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Biomedical subjects

J B Martin

Publications and source records attributed to J B Martin.

At least 55 records · Page 3Linked to original sources
PubMed1998

Central vein catheter-related thrombosis in intensive care patients: incidence, risks factors, and relationship with catheter-related sepsis.

OBJECTIVE: To evaluate the incidence and risk factors for catheter-related central vein thrombosis in ICU patients. DESIGN: Observational prospective multicenter study. SETTING: An 8-bed surgical ICU, a 10-bed surgical cardiovascular ICU, and a 10-bed medical-surgical ICU. PATIENTS: During an 18-month period, 265 internaljugular or subclavian catheters were included. Veins were explored by duplex scanning performed just before or < 24 h after catheter removal. Suspected risk factors of catheter-related central vein thrombosis were recorded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Fifty-seven catheters were excluded from the analysis. Therefore 208 catheters were analyzed. Mean age of patients was 64+/-15 years, simplified acute physiologic score was 12+/-5, organ system failure score at insertion was 1+/-1, and mean duration of catheterization was 9+/-5 days. A catheter-related internal jugular or subclavian vein thrombosis occurred in 33% of the cases (42% [95% confidence interval (CI), 34 to 49%] and 10% [95% CI, 3 to 18%], respectively). Thrombosis was limited in 8%, large in 22%, and occlusive in 3% of the cases. Internal jugular route (relative risk [RR], 4.13; 95% CI, 1.72 to 9.95), therapeutic heparinization (RR 0.47; 95% CI, 0.23 to 0.99), and age >64 years (RR, 2.44; 95% CI, 2.05 to 3.19) were independently associated with catheter-related thrombosis. Moreover, the risk of catheter-related sepsis was 2.62-fold higher when thrombosis occurred (p=0.011). CONCLUSIONS: Catheter-related central vein thrombosis is a frequent complication of central venous catheterization in ICU patients and is closely associated with catheter-related sepsis.

APACHE↗
PubMed1998

The component alignment model: a new approach to health care information technology strategic planning.

The evolving health care environment demands that health care organizations fully utilize information technologies (ITs). The effective deployment of IT requires the development and implementation of a comprehensive IT strategic plan. A number of approaches to health care IT strategic planning exist, but they are outdated or incomplete. The component alignment model (CAM) introduced here recognizes the complexity of today's health care environment, emphasizing continuous assessment and realignment of seven basic components: external environment, emerging ITs, organizational infrastructure, mission, IT infrastructure, business strategy, and IT strategy. The article provides a framework by which health care organizations can develop an effective IT strategic planning process.

Decision Making, Organizational↗
PubMed1996

Effect of subcutaneous tunneling on internal jugular catheter-related sepsis in critically ill patients: a prospective randomized multicenter study.

OBJECTIVE: To evaluate the effect of catheter tunneling on internal jugular catheter-related sepsis in critically ill patients. DESIGN: A prospective randomized controlled study involving 3 intensive care units (ICUs), stratified by number of catheter lumina (1 or 2) and center. SETTING: The 10-bed medical-surgical and 10-bed surgical ICUs at Saint Joseph Hospital and 8-bed surgical ICU at Clinique de la Défense, Paris, France. PATIENTS: Every patient older than 18 years admitted to the ICUs between March 1, 1993, and July 17,1996, who required a jugular venous catheter for more than 48 hours. INTERVENTION: Random allocation to tunneled or nontunneled catheters. MEASUREMENTS: Times to occurrence of systemic catheter-related sepsis, catheter-related septicemia, or a quantitative catheter-tip culture with a cutoff of 103 colony-forming units per milliliter. RESULTS: A total of 241 patients were randomized. Ten patients in whom jugular puncture was not achieved were subsequently excluded. The proportion of patients receiving mechanical ventilation (87%) and mean+/-SD age (65+/-4 years), Simplified Acute Physiologic Score (13.3+/-4.9), Organ System Failure score (1.5+/-1.0), and duration of catheterization (8.7+/-5.0 days) were similar in both groups. Taking into account the first 231 catheters (114 nontunneled [control], 117 tunneled), we found that tunnelization decreased catheter-related sepsis (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.13-0.83; P=.02), catheter-related septicemia (OR, 0.23; 95% CI, 0.07-0.81; P=.02), and, though not statistically significant, positive quantitative tip-culture rate (OR, 0.62; 95% CI, 0.35-1.10; P=.10). These results were slightly modified after adjustment on parameters either imbalanced between both groups (duration of catheter placement and cancer at admission) or prognostic (insertion by a resident, use of antibiotics at catheter insertion, cancer, and sex). CONCLUSION: The incidence of internal jugular catheter-related infections in critically ill patients can be reduced by using subcutaneous tunnelization.

