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Biomedical subjects

J M Richards

Publications and source records attributed to J M Richards.

At least 55 records · Page 3Linked to original sources
PubMed1990

Peripheral blood-derived stem cell collections for use in autologous transplantation after high dose chemotherapy: an alternative approach.

Peripheral blood-derived hematopoietic stem cells (PBHSC) can be utilized to reconstitute hematopoiesis in patients after high dose myeloablative chemotherapy. We have performed PBHSC reinfusion in 18 patients who have or had a history of tumor involving the bone marrow or a hypocellular bone marrow. The PBHSC were collected by continuous flow leukapheresis and subsequently cryopreserved. A median of 31.9 X 10(9) (range 18 X 10(9)-67.2 X 10(9)) mononuclear cells or a median of 4.85 X 10(8) mononuclear cells/kg (range 2.7 X 10(8)-11.0 X 10(8)) were collected. Fifteen patients had in vitro assays of granulocyte-monocyte colony-forming cells (CFU-GM) performed with a median of 2.7 X 10(4) (range 0-11.5 X 10(4)) CFU-GM/kg. To date, of the 18 patients collected, all have undergone high dose chemotherapy and PBHSC reinfusion. For the evaluable patients, granulocyte recovery (greater than 500 X 10(6)/ml) has occurred in a median of 15 days and platelet recovery (greater than 50 X 10(9)/ml without transfusion support) has occurred in a median of 43 days. Four patients have had prolonged thrombocytopenia and still require platelet transfusion at 80+, 97+, 124+, and 270+ days. PBHSC collection is safe and effective for hematopoietic reconstitution after high dose chemotherapy in the majority of patients; however incomplete hematopoietic reconstitution has been observed in 4/18 evaluable patients. This procedure requires further investigation.

Adult↗
PubMed1990

A randomized trial to improve self-management practices of adults with asthma.

The prevalence and impact of adult asthma are substantial, and poor self-management practices, especially failures to adhere to treatment regimens, appear to be a significant problem. Desirable characteristics of an intervention program to improve self-management were identified through needs assessment and review of existing patient education resources. A comprehensive program was developed that integrated a workbook with one-to-one counseling and adherence-enhancing strategies. A longitudinal 1-year study compared patients receiving this self-management program with "usual care" patients receiving standard asthma pamphlets. Patients were randomly assigned to conditions. Baseline score and asthma severity were statistically controlled. Self-management patients had substantially better adherence than usual care patients, as well as improved functional status, at follow-up. Hospital and emergency department visits decreased in both groups but did not differ between groups.

Adult↗
PubMed1989

Spectrometric and chromatographic methods for the analysis of polymeric explant materials.

Several analytical pyrolysis methods, namely pyrolysis mass spectrometry (Py-MS), time-resolved pyrolysis mass spectrometry (TRPy-MS), and pyrolysis short column gas chromatography mass spectrometry (Py-GC/MS) were used to analyze polymers of clinical interest both before and after implantation. A sample of Biomer, a poly(ether urethane urea) used in the Utah artificial heart, was analyzed using these methods. Two poly(ether urethanes) (Tecoflex and Pellethane) and a poly(dimethylsilicone) (Silastic) sample were analyzed using Py-GC/MS. The direct Py-MS of Biomer identified the components used in the manufacture of Biomer. Py-GC/MS of Biomer, Tecoflex, Pellethane, and Silastic also identified the components used in their manufacture. The analysis of explanted Biomer detected the presence of adsorbed cholestadiene, the reaction of chloride ions with a stabilizer, and the presence of a siloxane contaminant. The cholestadiene was detected on the outside housing of an artificial heart which had been implanted for 297 days. The cholestadiene was detected at low levels and was identified by library search on the MS data system. The siloxane contaminant was also identified by the MS data system. All of the methods demonstrated required only short instrumental analysis times (10 min or less). Data analysis required much more time, but much of the data analysis can be automated.

Biocompatible Materials↗
PubMed1989

Therapeutic uses of interleukin-2 and lymphokine-activated killer (LAK) cells.

