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Biomedical subjects

K Smith

Publications and source records attributed to K Smith.

At least 109 records · Page 6Linked to original sources
PubMed2000

Demographic, belief, and situational factors influencing the decision to utilize emergency medical services among chest pain patients. Rapid Early Action for Coronary Treatment (REACT) study.

BACKGROUND: Empirical evidence suggests that people value emergency medical services (EMS) but that they may not use the service when experiencing chest pain. This study evaluates this phenomenon and the factors associated with the failure to use EMS during a potential cardiac event. METHODS AND RESULTS: Baseline data were gathered from a randomized, controlled community trial (REACT) that was conducted in 20 US communities. A random-digit-dial survey documented bystander intentions to use EMS for cardiac symptoms in each community. An emergency department surveillance system documented the mode of transport among chest pain patients in each community and collected ancillary data, including situational factors surrounding the chest pain event. Logistic regression identified factors associated with failure to use EMS. A total of 962 community members responded to the phone survey, and data were collected on 875 chest pain emergency department arrivals. The mean proportion of community members intending to use EMS during a witnessed cardiac event was 89%; the mean proportion of patients observed using the service was 23%, with significant geographic differences (range, 10% to 48% use). After controlling for covariates, non-EMS users were more likely to try antacids/aspirin and call a doctor and were less likely to subscribe to (or participate in) an EMS prepayment plan. CONCLUSIONS: The results of this study indicate that indecision, self-treatment, physician contact, and financial concerns may undermine a chest pain patient's intention to use EMS.

Adult↗
PubMed2000

Effect of oral glucose on leucine turnover in human subjects at rest and during exercise at two levels of dietary protein.

The aim of this study was to determine the effect of glucose supplementation on leucine turnover during and after exercise and whether variation in the previous dietary protein content modulated this effect. Postabsorptive subjects received a primed constant [1-13C, 15N]leucine infusion for 6 h, after previous consumption of a high (1.8 g kg-1 day-1, HP, n = 16) or low (0.7 g kg-1 day-1, LP, n = 16) protein diet for 7 days. The subjects were studied at rest; during 2 h of exercise, during which half of the subjects from each dietary protocol received 0.75 g kg-1 h-1 glucose (HP + G, LP + G) and the other half received water (HP + W, LP + W); then again for 2 h of rest. Glucose supplementation suppressed leucine oxidation (P < 0.01) by 20% in subjects consuming the high protein diet (58.2 +/- 2.8 micromol kg-1 h-1, HP + G; 72.4 +/- 3.9 micromol kg-1 h-1, HP + W) but not the low protein diet (51.1 +/- 5.9 micromol kg-1 h-1, LP + G; 51.7 +/- 5.5 micromol kg-1 h-1, LP + W), with no difference in skeletal muscle branched-chain 2-oxo acid dehydrogenase (BCOADH) activity between groups. Glucose supplementation did not alter the rate of whole-body protein synthesis or breakdown. The sparing effect of glucose on leucine oxidation appears only to occur if previous protein intake was high. It was not mediated by a suppression of BCOADH fractional activity but may be due to reduced substrate availability.

3-Methyl-2-Oxobutanoate Dehydrogenase (Lipoamide)↗
PubMed2000

The role of clinical suspicion in evaluating a new diagnostic test for active tuberculosis: results of a multicenter prospective trial.

CONTEXT: In laboratory trials, nucleic acid amplification tests for the diagnosis of tuberculosis (TB) are more accurate than acid-fast bacilli (AFB) smear microscopy and are faster than culture. The impact of these tests on clinical diagnosis is not known. OBJECTIVE: To assess the performance of a nucleic acid amplification test, the enhanced Mycobacterium tuberculosis Direct (E-MTD) test, against a uniform clinical standard stratified by level of clinical suspicion. DESIGN: Prospective multicenter trial conducted between February and December 1996, documenting the clinical suspicion of TB at enrollment and using final comprehensive diagnosis as the criterion standard. SETTING: Six urban medical centers and 1 public health TB clinic. PATIENTS: A total of 338 patients with symptoms and signs consistent with active pulmonary TB and complete clinical diagnosis were stratified by the clinical investigators to be at low (< or =25%), intermediate (26%-75%), or high (>75%) relative risk of having TB. MAIN OUTCOME MEASURES: Sensitivity, specificity, and positive and negative predictive values of the E-MTD test in clinical suspicion of groups with low (n = 224); intermediate (n = 68); and high (n = 46) clinical suspicion of TB. RESULTS: Based on comprehensive clinical diagnosis, sensitivity of the E-MTD test was 83%, 75%, and 87% for low, intermediate, and high clinical suspicion of TB, respectively, and corresponding specificity was 97%, 100%, and 100% (P = .25). Positive predictive value of the E-MTD test was 59% (low), 100% (intermediate), and 100% (high) compared with 36% (low), 30% (intermediate), and 94% (high) for AFB smear. Corresponding negative predictive values were 99%, 91%, and 55% [corrected] (E-MTD test) vs 96%, 71%, and 37% (AFB smear). CONCLUSIONS: For complex diagnostic problems like TB, clinical risk assessments can provide important information regarding predictive values more likely to be experienced in clinical practice. For this series, a clinical suspicion of TB was helpful in targeting areas of the clinical spectrum in which nucleic acid amplification tests can make an important contribution.

