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Biomedical subjects

M Horne

Publications and source records attributed to M Horne.

At least 19 recordsLinked to original sources
PubMed1998

Glycocalicin levels in the plasma of HIV+ patients: an indicator of platelet turnover.

Glycocalicin (GC) is the carbohydrate-rich portion of platelet membrane glycoprotein Ib(alpha) that can be cleaved from circulating platelets by proteases. The plasma GC level is an indicator of platelet turnover. Using an ELISA for GC, we assayed the plasma of 20 normal children (age 6 to 13 years), 50 HIV+ children (ages 4 to 18 years), 32 normal adults (ages 21 to 53 years), and 50 HIV+ adults (ages 24 to 66 years). The results were adjusted for individual platelet counts to give GC indexes (GCI). The normal children and the normal adults had significantly different GCI distributions (P = .002). In both normal and HIV+ individuals the GCI decreased with increasing platelet count (-.73 < r < -.34). Twenty-eight percent of the HIV+ children and 28% of the HIV+ adults had elevated GCI values. The majority of these elevated values occurred in patients with platelet counts >100,000/microL. Neither the GCI nor the platelet count was correlated with viral load. The platelet count, however, was weakly correlated with the CD4 count in both children (r = .31) and adults (r = .30) infected with HIV. Also, the CD4 count was weakly and inversely correlated with GCI in HIV+ adults (r = -.34) and in children (r = -.24). We conclude that increased GCI and, by implication, increased platelet turnover is a relatively common feature of advanced HIV disease. Furthermore, GCI may be elevated in HIV+ patients even with a platelet count >100,000/microL, suggesting increased platelet turnover before thrombocytopenia develops.

Adolescent↗
PubMed1998

The effect of a perioperative clinical pathway for knee replacement surgery on hospital costs.

UNLABELLED: Clinical pathways are being introduced by hospitals to reduce costs and control unnecessary variation in care. We studied 766 inpatients to measure the impact of a perioperative clinical pathway for patients undergoing knee replacement surgery on hospital costs. One hundred twenty patients underwent knee replacement surgery before the development of a perioperative clinical pathway, and 63 patients underwent knee replacement surgery after pathway implementation. As control groups, we contemporaneously studied 332 patients undergoing radical prostatectomy (no clinical pathway in place for these patients) and 251 patients undergoing hip replacement surgery without a clinical pathway (no clinical pathway and same surgeons as patients having knee replacement surgery). Total hospitalization costs (not charges), excluding professional fees, were computed for all patients. Mean (+/-SD) hospital costs for knee replacement surgery decreased from $21,709 +/- $5985 to $17,618 +/- $3152 after implementation of the clinical pathway. The percent decrease in hospitalization costs was 1.56-fold greater (95% confidence interval 1.02-2.28) in the knee replacement patients than in the radical prostatectomy patients and 2.02-fold greater (95% confidence interval 1.13-5.22) than in the hip replacement patients. If patient outcomes (e.g., patient satisfaction) remain constant with clinical pathways, clinical pathways may be a useful tool for incremental improvements in the cost of perioperative care. IMPLICATIONS: Doctors and nurses can proactively organize and record the elements of hospital care results in a clinical pathway, also known as "care pathways" or "critical pathways." We found that implementing a clinical pathway for patients undergoing knee replacement surgery reduced the hospitalization costs of this surgery.

Adult↗
PubMed1998

Treating headaches. A conceptual framework.

BACKGROUND: Similar medications are effective in migraine and muscle contraction headache therefore the term recurrent headache is used to cover the spectrum of classic migraine and muscle contraction headache. OBJECTIVE: The concept of a threshold to headache triggers is proposed. Treatment for chronic headaches is directed at raising the threshold or removing triggers. DISCUSSION: The most important factors that lower the threshold to headaches are hormones, mood and sleep disturbance. Therapeutic strategies for raising the threshold and treatment of the acute headache are discussed.

Acute Disease↗
PubMed1997

'Do I have a brain tumour, doctor'?

Brain tumours cause symptoms through raised intracranial pressure, epilepsy and local effects. The progressive worsening of these symptoms and signs is the most important clue to the presence of a tumour.

Brain↗
PubMed1996

Achieving a 96.6 percent follow-up rate in a longitudinal study of drug abusers.

Longitudinal studies can be hampered by poor follow-up rates, seriously reducing generalizability of the findings. Understanding the barriers, as well as approaches to overcome and adapt to these impediments, resulted in a 96.6% 18 month follow-up rate of 479 drug abusers enrolled in an NIDA funded demonstration project aimed at reducing HIV transmission among St. Louis' most vulnerable drug-using population. In this paper, we discuss the importance of phone and systems tracking, creative team work and persistence and procedures for tracking out-of-treatment drug-users by analyzing the efforts needed to reach the study subjects. We also compared the characteristics of hard-to-reach respondents with those who were less difficult. The results revealed that employment status was the only characteristic associated with being hard-to-reach. Gender, race, age, education and psychiatric status did not discriminate recruitment difficulty in this sample. The study findings suggest that although unemployment predicted recruitment difficulty, and that the locator information provided by the respondent can be very helpful, a comprehensive tracking strategy as well as persistence and creative team work are the most important determinants of the rate of success of a follow-up investigation.