Interleukin-2 (IL-2) is the first of a growing list of lymphokines to be cloned and available for preclinical and clinical evaluation. A product of T-helper lymphocytes, IL-2 augments the cytolytic activity of T-lymphocytes and natural killer (NK) cells, stimulates the proliferation of these cells, and induces the formation of lymphokine-activated killer (LAK) cells. LAK cells exhibit cytolytic activity against a broad range of both freshly isolated and cultured tumor cells, while exhibiting limited cytolytic activity against normal cells. The apparently large therapeutic index suggested by in vitro studies is strongly supported by the antitumor responses seen in preclinical studies. Initial clinical studies reported encouraging response rates, but the actual role of IL-2 and/or LAK cell infusion in cancer therapy has yet to be determined, and may only represent the first step in managing the tumoricidal potential of the immune system.

Humans↗
PubMed1989

Patient characteristics relevant to effective self-management: scales for assessing attitudes of adults toward asthma.

The Asthma Opinion Survey, a 33-item Likert-type instrument, was designed to measure attitudes relevant to self-management in adult outpatients. Items fall into eleven clusters; General Vulnerability, Specific Vulnerability, Attitudes Toward Patient Knowledge, Recognition of Airway Obstruction, Accessibility of Health Care, Panic-Fear, Belief in Treatment Efficacy, Staff-Patient Relationships, Sense of Control, Personal Impact, and Social Impact. Factor analysis of the clusters yielded three factors Vulnerability, Perceived Quality of Care, and Recognition and Control. The items, clusters, and factors all had adequate to good score spreads and internal consistencies. Asthma opinions covaried significantly with demographic characteristics, asthma severity, and intensity of health care utilization, and correlated with the Asthma Symptoms Checklist, an instrument developed at the National Jewish Hospital-National Asthma Center, in ways supporting construct validity. These results suggest the Asthma Opinion Survey is achieving its intended purpose.

Adult↗
PubMed1989

Assessing the use of metered dose inhalers by adults with asthma.

The development and analysis of an instrument to evaluate the use of metered dose inhalers by patients in the University of Alabama at Birmingham (UAB) Asthma Program is presented. A total of 238 adult asthma patients demonstrated use of the metered dose inhaler for this analysis. Patient skill in using the inhaler was recorded using the instrument, Inhaler-Use Checklist, developed at UAB. The study found that most patients use metered dose inhalers incorrectly, despite training received from their physicians on proper use of inhalers.

Adult↗
PubMed1988

Phase I study of weekly 24-hour infusions of recombinant human interleukin-2.

Sixteen patients with metastatic melanoma or metastatic renal cell carcinoma were treated with six weekly 24-hour infusions of recombinant interleukin-2. At least three patients were treated at each dose, beginning at 3.0 mU/m2 for 24 hours each week for 6 weeks. Subsequent patients were treated at 4.5, 6.0, 8.0, and 10.0 mU/m2 for 24 hours. The incidence of diarrhea, rigors, rash, edema, and symptomatic hypotension was positively correlated with dose level. Symptomatic hypotension was dose limiting at the 10-mU/m2 level. Fever, nausea, and vomiting were seen at each dose level and could not be correlated with dose level. Lymphopenia and eosinophilia were observed at the completion of each 24-hour infusion, and an increase in peripheral blood absolute lymphocytes and eosinophils was observed over the 6-week treatment period. No thrombocytopenia was observed. No change in delayed-type hypersensitivity (type IV) as determined by skin testing could be demonstrated at any dose level. Natural killer cell cytotoxicity of peripheral blood lymphocytes increased over the treatment period, but the increase was unrelated to dose level in the range studied. One minor response was documented in a patient with renal cell carcinoma.

Adult↗
PubMed1988

Some simple scales for use in asthma research.

Several reviewers have recently identified a need for systematic efforts to improve the quality of questionnaires and other measures used in asthma research. This article applies standard psychometric techniques to scales developed to help meet this need. These scales assess asthma symptoms, respiratory diseases, the extent to which asthma inconveniences patients, medication regimens, and medication side effects. Scale quality was assessed by using data from 262 adult asthma patients. The results in general support the usefulness of these scales. The reliabilities indicate an acceptable to good level of internal consistency; the spread of scores is good; and correlations with external variables support validity.

Adult↗
PubMed1987

Widespread Legionella pneumophila contamination of dental stations in a dental school without apparent human infection.

