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Biomedical subjects

J Herman

Publications and source records attributed to J Herman.

At least 37 records · Page 2Linked to original sources
PubMed1999

Sandimmune to Neoral conversion and value of abbreviated AUC monitoring in stable pediatric kidney transplant recipients.

Neoral is a new microemulsion formulation of cyclosporin A (CsA) that has been reported to have better absorption characteristics than sandimmune. We converted 25 long-term pediatric renal transplant recipients with a mean age of 14.1 yr and a mean follow-up period of 6.4 yr from sandimmune (SIM) to neoral (NEO) on a 1:1 basis. The mean dosage of SIM or NEO required to maintain 'therapeutic range' steady-state trough levels between 100 and 200 ng/mL was similar. We compared 6-h CsA pharmacokinetic profiles taken approximately 6 months after the conversion to NEO with the previous SIM profiles of the same patients. Generally, in the NEO profiles the time to reach the maximum concentration was shorter and the maximum concentration was higher, showing a rapid decline towards the trough-level when compared to the previous SIM profiles. During intake of NEO the AUC0-12 h in the 12-h profiles correlates strongly with the AUC0-6 h in the 6-h profiles (r = 0.98), a similar finding to that which we reported previously for SIM. The median AUC0-6 h for NEO demonstrates a 70% increase compared to the median AUC0-6 h for SIM. Despite the increased drug exposure NEO was well tolerated and did not cause any apparent toxicity within the first 6 months after conversion. The CsA blood level 2 h after intake of NEO showed a higher correlation with the AUC0-12 h (r = 0.91) than the trough level (r = 0.64). The abbreviated profile based on three early sampling points and calculated by AUCPRED = 335.9 + 1.1*(C1) + 1.1*(C2) + 5.4*(C4) correlated well with the full AUC (r2 = 0.98, p < 0.0001). Mean prediction error (+/- SD) was 0.16% (+/- 4.32), and in no patients did the calculated values fall outside the 10% prediction error limit. We therefore conclude that NEO exhibits a higher bioavailability in children compared to SIM without causing apparent toxicity. Monitoring of the C2 might be a better alternative for trough level monitoring in daily clinical practice. A strategy of three early sampling points (C1, C2 and C4) allows a reliable AUC0-12 h prediction and can reduce the length of observation, making it a useful and cost-effective tool in clinical practice.

Administration, Oral↗
PubMed1999

Practice standards: the need for a personal element.

With rare exceptions, guidelines for clinical practice lack a personal element that allows for physicians' varying goals and patients' differing preferences. The importance of this element is illustrated by means of four examples: 1, hormone replacement therapy for the menopause; 2, early detection of breast cancer; 3, the treatment of acute streptococcal pharyngitis and 4, the diagnosis of symptoms that do not implicate any specific organ system. The advantages and disadvantages of guidelines are pointed out. Among the advantages are their usefulness as standards for audit and the fact that, in the process of reaching consensus, personal experience is taken into consideration. Chief among the disadvantages is their possible misuse by people outside of the profession. It is concluded that guidelines can be improved if their recommendations consider individual goals and preferences. They can become more influential if attention is paid to their proper dissemination.

Breast Neoplasms↗
PubMed1999

Collaborative practice agreements for advanced practice nurses: what you should know.

Advanced practice nurses (APNs) seeking employment are often presented with employment practice agreements. A collaborative practice agreement is a written statement that defines the joint practice of a physician and an APN in a collaborative and complementary working relationship. It provides a mechanism for the legal protection of the APN and sets out the rights and responsibilities of each party involved. All APNs, regardless of practice setting, should be knowledgeable about aspects of a collaborative practice agreement before they sign one. The purposes of this article are to delineate basic guidelines for evaluating and developing a collaborative practice agreement and to identify areas of special concern for APNs.

Cooperative Behavior↗
PubMed1999

[Endoscopic mobilization of the proximal portion of the great saphenous vein].

The authors describe a mini-invasive procedure in surgery of varicosities of the lower extremities. The objective is to reduce surgical trauma and improve the resulting cosmetic effect after extirpation of the great saphenous vein. The method was used in 9 patients of 35 operated between September and December 1998. The initial experience with endoscopic dissection of the proximal portion of the saphenous vein is favourable. The tissue traumatization is smaller, haematoma of the thigh is less common.

Adult↗
PubMed1999

Miniinvasive approaches in varicose vein surgery.

Authors present their own experience with the treatment of chronic venous insufficiency. Between August 1995 and November 1998 they operated on 318 patients for the disease of venous system. In 28 patients (i.e. 9%) they performed 30 miniinvasive interventions--8x retroperitoneoscopic lumbar sympathectomy and 22x endoscopic subfascial dissection of vein perforators. The rest of patients (91%) were treated by means of classical operations on superficial venous system.

Adult↗
PubMed1998

The good old days.

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Attitude of Health Personnel↗
PubMed1998

Equanimity upset

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Journal Article↗
PubMed1998

Mechanisms of inactivation of E-cadherin in breast cancer cell lines.