Adult↗
PubMed2000

Large-scale expression, refolding, and purification of the catalytic domain of human macrophage metalloelastase (MMP-12) in Escherichia coli.

We have cloned, overexpressed, and purified the catalytic domain (residues Gly106 to Asn268) of human macrophage metalloelastase (MMP-12) in Escherichia coli. This construct represents a truncated form of the enzyme, lacking the N-terminal propeptide domain and the C-terminal hemopexin-like domain. The overexpressed protein was localized exclusively to insoluble inclusion bodies, in which it was present as both an intact form and an N-terminally truncated form. Inclusion bodies were solubilized in an 8 M guanidine-HCl buffer and purified by gel filtration chromatography under denaturing conditions. Partial refolding of the protein by dialysis into a 3 M urea buffer caused selective degradation of the truncated form of the protein, while the intact catalytic domain was unaffected by proteolysis. An SP-Sepharose chromatography step purified the protein to homogeneity and served also to complete the refolding. The purified protein was homogeneous by mass spectrometry and had an activity similar to that of the recombinant enzyme purified from mammalian cells. The protein was both soluble and monodisperse at a concentration of 9 mg/ml. This purification procedure enables the production of 23 mg of protein per liter of E. coli culture and is amenable to large-scale protein production for structural studies.

Catalytic Domain↗
PubMed2000

Vertical banded gastroplasty: a treatment for morbid obesity.

Stomach stapling to aid the morbidly obese patient with weight loss has been available for years. Unfortunately, some methods of bariatric surgery (e.g., gastric bypass surgery) can lead to serious complications. This article discusses vertical banded gastroplasty (VBG) and presents on overview of morbid obesity and its inherent medical problems, the screening process and the physical and psychological needs of patients undergoing bariatric procedures, the anatomy and physiology of normal digestion, and the perioperative nursing considerations in caring for a patient undergoing VBG.

Adult↗
PubMed2000

Changes in spiritual beliefs after traumatic disability.

OBJECTIVES: To discover the effect of sudden-onset disability on spirituality, specifically, to investigate changes following the onset of disability in spiritual concepts and to outline a theoretical framework consisting of relationships with the self, others, the world, and a supreme power. STUDY DESIGN: The study used a cross-sectional, qualitative approach to understand changes in spirituality from the perspective of the disabled person. Intensive semistructured interviews were conducted with 16 participants, each of whom had either a spinal cord injury or brain injury, within the 2-year period after discharge from rehabilitation. Changes in spiritual concepts were explored in relation to 3 types of relationships (intrapersonal, interpersonal, and transpersonal) and 5 themes (awareness, closeness, trust, purpose, and vulnerability). RESULTS: Specific changes in spirituality described by sample members were: greater awareness of the self; a change in their view of their own independence; a sense of purpose in life that was not present before the onset of the disability; greater awareness of their own mortality and vulnerability; a new understanding of trust, especially when depending on others; loss of some significant relationships; greater appreciation and closeness with others and the world; and greater understanding of other disadvantaged groups. CONCLUSIONS: The interviews portrayed a significant ability to conceptualize issues in a spiritual context in the 2-year period after discharge from rehabilitation. Further, the changes reported suggest a positive effect of spirituality in the adjustment period following onset.

Adult↗
PubMed2000

The generality of cognitive bias in acute stress disorder.

Cognitive bias was investigated in acutely traumatised civilians with either acute stress disorder (ASD; n = 26) or no ASD (n = 24). Participants completed the Acute Stress Disorder Interview, the Beck Depression Inventory, the Beck Anxiety Inventory (BAI), the Impact of Event Scale (IES), and an Event Probability Questionnaire and an Event Cost Questionnaire that comprised items pertaining to (a) external harm, (b) somatic sensations and (c) social events. ASD participants exaggerated both the probability of negative external harm, somatic and social events occurring, and the adverse cost of those events more than non-ASD participants. Elevated probability and cost estimates were predicted by BAI and IES-Avoidance scores, respectively. These findings are discussed in the context of different patterns observed in other anxiety disorders, and interpreted in terms of network theories of posttraumatic stress.

