Search PubMed⌕ Search

Biomedical subjects

J S Harris

Publications and source records attributed to J S Harris.

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

Biomedical ethics and the role of the nurse: a case study and discussion.

Ethical issues are becoming of increasing concern to dermatology nurses as they struggle to maintain their role as patient advocate in the midst of cost constraints in the health care system. A case study is presented of one such dilemma. Suggestions are given for keeping nursing principles and advocacy at the forefront of patient care.

Adult↗
PubMed1997

Development, use, and evaluation of clinical practice guidelines.

The development and use of practice guidelines, if framed as recommendations for best practices in the prevention, diagnosis, treatment, and management of occupationally related health concerns and disability, can improve the quality of occupational medical practice and worker health and well being. Adherence to guidelines should improve the efficiency and effectiveness of prevention, care, and disability management by reducing the present wide variance in practices and then by moving the mean or median of process and outcome statistics toward recommended levels. The information developed for guidelines can also be used for patient discussion and expectation management. Practicing in evidence-based, agreed-upon ways should also make occupational medical practices more defensible. Guidelines should be explicit, be based on a review of the available evidence and benefits vs risks, have clear medical logic, link findings to diagnosis to treatment ot prevention, be time-based, and avoid recommending unproven approaches as a last resort. If possible, they should be reviewed and tested for usability. Guidelines that start with common occupational health concerns are best suited to prevention and outpatient care, because patients present in this way. The contents of a useful occupational health guideline would include a statement of purpose and scope, the method of development; the authors' and reviewers names and affiliations; an analysis of the specificity, sensitivity, and predictive power of mechanisms of illness or injury, symptoms, signs and tests; findings that point to a serious or emergent condition requiring immediate referral or treatment; diagnostic criteria; and initial treatment, including work with the patient in a therapeutic partnership. The guideline should also present information on factors known to be associated with work, and predictors of delayed recovery. Disability-duration statistics and methods of matching job requirements with worker abilities are also helpful. Guidelines should then outline reassessment of those patients whose health concerns remain after a reasonable recovery period. The recommendations should again be evidence-based and conform to the other attributes listed above. A discussion of management after reassessment, including behavioral referral, further testing, and procedures, is also quite useful. Recommendations for restoration of function and return to work complete guidelines focused on diagnosing, treating, and resolving activity limitations among workers. Simply developing and publishing guidelines has not resulted in improvement in practice. However, if used as the basis for peer-group interactions and actions by occupational health opinion leaders, guidelines can contribute to marked improvements in quality, worker satisfaction, and worker health.

Cost-Benefit Analysis↗
PubMed1995

Kinetics and inhibition of lipid exchange catalyzed by plasma cholesteryl ester transfer protein (lipid transfer protein).

The cholesteryl ester transfer protein-catalyzed cholesteryl ester transfer is inhibited by two compounds identified by a large-scale screening of cholesterol backbone-containing molecules. Kinetic analysis shows that U-95,594, an amino steroid, inhibits competitively the cholesteryl ester transfer protein-catalyzed transfer of both cholesteryl esters and triglycerides, as well from high-density lipoproteins as from synthetic microemulsions. In contrast, U-617, an organomercurial derivative of cholesterol, inhibits competitively the transfer of cholesteryl ester from either donor but is without any effect on triglyceride transfer. In addition to the rapid, competitive inhibition of cholesteryl ester transfer, U-617 also slowly and reversibly reacts with cholesteryl ester transfer protein to produce an additional 10-fold decrease in cholesteryl ester transfer activity but, again, without effect on triglyceride transfer.

Animals↗
PubMed1995

Method for measuring the activities of cholesteryl ester transfer protein (lipid transfer protein).

A continuous recording fluorescence assay was developed for cholesteryl ester transfer protein (CETP). The assay measures the increase in fluorescence accompanying the relocation of fluorescent lipids, cholesteryl esters and triglycerides, from a donor emulsion to an acceptor emulsion. In the absence of CETP, the quantum yields of the fluorescent lipids is low because their high concentrations in the donor emulsions result in self-quenching. CETP catalyzes the redistribution of the fluorescent lipids from the donor to the acceptor emulsions and fluorescence increases substantially. Efficient sonication and incorporation of apolipoproteins from human HDL into the emulsions significantly increased the transfer rates. Under optimal conditions, the redistribution of fluorescent compounds reaches equilibrium within < 30 min and the kinetics of this process are consistent with a simple, first-order reaction pathway. The redistribution kinetics support a mechanism of adsorption --> exchange --> desorption --> diffusion.

Boron Compounds↗
PubMed1995

Reversal of multidrug resistance phenotype by surfactants: relationship to membrane lipid fluidity.

