The importance of verbally verifying a health history.
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Biomedical subjects
Publications and source records attributed to E Sampson.
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Rural Newfoundland communities with and without expanded role nurses were compared on a before and after basis. The rural communities are located in a geographically isolated area served by a 40-bed hospital staffed by salaried physicians. Primary care visits within the community increased by 186 per cent after establishment of the family practice nurse community clinic and attendance at the hospital decreased by 35 per cent. Acute care days in hospital decreased 5 per cent in the experimental group and increased by 39 per cent in the control group. A major portion of the community based visits provided to the experimental group were classed as preventive. The total annual health service cost per 1,000 persons in the experimental group increased slightly more than in the control group (26 versus 21 per cent). Adequate management of certain indicator conditions and drugs was maintained by the family practice nurse when compared to the adequacy rating for the physician during the same time period.
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We examined the application of a radioimmunoassay kit, not requiring chromatography, to the measurement of aldosterone in healthy human subjects. Plasma aldosterone, urinary aldosterone, and plasma renin activity measurements were performed on samples from 47 subjects under conditions in which dietary sodium intake, posture, and times of sample collection were rigidly controlled. Nomograms are presented to illustrate the continuous, rather well defined, inverse relationship between 24 h sodium excretion and aldosterone measurements in plasma and urine. Mean plasma and urinary aldosterone values for subjects on normal sodium diets were 0.332+/-0.211 nmol/liter and 36.6+/-18.6 nmol/24 h and agreed well with previously reported values. A significant (p less than 0.05 increase in 24 h urinary aldosterone, plasma aldosterone and plasma renin activity resulted with decreased dietary sodium intake and conversely, a significant (p less than 0.05) decrease in each hormone occurred with increased dietary sodium intake. Rising from the supine to upright position resulted in a 230% increase in plasma aldosterone concentrations and a 284% increase in plasma renin activity.
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In 1971, 2,3,7,8-tetrachlorodibenzodioxin (TCDD)-containing waste oils were sprayed for dust control on residential, recreational, and work areas in Missouri. In several of these areas, the magnitude and the extent of this environmental contamination were not known until late 1982 or 1983. In the first phase of the investigation, a group of persons considered to be at highest risk of exposure and an appropriate comparison group were selected from reviews of Health Effects Survey screening questionnaires. These persons received complete medical examinations and a series of laboratory tests focused on detecting presymptomatic effects in key target organ systems (i.e., hepatic, dermatologic, immunologic, and neurologic effects). Comparisons of these two groups did not produce any firm indications of increased disease prevalence directly related to the putative exposures; of significance is the fact that no cases of chloracne or porphyria cutanea tarda were seen. Nevertheless, no overall definitive conclusion should be based just on this initial pilot study. Insights were provided that are being examined in more refined epidemiologic studies using different designs and strategies--especially of larger, more homogeneous population groups in which exposure status can be better characterized--focused primarily on discerning any potential effects on the urinary tract, liver, neurological, and immune systems. Concurrently, research into the development of replicable laboratory analytical methods and reference ranges for measuring TCDD body burden are being pursued.
INTRODUCTION: The proteolytic breakdown product corresponding to the extracellular domain (ECD) of the HER-2/neu oncoprotein p185 is found in the circulation of healthy individuals and patients having cancers of epithelial origin. For the current evaluation we sought to determine the analytical performance as well as the clinical utility of the newly developed ADVIA Centaur HER-2/neu assay (Bayer HealthCare LLC, Diagnostics Division, Tarrytown, NY, USA) in monitoring patients with metastatic breast cancer during the course of disease and treatment and to compare the obtained results with those of CA 15-3. METHODS: The analytical performance (including precision, normal range, interfering substances, minimum detectable concentration, dilution recovery, spiking recovery and high-dose hook effect) were determined. HER-2/neu and CA 15-3 values were measured in retrospective samples obtained from 59 patients with metastatic breast cancer undergoing treatment over a 6-12 month period. Serial changes in serum HER-2/neu and CA 15-3 were correlated with changes in clinical status on a visit-to-visit basis. For each pair of serial measurements, changes of equal to or greater than, or less than 15% for HER-2/neu and 21% for CA 15-3 were considered to indicate progression or lack of progression, respectively. RESULTS: The ADVIA Centaur HER-2/neu assay demonstrated within-run imprecision and total imprecision ranging from 3.0-5.6% and from 3.2-5.7%, respectively. The upper limit of normal was 15.2 ng/mL (90% CI: 14.2-17.0 ng/mL). No significant interference (<5%) was seen with bilirubins, hemoglobin, triglycerides and cholesterol or therapeutic drugs commonly present in the sera of breast cancer patients. The minimum detectable concentration (analytical sensitivity) was found to be 0.5 ng/mL. The patient population in the clinical study included breast cancer patients who responded to therapy (stable, partial or complete response) or had disease progression. HER-2/neu levels showed a concordance of 78.1% (82/105 restaging time points) with the clinical course of disease, whereas CA 15-3 levels showed a concordance of 76.2% (80/105 restaging time points). The concordance with clinical status increased to 85.7% (90/105 restaging time points) when both results were used in combination as a series test. CONCLUSIONS: The ADVIA Centaur HER-2/neu assay provides excellent analytical performance for serial testing of serum HER-2/neu levels. The clinical data demonstrate the usefulness of serum HER-2/neu in monitoring metastatic breast cancer patients during treatment. Furthermore, the results indicate that serum HER-2/neu and CA 15-3 may be useful in identifying disease progression or therapeutic response in different subgroups of women with metastatic breast cancer.
In 1971, waste oil containing 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) was sprayed for dust control on a number of residential, recreational, and work areas in Missouri. In several of them, the level and extent of environmental contamination were not known until late 1982 or 1983. Extrapolation from existing toxicological data indicated the potential for substantial adverse health effects in highly exposed populations. As a result, the Missouri Division of Health and the Centers for Disease Control initiated close collaboration with the Environmental Protection Agency (EPA) on review and evaluation of environmental data, the development of health advisories to EPA on the need for remedial or preventive actions at specific contaminated sites, a health education effort for the medical community and general public, establishment of a dermatological screening clinic, establishment of a central listing of potentially exposed persons through administration of a health effects survey questionnaire, and a pilot medical study of a "highest risk" cohort. Strategies for additional interventions will continue to be based on findings derived from this first phase of the investigation.
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