Search PubMed⌕ Search

Biomedical subjects

J Sayre

Publications and source records attributed to J Sayre.

At least 19 recordsLinked to original sources
PubMed1995

Dietary intake and counseling, weight maintenance, and the course of HIV infection.

OBJECTIVE: To define relationships among dietary intake and counseling, weight maintenance, and the clinical course of patients infected with the human immunodeficiency virus (HIV). DESIGN: A prospective cohort study in an HIV clinic in a county hospital. SUBJECTS: HIV-infected patients (68 with and 40 without acquired immunodeficiency syndrome [AIDS]) who had a good performance status and no chronic diarrhea were assessed at entry to the study and after 6 months. The following assessments were made: energy and nutrient intake based on 7-day food records, anthropometric measurements, immunologic function as lymphocyte T-cell subpopulations (ratio of CD4 to CD8), and serum cholesterol level. Patients were monitored to determine clinical outcome. INTERVENTION: All patients received standardized dietary counseling designed to address identified intake deficiencies and maintain body weight. MAIN OUTCOME MEASURES: Changes in energy and nutrient intake, body weight, and clinical outcome (ie, time to AIDS-defining illness and overall survival time). STATISTICAL ANALYSES PERFORMED: Group differences (HIV group vs AIDS group) were sought using chi 2 analyses and Student's t test. A multivariate regression model was used to determined the best predictors of clinical outcome. RESULTS: At baseline, total energy intake (based on 30 kcal/kg usual body weight) was adequate in both HIV and AIDS patients (101 +/- 4% and 103 +/- 5% [mean +/- standard deviation] of need, respectively). Despite dietary counseling and continued maintenance of energy intake, body weight, serum cholesterol level, and CD4 level progressively decreased. Consequently, saturated fat intake was found to be inversely related (P < .01) to serum cholesterol level. Clinical outcome (after 3.5 years) was associated with baseline ratio of CD4 to CD8 (P < .001), weight (P < .01), and serum cholesterol level (P < .001). Multivariate analysis related ratio of CD4 to CD8 (P < .001) and weight maintenance (P < .001) to favorable outcome in the final model. APPLICATIONS: Weight loss in patients with HIV infection is independently prognostic of clinical outcome, and development of hypocholesterolemia is not favorable for clinical outcome. Because weight loss progresses despite conventional dietary counseling to identify energy need, interventions earlier in the disease course should be considered along with increased target levels for energy intake.

Adult↗
PubMed1995

Vertebral size in elderly women with osteoporosis. Mechanical implications and relationship to fractures.

Reductions in bone density are a major determinant of vertebral fractures in the elderly population. However, women have a greater incidence of fractures than men, although their spinal bone densities are comparable. Recent observations indicate that women have 20-25% smaller vertebrae than men after accounting for differences in body size. To assess whether elderly women with vertebral fractures have smaller vertebrae than women who do not experience fractures, we reviewed 1,061 computed tomography bone density studies and gathered 32-matched pairs of elderly women, with reduced bone density, whose main difference was absence or presence of vertebral fractures. Detailed measurements of the dimensions of unfractured vertebrae and the moment arm of spinal musculature from T12 to L4 were calculated from computed tomography images in the 32 pairs of women matched for race, age, height, weight, and bone density. The cross-sectional area of unfractured vertebrae was 4.9-11.5% (10.5 +/- 1.4 vs 9.7 +/- 1.5 cm2; P < 0.0001) smaller and the moment arm of spinal musculature was 3.2-7.4% (56.4 +/- 5.1 vs 53.1 +/- 4.4 mm; P < 0.0001) shorter in women with fractures, implying that mechanical stress within intact vertebral bodies for equivalent loads is 5-17% greater in women with fractures compared to women without fractures. Such significant variations are very likely to contribute to vertebral fractures in osteoporotic women.

Aged↗
PubMed1995

Comparison of hard- and soft-copy digital chest images with different matrix sizes for managing coronary care unit patients.