Accidents, Traffic↗
PubMed2000

Ultrasonography for cervical length measurement: agreement between transvaginal and translabial techniques.

OBJECTIVE: To assess agreement between transvaginal and translabial ultrasonography for measuring cervical length in the second and third trimesters. METHODS: Eighty-four obstetric patients at 14-40 weeks' gestation were enrolled. Three images of the cervix were obtained by translabial (3.5-MHz curvilinear transducer) and transvaginal (6.5-MHz endovaginal probe) ultrasonography. The mean cervical length obtained by using each method was used for data analysis. The McNemar chi(2) test was used to assess the difference between techniques in their ability to obtain a measurement. The paired t-test was used to evaluate the differences between the measurements. The mean difference and SD for the differences were used to calculate the limits of agreement. An acceptable difference was defined as less than 0.5 cm. RESULTS: Cervical length measurements were obtained in 84 patients (100%) by using the transvaginal technique and in 80 patients (95%) by using the translabial technique (P =.1). Eighty patients had both transvaginal and translabial measurements for comparison. The mean difference in cervical length was 0.37 cm (P <.001; 95% confidence interval [CI] 0. 21, 0.52). The upper and lower limits of agreement were 1.75 cm (95% CI 1.48, 2.02) and -1.01 cm (95% CI -0.74, -1.28), respectively. The differences between the two measurements were within these limits 95% of the time. These limits of agreement were greater than the acceptable difference of 0.5 cm. CONCLUSION: Transvaginal and translabial techniques should not be used interchangeably for clinical assessment of cervical length because agreement between the methods is not within an acceptable range.

Adult↗
PubMed2000

Toxaphene in standard solutions and cleaned biota extracts--results of the first QUASIMEME interlaboratory studies. Quality Assurance of Information for Marine Environmental Monitoring in Europe.

Two interlaboratory studies on individual toxaphene congeners have been organised by the project Quality Assurance of Information for Marine Environmental Monitoring in Europe (QUASIMEME). Fifteen laboratories analysed two standard solutions in the first study and 13 laboratories analysed a standard solution and two cleaned biota extracts in the second study. The coefficients of variation obtained for the standard solutions were 6-21% and for the cleaned extracts 16-39%. Although the results were comparable to those of other studies, further improvement in the level of agreement between the participating laboratories was considered possible.

Animals↗
PubMed2000

Oncology healthcare professionals' attitudes toward elderly people.

BACKGROUND: Healthcare professionals are known to be particularly susceptible to ageist stereotyping because of increased exposure to elderly and infirm individuals. Demographic changes resulting in increasing numbers of elderly people and increased cancer incidence with age make it imperative to understand oncology healthcare professionals' attitudes towards older people. DESIGN: A descriptive survey design was conducted, within a regional Cancer Centre, to evaluate oncology healthcare professionals' attitudes towards elderly people. The measurement scale used was Kogan's Old People Scale. RESULTS: Regardless of gender, profession and clinical experience persistently negative attitudes were displayed towards elderly people. No statistically significant difference was detected between gender, profession, clinical experience or specialist education and although small in number, no large differences in scores were notable between group means. CONCLUSIONS: If oncology healthcare professionals are to provide optimal treatment and care for elderly people, negative attitudes must be addressed. These results indicate the need for a radical cultural shift in attitudes, especially when considered in conjunction with changing demographics and increased cancer incidence with age.

Adult↗
PubMed2000

A comparison of the WHOQOL-100 and the WHOQOL-BREF in detecting change in quality of life following liver transplantation.

The World Health Organization has recently produced a generic quality of life measure--the WHOQOL-100, together with an abbreviated version, the WHOQOL-BREF. Preliminary data suggest that the WHOQOL BREF provides a valid and reliable alternative to the lengthier WHOQOL-100. In the present study, the sensitivity to change of both versions was tested pre- and 3 months post liver transplantation in fifty patients and also in twenty-one non-transplanted liver disease controls. Quality of Life domains on both measures were highly correlated, and were sensitive to change following transplant and remained stable on repeat assessment in non-transplanted control patients. However, the sensitivity to change was significantly reduced for the Social domain in the WHOQOL BREF. It is concluded that the WHO-QOL-BREF is a useful alternative to the WHOQOL-100 in evaluating quality of life improvement following major therapeutic interventions for Physical, Psychological and Environmental domains of life quality. However, researchers interested in measuring the Social aspects of life quality may be best advised to use the lengthier WHOQOL-100.

Female↗
PubMed2000

Females' coping styles and control over poker machine gambling.

