Biomedical subjects
Publications and source records attributed to K Moore.
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The effect of carbamazepine (CBZ) on human chromosomes was studied in an effort to determine its mutagenic potential. Analysis of chromosome breakage, sister chromatid exchanges (SCE), and cell cycle studies were performed in peripheral lymphocyte cultures. The in vivo studies failed to detect any significant increase of chromosome aberrations or SCE or any slowing of the cell cycle. A significant dose-dependent increase in chromosome aberrations but not in SCE was observed in the in vitro analyses. No correlation was observed between chromosome breaks and SCE in either the in vivo or in vitro studies. The negative in vivo results indicate an absence of detectable chromosome-damaging effects of CBZ used in monotherapy in human subjects.
Rhabdomyolysis causes renal dysfunction associated with renal vasoconstriction, tubular toxicity and luminal obstruction. There is now accumulating evidence that renal injury, caused by lipid peroxidation, is important in the pathogenesis of renal failure. The proposed central role of free iron in this process is examined. Current data have shown that the heme center of myoglobin can initiate lipid peroxidation and renal injury without invoking release of free iron, and this process is due to redox cycling of the heme group from ferrous to ferric and to ferryl oxidation states. Alkaline conditions prevent myoglobin-induced lipid peroxidation by stabilizing the reactive ferryl myoglobin complex. This review explores the evidence for each of these mechanisms.
Research on postpartum onset obsessive-compulsive disorder (OCD) has focused exclusively on females. However, the authors present four cases of males with OCD onset that coincide with a spouse's pregnancy or delivery. The rapid onset and content of obsessions and compulsions are remarkably similar to those reported in previous studies of postpartum OCD in females. Each patient also responded to cognitive-behavioral therapy using exposure procedures. The implications of these cases for etiological models of postpartum OCD and future research directions are discussed.
The present study examined the development of phonological and reading skills in 171 students (98 males, 73 females) from the beginning of first grade (Time 1) to the end of second grade (Time 4). Based on their reading and intelligence scores at the end of second grade, these students were placed into nondisabled (ND), reading disabled (RD), or garden-variety poor reading (GV) groups. Although each group made gains in phonological processing, large differences were found between the ND and RD/GV groups. The RD and GV groups performed similarly on many of the tasks. Consistent with the literature, it was found that intelligence does not differentiate between good and poor readers. The most important finding of the present study was that reader-group membership at Time 4 could be very accurately determined from students' Time 1 scores. All of the children in the RD and GV groups were correctly identified, and only 3 of the 148 ND children were misclassified, indicating that children at risk for reading difficulties can be very accurately identified very early in their academic experiences.
PURPOSE: The Association of American Indian Physicians, the only national organization of its kind, conducted a series of focus groups to gather input from tribal leaders, Indian health professionals, and American Indian community members to guide the development of culturally appropriate diabetes education materials for the National Diabetes Education Program. METHODS: During the focus groups, participants shared their experiences with and recommendations for a variety of diabetes education materials. RESULTS: Overall, 95% of participants expressed a strong preference for diabetes education materials relevant to their specific tribe or culture. CONCLUSIONS: Recommendations from these focus groups were used to develop a national diabetes education campaign for American Indian communities.
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A review of patient records over a 14-day period revealed that daily weights were recorded in only 65.5% of patients receiving parenteral nutrition and 53% of patients receiving enteral alimentation despite a hospital nursing practice requirement for daily weights during nutritional support. A semi-structured questionnaire was given to staff nurses to elicit their opinions regarding the importance of weight obtainment and to ascertain their reasons why patients are not weighted. Of 74 staff nurses who completed the survey, 68% considered weights "very important" but only 34% believed this attitude to be prevalent among their co-workers. The three reasons most often cited for failure to weigh patients were: (1) "patient too critically ill"; (2) "nurse felt other priorities of care existed; and, (3) "patient refuses." The two factors nurses most often felt should be changed to increase body weight measurement were "nurse staffing shortage" and "scales broken and/or unreliable." This study documents a need for both logistical changes (eg, equipment availability and reliability and timing of patient weights) and educational changes at both nursing staff and patient level to improve compliance with established requirements for daily weights during nutritional support.
The objective of this study was to compare self-reported measures of diabetes care with measures derived from medical records in a well-defined population. Diabetes measures were collected through a 1997 Behavioral Risk Factor Surveillance System telephone survey of American Indians living on or near 7 Montana reservations (N = 398) and were compared with data collected from charts of a systematic sample of American Indians with diabetes seen in 1997 at Indian Health Service (IHS) facilities. Survey respondents were more likely to report a duration of diabetes > or = 10 years (44 vs 31%), annual dilated retinal exam (75 vs 59%), and an influenza immunization in the past year (73 vs 57%) compared with estimates from the chart audit. Estimates of pneumococcal immunization (88 vs 42%), annual cholesterol screening (86 vs 69%), and overweight, based on body mass index (67 vs 50%), were significantly higher from the chart audit. No significant differences were found between the survey respondents and the chart audit data for annual foot exams (65 vs 61%), annual blood pressure checks (98 vs 93%), high cholesterol (35 vs 41%), and high blood pressure (54 vs 64%). These findings suggest that self-reported data may over and underestimate specific measures of diabetes care.
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Developing a strategy and turnaround plan for a struggling medical group practice requires a combination of art and science. Orchestrating an effective about-face calls for decisive action on several fronts at once. Too many groups are slow to recognize the need to rescue a perilous situation. And rather than taking immediate action on multiple fronts, they try taking incremental steps over time. Implementing a successful turnaround requires both the diligence of follow-through and the vision to make necessary adjustments throughout the process.
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