Electrical control of facial pain.
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Adult↗
Biomedical subjects
J Doyle
Publications and source records attributed to J Doyle.
The 'Lorenzan sulphates'. A new group of vertebrate mucopolysaccharides.
1. The mucopolysaccharide from the glands of Lorenzini of Squalus acanthias has been isolated and purified. 2. The material is a sulphated polysaccharide containing glucosamine, galactosamine, galactose and traces of an uronic acid. 3. This vertebrate polysaccharide is unusual in appearing to have both amino sugars present in the molecule. The amino sugars are N-acetylated. 4. This molecule is one of a group of related mucopolysaccharides which vary in composition with the animal species. The generic name ;lorenzan sulphates' is suggested to describe these substances.
Animals↗
The push toward generalism: a view from surgery.
Recent proposals for health care reform center on restructuring the physician workforce in favor of more "generalists." These plans are based on several assumptions that have been neither clearly argued nor proved. Despite this, each of the plans enunciated thus far dictate that primary care physicians comprise at least 50% of the nation's physician workforce. Such a mandate has enormous repercussions for medical education. This paper takes issue with several assumptions underlying these reform initiatives, particularly the assumption that primary care does not include surgery. Because of the primary nature of surgical care, the prevalence of surgical diseases, the projected shortage of physicians entering general surgery, and the fact that surgical care is most effectively and efficiently provided by general surgeons, general surgery should not be handicapped as it would under present reform proposals. We recommend that the assumptions underlying plans to restructure the nation's physician workforce be tested, and that any reform enacted be based on rational criteria linked to the projected prevalence of disease in the nation as well as a determination of which practitioners care for those diseases most effectively and efficiently. We further recommend that medical students' time in surgical activities be increased rather than decreased, that general surgeons increase their activity in medical school curricular development and teaching, and that surgeons become involved more actively in the graduate training of primary care physicians.
Family Practice↗
Radiographic assessment of acetabular prosthesis anteversion: an experimental study.
Two trigonometric methods used to assess acetabular cup orientation radiographically derive the angle of anteversion differently and yielded statistically significantly different results when compared using a laboratory model of the pelvis. The need for standardisation is suggested.
Acetabulum↗
A model to evaluate the cost-effectiveness of oral therapies in the management of patients with major depressive disorders.
The introduction of a new antidepressant, venlafaxine, a serotonin norepinephrine reuptake inhibitor (SNRI), has provided researchers with the opportunity to take a closer look at the issues involved in selecting a product for a formulary. To aid decision makers in considering the adoption of this new therapy, a pharmacoeconomic simulation model was developed to evaluate the cost-effectiveness of SNRIs versus traditional oral therapies in the management of patients with major depressive disorders (MDDs) from a cost-based payer perspective. Four treatment regimens for MDD were compared: tricyclic antidepressants, selective serotonin reuptake inhibitors, heterocyclic antidepressants, and SNRIs. The principles of decision analysis were used to calculate outcome probabilities based on data from a meta-analysis. The expected cost of each regimen was calculated using cost data from a survey of three health maintenance organizations located in Missouri, Massachusetts, and California. The model suggests that SNRI therapy demonstrates the highest level of cost-effectiveness in an inpatient setting when using both brand and generic acquisition costs of the drugs. When comparing treatment regimens for out-patients, the generic heterocyclic antidepressants demonstrate the highest level of cost-effectiveness: when using band acquisition costs, the SNRIs demonstrate the highest level of cost-effectiveness. Sensitivity analysis calculated the robustness of the conclusions to all major parameters.
Administration, Oral↗
Microtitre plate assay for paralytic shellfish toxins using saxiphilin: gauging the effects of shellfish extract matrices, salts and pH upon assay performance.
Saxiphilin is a hydrophilic protein with a high affinity and specificity for paralytic shellfish toxins (PSTs) found in the circulatory fluid of many invertebrates and ectothermic vertebrates. Saxiphilin has been found to be closely related to the iron binding transferrins, a group of proteins that range in molecular weight between 70 and 90 kDa. One saxiphilin isoform, that from the centipede Ethmostigmus rubripes, has been used to develop a microtitre plate assay for PSTs which relies upon detection of bound tritiated saxitoxin (STX). In this study, this assay was challenged with differing conditions of salt concentration and identity, pH and addition of non-toxic extracts of commercial shellfish prepared following the Association of Official Analytical Chemists endorsed procedure, elements the assay would encounter if used for PST monitoring and may compromise assay performance. The assay tolerated up to 15% of the total reaction, volume being shellfish extract before assay signal started to diminish. The presence of these extract matrices had little effect upon assay accuracy and precision when measuring STX, as a typical PST. Also, the detection of STX in the presence of shellfish matrices could be confidently reproduced on different days by different experimenters. The elements present in the shellfish extracts were measured by inductively coupled plasma spectroscopy, with the most common cationic elements being Na followed by K, Mg and Ca. Only trace amounts of other cationic elements were also present. From these results, the effects upon the assay by the four most common salts of these elements, NaCl, KCl, CaCl(2) and MgCl(2) were measured. Both NaCl and KCl did not impair assay performance at concentrations as high as 550 mM. It should be noted, however, that greater than 80 mM of either of these salts must be present in the assay for it to achieve the maximal signal. Adding CaCl(2) and MgCl(2) to the assay had dramatic effects upon performance. In the case of CaCl(2), the NaCl that was present in standard assay conditions enhanced its negative impact upon the assay. With MgCl(2), NaCl counteracted its inhibitory effect to some extent. After taking into account sample dilutions of shellfish extracts however, the potential for an interfering effect by Ca or Mg is minimal. A pH of 5.4 or less is necessary for there to be any significant impact upon the assay, with the assay signal being stable up to an alkaline pH as high as 9. Using the conditions herein, this assay can be used to reliably detect 1.3 microg STXeq/100 g shellfish tissue if it were to be used for monitoring for PST contaminated shellfish. These results demonstrate that this assay is a highly robust diagnostic tool for the measurement of PSTs in shellfish extracts.
