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Biomedical subjects

J Smith

Publications and source records attributed to J Smith.

At least 1,567 records · Page 87Linked to original sources
PubMedDate not supplied

Poor adherence to placebo or amiodarone therapy predicts mortality: results from the CAMIAT study. Canadian Amiodarone Myocardial Infarction Arrhythmia Trial.

OBJECTIVE: This study examined the relationship between adherence, mortality, and psychosocial factors. METHODS: Subjects were 1141 patients participating in the Canadian Amiodarone Myocardial Infarction Arrhythmia Trial. Poor adherence to study medication (amiodarone or placebo), measured by pill count over 2 years, was defined as the lower 20th percentile of the pill count distribution. Predictors of adherence were also studied and included demographic and cardiac variables and, in a subset of participants (N = 671), measures of depression, distress, hostility, and social support. RESULTS: In survival analysis controlling for cardiac and demographic variables, poor adherence in the placebo and amiodarone groups was associated with an increased risk of sudden cardiac death (relative risk (RR) = 2.11, 95% confidence interval (CI) = 1.03-4.56, p < .05; and RR = 3.15, 95% CI = 1.34-7.44, p < .01, respectively), total cardiac mortality (RR = 2.04, 95% CI = 1.12-3.72, p < .02; and RR = 2.49, 95% CI = 1.32-4.72, p < .01, respectively), and all-cause mortality (RR = 2.25, 95% CI = 1.27-3.97, p < .001; and RR = 2.34, 95% CI = 1.32-4.17, p < .004, respectively). Logistic regression analysis identified two predictors of poor adherence to placebo: age > 70 years (odds ratio = 2.18, 95% CI = 1.11-4.29, p < .03) and social activities in the month before the index heart attack (odds ratio = 1.02, 95% CI = 1.00-1.04, p < .05). CONCLUSIONS: Poor adherence is associated with a greater risk of mortality. The relationship between adherence and social activities suggests a higher motivation to adhere to treatment in individuals more engaged in enjoyable activities.

Aged↗
PubMedDate not supplied

The clinical and laboratory diagnosis of Trichomonas vaginalis infection.

One hundred consecutive female patients attending an inner-city clinic for treatment of sexually transmitted diseases were evaluated for the presence of Trichomonas vaginalis by history, physical examination, 0.85% NaCl wet mount, Papanicolaou smear, and culture. Of the 100 women, 54 were found to be harboring the parasite, as determined by one or more positive diagnostic tests. This prevalence corresponds with that reported previously. The information gained from the history (symptoms and phase of menstrual cycle) and physical examination correlated poorly with results of cultures for T. vaginalis; the organism was isolated more often than symptoms or physical findings would have indicated. Culture was the most sensitive of diagnostic techniques; 48 (89%) of the 54 patients were identified by this method. The Papanicolaou smear detected 35 infections (65%), and the 0.85% NaCl wet mount, 28 (59%). The simplest and most efficient technique for screening women for infection with T. vaginalis may be the Papanicolaou smear, since it is part of the annual physical examination.

Adolescent↗
PubMedDate not supplied

Treatment regimens of STD patients in Cameroon: a need for intervention.

BACKGROUND AND OBJECTIVES: The management of patients with STDs is an important element in the fight against AIDS. To define effective STD control strategies a survey was carried out to understand the attitudes of STD patients and the treatment regimens they follow. STUDY DESIGN: The study was based on interviews with male patients with typical symptoms of urethritis leaving private pharmacies in Douala and Yaoundé. Each case was asked to answer a questionnaire comprising the origin of the therapeutic choice, the nature and cost of the treatment and any advice received. RESULTS: Fifty-six men in Douala and 86 in Yaoundé were recruited. The sources of prescription were dispensary (38%, 54%) private MD (9%, 15%) pharmacist (7%, 9%), diverse (46%, 21%) in Douala and Yaoundé respectively. At least two medicines were recommended in three-quarters of the patients. The most frequently used antibiotics were aminoglycosides and penicillin. The cost of the treatment ranged from $3.50 to $110. The more "medical" the initial visit, the higher was the cost of the prescribed treatment. In Douala only 49% of the prescribers advised the patients to treat their partners and condom promotion was done by 21% of the prescribers. CONCLUSION: This survey provides useful data on the care of patients with urethritis. Such surveys are simple, rapid, reasonable inexpensive (about $10,000) and contribute to the efficient design of STD control strategies. In addition, repeat survey to monitor the impact of the strategies are simple to carry out.

