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Biomedical subjects

J F Murray

Publications and source records attributed to J F Murray.

At least 55 records · Page 3Linked to original sources
PubMed1995

Radiographic abnormalities in tuberculosis and risk of coexisting human immunodeficiency virus infection. Results from Dar-es-Salaam, Tanzania, and scoring system.

First, we evaluated the age profile and chest radiographic abnormalities in 146 patients from Dar-es-Salaam, Tanzania, with new-onset intrathoracic tuberculosis (pulmonary, pleural, or hilar/mediastinal adenopathy), to identify features that were associated with human immunodeficiency virus (HIV) seropositivity or seronegativity; then, we combined these data with those from a companion investigation in Burundi to develop a simple scoring system to predict HIV serologic status. Using agreed-upon criteria and simplified reporting forms, initial chest radiographs were reviewed by three readers, first independently and then at a consensus conference. Of the 146 patients, 80 (55%) were HIV seropositive and 66 were seronegative. More seropositive than seronegative subjects were 31 to 40 yr old (p = 0.03). Because the radiographic characteristics of the two serologic groups were similar in Tanzania and Burundi, we combined the data for stepwise logistic regression that revealed four highly significant variables: age, small lesions, location, and lymphadenopathy. From these, we obtained an equation to calculate the probability that a given tuberculosis patients was HIV seropositive and then we derived a scoring system that in its simplest form (threshold) predicted serologic status correctly in 68.1% of patients; a graded scale was even more accurate in the high (89.1%) and low (82.6%) ranges. This scoring system should be useful when serologic testing is unavailable or refused.

AIDS-Related Opportunistic Infections↗
PubMed1995

Radiographic abnormalities in tuberculosis and risk of coexisting human immunodeficiency virus infection. Methods and preliminary results from Bujumbura, Burundi.

We evaluated the age profile and chest radiographic abnormalities in 158 patients from Bujumbura, Burundi, with new-onset intrathoracic tuberculosis (pulmonary, pleural, or hilar/mediastinal adenopathy), to identify features that were associated with and would allow prediction of HIV seropositivity or seronegativity. Using agreed-upon criteria and prepared reporting forms, initial chest radiographs were reviewed by three readers, first independently and then at a consensus conference. Of the 158 patients, 105 (66%) were HIV seropositive and 53 patients were seronegative. Seropositive subjects (mean age, 35.8 yr) were older (p = 0.001) than seronegative subjects (mean age, 29.4 yr). Significant or borderline differences between HIV-seropositive and -seronegative patients included the frequency of small nodular lesions (p = 0.03), upper lobe cavitation (p = 0.05), and lymphadenopathy (p = 0.12), and the location of parenchymal abnormalities (p = 0.0006). Stepwise logistic regression revealed four important variables: age, small lesions, location, and lymphadenopathy; these were then used to derive an equation to calculate the probability that a given tuberculosis patient was HIV seropositive. Our mathematical model fit the observed data and the equation predicted serologic findings reasonably well. We conclude that it is possible to determine with useful probability a Burundian tuberculosis patient's HIV serologic status.

AIDS-Related Opportunistic Infections↗
PubMed1995

Using comparative clinical and economic outcome information to profile physician performance.

This paper presents strategies and empirical examples of comparative physician profiling under conditions of limited patient sample sizes and varying patient severity. A method by which clinical and cost outcomes may be evaluated simultaneously is also presented. Physician economic and clinical performance are compared using data abstracted from nine hospitals into the MedisGroups clinical information management system for inpatients treated from July, 1990 through June, 1992. The main outcome measures are comparative total and ancillary adjusted charges, and morbidity status. Results suggest that objective comparative outcome data provide useful information to assist in evaluating physician performance. A simultaneous comparison of clinical outcomes and adjusted charges identifies physicians who experience favorable outcomes at lower charges, as well as those who have higher charges and/or poorer outcomes. Strategies outlined in this paper may be of value to clinicians, governing boards, and third party payors. These strategies may be used to assist with privileging and other peer review activities when pursued proactively within a Continuous Quality Improvement framework to improve care.

Ancillary Services, Hospital↗
PubMed1995

Using data from epidemiologic studies to revise probabilities.

Information about the relationship between risk factors and the probability of disease is often reported by an odds ratio, although its use for revising the probability of disease in a clinical setting is not intuitive and requires complex computations. A somewhat better approach is Bayesian probability revision. The authors present a method where likelihood ratios can be obtained from odds ratios, and they present simple computational methods for implementing all of the techniques described.