Aged↗
PubMed1996

An evaluation of telemedical support for a minor treatment centre.

A low-cost telemedicine link was established from an accident and emergency department in Belfast to support nurse practitioners running a minor treatment centre (MTC) in London. During the 12 months before the introduction of the telemedicine link, 6729 patients were seen in the MTC. Of these, 155 (2.3%) were referred to the nearest accident and emergency department and 802 (11.9%) were referred to their general practitioner (GP). During the first 12 months of the use of the telemedicine link, 9972 patients were seen in the MTC. Of these, 147 (1.5%) were referred to the accident and emergency department and 383 (3.8%) were referred to their GP. During the evaluation period, 51 patients were seen using the telemedicine link, representing 0.5% of all MTC attenders during that period. The total number of teleconsultations was less than expected. The reasons for this difference include random variation, but could also include confidence resulting from the presence of the link and a training effect. The telemedicine link for trauma and minor injuries was an extremely cost-effective way of providing medical expertise to cover the clinical risk of the 0.5-1.5% of the case load that required expert medical opinion. The direct costs of on-site medical staff would have been 50,000 pounds per annum, excluding overhead charges. The annual cost of the videolink, including overheads, was 7250 pounds, amounting to a saving of some 42,000 pounds per annum.

Emergency Medical Services↗
PubMed1995

Academic health centers. Vulnerabilities in 1995 and beyond.

Resources to support biomedical research in the nation's academic health centers are under considerable threat. Particularly vulnerable is the clinical research enterprise. New strategies and prioritization will be required to maintain the vitality of our clinical research and education enterprise.

Academic Medical Centers↗
PubMed1995

Gene therapy and pharmacological treatment of inherited neurological disorders.

The identification of mutant genes responsible for inherited neurological disorders gives an opportunity to consider new approaches to their treatment. Although replacement of defective genes in postmitotic neurons is unlikely to be possible in the near future, the identification of gene products, and definitive delineation of the cellular dysfunction and death that result from mutated gene products, may suggest new therapeutic options. This article reviews these advances and considers approaches that may provide hope for alleviation of these disorders.

Alzheimer Disease↗
PubMed1995

Characteristics of pregnant women, utilization, and satisfaction with prenatal services in St. Petersburg, Russia.

A descriptive study with a convenience sample of 47 subjects drawn from two birthing houses was conducted in St. Petersburg, Russia, under the auspices of the World Health Organization Healthy Cities Project. Data were collected with a self-administered questionnaire given to women in birthing houses after delivery and prior to discharge. Subjects ranged in age from 16 to 38 years. Sixty-one percent of women began prenatal care within the 1st trimester, 35% within the 2nd trimester, and 2% received no prenatal care. Younger women were more likely than older women to start prenatal care in the 1st trimester, but received less teaching by health care providers. Younger women also expressed more stress and need for counseling. In addition, 83% of low-birthweight babies were born to younger women. These findings indicate a focus by health care personnel on older pregnant women, although younger pregnant women were at higher risk for poor pregnancy outcome. The strongest statistically significant correlations were found among the patient satisfaction variables, indicating that satisfaction with prenatal services may influence when women begin prenatal care services.

Adolescent↗
PubMed1994

Guidelines for lumbar spine radiography in acute low back pain: effect of implementation in an accident and emergency department.

Guidelines for lumbar spine radiography were agreed by consultation between staff in the radiology, accident and emergency and neurosurgical departments of a large teaching hospital. Study of 322 consecutive patients over an eight month period showed that the proportion of patients referred for radiography was reduced from 48.4% to 27.2% following introduction of the guidelines (p = 0.0002). Successful use of such guidelines requires cooperation between clinical and radiological staff and frequent review of performance.

Adult↗
PubMed1993

The target of ammonia action in dictyostelium.

The weak base ammonia is implicated in a number of key processes in Dictyostelium development, notably aggregation and culmination. To determine its intracellular site of action, we compared its biological potency with that of other weak bases. All the bases inhibited these developmental processes effectively, but differed manyfold in potency in accordance with their activity in dissipating pH gradients, as measured by in vivo 31P NMR with pH-sensitive phosphonate probes. These results indicate that weak bases influence development by raising the pH of an intracellular acidic compartment.

Alkalies↗
PubMed1993

31P-NMR analysis of Entamoeba histolytica. Occurrence of high amounts of two inositol phosphates.