Previous studies have suggested that multidrug resistance (MDR) reversal by polyoxyethylene surfactants involves alterations in plasma membrane lipid physical state of resistant cells as one of the possible mechanism(s). To date, however, a detailed and critical examination of the relationship between membrane lipid fluidity and MDR reversal by these surfactants has not been performed. In the present studies, therefore, a series of experiments were conducted to critically examine the role of membrane lipid physical state in MDR reversal by employing a unique class of clinically important nontoxic lipophilic surfactants and the KB-8-5-11 drug-resistant cell line. MDR reversal was assessed by rhodamine-123 uptake. The effect of surfactants on plasma membrane lipid fluidity of these cells was assessed utilizing a fluorescence polarization technique with fluorophores DPH, TMA. DPH, 2-AS, and 12-AS. Our studies demonstrated that: (i) in vitro addition of active MDR-reversing surfactants (Solutol HS-15, Tween 40, and Cremophor EL, 10 micrograms/ml each) decreased lipid fluidity of isolated crude plasma membranes of resistant cells; (ii) the inactive surfactants (octylglucoside, hecameg) failed to influence membrane lipid fluidity; (iii) cells grown in the presence of active surfactants also exhibited a decreased plasma membrane lipid fluidity as measured with intact cells utilizing the probe TMA.DPH; and (iv) active surfactants did not influence lifetimes of the excited state of the fluorophores. These findings demonstrate that decrease of the plasma membrane lipid fluidity of KB 8-5-11 resistant cells may be one of the important mechanism(s) of MDR reversal by polyoxyethylene surfactants.

Cell Line↗
PubMed1995

Evidence for transbilayer, tail-to-tail cholesterol dimers in dipalmitoylglycerophosphocholine liposomes.

The behavior of multilamellar liposomes of 2,3-dipalmitoyl-sn-glycero-1-phosphocholine (DPPC) was studied by differential scanning calorimetry (DSC) in the presence of < or = 5 mol % of the amphiphilic solutes methyl oleate, cholesterol, pregnenolone, and dehydroandrosterone. The DSC thermograms indicate that the solutes are miscible only with the liquid-disordered (Id) phase, and not with the solid-ordered (so) phase. The slopes of the Tm vs solute concentration curves confirm this conclusion: It appears that the so-1d phase transition of DPPC, which corresponds to the melting of the phospholipid chains, can be treated as a simple melting process and, thus, could be used as a cryoscopic system. In that case, its melting point depression constant, Kf, can be calculated a priori from the experimentally measured heat of fusion per gram of DPPC, lf, and the temperature of the phase transition of pure DPPC, T(o), by the equation Kf = RTo2/(1000lf) = 12.3 +/- 0.9 K g M-1 cm3. With methyl oleate as the solute, the Tm vs methyl oleate concentration plot is linear, and from the slope we calculate Kf = 12.9 +/- 0.8 K g M-1 cm3. Thus, methyl oleate appears to form an ideal cryoscopic system with dipalmitoyllecithin liposomes: It is fully miscible with the 1d phase but is apparently insoluble in the s(o) phase. Pregnenolone and dehydroandrosterone also form ideal cryoscopic systems with dipalmitoyllecithin liposomes: The Tm vs solute concentration plots are linear and yield the correct MWs for these solutes.(ABSTRACT TRUNCATED AT 250 WORDS)

1,2-Dipalmitoylphosphatidylcholine↗
PubMed1995

Photopheresis and the role of the nurse.

Extracorporeal photochemotherapy (ECP, photopheresis) is a form of pheresis therapy approved by the federal Food and Drug Administration for treating the systemic manifestations of cutaneous T-cell lymphoma. Increasing evidence suggests that it may also be useful in treating many immune-related diseases, as well as in preventing and treating organ transplant rejection. Because the precise mechanism of action for photopheresis has not been clearly defined, research to determine future applications for this treatment is needed. It is important for dermatology nurses to understand photopheresis, to whom it is given, the nursing care for patients receiving photopheresis, and the current research and potential applications of this therapy.

Decision Trees↗
PubMed1994

Cutaneous T-cell lymphoma: a case study, treatment, and nursing implications.

In this case study, the course and treatment of fatal cutaneous T-cell lymphoma (CTCL) in an adult male is presented. Following diagnosis, the patient received multiple therapeutic regimens, including extracorporeal photochemotherapy, also known as photopheresis. The different treatments for CTCL are described. Photopheresis is useful in the care of CTCL patients, and nurses will play a large part in their care.

Algorithms↗
PubMed1992

Cerebral metabolic responses and vasopressin and oxytocin secretions during progressive water deprivation in rats.

