Biomedical subjects
M Gordon
Publications and source records attributed to M Gordon.
Dietary antioxidants in disease prevention.
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A cost-benefit analysis of the average smoker: a government perspective.
The aim of this paper was to compare the benefit and costs of cigarette smoking from the government's perspective during a one-year period. This was undertaken by estimating, among other things, the publicly financed health care expenditure attributable to smoking and comparing it with tobacco taxes paid by smokers. This comparison of benefits and costs may provide a yardstick from which to measure the relative worth (in financial terms) an average smoker is to the government, an assessment that may be important when assessing health priorities and any level of commitment to reducing smoking rates. It is estimated that in 1989-90 an average smoker cost the government $203.57, while benefits received totalled an average of $620.56 in the same year. If the government were serious about addressing cigarette smoking as a primary health objective its efforts would portray this. The results of this analysis suggest that the objective of raising revenue from smoking is more of a priority than reducing smoking rates.
On-site acute care for residents of long-term care facilities.
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CPR survival of older nursing home patients.
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Physicians, ethics, advance directives, and long-term care.
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Intermittent cyclic therapy with etidronate prevents corticosteroid-induced bone loss: two years of follow-up.
The purpose of this study was to evaluate the efficacy of intermittent cyclic therapy (ICT) with etidronate in preventing the loss of lumbar vertebral bone mineral density (BMD) in patients taking corticosteroids. The study population was a cohort of patients taking corticosteroids for at least two years for polymyalgia rheumatica, asthma, rheumatoid arthritis, systemic lupus erythematosus or other conditions. A tertiary care university teaching hospital-affiliated rheumatology office practice. Inclusion and exclusion criteria yielded eighty-eight patients taking corticosteroids for at least two years who had not taken estrogen or fluoride and had no causes of secondary osteoporosis. Changes relative to baseline in individual vertebral (L2-L4) BMD measurements after one and two years were compared between patients who had taken ICT with etidronate (n = 42) and those who had not (n = 46). We found that BMD in the lumbar spine increased significantly over baseline in patients who had taken ICT with etidronate, by 3.9% after one year and by 5.6% after two years, whereas it decreased by 3.7-3.8% in patients who had not. We conclude that ICT with etidronate prevents corticosteroid-induced osteoporosis and progressively ameliorates BMD over two years. Double blind trials are underway to evaluate whether this increased BMD is associated with reductions in vertebral fracture rates.
Do-not-resuscitate practice, guidelines and policies in long-term care in Ontario: results of a survey.
We used a survey to determine the prevalence of do-not-resuscitate (DNR) guidelines and protocols, and opinions related to cardiopulmonary resuscitation (CPR) in facilities that provide long-term care (LTC) in Ontario. Questionnaires completed by 357 of 474 facilities providing LTC, revealed that most have written DNR policies. Over half inform residents about the policy on admission, and a third later on, with most indicating DNR status on the chart. Over half the institutions can provide CPR, mostly basic cardiac life support. Most institutions rely on emergency ambulance services to treat cardiac arrests. In the absence of a DNR order, almost half will perform CPR, and a quarter have a protocol to deal with this circumstance. Most respondents indicated that staff, families and residents would welcome a protocol to deal with absent DNR orders in cardiac arrests. Most believe that staff, families and residents would welcome DNR as the basic policy, with CPR as the exception. There is a high awareness in facilities that provide LTC of the limits of CPR in the elderly. Without specific legislation, most facilities have policies and protocols, but there are inconsistencies across Ontario.
Minimizing epidermal stripping in the very low birth weight infant: integrating research and practice to affect infant outcome.
As smaller infants are cared for in our NICUs, maintaining skin integrity and preventing epidermal stripping have become key aspects of neonatal nursing care. This article describes a research utilization project in which research-based knowledge, expert information, and scientific practice guided a practice change in one NICU. The implementation process, based on the Iowa model, included the following steps: identification of triggers; review, critique, and evaluation of the literature; determination of the soundness of the research base; identification of alternate strategies; making the practice change; and evaluation of the outcomes. Initial monitoring suggests that the recommended interventions can be successful with very low birth weight infants.
Vitamin D and calcium in the prevention of corticosteroid induced osteoporosis: a 3 year followup.
OBJECTIVE: To determine the efficacy and safety of vitamin D 50,000 units/week and calcium 1,000 mg/day in the prevention of corticosteroid induced osteoporosis. METHODS: A minimized double blind, placebo controlled trial in corticosteroid treated subjects in a tertiary care university affiliated hospital. The sample was 62 subjects with polymyalgia rheumatica, temporal arteritis, asthma, vasculitis, or systemic lupus erythematosus. The primary outcome measure was the percentage change in bone mineral density (BMD) of the lumbar spine in the 2 treatment groups from baseline to 36 mo followup. RESULTS: BMD of the lumbar spine in the vitamin D and calcium treated group decreased by a mean (SD) of 2.6% (4.1%) at 12 mo, 3.7% (4.5%) at 24 mo, and 2.2% (5.8%) at 36 mo. In the placebo group there was a decrease of 4.1% (4.1%) at 12 mo, 3.8% (5.6%) at 24 mo, and 1.5% (8.8%) at 36 mo. The observed differences between groups were not statistically significant. The difference at 36 mo was-0.693% (95% CI -5.34, 3.95). CONCLUSION: Vitamin D and calcium may help prevent the early loss of bone seen in the lumbar spine as measured by densitometry of the lumbar spine. Longterm vitamin D and calcium in those undergoing extended therapy with corticosteroids does not appear to be beneficial.