Epidemiologic Methods↗
PubMed1995

A glossary of medical decision-making terms.

Many of the terms used in medical decision making are foreign to clinicians. This problem creates a barrier that can prevent physicians from acquiring these new clinical tools. This glossary contains definitions of the most common terms as well as examples of their usage by using Down syndrome as the illustrative condition.

Decision Support Techniques↗
PubMed1995

Tuberculosis and HIV infection worldwide.

The incidence of HIV-associated tuberculosis is increasing worldwide and will continue to increase during the foreseeable future, especially in developing countries. HIV infection appears to increase the opportunity for M. tuberculosis to succeed in causing infection after inhalation into the lungs. Moreover, there is persuasive evidence that in the presence of HIV infection, new-onset tuberculous infection will progress rapidly to clinically significant disease and the likelihood that latent tuberculous infection will reactivate is enormously increased. The accelerating and amplifying influence of HIV infection is contributing to the increasing incidence of disease caused by multidrug-resistant strains of M. tuberculosis. Neither clinical or radiographic features reliably distinguish the majority of patients with HIV-associated tuberculosis from those who are non-HIV-infected. The remainder, however, may have atypical manifestations and be difficult to diagnose. Six months of chemotherapy with conventional antituberculosis drugs cures most patients, but many die during or after treatment of other AIDS-related complications.

AIDS-Related Opportunistic Infections↗
PubMed1994

Understanding patient-centered care in the context of total quality management and continuous quality improvement.

BACKGROUND: Implementing patient-centered care (PCC) requires a fundamental shift in thinking-from how to best provide a wide variety of independent services to how to effectively combine individual service components into an integrated health care experience that meets patient needs and preferences. DISCUSSION: PCC attempts to improve patient care by organizationally and physically moving selected service functions such as basic laboratory, pharmacy, admitting/discharge, medical records, housekeeping, and material support services to patient care areas, thus effecting an organizational restructuring. PCC creates teams composed of multiskilled or cross-trained individuals capable of providing more of the services directly on the patient care unit. Extensive redesign of the basic work processes as proposed by PCC advocates may result in significant changes in employee job scope, task responsibilities, professional autonomy, and reporting relationships. From the employee's perspective such changes may be neither warranted nor welcomed. Therefore, critical PCC implementation issues include obtaining employee buy-in and establishing appropriate incentive structures to facilitate the desired changes. How does PCC fit in with the popular improvement philosophies of total quality management (TQM) and continuous quality improvement (CQI)? Inherent within TQM and CQI is the belief that it is wiser to maximize efforts to design a product or process to be right the first time and to minimize resources devoted to inspection and repair caused by poor processes. PCC builds upon previous TQM/CQI health care efforts by focusing on ways to reduce the white space handoff problem by examining what, if any, changes in underlying structures and processes may be required. In the PCC hospital, TQM/CQI can function as intended, as a methodology for examining and improving the process of care and patient-care outcomes, regardless of internal departmental or profession-based organizational boundaries. CONCLUSION: For hospitals to remain competitive in today's rapidly changing environment, it is becoming necessary to reevaluate both how they are organized and how their work processes have been designed and controlled. The groundwork already laid by TQM/CQI initiatives will facilitate the more fundamental and long-lasting improvements derived from the redesign of the patient-care unit as prescribed by the goals of PCC.

Hospital Restructuring↗
PubMed1994

Subjective and employment outcome following secondary carpal tunnel surgery.

Forty-five patients (50 hands) who had undergone secondary carpal tunnel surgery participated in a telephone questionnaire survey. The mean follow-up time from the second carpal tunnel surgery was 31 months (range, 9-92 mo). Only 24 patients (53%) reported significant improvement in their symptoms. Thirty-nine patients were unemployed workers who had experienced an average time off work of 28.7 months (+/- 4) before their secondary carpal tunnel surgery. Eleven of the 39 previously unemployed workers (28%) returned to work after the secondary carpal tunnel surgery. Factors associated with poor subjective and employment outcome included worker's compensation case involvement (p < 0.003). Occupations associated with repetitive hand movements or vibrating tools were associated with poor employment outcomes (p < 0.006). Although secondary surgery for carpal tunnel syndrome can be effective in relieving symptoms, patients and surgeons must have realistic expectations of the procedure, especially with respect to long-term employment goals.

Adult↗
PubMed1994

The Rorschach and diagnosis of neurotic conditions in children and adolescents: a case study.

