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Biomedical subjects

L Love

Publications and source records attributed to L Love.

At least 19 recordsLinked to original sources

The Canadian National Outcomes Measurement Study in Schizophrenia: overview of the patient sample and methodology.

OBJECTIVE: The Canadian National Outcomes Measurement Study in Schizophrenia (CNOMSS) is a prospective survey of routine clinical practice. METHOD: Patients with schizophrenia or a related disorder were consecutively enrolled from all regions of Canada. Both academic and community psychiatric clinics were included and patients were followed up for 2 years. Clinical and functional status, quality of life, medication and economic costs were assessed at enrollment and monitored throughout the follow-up period. RESULTS: Patients attending an academic clinic tended to be younger and more severely ill than those from community clinics. Both types of sites prescribed atypical neuroleptics to more than three-quarters of the patients. The majority of those enrolled were unemployed and living in poverty. Poor clinical status was associated with poverty. CONCLUSION: The CNOMSS provides demographic, clinical and treatment-related information about a large Canada-wide sample of psychiatric patients. The following three articles in this issue of Acta Psychiatrica Scandinavica explore issues related to medication, quality of life and resource utilization.

Academic Medical Centers↗

Medication decisions and clinical outcomes in the Canadian National Outcomes Measurement Study in Schizophrenia.

OBJECTIVE: To evaluate over a 2-year period, patients from academic/non-academic centres, from each region of Canada, to determine whether location or other variables such as medication type, gender or income was associated with outcome as defined by non-hospitalization and persistence on original treatment. METHOD: A total of 448 patients were recruited from academic and non-academic centres across all provinces of Canada and followed up for 2 years. RESULTS: Patients from British Columbia had significantly lower rates of hospitalization than patients from other provinces. Male patients showed greater symptomatic improvement at 2 years from initial assessment compared to females. Patients on clozapine, risperidone and olanzapine were least likely to be hospitalized. CONCLUSION: There were some regional differences noted in both utilization of types of antipsychotic medications and hospitalization rates. In this sample of stable out-patients over 70% who started on monotherapy with clozapine, risperidone, olanzapine and quetiapine remained on the same medication over the 2-year study period.

Academic Medical Centers↗

Resource utilization in a Canadian national study of people with schizophrenia and related psychotic disorders.

OBJECTIVE: To determine how the use of the newer, so called atypical antipsychotic medications, effects the pharmacoeconomic treatment burden of schizophrenia and related conditions and to provide a clear comparison of the costs and risks associated with these atypical drugs. METHOD: In this 2-year, open-label, prospective study, resource utilization (RU) data were collected on 160 patients with these conditions. A comparison between risks and costs was performed by combining the generalized CNOMSS data on both economic factors and risk assessments. RESULTS: The main findings of the study were that the total adjusted 1- and 2-year costs were lowest for quetiapine. Drug acquisition costs were lowest for risperidone for both the 1- and 2-year cohorts. Clozapine use was predictably associated with the highest overall and medication costs at both 1 and 2 years. CONCLUSION: Treatment with risperidone or quetiapine was associated with the lowest overall costs when compared with olanzapine or clozapine.

Adult↗

Ammonia emission and deposition in Scotland and its potential environmental impacts.

The main source of atmospheric ammonia (NH3) in Scotland is livestock agriculture, which accounts for 85% of emissions. The local magnitude of emissions therefore depends on livestock density, type, and management, with major differences occurring in various parts of Scotland. Local differences in agricultural activities therefore result in a wide range of NH3 emissions, ranging from less than 0.2 kg N ha(-1) year(-1) in remote areas of the Scottish Highlands to over 100 kg N ha(-1) year-1 in areas with intensive poultry farming. Scotland can be divided loosely into upland and lowland areas, with NH3 emission being less than and more than 5 kg N ha(-1) year(-1), respectively. Many semi-natural ecosystems in Scotland are vulnerable to nitrogen deposition, including bogs, moorlands, and the woodland ground flora. Because NH3 emissions occur in the rural environment, the local deposition to sensitive ecosystems may be large, making it essential to assess the spatial distribution of NH3 emissions and deposition. A spatial model is applied here to map NH3 emissions and these estimates are applied in atmospheric dispersion and deposition models to estimate atmospheric concentrations of NH3 and NH4+, dry deposition of NH3, and wet deposition of NHx. Although there is a high level of local variability, modelled NH3 concentrations show good agreement with the National Ammonia Monitoring Network, while wet deposition is largest at high altitude sites in the south and west of Scotland. Comparison of the modelled NHx deposition fields with estimated thresholds for environmental effects ("critical loads") shows that thresholds are exceeded across most of lowland Scotland and the Southern Uplands. Only in the cleanest parts of the north and west is nitrogen deposition not a cause for concern. Given that the most intense effects occur within a few kilometres of sources, it is suggested that local spatial abatement policies would be a useful complement to traditional policies that mitigate environmental effects based on emission reduction technologies.

Ammonia↗

Concentrations of ammonia and nitrogen dioxide at roadside verges, and their contribution to nitrogen deposition.

