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Biomedical subjects

J M Thompson

Publications and source records attributed to J M Thompson.

261 records · Page 15Linked to original sources
PubMedDate not supplied

Microwave hyperthermia in the treatment of spontaneous canine tumours: an analysis of treatment parameters and tumour response.

Fifty-one spontaneous canine tumours were treated with combined radiation and hyperthermia in a pilot study designed to investigate the feasibility and efficacy of the combined modality treatment in the dog. The tumours varied in site and histological type: 35 were in the oral cavity and included squamous cell carcinoma, melanoma and various 'sarcomas'. All animals received radiation (36-40 Gy in four weekly fractions) and post-irradiation hyperthermia (prescription -44 degrees C for 30 min) on one or two occasions. The microwave hyperthermia system was technically satisfactory in elevating tumour temperature to 44 degrees C or above in 95 per cent of treatments. However, thermal gradients of the order of 3-5 degrees C were frequently measured across the tumour, and rarely did all peripheral points achieve the target of 44 degrees C for 30 min. The overall tumour response rate (CR + PR) was 87.7 per cent with 60.7 per cent of tumours achieving complete regression. Smaller lesions showed a significantly greater response rate (P = 0.004) and those lesions which received two thermal treatments show an increased response (P = 0.0095). Fifty-one per cent of tumours showed significant necrosis following hyperthermia. Normal tissue necrosis was seen in three patients; in two cases this was attributed to hyperthermia. Local tumour control rate and necrosis was not correlated with measured minimum, mean or maximum thermal doses.

Animals↗
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Outcome evaluation and prediction in a comprehensive-integrated post-acute outpatient brain injury rehabilitation programme.

Outcomes for 29 individuals with brain injuries (BI) were examined following a comprehensive-integrated rehabilitation programme. From programme admission to completion, proportion living with no supervision increased from 59% to 93%; proportion in transitional or competitive work placements increased from 7% to 59%; unemployment decreased from 76% to 31%. Significant changes in behaviour and functional abilities and achievement of individual goals were also documented with the Portland Adaptability Inventory (PAI) and Goal Attainment Scaling. One year follow-up of 21 graduates indicated general maintenance of gains in independent living and work. At follow-up 86% were living without supervision; 48% were in competitive work; one in transitional work; and 29% unemployed. Although individuals entering treatment less than 1 year after injury showed greater gains than those injured more than 1 year prior to admission, both early and late intervention groups showed significant changes on outcome measures. More extensive disabilities as measured by the PAI had a negative impact on programme outcome. Except for reading ability, neuropsychological measures obtained prior to admission did not significantly predict outcome. Programme costs are reported. Results indicate that the group-oriented comprehensive-integrated approach to post-acute brain injury rehabilitation is effective and cost-effective, and recommend early intervention for optimal outcomes.

Activities of Daily Living↗
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Measurement of blood flow in the chick egg yolk sac membrane.

Blood vessels of the yolk sac membrane are the transport route by which a chick embryo obtains nutrients from the egg yolk. After 4 days of incubation at 37 degrees C a sparse network of blood vessels are visible within the membrane and they become denser over the following days. The preparation has been used to assess angiogenesis. Using visual inspection to assess the growth of new vessels towards pellets of test substances placed on the membrane surface, responses are judged negative or positive. Laser Doppler flowmetry has been used to investigate the potential of this technique to quantify blood flow through the yolk sac membrane. Measurements have been taken from capillary beds and single larger vessels over a range of temperatures and from avascular yolk and egg white using a Perimed PF3 with PF310 bent-tipped probe. Capillary beds exhibited vasomotion (about one cycle per minute) and oscillations of longer duration (about five cycles per hour). Cardiac pulses, strongly present in larger vessels (mean 90 pu, pulse 75 pu), were not easily identified in the capillary bed. Avascular yolk measurements gave flux values (due to Brownian motion of yolk proteins) which were greater than for capillary beds but without oscillations. Angiogenesis was stimulated by pellets containing 2 micrograms of basic fibroblast growth factor. There were significant increases in single vessel blood flow after 24 h compared with blank control pellets placed on the same egg.

Animals↗
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Changing dynamics in employer-sponsored health insurance. One market's perspective.

Using their sponsored health benefits as a mechanism for change, employers have been able to exert significant influence over the nation's health care system. By examining how employers design, purchase and manage these programs, much insight can be gained. Twenty-five mid- to large-sized companies in a Middle-Atlantic metropolitan area were interviewed during May-July 1998. The study was modeled after a similar effort conducted in 1991, the results of which were published in this journal in 1993. The study found that many of the dynamics in employer-sponsored health insurance are changing. The findings suggest that a more distanced relationship between employers and employees is the major factor underlying the evolution, an intentional change to force a shift in medical care decision-making and responsibility to more of a shared process between the employee and the employer. These trends have important implications for local markets relevance and the national situation.

Choice Behavior↗
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Association of market, mission, operational, and financial factors with hospitals' level of cash and security investments.