An investigation of the relationship between impaired control over gambling, coping strategies, and demographic variables was conducted by surveying female poker machine players (N = 163) in their gaming venues. Metropolitan (n = 14) and regional (n = 6) gaming venues in Victoria, Australia participated. Control over gambling was measured using the Impaired Control Over Gambling Scale (Baron & Dickerson, 1994). Coping strategies were measured using (Folkman et al., 1986) adaptation of the Revised Ways of Coping Checklist (Vitaliano et al., 1985). MANOVA supported the hypothesis that the lower the control over gambling the greater the reliance on emotion-focused coping (blamed self, wishful thinking, avoidance) with F = 9.92, 13.35, 14.04 respectively, all significant at p <.001. MANOVA failed to supported the hypothesis that problem-focused strategies (problem focus, seek social support) would be significantly related to control over gambling with F =.82 and.21 respectively. Control over gambling was not related to age, employment, relationship status, education, or distress from significant life events, further supporting the relationship between control and coping strategies. Ways in which coping styles might be related to pathological gambling are discussed.

Journal Article↗
PubMed2000

Tris lipidation: a chemically flexible technology for modifying the delivery of drugs and genes.

1. One of the major challenges in the development of pharmaceuticals is their formulation with other materials to give them the desired bioavailability profile when administered into the body. 2. We have developed a flexible platform technology (Tris lipidation) to simply and effectively alter the lipophilicity of drugs. As implied by the name, the technology uses the common buffer Tris as a linker between the drugs of interest and a domain of variable hydrophobicity. 3. We demonstrate, using a mouse melanoma model, that Tris-lipidated conjugates of the widely used cytotoxic and anti-inflammatory drug methotrexate (MTX) display enhanced potency in the local treatment of tumours and reduced systemic toxicity when compared with the unconjugated drug. 4. With genes now being predicted to be the pharmaceuticals of the future, we show that Tris-lipidated cationic peptides can efficiently deliver DNA into (transfect) cells in culture. Furthermore, by comparing the abilities of variants of these Tris-based cationic lipids to transfect cultured cells, we demonstrate that modifications made to variable regions of Tris-lipidated compounds can dramatically alter their delivery profiles.

Animals↗
PubMed2000

Treatment of multiple cutaneous leiomyomas with CO2 laser ablation.

BACKGROUND: Cutaneous leiomyomas are benign tumors that can be exquisitely painful. Symptomatic lesions often necessitate treatment, but many options are inadequate or create substantial morbidity. Without a definitive therapy of first choice, the search continues for alternative methods to alleviate discomfort in affected patients. OBJECTIVE: To describe the use of CO2 laser ablation for the symptomatic treatment of a 73-year-old woman with multiple cutaneous leiomyomas in whom pharmacologic therapy was contraindicated and surgical excision was impractical. METHODS: CO2 laser ablation of six symptomatic cutaneous leiomyomas was performed under local anesthesia. After initial success, all remaining symptomatic lesions were treated. RESULTS: There was complete pain relief in the originally treated lesions 9 months postoperatively, and in all remaining treated lesions 3 months postoperatively. CONCLUSION: CO2 laser ablation may be an effective alternative treatment for symptomatic cutaneous leiomyomas.

Aged↗
PubMed2000

Toxicities and outcomes associated with nefazodone poisoning: an analysis of 1,338 exposures.

Toxicities and medical outcomes associated with nefazodone poisoning were characterized using national poisoning data from the American Association of Poison Control Centers and through prospective collection of additional data elements. Nefazodone exposures involving concomitant agents were excluded. There were 1,338 human exposures included in the final data analysis. Seventy-five percent of exposures were acute and 20% involved children < 13 years. Twenty-five percent of patients remained asymptomatic. There were no deaths. No dose response relationship was evident in the 45 cases where estimated doses were available. The most common manifestations were drowsiness (17.3% of all patients), nausea (9.7%), and dizziness (9.5%). The most common serious clinical effect was hypotension (1.6%). The median onset time for symptoms was 1.75 hours. Manifestations resolved within 8 to 24 hours. Most patients were treated with only gastrointestinal decontamination. No patients required intubation, mechanical ventilation, or vasopressors. Nefazodone appears to be of low toxicity during poisonings.

Adolescent↗
PubMed2000

Measurement of cancer attitudes: a review.

Many psychologists maintain that the attitudes we hold about a particular topic or subject will influence the way in which we behave towards it: positive attitudes lead to positive behaviours and vice versa. A literature search was conducted using the databases of MEDLINE and CINAHL. This produced research-based evidence showing that despite treatment advances, cancer remains one of the most feared of all diseases, not only among the public but also among oncology health-care professionals. However, the practice of measuring attitudes is fraught with difficulties. This review article will discuss the link between attitudes and behaviour and review pertinent literature regarding public and professional attitudes towards cancer before critically analysing the most common tools for evaluating cancer attitudes and making recommendations for the future of attitude measurement.

Journal Article↗