Perchloric-acid extracts of axenic Entamoeba histolytica were investigated by 31P-NMR spectroscopy. All major 31P resonances observed were assigned to specific compounds. The cells contained inorganic phosphate (1039 nmol/g wet cells), pyrophosphate (16 nmol/g wet cells), nucleoside diphosphates (91 nmol/g wet cells), nucleoside triphosphates (275 nmol/g wet cells), NAD(P) (60 nmol/g wet cells), phosphocholine (184 nmol/g wet cells), phosphoethanolamine (214 nmol/g wet cells), cytidine 5'-diphosphocholine (41 nmol/g wet cells) and cytidine 5'-diphosphoethanolamine (55 nmol/g wet cells). The latter four compounds may act as intermediates in the salvage pathway for the synthesis of phosphatidylethanolamine and phosphatidylcholine. E. histolytica trophozoites also contained two inositol phosphates in large quantities, InsP3 (0.26 mumol/g wet cells) and InsP7 (0.11 mumol/g wet cells). These components were identified by 31P-NMR, using homonuclear J-resolved and two-dimensional 1H-31P correlative, analyses as myo-inositol trisphosphate, Ins(2,4,6)P3, and pentakisphospho-myo-inositol diphosphate, Ins(1,2,3,4,6)P5(5)P2.

Animals↗
PubMed1993

Molecular genetics in neurology.

There has been remarkable progress in the identification of mutations in genes that cause inherited neurological disorders. Abnormalities in the genes for Huntington disease, neurofibromatosis types 1 and 2, one form of familial amyotrophic lateral sclerosis, fragile X syndrome, myotonic dystrophy, Kennedy syndrome, Menkes disease, and several forms of retinitis pigmentosa have been elucidated. Rare disorders of neuronal migration such as Kallmann syndrome, Miller-Dieker syndrome, and Norrie disease have been shown to be due to specific gene defects. Several muscle disorders characterized by abnormal membrane excitability have been defined as mutations of the muscle sodium or chloride channels. These advances provide opportunity for accurate molecular diagnosis of at-risk individuals and are the harbinger of new approaches to therapy of these diseases.

Chromosome Mapping↗
PubMed1992

Cytotoxicity of dichloromethane diphosphonate and of 1-hydroxyethane-1,1-diphosphonate in the amoebae of the slime mould Dictyostelium discoideum. A 31P NMR study.

Two pyrophosphate analogues, dichloromethane diphosphonate (Cl2MDP), and 1-hydroxyethane-1,1-diphosphonate (EHDP), at concentrations of 0.5-1 mM, efficiently inhibited the growth of amoebae of the slime mould Dictyostelium discoideum. Cell viability decreased markedly upon incubation with the diphosphonates. The mechanism of toxicity was investigated by in vivo 31P NMR spectroscopy and the formation of analogues of ATP [adenosine 5'-(beta, gamma-dichloromethane triphosphate) and adenosine 5'-(beta, gamma-1-hydroxyethane triphosphate)] was demonstrated. These two compounds were identified from their 31P NMR spectra in perchloric acid extracts prepared from amoebae poisoned with Cl2MDP or EHDP and may have been synthesized by reversible pyrophosphate exchange catalysed by cytosolic aminoacyl-tRNA synthetases.

Animals↗
PubMed1992

Multinuclear NMR spectroscopy of the cellular slime mold Polysphondylium pallidum. Monitoring of the encystment and excystment processes.

Polysphondylium pallidum microcysts and amoebae have been investigated by 31P- and natural-abundance proton-decoupled 13C-NMR spectroscopy. Microcysts have been found to contain as prominent metabolites a phosphomonoester, inositol hexakisphosphate (1.4 mM), two phosphodiesters [glycerophosphocholine (5.5 mM) and glycerophosphoethanolamine (2.6 mM)], as well as nucleoside triphosphates (3 mM) and polyphosphates (greater than 10 mM), the polyamines 1,3-diamino-propane (3.5 mM), putrescine (16 mM) and spermidine (3 mM) and the sugar trehalose (31 mM). In vivo 31P-NMR has shown that the level of nucleoside triphosphates in microcysts was maintained metabolically and that the pH of their cytosol, deduced from the chemical shift of cytosolic Pi was 7.2. The absence of trehalose, glycerophosphocholine and glycerophosphoethanolamine in P. pallidum amoebae was the most remarkable difference from microcysts. Microcyst germination (excystment), induced by reduction of the ionic strength of the microcyst bathing medium, was monitored non-invasively by 31P- and 13C-NMR spectroscopy. The major modifications observed during excystment were the progressive disappearance of trehalose used as energy source, of glycerophosphocholine and glycerophosphoethanolamine used as membrane phospholipid precursors, and, finally, the appearance of NMR-visible polyphosphates and of cellobiose. As a mirror situation, P. pallidum amoebae responded to a high-ionic-strength stress by production of trehalose, glycerophosphocholine, and glycerophosphoethanolamine, and induction of an encystment process.

Animals↗