The diagnosis of neurotic disturbance in children and adolescents can be an exceedingly complex decision given the impact of developmental and situational factors on aspects of personality organization and personality style. The potential for rapid regression, rapid development, and incomplete structuralization of personality organization and style complicates our understanding of the meaning of particular symptoms or behavior. The Rorschach offers help in sorting through these issues because it can uniquely assess aspects of personality organization, personality style, and the impact of developmental or situational factors.

Adolescent↗
PubMed1994

Changes in progesterone secretion following treatment with transforming growth factor alpha (TGF-alpha) during the follicular phase of the sheep oestrous cycle.

The effects of transforming growth factor alpha (TGF-alpha) on ovarian steroid secretion were investigated. Three crossbred ewes synchronized for oestrus with ovarian autotransplants were infused with TGF-alpha (30 micrograms in 12 h) via the ovarian artery for 12 h before withdrawal of progestagen pessary. Three ewes were used as controls. Jugular and ovarian venous blood samples were taken at intervals of 10 min at two stages during the follicular phase (21-27 h and 38-42 h after pessary withdrawal) and every 2 h from 44 to 86 h. Plasma LH and FSH concentrations, and ovarian secretion rates of inhibin, androstenedione, oestradiol and progesterone were determined using radioimmunoassays. LH pulse amplitude increased in ewes treated with TGF-alpha in the early follicular phase (0.92 +/- 0.25 micrograms l-1 in controls versus 3.10 +/- 0.35 micrograms l-1 in TGF-alpha treated ewes; P < 0.05) and remained high in the late follicular phase. Plasma FSH concentrations were high during the follicular phase in ewes treated with TGF-alpha (P < 0.05). The infusion of TGF-alpha had no significant effect on the ovarian rate of secretion of androstenedione and, although the secretion rates of oestradiol and inhibin were consistently lower in TGF-alpha-infused ewes, the differences were not significant. The ratio of secretion of androstenedione to oestradiol was greater during the follicular phase in TGF-alpha-treated ewes (P < 0.05), suggesting that the efficiency of aromatization had been impaired.(ABSTRACT TRUNCATED AT 250 WORDS)

Androstenedione↗
PubMed1994

[Multiresistant tuberculosis].

Multiresistant tuberculosis has been recognized since the advent of triple-drug therapy with isoniazid, streptomycin and PAS in the fifties, but the recently observed strains of Mycobacterium tuberculosis resistant both to isoniazid and to rifampicin, the rapid spread of the infection and the development of severe disease in HIV infected patients have raised grave problems in controlling tuberculosis in the world. The disease is difficult and expansive to treat in industrialized countries and is incurable in many developing countries. The increased prevalence of resistant strains in southeast Asia or in Subsahara Africa is a real disaster as both the incidence of tuberculosis and of HIV infection is high. It is extremely difficult or even impossible to deal with such a disaster without new antituberculosis drugs and improved means of prevention. Only a few countries have maintained surveillance of resistant strains of tuberculous bacilli and we do not have any precise and reliable image of the importance of multiresistance in the world. It is nevertheless clear that in certain major urban areas such as New York City multiresistance has increased rapidly. In order to improve on this situation, or to prevent it, it is important to recognize that resistant tuberculosis is induced by man himself directly via insufficient quality control Two types of measures are required: 1. The clinician must prescribe a therapeutic regimen including at least two, and preferably three, drugs active against the infecting strain. 2. Patient compliance to both dose and frequency is mandatory.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS-Related Opportunistic Infections↗
PubMed1993

An evaluation of rapid exchange and simultaneous grip tests.

The usefulness of the rapid exchange grip test and a modification of this test, the rapid simultaneous grip test, in detecting submaximal grip efforts was evaluated. Uninjured subjects giving maximal or submaximal grip efforts were tested at grip rates of 80 and 100 repetitions per minute. Rapid exchange grip at 80 repetitions per minute yielded a sensitivity of 86% and a specificity of 97%. Rapid simultaneous grip at 80 repetitions per minute yielded a sensitivity of 81% and a specificity of 93%. Poorer sensitivities and specificities resulted when a clinical population of patients was tested. Patients who were not giving maximal efforts tended not to comply with the test protocol. The rapid exchange and rapid simultaneous grip tests do assist in detecting submaximal grip efforts; limits to these tests are emphasized.

Adolescent↗
PubMed1993

The rorschach search for the borderline Holy Grail: an examination of personality structure, personality style, and situation.