Loss of E-cadherin (CDH1) function is thought to contribute to progression in breast cancer and other solid tumors by increasing proliferation, invasion, and/or metastasis. In some cases, the restoration of CDH1 function may be an important therapeutic option. This possibility will depend on the mechanism by which CDH1 is inactivated. Here we present analyses of CDH1 expression, genetic mutation, and promoter methylation in CDH1 in 10 commonly used breast cancer cell lines. Five cell lines (BT-474, MCF-7, MDA-MB-361, MDA-MB-468, and T-47D) expressed CDH1 and were genetically normal. Five others (SK-BR-3, 600 MPE, MDA-MB-134 IV, CAMA1, and MDA-MB-435) did not express CDH1. Fluorescence in situ hybridization analyses of each of these cell lines showed evidence for the physical deletion of one allele of CDH1, and three cell lines were found to carry homozygous deletions. SK-BR-3 was deleted from exon 12 through the promoter; exon 6 was deleted in MDA-MB-134 IV cells, and 600 MPE cells carried a 21-bp deletion in the splicing acceptor site for exon 9. CAMA1 seemed to have been inactivated through promoter methylation. No explanation was found for the inactivation of CDH1 in MDA-MB-435.

Alleles↗
PubMed1998

Documenting acute care nurse practitioner practice characteristics.

Acute care nurse practitioners are functioning in a health care system that is changing rapidly. Simultaneously, the ACNP role is evolving. It is imperative that ACNPs document practice characteristics to communicate effectively within the health care system. The purpose of this article is to describe the process of documenting ACNP practice. Content includes rationale for documenting ACNP practice characteristics, a description of types and sources of data to collect, a discussion of barriers to documentation, and a format for a documentation tool.

Acute Disease↗
PubMed1998

Shortcomings of the randomized controlled trial: a view from the boondocks.

The randomized controlled trial (RCT), despite its well-known limitations, continues to be regarded as a gold standard in determining whether an intervention does more harm than good. Some recent evidence suggests that it tends to overvalue the modalities it tests. Moreover, the accuracy with which the disorder under consideration is diagnosed can be critical to the performance of a new intervention designed for it. When technological progress allows us to diagnose milder instances, some therapies, possibly useful in dire circumstances, will appear ineffective if most of a trial population is at low risk. Human individuality makes it impossible to duplicate a RCT. As a result, Popper's criterion of falsifiability may not be met and so the carrying out of a large-scale therapeutic experiment may not be a scientific activity. Finally, it is doubtful whether group probabilities derived from RCTs can be safely applied to individuals. These and other reservations concerning the applicability of the RCT to clinical practice are discussed.

Evidence-Based Medicine↗
PubMed1998

[The changing clinical picture of gastroduodenal ulcer disease].

OBJECTIVE: The authors evaluate the changing clinical picture of gastroduodenal ulceration in recent years. METHOD: They analysed their own clinical material from January 1994 till April 1998 when at the Second Surgical Clinic in Olomouc 188 patients were hospitalised on account of gastroduodenal ulceration. RESULTS: The group of patients comprised a high proportion of patients above 60 years of age (102, i.e. 55%) and twice as many cases of duodenal ulcers as compared with gastric ones. In 4% ulcers were present at both sites. In 92% (173 patients) acute admissions were involved and only in 8% (15 patients a planned admission for elective treatment was involved. As to complications haemorrhage was most frequent (84%), perforations in 13% and pylorostenosis in 3%. Of the acute admissions 56 patients were operated, i.e. 32%, the rest were treated by conservative methods. The surgical lethality was 12%, the lethality of the conservatively treated patients 5%. CONCLUSION: Gastroduodenal ulceration is at present characterised by a predominance of conservative treatment, a decline of elective operations, a high percentage of complications in particular in advanced age, more frequent affection of the duodenum and late indication for surgery, when conservative treatment is not very successful.

Adolescent↗
PubMed1998

[Chronic venous insufficiency--a mini-invasive therapeutic approach].

The authors describe their own experience assembled with treatment of chronic venous insufficiency. During the period from VII/95 to III/98 they operated 257 patients with diseases of the venous system. In 22 patients (8%) they operated 24 times by miniinvasive procedures. Eight times retroperitoneoscopic lumbar sympathectomy and sixteen times endoscopic subfascial dissection of the perforators was performed. The remaining patients (92%) were treated by classical operations of the superficial venous system.

Adult↗
PubMed1997

Medicine and evolution: time for a new paradigm?

The theory of Evolution is being invoked frequently in medicine to account for counter-intuitive findings such as programmed cell death in congestive heart failure and the fact that fever can prove both blessing or curse, depending on the circumstances. These and other examples of what might be called maladaptive adaptations are discussed, and it is suggested that human development may have reached a stage where the roles of mutation and selection are drastically changed. By creating an environment both mutagenic and protective, we have altered the balance between the two great driving forces of evolution, increasing the frequency of mutations and reducing the need for adaptation. As a result, new diseases have arisen and the whole evolutionary process seems to have lost some of its benevolence, no longer insuring the survival of the fittest. We must entertain the possibility that Darwin's theory cannot explain the last few millennia of human evolution and is now useful chiefly as an approximation applicable to very long periods of time.

Animals↗