Adolescent↗
PubMedDate not supplied

"Troo, the Traumaroo" bicycle and playground safety program: a pilot study of kindergarten through second graders in the southwest.

"Troo, the Traumaroo" bicycle and playground safety education program created for kindergarten, first, and second grade students, was provided to a convenience sample of seven elementary schools in a Southwestern city. Favorable principal, classroom teacher, and school nurse evaluations indicated that the "Troo, the Traumaroo" program was successful in providing young children with bicycle and playground safety in a fun and entertaining way. Results of this pilot study indicated that kindergarten children pre-tested for bicycle safety knowledge prior to participating in the program, had significantly higher bicycle safety knowledge scores 30 days after participating in the program (p < .0001).

Bicycling↗
PubMedDate not supplied

A preliminary investigation on the use of the Portage system in day nursery settings.

The paper describes the impact of a training programme for local authority day nursery staff on the use of the Portage system with handicapped children. The results suggest that the staff mastered the techniques and were able to continue using them, though some modification to the system seems indicated for these settings. These findings were discussed in the light of more general issues about the support needed for day nursery staff.

Child Day Care Centers↗
PubMedDate not supplied

Hemiparkinsonism with infarction of the ipsilateral substantia nigra.

An elderly man suffering from dementia associated with hypertension developed right-sided parkinsonism marked by rigidity and flexion. At autopsy the brain showed generalized vascular changes chiefly in the white matter, diffuse plaque and neurofibrillary tangle formation in the temporal cortex, and a discrete gliotic scar in the right substantia nigra. Hemiparkinsonism with a strictly unilateral lesion confined to the substantia nigra has, to our knowledge, not been described before, and the fact that it was ipsilateral adds to its theoretical interest.

Brain↗
PubMedDate not supplied

Optical coherence tomography as a diagnostic aid to visual inspection and colposcopy for preinvasive and invasive cancer of the uterine cervix.

The purpose of this study was to determine the sensitivity and specificity of optical coherence tomography (OCT) under two well-defined clinical settings. First, as an aid to cervical cancer screening, using visual inspection with acetic acid (VIA) in low-resource settings, and the second, as an adjunct to the traditional management of abnormal cervical cytology with colposcopy and biopsy. Patients referred for colposcopy with > or = atypical squamous cells of undetermined significance were accrued for the study. Each subject underwent VIA and colposcopy. OCT was performed in all VIA- and colposcopy-positive areas and at the squamocolumnar junction in all four quadrants. The sensitivity of VIA for > or = cervical intraepithelial neoplasia 2 was 76% (95% CI 58-88). When OCT was applied to VIA as a secondary screen, the specificity improved from 34% (95% CI 27-41) to 61% (95% CI 60-74). With liberal diagnostic criteria for the majority of the colposcopy examinations, OCT showed an even greater relative improvement in specificity. OCT proved to be a fair diagnostic modality (receiver operating characteristic curve 0.73) adjunctive to VIA and colposcopy. On the basis of the above findings, we believe that this technology could potentially show greatest utility in the management of cervical dysplasia in low-resource settings where a single episode of care is most desirable.

Adolescent↗
PubMedDate not supplied

Binary fission of Pneumocystis carinii trophozoites grown in vitro.

Trophozoites grown in vitro were shown to undergo binary fission by transmission electron microscopy (TEM). Standard fixation with subsequent embedding in Spurr was employed using 3% glutaraldehyde and 1% osmium tetroxide with 5% sucrose added to both fixatives and 0.1 M cacodylate buffer washes. Trophozoites were grown on WI-38 cells in vitro. Trophozoites were found in various stages of fission. The dividing trophozoite has daughter cells that are rounder than the pleomorphic, non-dividing trophozoites. Tubular forms external to the dividing trophozoites were decreased in number; tubular forms when present were concentrated around the forming septa. Nuclear material was sometimes, but not always, well defined in both daughter cells. There was no concentration of nuclear material at the poles. Vacuoles without membrane were present in the dividing forms. Separate nuclear regions were sometimes found in the dividing trophozoites. These observations suggest that binary fission does occur in culture; however, the significance of binary fission to the life cycle of Pneumocystis carinii (Pc) is not yet clear.