OBJECTIVE: This study was to determine whether different digital display formats for portable chest radiographs of coronary care unit patients would provide comparable information for clinical care. In particular, we tried to ascertain whether 1024 x 1024 pixel (1K) images on a picture archiving and communication system (PACS) workstation would be comparable to 1760 x 2140 pixel (2K) images on workstations or to digital films. If comparability could be proved, we hypothesized that 1K workstations could considerably lower equipment and film costs and facilitate image transmission from point to point. MATERIALS AND METHODS: Four chest radiologists read a panel of chest studies assembled from 98 coronary care unit patients, comparing 1K and 2K soft-copy images with digital hard copies. For all three image types for the 98 patients, the readers evaluated nine image parameters that the cardiologists deemed essential for clinical decision making. Two other chest radiologists reviewed each patient's three image types, historical chest images, current and prior radiologic reports, and medical record to determine the consensus, or "truth findings." RESULTS: With one exception (small pleural effusions), the receiver operating characteristic analysis showed no significant differences in the clinical information derived from the three image types. CONCLUSION: For clinical management in a coronary care unit, comparable information can be obtained from digital radiologic chest studies using a 1K x 1K soft-copy format, a 2K x 2K soft-copy format, or a hard copy (film). Substantial savings in cost and time are therefore possible by using soft-copy images and lower resolution (1K x 1K) workstations and, when necessary, by transmitting images on regular telephone lines.

Coronary Care Units↗
PubMed1994

Evaluation of myocardial motion tracking with cine-phase contrast magnetic resonance imaging.

RATIONALE AND OBJECTIVES: The accuracy of myocardial motion measurements, computed from cine-phase contrast (cine-PC) magnetic resonance (MR) velocity data, was compared with directly visualized motion of MR signal voids caused by implanted tantalum markers in anesthetized dogs. METHODS: Magnetic resonance imaging (MRI) data were electrocardiogram-gated and divided into 16 phases per cardiac cycle. Myocardial trajectories as a function of time in the cardiac cycle were measured using both methods for four to seven markers in each of eight animals. RESULTS: The peak observed in-plane excursion was 4.0 +/- 2.1 mm. The average deviation between displacements derived from velocity data versus displacements visualized directly was 1.1 +/- 0.7 mm (27.5% of the peak displacement). The difference was less if three separate MR scans were used to measure each velocity component in the cine-PC method. This improvement is probably caused by improved temporal resolution. CONCLUSIONS: Cine-PC MRI offers a noninvasive method for accurate quantification of myocardial motion.

Animals↗
PubMed1992

Current attitudes and practice of American Society of Clinical Oncology-member clinical oncologists regarding cancer prevention and control.

PURPOSE AND METHODS: A nationwide needs assessment survey including a validated Cancer Prevention and Early Detection Attitude Inventory of 1,500 randomly selected American Society of Clinical Oncology (ASCO)-member clinical oncologists was conducted via a 67-item, mailed questionnaire to assess practice and attitudes regarding cancer prevention and control. RESULTS: Responses of 729 physicians from 48 states representing medical (57%), radiation (17%), surgical (16%), and pediatric oncology (6%), and hematology/other (4%) fields were obtained. Except for ambivalence regarding an important role for diet in cancer causation, cancer prevention and control recommendations were widely endorsed despite skepticism about their impact on reducing deaths from cancer. Surprisingly, a significantly (P less than .001) more favorable attitude for cancer prevention and control issues was found in physicians with greater than 20 years practice compared with younger oncology colleagues, as measured by a 22-item Cancer Prevention and Early Detection Attitude Inventory. Among all physicians, participation in cancer therapy trials exceeded that in cancer prevention and control trials (91% v 27%, P less than .01). Formal instruction during postgraduate training in cancer screening (34%) or prevention (23%) was received by few oncologists; nonetheless, 69% considered themselves a resource for cancer prevention and control issues in their practice communities. Of potential barriers to cancer prevention and control activity, only lack of patients without cancer (53%) and difficulty in including such activity economically into clinical practice (65%) were majority selections. Importantly, 64% agreed they could "motivate their patients to change lifestyle to reduce cancer risk." CONCLUSION: Clinical oncologists may represent a potential resource for implementation of cancer prevention and control objectives if economically feasible models for their use in practice settings can be identified.

Adult↗
PubMed1990

Psychodynamics revisited: an object-relations framework for psychiatric nursing.

Recent trends in psychiatry, such as shorter hospitalization and the renewed preeminence of biological treatments, are changing the practice of psychiatric nursing. The traditional tension-reduction model of anxiety and defense mechanisms is less suitable for clients in shortterm settings where somatic therapies are often the treatment of choice. For nurse therapists who wish to do more than alleviate symptoms, object-relations theory offers an alternative therapeutic framework that focuses on behavioral change, yet is suitable for seriously ill clients. Object-relations theory allows the nurse to assess the developmental level of clients' behavior in terms of specific ego functions. Through therapeutic interventions focused on repairing developmental deficiencies in the client's ego, nurses can facilitate significant behavioral change.