Human gastric intrinsic factor expression is not restricted to parietal cells.
Gastric parietal cells have been accepted as the only site of intrinsic factor production in the human stomach. In animals, however, intrinsic factor has been localised to various other cell types of foregut origin, including chief and enteroendocrine cells in gastric mucosa, and duct cells from salivary glands and pancreas. The availability of recombinant human intrinsic factor has led to production of high titre, monospecific antiserum which was used to reexamine the distribution and subcellular localisation of intrinsic factor in the human stomach. Immunolight microscopy revealed that most positively stained cells were gastric parietal cells, but at the margins of the anatomical regions (e.g. cardia/fundus, body/antrum) clusters of gastric chief cells and individual enteroendocrine cells were found to contain intrinsic factor. Immunoelectron microscopy demonstrated the highest antigen density on endocytic and apical membranes of parietal cells. Exocrine secretory granules of a subpopulation of chief cells, the secretory granules of some enteroendocrine cells, and the plasma membranes and smooth vesicles of endothelial cells of the lamina propria capillaries underlying enteroendocrine cells were also positive for the antigen. Labelling in all cells was specific, as it was abolished by preabsorption of the antisera with purified recombinant human intrinsic factor. These findings demonstrate a potential for cellular expression of human intrinsic factor in nonparietal cells. Because such expression occurs normally at the margins of anatomical gastric regions, it suggests that local factors may influence expression of intrinsic factor.
Saving Medicare. Is privatization the answer?
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Creating a living will. Experience at a multilevel geriatric facility.
PROBLEM: How to ensure that residents of a multilevel long-term care facility are able to indicate treatment preferences for the future (when they will be unable to participate in decision making). OBJECTIVE OF PROGRAM: To review the methods used to create a "living will" document suitable for a long-term care population that can be used as a guide and template for other long-term care populations. MAIN COMPONENTS OF THE PROGRAM: The process includes gathering information, developing possible models, designing the document, the review process, and implementing the document. CONCLUSIONS: Developing a living will document is not a simple process. The design should suit the population for whom the document is developed. Primary care physicians, other health care providers, and clergy should provide input.
Analysis of gp39/CD40 interactions using molecular models and site-directed mutagenesis.
The interaction between gp39 (CD40L, TRAP, T-BAM) on activated T cells and mast cells and CD40 on antigen-presenting cells modulates immune responses. Gp39 and CD40 are homologous to tumor necrosis factor (TNF) and its receptor (TNFR), respectively. The TNF-beta/TNFR interaction has been analyzed on the basis of mutagenesis experiments and crystal structures. Using the interaction of TNF-beta/TNFR as a guide, we previously reported a site-directed mutagenesis study in which we identified residues in gp39 (K143, Y145) and CD40 (Y82, D84, N86) involved in gp39/CD40 interactions. Here we describe the use of the TNF-beta/TNFR complex crystal structure as a template to prepare molecular models of gp39, CD40, and their approximate interaction. The application of these models has allowed us to extend our mutagenesis analysis of gp39/CD40 interactions. These experiments have led to the identification of additional gp39 (Y146, R203, Q220) and CD40 (E74, E117) residues that contribute to the gp39/CD40 interaction. We also further explored the importance of gp39 residue Y145 and CD40 residue Y82 for the gp39/CD40 interaction by conservatively replacing these residues with Phe. The results of these studies have enabled us to approximately outline the binding sites in gp39 and CD40. It appears that the gp39/CD40 interaction is centered on at least two clusters of residues and involves residues of two adjacent gp39 monomers. The molecular regions involved in the gp39/CD40 interaction essentially correspond to those in the homologous TNF-beta/TNFR system.
Decisions and care at the end of life.
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Cardiopulmonary resuscitation and neurological complications in the elderly.
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The cloning of Grb10 reveals a new family of SH2 domain proteins.
SH2 domains function to bind proteins containing phosphotyrosine and are components of proteins that are important signal transducers for tyrosine kinases. We have cloned SH2 domain proteins by screening bacterial expression libraries with the tyrosine phosphorylated carboxyterminus of the epidermal growth factor (EGF) receptor. Here we report the identification of a new SH2 domain protein, Grb10. Grb10 is highly related to Grb7, an SH2 domain protein that we have previously identified. In addition to an SH2 domain, Grb7 and Grb10 have a central domain with similarity to a putative C. elegans gene likely to be involved in neuronal migration. At least three forms of Grb10 exist in fibroblasts apparently due to alternate translational start sites. Grb10 undergoes serine but not tyrosine phosphorylation after EGF treatment resulting in a shift mobility in a large fraction of Grb10 molecules. However Grb10 appears to bind poorly to EGF-Receptor and the true binding partner for the Grb10 SH2 domain is unclear. Grb10 maps to mouse chromosome 11 very close to the EGF-Receptor which is remarkably similar to Grb7 that maps near the EGF-Receptor related HER2 receptor. The finding of multiple family members with evolutionarily conserved domains indicates that these SH2 domain proteins are likely to have an important, although as of yet, unidentified function.
Private-sector funding and our health care system.
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