Bimonthly integrated measurements of NO2 and NH3 have been made over one year at distances up to 10 m away from the edges of roads across Scotland, using a stratified sampling scheme in terms of road traffic density and background N deposition. The rate of decrease in gas concentrations away from the edge of the roads was rapid, with concentrations falling by 90% within the first 10 m for NH3 and the first 15 m for NO2. The longer transport distance for NO2 reflects the production of secondary NO2 from reaction of emitted NO and O3. Concentrations above the background, estimated at the edge of the traffic lane, were linearly proportional to traffic density for NH3 (microg NH3 m(-3) = 1 x 10(-4) x numbers of cars per day), reflecting emissions from three-way catalysts. For NO2, where emissions depend strongly on vehicle type and fuel, traffic density was calculated in terms of 'car equivalents'; NO2 concentrations at the edge of the traffic lane were proportional to the number of car equivalents (microg NO2 m(-3) = 1 x 10(-4) x numbers of car equivalents per day). Although absolute concentrations (microg m(-3)) of NH3 were five times smaller than for NO2, the greater deposition velocity for NH3 to vegetation means that approximately equivalent amounts of dry N deposition to road side vegetation from vehicle emissions comes from NH3 and NO2. Depending on traffic density, the additional N deposition attributable to vehicle exhaust gases is between 1 and 15 kg N ha(-1) y(-1) at the edge of the vehicle lane, falling to 0.2-10 kg N ha(-1) y(-1) at 10 m from the edge of the road.

Air Pollutants↗

Subjective health in spinal cord injury after outpatient healthcare follow-up.

OBJECTIVE: To compare self-reported health, independence, and depression in two samples of people with spinal cord injury (SCI), one which receives regular, comprehensive outpatient health care follow-up and one that does not. DESIGN: Exploratory study of self-reported secondary conditions in 235 individuals with SCI who received health care follow-up using post hoc quasi-experimental comparisons with a group of 136 people with SCI who had no health care follow-up. SETTING: Outpatients at a Veterans Affairs Health Care System SCI Center. MAIN OUTCOME MEASURES: The Check Your Health Instrument surveyed three self-report measures: overall health, independence, and depression. The Secondary Conditions Screening Instrument (SCSI) addressed 40 secondary conditions that may have been experienced in the prior year. RESULTS: Study participants who receive ongoing SCI health care reported higher subjective health, independence, and absence of depression scores compared to those that did not receive regular SCI health care follow-up. Results on the SCSI showed similar secondary conditions in the two groups, but higher frequency and severity in the no follow-up group. CONCLUSION: SCI outpatient health care follow-up is associated with higher subjective health, independence, and absence of depression.

Activities of Daily Living↗

The MedWatch Program.

Explore the source record for details and available documents.

Adverse Drug Reaction Reporting Systems↗

The persistent computed tomography nephrogram: its significance in the diagnosis of contrast-associated nephrotoxicity.

A study was undertaken to find out if there is a quantitative relationship between the development of contrast-associated nephrotoxicity (CAN) and the mean renal cortical attenuation (RCA) as seen on computed tomography (CT) examination of the kidneys 24 hours after injection of contrast medium. 96 patients undergoing aortography were selected, who were considered "high risk" either because of the presence of a baseline serum creatinine (Cr) of 123.76 mumol l-1 (1.4 mg dl-1) or higher, or who were 73 or older with or without elevated creatinine levels. A CT study of the kidneys at approximately 24 h was correlated with baseline serum creatinine as well as 24 h Cr (48-72 h Cr when available). Medical history and medications were recorded. Eight of 96 patients had RCA of 108-236 HU at 24 h CT and all developed significant CAN of varying degree; 3/96 had RCA ranging from 48 to 67 HU and had transient CAN; two other patients with RCA of 67-90 HU developed CAN; and there was increased incidence of CAN in patients: (a) with pre-existing renal insufficiency; (b) with diabetes with renal insufficiency; (c) on diuretics; (d) who were older; and (e) had a unilateral atrophic kidney. It was concluded that a 24 h CT study evaluating the RCA had better predictive value for the development of CAN than a 24 h creatinine level.

Age Factors↗

A comparison of breath-actuated and conventional metered-dose inhaler inhalation techniques in elderly subjects.

BACKGROUND: Poor coordination of canister actuation and inspiration often prevents adequate metered-dose inhaler (MDI) usage by patients, perhaps especially so among the elderly. Breath-actuated inhalers (BAI) have been developed to prevent this problem. METHODS: We compared the adequacy of inhaler technique and patient preferences between MDI and BAI in a group of elderly subjects (mean age, 70.8 +/- 5.4 years). Half of the subjects were regular MDI users; half had never before used one. Two trained observers assessed the adequacy of MDI and BAI usage subjectively while performance was monitored objectively using a light source and infrared system to detect canister actuation and a spirometer to measure the inspiratory volume. If canister actuation was not followed by at least a 50 percent vital capacity, inhaler use was deemed unsuccessful. A brief teaching session preceded inhaler usage. RESULTS: By subjective assessment, BAI was used successfully more often than MDI (79 vs 60 percent, p < 0.05). By objective assessment, BAI was used successfully more often than MDI (64 vs 36 percent, p < 0.0005), although the percentage of inhalations scored adequate was lower than when assessment was subjective. Neither device was used correctly as often by those unfamiliar with MDIs as by those who were regular users. A significantly higher percentage of patients preferred BAI to MDI (71 vs 19 percent, p < 0.005), similar preferences being reported by MDI familiar and MDI unfamiliar groups. CONCLUSIONS: We conclude that (1) elderly subjects frequently handle inhalers poorly, (2) mishandling is better detected by objective than subjective monitoring, and (3) BAI is used correctly and preferred by patients more often than conventional MDIs.

