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Biomedical subjects

J Price

Publications and source records attributed to J Price.

At least 73 records · Page 4Linked to original sources
PubMed2000

Validation and use of an instrument to measure the learning environment as perceived by medical students.

BACKGROUND: Aiming to inform curriculum changes in medical school, we developed, administered, and validated a 31-question survey to measure the learning environment as perceived by medical students. DESCRIPTION: We administered the survey annually in 4 medical school classes in a Southeastern medical school from May 1994 through May 1997 (N = 619). EVALUATION: The survey responses reflected 3 dimensions of the medical school learning environment: the teacher-learner relationship (T-L R), the physician-patient relationship (Phys-Pt R), and self-efficacy. We found that the 3 dimensions are equally valid and reliable for all students, but that the mean values on all 3 dimensions differed by year in school and number of survey responses. CONCLUSIONS: As students progress through school, they perceive deteriorating T-L Rs, feel diminishing self-efficacy, and accord less value to the Phys-Pt R. Based on these results, we developed training programs for faculty members to promote teaching attributes known to facilitate relationship formation between teacher and learner, and learner-centered and self-directed learning.

Attitude of Health Personnel↗
PubMed2000

E1A-mediated paclitaxel sensitization in HER-2/neu-overexpressing ovarian cancer SKOV3.ip1 through apoptosis involving the caspase-3 pathway.

HER-2/neu-overexpressing breast cancer cells are more resistant to the chemotherapeutic agent paclitaxel (Taxol) than low-HER-2/neu-expressing breast cancer cells, and the adenoviral type 5 EIA can down-regulate HER-2/neu overexpression. Therefore, in this study, we asked (a) whether EIA might sensitize response to paclitaxel in human HER-2/neu-overexpressing ovarian cancer cells, and, if so, what is the mechanism responsible; and (b) whether this enhanced chemosensitivity would translate into a therapeutic effect in an ovarian cancer xenograft model. Consequently, we demonstrated that: (a) adenovirus type 5 E1A could enhance the sensitivity of paclitaxel in paclitaxel-resistant HER-2/neu-overexpressing human ovarian cancer cells in vitro by inducing apoptosis, (b) this induction was heavily dependent on activation of the caspase-3 pathway, and (c) nude mice bearing i.p. HER-2/neu-overexpressing human ovarian cancer cells and treated with both paclitaxel and E1A gene therapy survived significantly longer than did mice treated only with paclitaxel or E1A gene therapy. Thus, we concluded that the E1A gene enhanced both the in vitro and in vivo sensitivity of paclitaxel in paclitaxel-resistant HER-2/ neu-overexpressing ovarian cancer SKOV3.ipl cells. Because a Phase I clinical trial using E1A gene targeted to HER-2/neu down-regulation has recently been completed, the current study also provided a scientific basis to further develop a novel therapy that combines paclitaxel and E1A gene therapy and its testing in a Phase II trial.

Adenovirus E1A Proteins↗
PubMed2000

Fibro-fatty nodules and low back pain. The back mouse masquerade.

BACKGROUND: Few useful interventions exist for patients with persistent low back pain. We suggest that a fibro-fatty nodule ("back mouse") may be an identifiable and treatable cause of this and other types of pain. METHODS: We describe 2 patients with painful nodules in the lower back and lateral iliac crest areas. In both cases, the signs and symptoms were unusual and presented at locations distant from the nodule. One patient complained of severe acute lower abdominal pain, and the other had been treated for chronic recurrent trochanteric bursitis for several years. RESULTS: In both patients, symptoms appeared to be relieved by multiple injection of the nodule. DISCUSSION: There is agreement that back mice exist. Referred pain from the nodules might explain the distant symptoms and signs in these cases. Multiple puncture may be an effective treatment because it lessens the tension of a fibro-fatty nodule. CONCLUSIONS: Randomized trials on this subject are needed. In the meantime, physicians should keep back mice in mind when presented with atypical and unaccountable symptoms in the lower abdomen, inguinal region, or legs.

Bursitis↗
PubMed1999

Changes in forebrain function from waking to REM sleep in depression: preliminary analyses of [18F]FDG PET studies.