Amphibian Proteins↗
EEG alpha reactivity and self-regulation correlates of smoking and smoking deprivation.
Twelve nonsmokers, ten ex-smokers, ten deprived smokers (2-3 hours), and ten nondeprived smokers were exposed to a short-term (18-sec) vigilance task and underwent 6 min of biofeedback-assisted alpha amplitude enhancement and suppression training. Cigarette smoking was found to be associated with decreased alpha suppression to the vigilance task. However, no consistent role of cigarette smoking in alpha self-regulation emerged from the results.
Adult↗
A qualitative study of factors influencing psychiatric nursing practice in Australian prisons.
TOPIC: Factors influencing the practice of psychiatric nursing in Australian prisons. METHODS: A qualitative study of psychiatric nurses (N = 30) working in a prison. FINDINGS: The psychiatric nurses identified the following factors as influencing their work: challenging patients, threats to personal survival of patients, the technology and artifice of confinement, conflicting values of nurses and corrections staff, stigma by association, and prisoner identification of the nurses with prison administration. CONCLUSIONS: Psychiatric nurses who work in forensic settings must adapt to less than optimal practice conditions.
Australia↗
Reducing relapse in depressed outpatients with atypical features: a pilot study.
BACKGROUND: Patients with major depressive disorder (MDD) and atypical features have reactive mood plus at least two symptoms: hypersomnia, hyperphagia, leaden paralysis or a lifetime sensitivity to rejection. These patients respond to cognitive therapy (CT) or phenelzine (PHZ) significantly more than pill placebo (PBO). The purpose of this report is to motivate research on tolerable continuation phase treatment designed to reduce the significant risk of relapse and recurrence which depressed patients with atypical features face. METHODS: Outpatients with DSM-III-R MDD and atypical features who responded to acute-phase CT, clinical management plus PHZ or PBO (n = 31) were randomized to continue or discontinue treatment for 8 months and participate in 16 months or treatment-free follow-up. RESULTS: A log-rank test showed that the relapse and recurrence-free survival over the 24 months after the acute phase was significantly greater for the responders who continued treatment than for those who discontinued treatment. Kaplan-Meier estimates of relapse and recurrence were significantly higher for patients whose treatment was discontinued than for those whose treatment continued (83 vs 49% based on unblinded ratings of the Research Diagnostic Criteria for MDD or of self/other referral for treatment of depressive symptoms). CONCLUSIONS: We note several important limitations of the design and analysis of these pilot data. We hypothesize that not only pharmacotherapy, but also CT used as a continuation phase treatment may reduce relapse in this population. This hypothesis warrants rigorous evaluation in samples of outpatients with MDD and atypical features that are large enough to allow comparative tests.
Acute Disease↗
Influence of extracted teeth on DMF surface increments in clinical trials of caries preventives.
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Adolescent↗
Capturing policy in hearing-aid decisions by audiologists.
Two studies are reported that together demonstrate that a rigorous protocol of cue elicitation employing behavioral observations of actual clinical behavior can be rewarded with powerful policy capturing in social judgment theory experiments. The decision policies of 16 clinical audiologists were derived in a study of the decision to recommend hearing-aid amplification. Using discriminant function analysis for each judge, the percentage correct classification rates for the hearing-aid recommendation criterion variable for all judges were high, with an average correct rate of 89.9%, despite widely divergent recommendation rates (21.4% to 87.1%) associated with individual decision behaviors.
Attitude to Health↗
Leukemia in Down syndrome: a review.
The incidence of leukemia is higher in children with Down syndrome (DS) than in normals. In approximately 50% of cases the type of leukemia is acute megakaryoblastic leukemia (AMKL) and it occurs during the first 4 years of life. The leukemic cell also has features of erythroid progenitors and therefore appears to be a precursor cell with biphenotypic properties. In addition, newborns with DS frequently develop transient leukemia (TL), which is characterized by the presence of megakaryoblasts in the blood which disappear during the first 1-3 months of life. The incidence of this disorder is unknown although preliminary studies suggest that megakaryoblasts may be found frequently in the blood of DS newborns. TL does not occur in normal newborn infants. Although TL disappears spontaneously, many of these children will develop AMKL at 1-4 years of age. Recent surveys suggest that 20-30% of newborns with TL will develop AMKL. Preliminary evidence suggests that TL is a clonal proliferation, can be fatal, and may occur in a specific subgroup of DS children. The observations in this report are drawn from our own experience, reports in the literature, and data accumulated in the Canadian Down Syndrome Leukemia Registry.