Administration, Inhalation↗

Persistent CT nephrogram: significance in the diagnosis of contrast nephropathy--an update.

Contrast nephropathy (CN), a well-known complication of intravascular contrast medium, is associated with dense cortical nephrograms. These may be detected on unenhanced computed tomography (CT). We report the initial findings of a series of patients at risk for CN who received contrast for coronary arteriography or aortic arch angiography. Unenhanced CT scans were performed 22-26 h after contrast, and the mean cortical attenuation measured. These results were correlated with serial blood urea nitrogen (BUN) and serum creatinine measurements. The patients in this study, all of whom had either elevated baseline creatinine values, were over 73 years or both, had a high incidence of cortical contrast retention and contrast nephropathy.

Acute Kidney Injury↗

Effect of dietary crude-protein type on fertilization and embryo quality in dairy cattle.

An experiment was conducted to determine whether balancing dietary crude protein for optimal rumen degradability would improve fertilization rate and quality of ova in lactating dairy cows. Thirty-eight Holstein cows in early lactation were fed 1 of 2 diets formulated to be isocaloric and isonitrogenous, containing 16% crude protein. Diet 1 contained 73% rumen degradable intake protein, whereas diet 2 contained 64% rumen degradable intake protein. The cows were induced to superovulate and were inseminated, and ova were recovered nonsurgically on postbreeding day 7. Ova were counted and classified as fertilized or unfertilized. Fertilized ova were scored as excellent, good, fair, poor, or degenerate. Unfertilized ova and poor and degenerate embryos were considered to be nontransferable ova and excellent, good, and fair embryos were considered to be transferable ova. There were no differences for mean number of fertilized, unfertilized, transferable, or nontransferable ova recovered from cows fed the 2 diets (P greater than 0.10). Mean percentage of fertilized ova recovered from cows was greater (P less than 0.05) in those fed diet 2, compared with diet 1. Mean percentage of transferable ova recovered from cows tended to be greater (P = 0.06) in those fed diet 2, compared with diet 1. More cows failed to yield transferable ova (P less than 0.05) when fed diet 1, compared with diet 2. Fertilization failure or early degeneration of embryos may occur in cows fed excess rumen degradable protein.

Animal Feed↗

Persistent CT nephrogram: significance in the diagnosis of contrast nephropathy.

The prospective study involved 50 patients without known renal masses or previous renal surgery who received intravascular contrast medium for various radiologic procedures and subsequently underwent unenhanced computed tomography (CT) of the kidneys 22-26 hours later. In 42 patients, cortical readings did not exceed 50 HU and corticomedullary attenuation differences (CMADs) did not exceed 10 HU. In seven patients (intermediate group), there was persistent cortical enhancement (mean attenuation, 58.3-84.8 HU; CMAD, 10.3-40.3 HU), but there was no significant rise in levels of blood urea nitrogen or serum creatinine. A single patient had contrast nephropathy and exhibited a mean cortical attenuation of 141.6 HU and a mean CMAD of 85.8 HU on the 24-hour CT scan. The authors have seen two additional cases of contrast nephropathy presaged by mean cortical attenuations of 162 and 209 HU on the 24-hour CT scan. One of these patients had been in the intermediate group in the prospective study. A cortical attenuation of 55-110 HU on a 24-hour postcontrast scan may help identify a group of patients with subclinical renal impairment who are at high risk of nephropathy on subsequent exposure to contrast medium, while cortical attenuations in excess of 140 HU seem to be an early indicator of contrast nephropathy.

Adult↗

Computed tomography of posterior pararenal and properitoneal metastases.

Identification of the retroperitoneal fascial planes with modern computed tomographic scanners allows for precise localization of pathologic processes in the individual compartments of the retroperitoneum. Metastatic disease to the posterior pararenal space or properitoneal space in 6 patients is reported. Two patients had diffuse histiocytic lymphoma and 4 had metastatic melanoma.

Female↗

Experience with the Pelorus stereotactic system.

The Pelorus stereotactic system, by its unique approach, alleviates the need for the traditional head frame and computer-generated coordinates which are common to most other systems. Despite its simplicity, it sacrifices nothing in terms of the range of problems for which it can be used to diagnose and treat. In fact, its unencumbered design may make it more appropriate for advanced procedures than conventional systems.

Humans↗