Based on recent functional brain imaging studies of healthy human REM sleep, we hypothesized that alterations in REM sleep in mood disorder patients reflect a functional dysregulation within limbic and paralimbic forebrain structures during that sleep state. Six unipolar depressed subjects and eight healthy subjects underwent separate [18F]2-fluoro-2-deoxy-D-glucose ([18F]FDG) PET scans during waking and during their first REM period of sleep. Statistical parametric mapping contrasts were performed to detect changes in relative regional cerebral glucose metabolism (rCMRglu) from waking to REM sleep in each group as well as interactions in patterns of change between groups. Clinical and EEG sleep comparisons from an undisturbed night of sleep were also performed. In contrast to healthy control subjects, depressed patients did not show increases in rCMRglu in anterior paralimbic structures in REM sleep compared to waking. Depressed subjects showed greater increases from waking to REM sleep in rCMRglu in the tectal area and a series of left hemispheric areas including sensorimotor cortex, inferior temporal cortex, uncal gyrus-amygdala, and subicular complex than did the control subjects. These observations indicate that changes in limbic and paralimbic function from waking to REM sleep differ significantly from normal in depressed patients.

Adult↗
PubMed1999

Prevalence and detection of serious psychiatric disorder in defendants attending court.

BACKGROUND: Diversion programmes in magistrates' courts are designed to provide immediate advice or access to mental-health treatment facilities for defendants when appropriate. The prevalence of serious psychiatric disorder and the proportion of defendants who might require transfer are unknown. We undertook a study to address these issues and to find out whether defendants with such disorders are reliably detected by court personnel and referred to psychiatric staff in court diversion programmes. METHODS: A two-phase screening method used questionnaires for psychiatric disorder (the general health questionnaire and psychotic screening questionnaire) and screening instruments for alcohol and substance misuse followed by standard psychiatric interview (schedules for clinical assessment in neuropsychiatry). The detection rate of defendants with serious psychiatric disorder by court staff was observed. FINDINGS: The frequency of serious psychiatric disorder was 1.31% (three of 229) among defendants appearing in court direct from the community and 6.57% (96 of 1460) among those held in custody overnight. Of the 99 defendants with serious psychiatric disorder, 34 had schizophrenia and other psychoses and 55 had depressive disorders. 42 (76%) of the 55 individuals with depressive disorders had suicidal ideas, which were recorded on the first-phase screening questionnaire in many cases. Only 14 of 96 defendants from overnight custody with serious psychiatric disorder were detected by court staff and referred to the court diversion programme. INTERPRETATION: There is a substantial rate of psychiatric disorder in the court population, which is not satisfactorily detected with the current system. Brief screening questionnaires and training of court staff are probably necessary for detection of people with serious psychiatric disorder passing through the courts.

Adult↗
PubMed1999

The problems of treating adolescent asthma: what are the alternatives to inhaled therapy?

The prevalence of asthma in children and adolescents continues to increase world-wide, with asthma remaining the most common chronic illness of childhood. Morbidity is high in the latter age group, indicating that many adolescents with asthma symptoms are not receiving appropriate treatment for their condition. Inadequate symptomatic control should alert the physician to the possibility of non-compliance, which is not limited to those patients with a poor understanding of their condition. Psychosocial problems, such as isolation and low self-esteem, are inherent in adolescents with asthma due, in part, to the highly visible nature of symptoms and the method of delivery of current inhaled therapy. Compliance with therapy in adolescents in particularly low if the dosing regimen is more than twice daily, with poor inhaler technique contributing to ineffective control. Failure to take asthma medication can result in asthma exacerbations and increased disease severity, with the resultant need for powerful medication and hospitalization (incurring substantial patient and healthcare costs). Although better management techniques, such as tailoring medication and individualizing treatment regimens may improve compliance in this group, there is an obvious need for alternative treatment options. An effective and well tolerated oral tablet therapy, with a simple unobtrusive regimen, would provide a potential solution to the high level of non-compliance seen in this age group. The leukotriene receptor antagonists offer a practical alternative amongst existing oral therapies, and their efficacy and simple oral dosing regimen may prove valuable in increasing compliance in adolescents.

Administration, Oral↗
PubMed1999

A sonic boom for gene delivery.

A new method for infecting embryos with retroviral vectors allows transgenes to be expressed with high efficiency during very early stages of neural development.

Animals↗
PubMed1999

Conservatism and defense style.

The dynamic theory of conservatism suggests that conservatism can be described as an ego-defensive behavior. Furthermore, the theory of defense style suggests that defensive behaviors are revealed in individuals' attitude structures. The present study was designed to examine the relationship between conservatism and defense style. Measures of conservatism, anal personality traits, and defense style were completed by 238 university students (103 men, 134 women, 1 unidentified). The measure of anal personality traits was included to replicate factors previously discovered with similar conservatism measures. A principal components analysis with oblimin rotation indicated that conservatism and anal personality traits loaded alongside mature defense style. The findings suggest that conservatism can be located within the theoretical model of defense style. However, it is suggested that the match between liberal attitudes and mature defense style be investigated in future research.