Animals↗
PubMedDate not supplied

Post-transfusion survival of 50Cr-labeled erythrocytes in neonatal foals.

Erythrocytes transfused allogeneically into mature horses have a short survival (less than 4 days) compared with an expected erythrocyte life span of 140-150 days. Yet, foals undergo transfusions for neonatal isoerythrolysis successfully. The authors have determined the survival of transfused erythrocytes in neonatal foals, using the stable isotope, 50Cr, to label the erythrocytes. Normal foals underwent transfusions with labeled erythrocytes from three sources: their own erythrocytes (autologous), the erythrocytes of their dam, and the erythrocytes of an unrelated castrated male. After transfusion, samples were taken at 15 minutes and then daily for a week and every 2 or 3 days for 20 days. A stable isotope of iron (57Fe) and 50Cr were determined on diluted-packed erythrocytes by inductively coupled argon-coupled mass spectrometry techniques. 57Fe was used as measure of the sample hemoglobin concentration. The ratio of 50Cr to 57Fe decreased exponentially in all foals. Half-time (T1/2) was 11.7 days (standard error = 2.2) for four foals that underwent autologous transfusions, 5.5 +/- 1.0 days for five foals that underwent transfusions with the erythrocytes of their dams, and 5.2 +/- 1.1 days for five foals that had transfusions with erythrocytes from an unrelated gelding. The authors conclude that erythrocytes that are transfused allogenically into neonatal foals will survive longer than those transfused into mature horses and that 50Cr labeling can be used to measure survival of transfused erythrocytes.

Animals↗
PubMedDate not supplied

Effects of renal neutral endopeptidase inhibition on sodium excretion, renal hemodynamics and neurohormonal activation in patients with congestive heart failure.

We investigated the effects of inhibiting endogenous atrial natriuretic factor (ANF) metabolism on renal hemodynamics, sodium excretion and neurohormones in 12 patients with New York Heart Association functional class II congestive heart failure (CHF) due to left ventricular systolic dysfunction. In a randomized, placebo-controlled, double-blinded fashion, 8 patients received a single oral dose of candoxatril, an inhibitor of renal neutral endopeptidase, and 4 patients received placebo. Candoxatril treatment increased plasma ANF by 70 +/- 71 pg/ml (p < 0.015 vs. placebo) and plasma cGMP by 7.9 +/- 2.7 pmol/ml (p < 0.001 vs. placebo), with maximal effects at 3.5 h. Urinary cGMP more than doubled (p = 0.025 vs. placebo). Candoxatril increased urinary sodium by 2.7 +/- 2.0 mEq/h (p < 0.05 vs. placebo) and significantly elevated filtration fraction with no significant effect on glomerular filtration rate, renal plasma flow or lithium clearance. A significant reduction in aldosterone concentration with a similar trend in plasma renin activity was noted in candoxatril-treated patients. Thus in patients with moderate heart failure, renal neutral endopeptidase inhibition increases urinary sodium excretion. The lack of an effect on renal hemodynamics suggests that this natriuresis results from ANF-mediated inhibition of tubular sodium reabsorption. These findings justify additional investigation into potential clinical benefit of endopeptidase inhibition in patients with CHF.

Adult↗
PubMedDate not supplied

Enhancing the performance of the AutoPap 300 QC system with optimal staining and presentation of cervical smears.