Adolescent↗
Hydrops fetalis and neonatal leukemia in Down syndrome.
Four newborn infants with Down syndrome and manifestations of neonatal leukemia are described. One of the four was stillborn, two died shortly after birth, and a fourth survived and all evidence of leukemia disappeared in the first month of life. Three of the four cases had hydrops fetalis, and a fourth was a macerated stillborn. Nine other similar reported cases are reviewed. We conclude that neonatal leukemia in Down syndrome is a form of leukemia that is usually transient, with spontaneous recovery, but may be fatal at or around the time of birth with manifestations of hydrops fetalis, hepatosplenomegaly, and/or progressive liver disease.
Adult↗
Prostate cryoablation: update 1998.
Transrectal ultrasound-guided percutaneous transperineal prostate cryoablation has many attractive features both to the patient and to the urologist. The procedure typically can be done in a period of 2 hours or less on an outpatient basis with minimal blood loss and with the patient under regional or general anesthesia. With more experience in using the equipment and the techniques described, urologists can treat all stages of localized prostate cancer with relatively little morbidity. The results of this technique in the treatment of prostate cancer continue to appear promising. With follow-up of 5 years or more available in several series, cryoablation appears to be an effective modality for the eradication of localized prostate cancer, particularly low-volume cancer (PSA less than 10 ng/ml and Gleason score less than 7). Improved results, i.e., undetectable postcryoablation PSA levels and negative biopsies, may occur with modifications such as double freezing and pullback apical freezing. However, the complication rate also may increase with increased tissue destruction. To date, most complications reported have been relatively minor and require limited intervention. Notably, complications, especially incontinence, are significantly greater, in spite of successful eradication of residual tumor, in patients who undergo salvage cryoablation for recurrent disease after radiation therapy. In our experience, transrectal ultrasound-guided prostate cryoablation appears to be effective in controlling local prostate cancer in 81% of patients with minimal morbidity. As with radical prostatectomy and irradiation techniques, longer follow-up is required; however, at this time prostate cryosurgery can be considered in the following situations: as a primary treatment alternative to surgery or irradiation, as salvage treatment for recurrent cancer after irradiation, and for debulking of large symptomatic primary tumors. We look forward to the prospective randomized clinical trial comparing prostate cryoablation with external irradiation.
Cryosurgery↗
New directions in materials management ... dialog.
Today, the VHA stands as the country's largest hospital purchasing program, representing hospitals that purchase over $1.5 billion in supplies each year. But not all of that comes through VHA programs, and it is in the relationship between the individual institutions and the VHA system, that the group draws its strength and discovers its limitations. At once highly sophisticated and fiercely independent, the materials managers that make up the VHA program must weigh the significant opportunities inherent in the group's size and scope against the individual demands of their institutions. Mutual understanding leads to consensus and eventually to commitment and out of that process comes a number of highly innovative programs, such as standardization and single sourcing and the VHA Plus private label program, that are helping to make the VHA not simply the country's leading purchasing organization, but its most innovative as well--a true materials management system.
Hospitals↗
Role of materials managers broadens in provider/manufacturer relations. Business, sales knowledge--a must.
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Commerce↗
Alternative donor bone marrow transplantation for children with juvenile myelomonocytic leukemia.
The purpose of this study was to evaluate the outcome of children with juvenile myelomonocytic leukemia (JMML) treated with alternative donor bone marrow transplantation (BMT). Twelve consecutive patients with JMML confirmed by in vitro clonogenic assays underwent alternative donor BMT. Ten patients received pretransplant chemotherapy for one to seven cycles (cytosine arabinoside regimens). Eight underwent splenectomy before the transplant. Donors were unrelated for nine patients and partially matched related for three. Conditioning included total body irradiation for all but one patient. Graft-versus-host disease (GVHD) prophylaxis included in vitro partial T-lymphocyte depletion for five patients with cyclosporine arabinoside, and cyclosporine arabinoside and methotrexate for seven. Acute GVHD developed in all patients, and chronic GVHD developed in 7 of 11 evaluable patients. Relapses occurred in two patients, and two died of transplant-related causes. Eight patients remain in remission with a median follow-up of 31 months after the BMT. The event-free survival rate for this series is 64% (95% confidence interval, 27%-85%). The roles of pretransplant chemotherapy and splenectomy for leukemic reduction to prevent relapse, and the use of conditioning regimens with total body irradiation require study in a larger series of patients. GVHD may be beneficial in preventing relapses, which has been the major cause of treatment failure for these patients.
Adolescent↗