Adult↗
PubMed1996

Involving physicians in clinical pathways: an example for perioperative knee arthroplasty.

BACKGROUND: At Stanford University Hospital, attempts to improve the case management program led to the development of clinical paths, a multidisciplinary case management tool. Successful design and implementation of clinical paths depend on physician leadership. However, since physicians are trained to function independently and to treat each clinical problem as unique, they tend to resist attempts to have them follow clinical paths. Strategies to get physicians who perform the same clinical procedure to agree with each other on a sequence of common interventions had to be developed. Clinical paths define the expected processes of care and therefore allow for the introduction of continuous quality improvement (CQI) into the clinical arena. A structure had to be developed for the effective use of pathways in a CQI framework, and physicians had to be encouraged to function as CQI leaders. EXAMPLE: Description of the design of a perioperative knee arthroplasty pathway demonstrates the steps needed for successful physician involvement in pathway design and its integration into clinical CQI. CONCLUSIONS: With sensitive facilitation, physicians can become productive leaders of the design of clinical paths, and when they learn the benefits of improved efficiency, outcomes, and costs their involvement becomes self-sustaining. A quality improvement group led by physicians to develop the pathway after implementation can mark the beginning of clinical CQI implementation.

Arthroplasty↗
PubMed1995

Central nervous system noradrenergic and dopaminergic turnover in response to acute neuroleptic challenge.

The objective of this study was to obtain direct neurochemical measures of the central nervous system's response to a typical neuroleptic, haloperidol, in human subjects. Nine healthy volunteers participated in this study. Central nervous system neuronal activity was assessed by measuring the plasma concentration and overflow from the brain of dopamine, norepinephrine, and their lipophilic and acidic metabolites after acute intravenous administration of haloperidol. By combining bilateral internal jugular vein blood sampling with cerebral blood flow scans we were able to differentiate between cortical and subcortical responses to haloperidol. The central nervous system response to haloperidol administration displayed a degree of regional specificity. Dopamine release, estimated from the overflow of homovanillic and dihydroxyphenylacetic acids, was reduced in cortical but not subcortical brain regions. Norepinephrine turnover was increased in cortical and subcortical brain regions. The overflow of homovanillic acid from the brain into the internal jugular veins was not related quantitatively to the arterial plasma concentrations of the catecholamines examined, homovanillic and dihydroxyphenylacetic acids or prolactin. Measurements of catecholamines and their metabolites in arterial plasma gave little indication as to monoaminergic neuronal activity in the brain.

Adolescent↗
PubMed1995

Disseminated intravascular coagulation associated with granulocyte colony-stimulating factor therapy in a child with human immunodeficiency virus infection.

We report a case of disseminated intravascular coagulopathy, apparently caused by exposure to granulocyte colony-stimulating factor (G-CSF). The medical records of patients treated for more than 30 consecutive days with subcutaneously administered G-CSF were reviewed for the occurrence of thrombocytopenia or coagulation abnormalities. New-onset thrombocytopenia with a platelet count less than 100 x 10(9) cells/L (< 100,000 cells/mm3) developed in 9 of 23 patients (39%) after a median of 11 weeks of treatment with G-CSF at dosages between 1 and 10 micrograms/kg per day.

Adolescent↗
PubMed1995

MUJA: manipulation under joint anesthesia/analgesia: a treatment approach for recalcitrant low back pain of synovial joint origin.

OBJECTIVE: These four cases show how application of manipulation under joint anesthesia/analgesia (MUJA) may benefit the patient with low back pain (LBP) of synovial joint origin when prior treatment options fail. We propose that MUJA should be considered as a treatment option for those with recalcitrant synovial joint-mediated LBP. CLINICAL FEATURES: We report four cases of patients with LBP successfully treated by this protocol. These four patients were neurologically normal and suffered from lumbar zygapophyseal joint and/or sacroiliac joint mediated pain diagnosed by fluoroscopically guided, contrast enhanced, intra-articular anesthetic injections. There were various radiographic findings. INTERVENTION AND OUTCOMES: All four individuals were treated with manipulation after facilitatory intra-articular anesthetic/corticosteroid injections into lumbar zygapophyseal and/or sacroiliac joints. Some also required physical therapy interventions to resolve their LBP. CONCLUSIONS: Anecdotal success with MUJA is enticing; MUJA appears to be a viable alternative for those patients in whom traditional treatment options for LBP of synovial joint origin have failed. However, prospective, quality research is required before MUJA can be formally validated or not in the treatment of documented lumbar zygapophyseal joint and/or sacroiliac joint mediated LBP.

Adult↗