Adolescent↗
PubMed1999

Effects of an organized critical care service on outcomes and resource utilization: a cohort study.

OBJECTIVE: To determine whether the presence of an on-site, organized, supervised critical service improves care and decreases resource utilization. DESIGN: The study compared two patient cohorts admitted to a surgical intensive care unit during the same period of time. The study cohort was cared for by an on-site critical care team supervised by an intensivist. The control cohort was cared for by a team with patient care responsibilities in multiple sites supervised by a general surgeon. The main outcome measures were duration of stay, resource utilization, and complication rate. SETTING: Study patients were general surgical patients in an academic medical center. RESULTS: Despite having higher Acute Physiology and Chronic Health Evaluation II scores, patients cared for by the critical care service spent less time in the surgical intensive care unit, used fewer resources, had fewer complications and had lower total hospital charges. The difference between the two cohorts was most evident in patients with the worst APACHE II score. CONCLUSIONS: Critical care interventions are expensive and have a narrow safety margin. It is essential to develop structured and validated approaches to study the delivery of this resource. In this study, the critical care service model performed favorably both in terms of quality and cost.

APACHE↗
PubMed1999

Evaluation of clinical practice guidelines on outcome of infection in patients in the surgical intensive care unit.

OBJECTIVE: In this study, clinical practice guidelines were developed by a multidisciplinary team for patients with infections admitted to a surgical intensive care unit (ICU). DESIGN: A 51-day baseline audit period (Phase I) in a 20-bed (private rooms) surgical ICU was compared with a 34-day period in the same unit after implementation of the guidelines (Phase II). PATIENTS: Phase I included 182 patients (670 patient days), and Phase II included 139 patients (427 patient days). RESULTS: There was no significant difference between patients in the Phase I and Phase II groups regarding age (65.4/19-95 vs. 64.8/18-90 yrs), gender (56% male vs. 55% male), severity of illness (mean Acute Physiology and Chronic Health Evaluation III, 38 vs. 39.1), total infections (respiratory, 8% vs. 4%; urinary tract, 15% vs. 4%; wound, 4% vs. 3%; skin/soft tissue, 3% vs. 7%; sepsis, 5% vs. 3%; intra-abdominal, 9% vs. 17%), and no infection (64% vs. 67%). Clinical outcomes of patients with infections in the Phase I group compared with those in the Phase II group were as follows: clinical improvement or cure, 64% vs. 76%; persistent infection, 17% vs. 11%; clinical failure, 0 vs. 2%; and death, 18% vs. 7% (p = NS). When patients with infections were compared, death rates were 20% in the Phase I group and 5.6% in the Phase II group (p = .02). After implementation of the clinical pathways, antibiotic costs were reduced from $676.54 per patient to $157.88 per patient (p = .001). Length of stay in the ICU was 3.7 days in the Phase I trial and a mean of 3 days in the Phase II trial (p = NS). Specimens of Escherichia coli demonstrated a trend toward a decreased resistance to all antibiotics and Pseudomonas aeruginosa to ciprofloxacin and aminoglycosides (p = NS). CONCLUSIONS: In this study, the use of clinical practice guidelines for patients who were admitted to the surgical ICU was shown to reduce costs, without adversely affecting patients' outcomes. This study has important implications for the use of clinical practice guidelines for the management of patients with infections who are admitted to surgical ICUs.

Aged↗
PubMed1999

Patient recall and appropriate timing for obtaining informed consent for endoscopic procedures.

OBJECTIVES: Although informed consent is an issue in many medical malpractice claims, there is no standardized time or method to obtain informed consent for endoscopic procedures. The objectives of this study were to determine whether sedation for endoscopic procedures interfered with pre-endoscopic informed consent and to determine the appropriate time to obtain informed consent. METHODS: Patients undergoing a sedated esophagogastroduodenoscopy had informed consent obtained either 48-72 h before the procedure (group 1A, n = 50) or 10-60 min before the procedure (group 1B, n = 50). Patients undergoing an unsedated flexible sigmoidoscopy had informed consent obtained either 48-72 h before (group 2A, n = 47) or 10-60 min before the procedure (group 2B, n = 49). Methods of informed consent consisted of an oral and a written explanation about the procedure. Patients were sedated with midazolam and meperidine. A Trieger test evaluated recovery from sedation. Recall was assessed by asking six questions about the procedure before discharge and again 2-3 days later. RESULTS: Standard t tests and Mann-Whitney U nonparametric rank tests were used to compare the 1) 1-h recall scores, 2) 2-3-day recall scores, and 3) recall difference scores for groups 1A and 1B, 1A and 2A, 2A and 2B, and 1B and 2B. There were no differences in recall for the different groups. CONCLUSIONS: This study shows that sedation for endoscopic procedures does not interfere with pre-endoscopic informed consent. Informed consent for endoscopic procedures can be obtained at any time before sedation with similar recall.

