse maternal or child health outcomes; two used preterm or low birth weight infants; and two used infants with failure to thrive. Only eight used participants not considered to be at risk of adverse child health outcomes. RESULTS: Seventeen studies reported Home Observation for Measurement of the Environment (HOME) scores, 27 reported other measures of parenting, and 10 reported both types of outcome. Twelve studies were entered into the meta analysis. This showed a significant effect of home visiting on HOME score. Similar results were found after restricting the analyses to randomised controlled trials and to higher quality studies. Twenty one of the 27 studies reporting other measures of parenting found significant treatment effects favouring the home visited group on a range of measures. CONCLUSIONS: Home visiting programmes were associated with an improvement in the quality of the home environment. Few studies used UK health visitors, so caution must be exercised in extrapolating the results to current UK health visiting practice. Further work is needed to evaluate whether UK health visitors can achieve similar results. Comparisons with similar programmes delivered by paraprofessionals or community mothers are also needed.
Child↗