Following isolation of Legionella pneumophila from a special dental station water circuit, used primarily to cool high-speed dental drills which produce fine aerosols, a case finding and environmental survey was undertaken. Widespread colonization of the dental stations was found and the results suggested that amplification of the background levels of L. pneumophila was taking place within the stations. However there was no evidence for transmission causing human infection.

Antibodies, Bacterial↗
PubMed1987

Promoting self-management in adults with asthma: an overview of the UAB program.

Most asthma self-management programs have focused on children, but the prevalence and impact, both personal and economic, of adult asthma is substantial. Moreover, failure to adhere to treatment regimens appears to be a significant problem in adult asthma. It appears important, therefore, to develop asthma self-management programs for adults. The UAB program is based on the Health Belief Model for health behavior and on the PRECEDE Model for patient education. A needs assessment and a review of existing educational materials were used to specify the content of a self-care workbook. This workbook seeks to increase cognitive skills, encourage daily self-assessment of asthma, demonstrate success in asthma self-management, and promote effective social support. The overall intervention integrates this workbook with systematic reinforcement of self-monitoring and self-management. A prospective controlled study is comparing patients receiving this "special intervention" with "usual care" patients who receive only routinely available pamphlets providing information about asthma. Patients are randomly assigned to treatments by the closed envelope technique. Sample sizes were determined on the basis of statistical power. Outcomes in five areas are assessed: (1) health care utilization, (2) functional status, (3) knowledge, (4) adherence, and (5) psychological reactions.

Academic Medical Centers↗
PubMed1986

Retrieval and analysis of a clinical total artificial heart.

Examination by light microscopy, scanning electron microscopy (SEM), and x-ray microanalysis of a clinical total artificial heart (TAH) implanted for 112 days revealed no evidence of calcification, pannus, or vegetative thrombus. A macroscopic thrombus was seen along the suture line in the right atrium but did not obstruct blood flow or valve function. Microscopic thrombi (less than 0.1 mm) and evidence of microemboli were observed on the pumping diaphragm using SEM. Characterization of selected polyetherurethane (PEU) samples from the pumping bladders and housing by Curie-point pyrolysis mass spectrometry (Py-MS) revealed unexpected differences between postmortem retrieved ventricles. Although the origin of these differences could be traced back to batch-to-batch variations in the original PEU material (Biomer), the precise nature of the observed differences in chemical structure and/or composition is still unknown. Numerical comparison between pyrolysis mass spectra from PEU samples exposed to blood or tissue and unexposed samples from the same ventricles did not detect evidence of biodegradation. Continual improvements in fabrication and quality control should minimize surface imperfections and ensure polymer reproducibility; however, existing materials and design parameters appear to be adequate for continued clinical implantation.

Electron Probe Microanalysis↗
PubMed1986

Cardiorespiratory function in 16 full-term infants with sudden infant death syndrome.

Twenty-four-hour tape recordings of ECG and breathing movements from 16 term infants (greater than or equal to 37 weeks' gestation) who subsequently died of sudden infant death syndrome (SIDS) were compared with recordings from surviving infants from the same populations. Apneic pauses of varying durations, periodic and regular breathing patterns, heart and respiratory rates during regular breathing were measured. Only one of 16 full-term infants with SIDS had findings outside the range of age-matched control infants (an excess of periodic breathing patterns and an absence of regular breathing). When the first recordings of each of infants who died of SIDS, except one who had cyanotic episodes prior to death, were compared to recordings of survivors (six for each case) closely matched for age, gestation, and weight at birth, no differences in breathing patterns or heart or respiratory rates during regular breathing could be demonstrated. These particular measurements of cardiorespiratory function were, therefore, unable to identify the majority of full-term infants at risk for SIDS.

Apnea↗
PubMed1985

Notes on AIDS.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Pyrolysis mass spectrometry of complex organic materials.

Pyrolysis mass spectrometry in combination with computerized multivariate statistical analysis enables qualitative and quantitative analysis of nonvolatile organic materials containing molecular assemblies of a complexity and size far beyond the capabilities of direct mass spectrometry. The state of the art in pyrolysis mass spectrometry techniques is illustrated through specific applications, including structural determination and quality control of synthetic polymers, quantitative analysis of polymer mixtures, classification and structural characterization of fossil organic matter, and nonsupervised numerical extraction of component patterns from complex biological samples.

Biochemical Phenomena↗