Using a resource dependency framework and financial theory, this study assessed the market, mission, operational, and financial factors associated with the level of cash and security investments in hospitals. We ranked hospitals in the study sample based on their cash and security investments as a percentage of total assets: hospitals in the high cash/security investment category were in the top 25th percentile of all hospitals; those in the low cash/security investment group were in the bottom 25th percentile. Findings indicate that high cash/security investment hospitals are under either public or private nonprofit ownership and have greater market share. They also serve more complex cases, offer more technology services, generate greater profits, incur a more stable patient revenue base, and maintain less debt.

Accounts Payable and Receivable↗
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Hospital marketing orientation and managed care processes: are they coordinated?

The hospital marketing function has been widely adopted as a way to learn about markets, attract sufficient resources, develop appropriate services, and communicate the availability of such goods to those who may be able to purchase such services. The structure, tasks, and effectiveness of the marketing function have been the subject of increased inquiry by researchers and practitioners alike. A specific understanding of hospital marketing in a growing managed care environment and the relationship between marketing and managed care processes in hospitals is a growing concern. Using Kotler and Clarke's framework for assessing marketing orientation, we examined the marketing orientation of hospitals in a single state at two points in time--1993 and 1999. Study findings show that the overall marketing orientation score decreased from 1993 to 1999 for the respondent hospitals. The five elements of the Kotler and Clarke definition of marketing orientation remained relatively stable, with slightly lower scores related to customer philosophy. In addition, we evaluated the degree to which selected managed care activities are carried out as part of its marketing function. A significant (p < .05) decrease in managed care processes coordinated with the formal marketing function was evident from 1993 to 1999. With increasing numbers of managed care plan enrollees, hospitals are likely focusing on organizational buyers as important customers. In order to appeal to organizational buyers, hospital executives may be focusing more on clinical quality and cost efficiency in the production of services, which will improve a hospital's position with organizational buyers.

Contract Services↗
PubMedDate not supplied

Gold therapy in rheumatoid arthritis. Interim report of the Canadian multicenter prospective trial comparing sodium aurothiomalate and auranofin.

One hundred and twelve patients with classical or definite rheumatoid arthritis (RA) were randomly assigned to receive either sodium aurothiomalate (GSTM) or auranofin (AF). Monthly clinical assessments (morning stiffness, grip strength, articular index, pain, quality of life) and concurrent hematological, biochemical, and urine studies were performed to monitor the efficacy/toxicity (E/T) ratio. Ninety-two patients have completed 3 months; 65, 6 months; 47, 9 months; and 30, 12 months. The groups were numerically balanced at each time period. Analysis of the 0-6 month period suggests that both drugs were equally and significantly beneficial after 3 months and that this was maintained at 6 months. Toxicity was as frequent in both groups but more serious in the GSTM group. The main side effects were gastrointestinal (diarrhea) in the AF group and mucocutaneous in the GSTM group. Half of the withdrawals (14 in each group) were because of side effects in the GSTM group and for inadequate therapeutic efficacy in the AF group. This study suggests that after 6 months of treatment the E/T ratio of AF is greater than or equal to that of GSTM. These conclusions will need to be confirmed during the ongoing longer observation period. A significant clinical difference between the 2 drugs is that in a given patient treated with GSTM, the onset of toxicity coincides with a good therapeutic effect. This relationship does not appear to exist during AF treatment.

Arthritis, Rheumatoid↗
PubMedDate not supplied

A randomised, double-blind study of cicaprost, an oral prostacyclin analogue, in the treatment of Raynaud's phenomenon secondary to systemic sclerosis.

Cicaprost is a new synthetic prostacylin analogue which is metabolically stable and bioavailable after oral administration; in previous studies it has been shown to have vasodilator antiplatelet effects. In this pilot study, we investigated the clinical efficacy of and patient tolerance to two dosage levels of cicaprost (2.5 micrograms tds and 5 micrograms tds) in the treatment of Raynaud's phenomenon secondary to systemic sclerosis (SSc). This was a three centre, double-blind, placebo controlled study of 49 patients carried out over four winter months. For a period of 10 days, 16 patients were given a placebo, 16 received cicaprost 2.5 micrograms tds and 17 received cicaprost 5 micrograms tds. Response was assessed based on the total number and duration of Raynaud's attacks, the average severity of the attacks, the number of painful attacks as a proportion of all attacks, a digital ulcer count, and the patients' opinion of the treatment. Although the clinical and laboratory parameters of digital vasospasm did not show statistically significant improvement in those who received cicaprost compared with those on the placebo, the severity of attacks lessened in the patients who received cicaprost 5 micrograms tds, and a statistically significant difference was seen in the average severity at week 2 post-treatment (p = 0.02). The apparent lack of overall significance was probably related to the short treatment period and relatively low doses of cicaprost used in this exploratory study. Longer studies with dose titration are probably needed to demonstrate the beneficial effects, if any, of cicaprost in patients with Raynaud's secondary to SSc, and these are being planned.

Administration, Oral↗