Designing facilities to deliver patient-focused care around service lines.
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Economic Competition↗
Biomedical subjects
M Darby
Publications and source records attributed to M Darby.
Taking a critical look at technology: smarter purchasers make smarter users.
That new technology being lauded in today's medical journals may not be just what the doctor ordered for your healthcare organization. The decision to use it, the experts say, should rely on a thorough assessment of cost, quality and, especially, patient outcomes.
Capital Expenditures↗
Health status assessment--a vital sign for planning patient therapy.
To better understand patient problems, some physicians are gathering and evaluating data on patients' perceptions of their health and emotional strengths. The tool--the SF-36 or Health Status Questionnaire--can be incorporated into practice with a small investment in technology and a few minutes with the patient.
Health Resources↗
Decentralization, physician buy-in key to IDS success, expert says.
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Chicago↗
Use of ultrasound in positioning a catheter for thrombolysis of an occluded prosthetic femoropopliteal graft.
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Blood Vessel Prosthesis↗
The use of ultrasound for monitoring breast tumour response to pro-adjuvant therapy.
In a prospective study, use of serial ultrasound (US) for monitoring tumour response to pro-adjuvant chemotherapy was assessed in 16 patients. Comparison was made with mammographic and pathological tumour size measurements. Clinical and radiological response to treatment was assessed using UICC (International Union Against Cancer) criteria. Comparison of clinical and US response to treatment showed some agreement in 60% and disagreement in 40%. This was comparable with clinical versus mammographic responses (55% and 45%). Correlation between calliper and pathological measurement was similar to that between US and pathological measurement (r = 0.51, P = 0.05; r = 0.50, P < 0.05). Mammography showed poorer correlation (NS). For assessment of final tumour size, US clinical measurements were comparable and better than mammography. US may be a useful tool in monitoring the response of breast tumours to pro-adjuvant therapy.
Adult↗
Pharmacokinetics relevant to the anti-carcinogenic and anti-tumor activities of glucarate and the synergistic combination of glucarate:retinoid in the rat.
Alone and in synergistic combination with retinoids, dietary glucarate inhibits both the chemical induction and growth of rat mammary tumors. To investigate the pharmacokinetics of glucarate, [14C]glucarate was synthesized, converted to the calcium salt, and administered to rats bearing primary mammary tumors. When given by gavage, [14C]glucarate, as the calcium salt, showed a biphasic response in the blood. After peaking within 1 hr of administration at a level of 0.4 mumol/mL (normal endogenous level is approximately 0.04 mumol/mL), its plasma concentration dropped to 0.1 mumol/mL at 3 hr. In the second phase, there was a semilog increase to 0.6 mumol/mL at 15 hr, followed by a slow rise to 0.75 mumol/mL at 24 hr. Of the 38% of the administered glucarate that was recovered, 38% was excreted in the urine, and 30% remained in the gastrointestinal tract at 24 hr. Glucarate was concentrated 3- to 4-fold in the liver and intestinal mucosa, compared to the level in serum. With minor exception, the pharmacokinetics of [14C]13-cis-retinoic acid administered by gavage to rats was similar or not the semipurified diets were supplemented with 64 mmol/kg of calcium glucarate. During the interval between 5 and 10 hr post-administration of [14C]13-cis-retinoid, there was a transient 35-50% rise in the plasma level in rats on the glucarate-supplemented diet. This rise had no observable effect on the level of retinoid in major organs or in the tumor. A glucarate-binding protein was detected in the tumor cytosol. This potential receptor had a Ka of 1.49 x 10(7) M-1.
Animals↗
Angiomyolipoma of the kidney: a clinical enigma in diagnosis and management.
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Hemangioma↗
First-trimester maternal serum alpha-fetoprotein and chorionic gonadotropin in aneuploid pregnancies.
First-trimester maternal serum alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) levels were measured in samples from 29 women with cytogenetically abnormal pregnancies and 145 women with cytogenetically normal pregnancies matched for gestational age, race, and sample storage time. All patients had a risk of fetal aneuploidy greater than or equal to that of a mother 35 years of age. AFP was significantly lower in samples from pregnancies affected with trisomy 21 (0.67 MoM; p less than 0.05), while HCG values were no different from those of matched controls. Trisomies 13 and 18 could not be distinguished from matched controls by AFP. However, levels of HCG were significantly lower in such pregnancy samples, with median values of 0.65 MoM in trisomy 13 and 0.32 MoM in trisomy 18 (p less than 0.05). Variations in AFP and HCG levels suggest that expressed differences between autosomal aneuploidies include differences in fetal and placental protein production in the first trimester.
Aneuploidy↗
Hypertrophic pulmonary osteoarthropathy in pulmonary metastatic disease. A case report and review of the literature.
We present a case of a woman with pulmonary metastatic disease from breast carcinoma who presented with features of pulmonary osteoarthropathy (HPOA). We document the unusual presentation with classical features of HPOA in the absence of finger clubbing and the response of the scintigraphic appearances to antitumor chemotherapy.
Adult↗
Dental assisting: influence on hygienists and students.
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Clinical Competence↗
Seminar in Poland.
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International Cooperation↗
Cardiac flow measurement by ultrafast CT: validation of continuous and pulsatile flow.
To gauge the accuracy of ultrafast CT in measuring cardiac output and myocardial perfusion in humans, measurements of continuous and pulsatile flow were made in a large asymmetrical phantom. The variation in the relationship between Hounsfield number and contrast concentration was assessed in a human thorax phantom. Radiopaque contrast medium was injected during perfusion of the phantom at a range of flow rates between 1.5 and 8 L/min. The phantom was scanned in two modes (50 and 100 ms) during continuous and pulsatile flow and with the phantom surrounded by air and by water. Flow in the tubes was calculated using indicator dilution theory, and flow in the tissue-equivalent chamber was calculated by applying first-pass distribution principles. The standard deviation of the difference between calculated and measured flow varied from 0.2 to 0.6 L/min, giving 95% limits of agreement from 0.4 to 1.2 L/min. The constant (K) relating Hounsfield unit number to iodine concentration varied widely both in different locations within the phantom and under different scan conditions (17.2-27.6 HU/mg I). Within a human thorax phantom, K varied from 14.15 to 23.18 HU/mg I and was dependent on location within the thorax phantom, the scan mode, and the cross-sectional diameter of the phantom. These data suggest that though the ultrafast CT scanner can measure continuous and pulsatile flow accurately in tubes, precise measurements of cardiac output in humans will require K to be assessed for each subject. Measurements of flow in tissue should be possible.
Cardiac Output↗
Healing the home.
Domestic violence is one of the biggest threats to the health of women in the U.S. Here's how health plans are preventing, identifying, and treating abuse.
Attitude of Health Personnel↗