Progressive water deprivation increased plasma osmolality, plasma Na+ concentration, and hematocrit in proportion to the severity of dehydration. With increases of 2% in plasma osmolality (24 h dehydration), glucose utilization increased in the supraoptic nuclei and tended to increase in the neural lobe. With further dehydration, glucose utilization also increased in the paraventricular nuclei. These increases were paralleled by depletion of vasopressin and oxytocin contents in the neural lobe and by the enhanced secretion of both hormones into plasma, with a predominant increase of vasopressin. These changes were proportional to the degree of dehydration. With progression of dehydration, decreases in intracellular and extracellular volumes accentuate. Reductions in extracellular volume result in increased angiotensin II (ANG II) formation. Accordingly, glucose utilization in the subfornical organ (SFO), a primary site of ANG II action, increased after 48 and 72 h of dehydration. The median preoptic nucleus, which receives direct inputs from the SFO, also increased glucose utilization at these times. Glucose utilization also increased in the organum vasculosum laminae terminalis, probably in response to the converging inputs from osmoreceptors, volume receptors, and ANG II receptors. Decreases in glucose utilization were observed in the caudal and rostral ventrolateral medulla, perhaps as compensatory responses to decreased extracellular volume to prevent fall in arterial blood pressure.

Animals↗
PubMed1992

The drug research process.

The Department of Dermatology at the Washington Hospital Center conducts research on drugs and products for various drug companies prior to their approval by the Food and Drug Administration. The purpose of this article is to describe this interesting and rewarding process which can give dermatology nurses the opportunity to assist patients who might not have found effective or affordable treatment for their condition.

Clinical Trials as Topic↗
PubMed1992

Allocation of cadaver kidneys.

Nurses who work in renal transplantation often express frustration related to what they see as inequities in the distribution system of scarce and valuable resources. Specific guidelines, however, are used to determine the allocation of these resources. This article will discuss some of the methods used to determine who receives cadaveric kidneys. The knowledge regarding how these resources are allocated should provide the nurse with a greater sense of control and lead to less job frustration.

Humans↗
PubMed1991

Methods of data analysis in the emergency medicine literature.

The authors hypothesized that data analysis in the current emergency medicine literature uses relatively few methods and sought to determine the frequency distributions of each method of analysis. The authors defined their population as original contributions in three refereed emergency medicine journals from September, 1985 through July, 1989. Letters to the editor, brief reports, reviews, and case reports were excluded. The authors reviewed 250 randomly selected articles and identified the method(s) of data analysis in each. The absolute frequency distribution of statistics were as follows: descriptive statistics only, 31%; contingency tables, 35% (chi 2, 28.4%; Fisher's exact test, 13.2%; McNemar's test, 0.4%); Student's t-test, 34%; ANOVA/ANCOVA, 12%; regression techniques, 8% (simple linear regression, 4.0%; multiple regression, 3.6%; logistic regression, 1.6%); nonparametric tests, 7% (Mann-Whitney, 2.8%; Wilcoxon, 2.4%; Dunnett, 0.8%; Kolmogorv-Smirnov, 0.4%; Kruskal-Wallis, 0.4%); multiple comparisons, 6% (Scheffé, 4.4%; Newman-Keuls, 2.0%); correlation techniques, 4% (Pearson product-moment correlation coefficient, 2.8%; Kendall's tau, 0.8%; Spearman's rho, 0.4%); confidence intervals, 2%. Correction techniques were used in 9% (Dunn-Bonnferoni, 4.8%; Yates correction, 4.4%). No statistics were found in 2% of the articles reviewed. Five statistical methods account for the vast majority (97% cumulative) of statistical uses in emergency medicine literature. This information should prove useful in deciding which tests should be emphasized in educating emergency physicians.

Curriculum↗
PubMed1991

Watching the numbers: basic data for health care management.

Resource utilization is a reasonable first tier measure of the value of health care services received by an employed population. It is generally inversely related to the overall quality of care. Newer time-based measures of efficiency and surveys of customer satisfaction will allow health care organizations to improve efficiency and effectiveness, thereby improving value and moderating cost increases.

Cost-Benefit Analysis↗
PubMed1991

A comprehensive approach to corporate health management.

The Northern Telecom Inc. Health, Safety and Environment program is an integrated, cross-functional approach to the management of health and health-related risks. We describe the key structural elements of the program and some preliminary data using survey and insurance claims data to follow changes in health-risk factors and diagnosis-specific costs during 5 years of operation of this comprehensive safety, industrial hygiene, primary care, disease prevention, and health promotion program. A pilot study demonstrated significant improvements in risk factors, health service use, and health-related costs. On a company-wide basis, there have been similar changes. We compare these results to published data and discuss possible reasons for the improvements in risks and costs. We conclude that a comprehensive information and skill-building program aimed at management as well as employees and dependents generates synergistic cost-beneficial change.

Cost-Benefit Analysis↗