Adult↗
PubMed1988

Improved survival for frail elderly inpatients on a geriatric evaluation unit (GEU): who benefits?

Previously reported data from a randomized controlled trial showed that admission to the geriatric evaluation unit (GEU) and follow-up clinic at the Sepulveda VA Medical Center leads to significantly improved outcomes for frail elderly hospital patients--including a 50% reduction of one-year mortality (p less than 0.005). In the present paper, two-year survival curves for GEU and control groups are reported. In addition, we subdivided the population by potential baseline risk factors (both patient- and treatment-related) and examined one-year survival using 12-month survival curves and odds ratios. There is evidence for GEU-related survival effects in specific subgroups of patients (e.g. patients with heart and pulmonary disease, patients with low baseline scores in functional status and mental status, and patients with high baseline morale scores). Finally, employing stepwise logistic regression, we determined the predictors of one-year survival in the pooled study population. These factors were: assignment to the GEU (adjusted odds ratio = 2.45; p less than 0.001); not having a heart diagnosis (2.24; p less than 0.001); and having primarily "geriatric/rehabilitation" problems (1.95; p less than 0.005). A predictive model derived from the regression defines patient subgroups likely to survive only when assigned to the GEU: cardiac patients with primarily "geriatric" or "rehabilitation" problems, and non-cardiac patients whose problems are primarily "medical". The dramatic effect of the GEU on survival appears to be concentrated on certain identifiable subgroups of patients who might be targeted to maximize program cost-effectiveness.

Activities of Daily Living↗
PubMed1988

Clinical significance of a single test for anti-cardiolipin antibodies in patients with systemic lupus erythematosus.

PURPOSE: Clinicians have difficulty interpreting results of tests for anti-cardiolipin antibodies (aCL) because of conflicting reports of the clinical associations of these antibodies in patients with systemic lupus erythematosus (SLE). We therefore decided to evaluate the clinical associations of aCL in an effort to facilitate interpretation of single reports of either positive or negative test results. We also assessed the role of estrogen on the development of aCL. PATIENTS AND METHODS: The study population consisted of 85 consecutive outpatients with SLE and 40 control subjects. Serum samples and clinical and laboratory data were obtained from each patient and control. Testing for aCL was performed using a standardized enzyme-linked immunoabsorbent assay developed at an international workshop. RESULTS: The presence of aCL was documented in 42.4 percent of patients with SLE and 7.5 percent of control subjects. In patients with SLE, these antibodies were significantly associated with thrombosis, fetal loss, and thrombocytopenia, but not with other manifestations. Measurement of all isotypes optimized clinical correlations. Titers did not add clinical utility. Fluctuations of levels of aCL occurred, making it difficult to interpret a single negative result. Among control subjects, the presence of aCL was not significantly more common in women who used oral contraceptives. CONCLUSION: Our findings suggest that positive results of testing for aCL correlate with a predisposition for thrombosis, fetal loss, and thrombocytopenia in patients with SLE; however, the test is not predictive for other clinical manifestations of SLE, including activity and severity of disease. We believe that measurement of all isotypes of aCL should be performed in patients with SLE considering pregnancy, to identify those with a high risk of fetal loss, and in SLE patients with a thrombotic episode.

Adult↗
PubMed1987

Clinical, functional, and psychosocial characteristics of an incontinent nursing home population.

Although urinary incontinence is recognized as a prevalent, disruptive, and costly problem among nursing home residents, the factors associated with this condition have not been carefully studied. We compared clinical, functional, and psychosocial characteristics of 50 incontinent and 50 continent nursing home residents. In spite of a selection bias due to the informed consent process that resulted in the exclusion of many of the most functionally impaired incontinent residents, the incontinent study participants had significantly greater impairments in functional abilities related to toileting and, on average, took longer to perform a timed series of toileting-related tasks than did the continent comparison group. With the exception of bacteriuria, we did not find incontinence to be associated with most of the major clinical conditions and medications we examined, nor did we find differences in morale and most measures of social activities between the incontinent and continent residents. The data highlight the strong association between functional disability and incontinence in the nursing home setting and suggest that a standard functional assessment of toileting skills could make an important contribution to the care of incontinent residents.