OBJECTIVE: To optimize the staining and presentation of slides for the AutoPap 300 QC System, an automated cytology screening system which examines conventionally prepared cervical smears, and to assess subsequent scanning and scoring rates and compare them to those of laboratories not adopting these changes. STUDY DESIGN: In this study, procedures were developed for optimal presentation and staining of slides for the AutoPap System in response to observations made in preclinical trials. Three thousand eight hundred fifty-five slides were then submitted to the device for analysis in a prospective, blind, clinical evaluation study. The scanning and scoring rates were compared to those of a cohort of 12,525 slides that were analyzed in other laboratories which had not adopted these procedures. RESULTS: Two hundred forty (6.2%) slides failed scanning due to physical defects. An additional 70 slides (2.0% of scanned slides) did not complete scoring due to staining limitations. The laboratories in the clinical trials that had not adopted these preanalytic method changes had higher scanning failure rates due to physical limitations (15.0%) and incomplete scoring rates due to staining limitations (6.2%). CONCLUSION: The present study demonstrated that the performance of the AutoPap 300 is enhanced by meticulous attention to preanalytic staining and presentation procedures.

Automation↗
PubMedDate not supplied

Snowboarder's talus fracture. Mechanism of injury.

Fracture of the lateral process of the talus is an injury unique to snowboarders and is of particular clinical relevance because it masquerades as an anterolateral ankle sprain and is difficult to detect on standard radiographic views. Misdiagnosis can lead to long-term morbidity in a young and active population, with ensuing severe degeneration of the subtalar joint. To date, the precise mechanism of injury has not been established, making it difficult to identify potential preventive strategies in equipment design or snowboarding technique. Fracture of the lateral process of the talus in snowboarders has been thought to result from pure dorsiflexion and inversion combined with axial loading. We hypothesized, however, that external rotation is a key component of the mechanism of injury. Ten cadaveric ankles were mounted on a materials testing machine in a position of fixed dorsiflexion and inversion. All ankles were loaded to failure axially, with or without combined external rotation. No fractures occurred after axial loading in dorsiflexion and inversion, but six of eight specimens sustained fractures of the lateral process of the talus when similarly loaded with external rotation added, supporting our hypothesis. Further study is needed to evaluate the relationship between various types of snowboarding equipment and fracture mechanism.

Aged↗
PubMedDate not supplied

The effect of ankle disk training on muscle reaction time in subjects with a history of ankle sprain.

The purpose of this study was to determine whether 8 weeks of ankle disk training alters ankle muscle onset latency of patients with a history of lateral ankle sprain. The training was completed by eight minimally symptomatic subjects with a history of nonrehabilitated, unilateral, inversion ankle sprain sustained between 6 and 16 months before entry into the study. Ankle inversion perturbations monitored by fine-wire electromyography were performed in four lower extremity muscles (anterior tibialis, posterior tibialis, peroneus longus, and flexor digitorum longus) of all subjects on both the injured (experimental) and noninjured (control) legs. Testing was performed at study entry and after 8 weeks of ankle disk training on the previously injured ankle. Results revealed a statistically significant decrease in the anterior tibialis onset latency in both the experimental (67.6 +/- 20.3 to 51.7 +/- 17.6) and control (65.5 +/- 9.8 to 53.8 +/- 23.7) ankles after the training period. These findings indicate that muscle onset latency decreases in specific ankle muscle groups after ankle disk training in previously injured ankles. Both the experimental and control ankles demonstrated a significant change, which raises the question as to whether a proprioceptive cross-training effect occurred.

Adult↗
PubMedDate not supplied

The effects of knee brace wear on perceptual and metabolic variables during horizontal treadmill running.

Past research has indicated that runners who wear a Lenox Hill Derotation Brace during treadmill running at 6 mph have an approximate 5% increase in oxygen consumption compared to those who run without the brace. The present study expanded those findings by determining the metabolic and perceptual effects of wearing four commercially available braces while treadmill running at speeds of 6, 7, and 8 mph. The four braces used in this study were the Generation II Poli-Axial Knee Cage, the Orthotech Performer, the CTi Brace, and the Lenox Hill Derotation Brace. Results indicated that the braces caused increases (P less than 0.008) in oxygen consumption, heart rate, and ventilation in the 3% to 8% range compared to running without the brace. Peripheral ratings of perceived exertion were also elevated (P less than 0.001) between 9% and 13%. However, no significant differences were found between the braces. Analysis of covariance indicated the weight of the brace accounted for the increased oxygen consumption during the treadmill runs. We concluded that the braces examined in this study will cause a consistent increase in metabolic cost, which is related to the weight of the braces.

Adolescent↗