Much of the research on the use of the Rorschach to diagnose borderline disturbance has sought to discover a specific borderline pattern or Rorschach configuration. Given our increased understanding of borderline functioning representing a level of personality organization (or personality structure), this single pattern approach is excessively simplistic. It fails to consider the complex interaction between personality structure, personality style, and situational variables. An approach to the Rorschach assessment of borderline functioning is presented using a clinical example. The patient was tested at the onset of psychotherapy and then some 4 years into treatment. Results from the two testings were compared using Weiner and Exner's (1991) Rorschach variable clusters for assessing change in psychotherapy.

Journal Article↗
PubMed1993

Epidermal growth factor acts directly on the sheep ovary in vivo to inhibit oestradiol-17 beta and inhibin secretion and enhance progesterone secretion.

Epidermal growth factor (EGF) is a potential intra-ovarian modulator of gonadotroph action on differentiated follicular cells. Specific binding sites have been identified in the ovary and functional differentiation in cultured granulosa cells can be modulated by treatment with EGF. The aim of this study was to determine if EGF was capable of altering ovarian function in vivo during the follicular phase of the sheep oestrous cycle. Fourteen cross-bred ewes with ovarian autotransplants were treated with progestagen pessaries for 12 days. Three ewes were infused with murine EGF (mEGF) via the jugular vein (75 micrograms/kg bodyweight per 12 h) during the 12 h preceding progestagen pessary withdrawal, and received an injection of a prostaglandin analogue at 0 h to induce luteolysis. Over the same time-period, two doses of EGF were administered to other groups of ewes by infusion into the ovarian artery (low: 6 micrograms/12 h, n = 3 and high: 60 micrograms/12 h, n = 3). The remaining five ewes were not infused with EGF (controls). Jugular and ovarian venous blood samples were taken at 10-min intervals at two stages during the follicular phase (21-27 h and 38-42 h after pessary withdrawal) and every 2 h from 44 to 76 or 86 h. mEGF, LH, FSH, inhibin, androstenedione, oestradiol-17 beta and progesterone concentrations in plasma were determined using radioimmunoassays. The secretion rates of androstenedione, oestradiol, progesterone and inhibin by the ovary were calculated. EGF acted directly on the ovary in a dose-dependent manner. Oestradiol secretion was inhibited following treatment with EGF but androstenedione secretion was unaffected. EGF appears therefore to act within the granulosa cells to inhibit aromatization. Inhibin secretion was also suppressed by treatment with EGF, though it was not possible to determine if this was caused by a direct or indirect action of EGF on granulosa cells. The rate of progesterone secretion increased in ewes receiving systemic (i.e. via the jugular vein) and high-dose intra-arterial infusions of EGF, even though a preovulatory LH surge was not observed in these animals during the entire experimental period. Concomitant increases in both LH and FSH secretion were associated with these effects of EGF on ovarian function. In conclusion, EGF appears to act directly on the granulosa cells of the follicle to inhibit aromatization and also to inhibit inhibin production. The low levels of oestradiol and inhibin in the presence of high levels of gonadotrophin indicate that atresia may have been induced in medium to large antral follicles.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1993

Osteoid osteoma of the hamate: report of a case and review of the literature.

There are 7 reported patients with osteoid osteoma of the hamate. Only 1 of these has involved the hook of the hamate. This article reports the second patient with osteoid osteoma involving the hook of the hamate. The clinical features, the diagnostic problems, and the management of this lesion are reviewed.

Adult↗
PubMed1992

Pulmonary edema associated with salt water near-drowning: new insights.

In this case report we describe the clinical and laboratory findings of a man who nearly drowned after aspirating a large quantity of seawater. The aspiration of salt water, which is strongly hypertonic with respect to plasma, resulted in severe pulmonary edema, both from the quantity of aspirated seawater and the osmotically driven ultrafiltrate of plasma that accumulated in the air spaces. The initial concentration of protein in the edema fluid sample was very low, 0.7 g/dl, consistent with only a minimal increase in epithelial permeability. Approximately 4 h later, there was a marked increase in the concentration of protein in the residual alveolar fluid associated with improvement in several clinical indices, indicating that the excess alveolar fluid was reabsorbed very rapidly. In addition, the magnesium concentration was markedly elevated because of the aspiration of magnesium-containing seawater, which may have diagnostic importance for near-drowning in salt water. The data from this case provide evidence for well-preserved alveolar epithelial barrier function after aspiration of large quantities of hypertonic salt water.

Animals↗