Activities of Daily Living↗
PubMed1985

Treatment of first episode genital HSV with oral acyclovir: long term follow-up of recurrences. A preliminary report.

Systemic acyclovir (ACV) treatment has been shown to have significant effects on shortening the clinical course of first episode genital HSV infections, decreasing the quantity of HSV antibody in convalescent phase serum, without affecting the incidence of recurrences in 6 months of follow-up. In order to assess long term recurrence patterns, we prospectively studied subjects enrolled in a randomized double blind trial of oral ACV for first episode genital HSV. Sixty-three of sixty-eight subjects were followed monthly for recurrences for a mean of 36 months with 90% of subjects completing two years. There was no difference in the incidence of recurrence (90%) in (29) placebo vs (37) ACV treated HSV-2 infected subjects. Recurrences rates were similar between ACV and placebo treated subjects with nonprimary HSV-2 infection followed 2 years. The majority of these subjects were found to have HSV-2 antibody in their acute sera suggesting prior asymptomatic acquisition of HSV-2 infection and therefore established ganglionic latency at the time of first clinical disease. In subjects with true primary HSV-2 infection, however, mean recurrence rates were significantly lower in ACV treated subjects after 6 months, 0.87 ACV vs 3 placebo per 6 month period (p less than 0.01). The percentage of subjects experiencing recurrences after 1 year was also reduced by ACV treatment (70% placebo subjects vs 12.5% ACV subjects).(ABSTRACT TRUNCATED AT 250 WORDS)

Acyclovir↗
PubMed1985

Competitive binding kinetics in ligand-receptor-competitor systems. Rate parameters for unlabeled ligands for the formyl peptide receptor.

We describe the real-time kinetics of the competition of different ligands for the same receptor and use the computer routine SAAM to simulate this competition. Based on the simulation, we have developed two experimental approaches whereby the parameters of the interaction of nonlabeled ligands with their receptor can be detected; briefly, the analysis of the nonlabeled ligands depends on the perturbation of the kinetics of interaction of labeled ligands with the receptor with which they are in competition. The approach relies primarily upon an analysis of the kinetics of the competition between fluorescent and nonfluorescent ligands using a real-time, homogeneous binding assay in the fluorescence flow cytometer. A secondary approach depends upon an examination of the kinetic impact of antagonists on the responses of cells stimulated by agonists at the same receptor. Experimental verification of these approaches has been obtained using the N-formyl peptides (and their antagonists) which bind to receptors on human neutrophils and produce rapid cell stimulation. We find that agonistic N-formyl peptides have residence times of minutes while nonstimulatory antagonists have residence periods of, at most, a few seconds at these receptors. The limitations and general range of applicability of these procedures are discussed. The main advantage of these approaches is that they permit the evaluation of kinetic parameters of unlabeled ligands, even those which bind weakly or which have brief residence times--properties which make analyses by conventional methods difficult.

Binding, Competitive↗
PubMed1981

Liver scans in evaluation of lesions of the diaphragm.

Three patients had chest radiographs suggesting pathology associated with the right hemidiaphragm. The patients' histories included trauma in one case, recently diagnosed leukemia in a second, and Hodgkin's disease in the third. In all three cases, the Tc-99m-sulfur colloid liver scan provided a noninvasive identification of the nature of the diaphragmatic densities seen on the chest radiographs, thus affecting patient management.

Adolescent↗
PubMed1980

Increased lead absorption in inner city children: where does the lead come from?

Pica for lead-containing paint has been questioned as the principal mechanism for the widespread moderately elevated blood lead levels (30 to 80 microgram/100 ml) in inner city children. This study explored the hypothesis that lead-contaminated household dust is a major source of lead for these children; hand contamination and repetitive mouthing is the proposed mechanism of ingestion. Forty-nine inner city children with blood lead 40 to 70 microgram/100 ml were matched with 50 children with blood lead less than or equal to 29 microgram/100 ml from the same inner city environment. House dust lead and lead on hands were found in significantly greater quantity among experimental subjects. Other factors differed between groups; lead content of peeling paint, soil lead, and pica affected more experimental than control children, but did not account for more than 50% of experimental cases. The cause of moderate blood lead elevation is multifactoral: no single source accounted for all children with elevated levels. However, lead contamination of house dust and hands appears to be a major factor in this condition.

Child, Preschool↗