Adult↗
PubMed1999

Strand displacement amplification and homogeneous real-time detection incorporated in a second-generation DNA probe system, BDProbeTecET.

BACKGROUND: Amplified DNA probes provide powerful tools for the detection of infectious diseases, cancer, and genetic diseases. Commercially available amplification systems suffer from low throughput and require decontamination schemes, significant hands-on time, and specially trained laboratory staff. Our objective was to develop a DNA probe system to overcome these limitations. METHODS: We developed a DNA probe system, the BDProbeTecTMET, based on simultaneous strand displacement amplification and real-time fluorescence detection. The system uses sealed microwells to minimize the release of amplicons to the environment. To avoid the need for specially trained labor, the system uses a simple workflow with predispensed reagent devices; a programmable, expandable-spacing pipettor; and the 96-microwell format. Amplification and detection time was 1 h, with potential throughput up to 564 patient results per shift. We tested 122 total patient specimens obtained from a family practice clinic with the BD ProbeTecET and the Abbott LCx(R) amplified system for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae. RESULTS: Based on reportable results, the BDProbeTecET results for both organisms were 100% sensitive and 100% specific relative to the LCx. CONCLUSIONS: The BDProbeTecET is an easy-to-use, high-throughput, closed amplification system for the detection of nucleic acid from C. trachomatis and N. gonorrhoeae and other organisms.

Chlamydia trachomatis↗
PubMed1998

Subdural haemorrhages in infants: population based study.

OBJECTIVES: To identify the incidence, clinical outcome, and associated factors of subdural haemorrhage in children under 2 years of age, and to determine how such cases were investigated and how many were due to child abuse. DESIGN: Population based case series. SETTING: South Wales and south west England. SUBJECTS: Children under 2 years of age who had a subdural haemorrhage. We excluded neonates who developed subdural haemorrhage during their stay on a neonatal unit and infants who developed a subdural haemorrhage after infection or neurosurgical intervention. MAIN OUTCOME MEASURES: Incidence and clinical outcome of subdural haemorrhage in infants, the number of cases caused by child abuse, the investigations such children received, and associated risk factors. RESULTS: Thirty three children (23 boys and 10 girls) were haemorrhage. The incidence was 12.8/100 000 children/year (95% confidence interval 5.4 to 20.2). Twenty eight cases (85%) were under 1 year of age. The incidence of subdural haemorrhage in children under 1 year of age was 21.0/100 000 children/year and was therefore higher than in the older children. The clinical outcome was poor: nine infants died and 15 had profound disability. Only 22 infants had the basic investigations of a full blood count, coagulation screen, computed tomography or magnetic resonance imaging, skeletal survey or bone scan, and ophthalmological examination. In retrospect, 27 cases (82%) were highly suggestive of abuse. CONCLUSION: Subdural haemorrhage is common in infancy and carries a poor prognosis; three quarters of such infants die or have profound disability. Most cases are due to child abuse, but in a few the cause is unknown. Some children with subdural haemorrhage do not undergo appropriate investigations. We believe the clinical investigation of such children should include a full multidisciplinary social assessment, an ophthalmic examination, a skeletal survey supplemented with a bone scan or a skeletal survey repeated at around 10 days, a coagulation screen, and computed tomography or magentic resonance imaging. Previous physical abuse in an infant is a significant risk factor for subdural haemorrhage and must be taken seriously by child protection agencies.

Child Abuse↗
PubMed1998

A study of the potential of the embryonic rat telencephalon to generate oligodendrocytes.

A major question in neural development is whether each part of the telencephalon has an equal potential to generate each cell type. In this study, we address this question specifically in regard to the generation of oligodendrocytes. We cultured precursor cells from two different regions of the rat embryonic telencephalon--the ganglionic eminence that the anlage of the cerebral cortex--from different stages of development, and labeled the cells with a retroviral vector to follow their fate. We discovered that multipotential precursor cells from E13 ganglionic eminence have several orders of magnitude higher capacity to generate oligodendrocyte than the equivalent cells from E13 cerebral cortex. This failure of cortical precursor cells to generate oligodendrocytes at early development stages (E12-E13) could not be reversed by growth factors, permissive growth media, or a permissive striatal cell environment. A combination of striatal contact and plus specific growth factors, however, did induce the production of oligodendrocytes. We conclude that telencephalic precursor cells do not have the potential to generate oligodendrocytes, but that this potential is significantly greater in striatal than cortical multipotential precursor cells.

Animals↗