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Biomedical subjects

M Kane

Publications and source records attributed to M Kane.

117 records · Page 7Linked to original sources
PubMedDate not supplied

A rapid agglutination assay to detect anti-streptokinase antibodies.

BACKGROUND: Streptokinase resistance may cause suboptimal thrombolytic therapy. AIM: To develop a rapid latex-bead assay to detect streptokinase antibodies. METHODS: Sera were obtained from 16 patients presenting with acute myocardial infarction (MI) before treatment with streptokinase and 1 and 6 months post treatment, and from 100 controls. Sera were assayed for anti-streptokinase antibodies using a functional streptokinase-neutralising assay. RESULTS: Streptokinase-neutralising activity was low in controls (54 +/- 5U/ml) and patients prior to treatment (101 +/- 18), increasing to 2,110 +/- 823 and 1,017 +/- 169 at 1 and 6 months (mean +/- SEM). The latex assay had a sensitivity of 94% and a specificity of 93% for detecting individuals with > 350U/ml of streptokinase resistance, which is sufficient to neutralise the drug clinically. CONCLUSIONS: Estimation of streptokinase resistance using an enzyme immunoassay and a latex bead assay correlated well with serum neutralising activity. This assay can rapidly identify patients who have a high level of streptokinase-neutralising activity.

Agglutination Tests↗
PubMedDate not supplied

Exclusion of atrial thrombus by transesophageal echocardiography.

To determine whether transesophageal echocardiography (TEE) is useful in ruling out the presence of atrial thrombus, we performed TEE in 20 patients immediately before valve replacement or valve repair and within 3 days of an autopsy in one patient. Mitral stenosis was the predominant lesion in three patients, mitral regurgitation was seen in 11 patients, five patients had mitral prosthesis malfunction, one patient had a tricuspid prosthesis malfunction, and one patient had aortic stenosis. Eight patients were in atrial fibrillation. Four patients demonstrated spontaneous contrast in the associated atria. Nine patients were receiving oral anticoagulation. Mean left atrial diameter was 5.3 +/- 1.3 mm. TEE revealed no evidence for atrial thrombus in 18 of the 21 patients; this finding was confirmed by careful inspection of the atria including the appendages. TEE demonstrated a left atrial thrombus in two patients and a right atrial thrombus in another (confirmed at the time of surgery or at autopsy). In all cases transthoracic echocardiography was negative. Our data suggest that TEE is useful in ruling out atrial thrombus, and therefore may be a useful test preceding interventions associated with an increased risk of embolism from the atria such as cardioversion, mitral valvuloplasty, or valve replacement.

Adult↗
PubMedDate not supplied

State contracting initiatives for quality improvement in asthma care.

This article examines the role of a state Medicaid program in standardizing and implementing quality performance measures for providers. It describes the Asthma Education and Primary Care Clinician Linkages Quality Improvement Program (QIP), one aspect of the ongoing Hospital Quality Initiative in Massachusetts. In October 1996, the second year of the initiative, the Massachusetts Division of Medical Assistance requested that all contracting hospitals submit quality improvement process and outcome measures related to asthma care, including practice guidelines, patient education materials, and documentation mechanisms to facilitate patients' appropriate follow-up contact with primary care clinicians. A team of evaluators reviewed these materials to determine whether hospitals had baseline data in place for asthma QIP development. Information forums were held with three reviewers and the hospitals to discuss various programs and progress toward quality improvement in asthma care. Reviewers also worked to identify hospital programs that could be used as models and those that would benefit from assistance in meeting the state's program goals.

Asthma↗
PubMedDate not supplied

Lifting: why nurses follow bad practice.

This article reports on a research study of a group of third-year undergraduate student nurses, investigating their use of lifting techniques and their potential to conform to ward practice in the selection of lifts. A questionnaire which included a vignette was administered to 19 students. Results showed that 50 per cent would conform to the selection of a two-person lift by a staff nurse even when they knew that the lift was unsafe. The authors suggest possible variables which may influence the selection of lifts.

Biomechanical Phenomena↗
PubMedDate not supplied

Anti-idiotype cancer vaccines: pre-clinical and clinical studies.

We have previously shown that anti-idiotypic antibodies (Ab2) that functionally mimic the epitope defined by anti-colorectal carcinoma (CRC) monoclonal antibody (Ab1) CO17-1A induce in cancer patients highly specific anti-anti-idiotypic antibodies (Ab3) which are Ab1-like in their binding specificity to tumor cells and antigen. Ab1 GA733, originally produced against gastric carcinoma, binds to the same antigen as Ab1 CO17-1A, but to a different epitope. Ab2 against Ab1 GA733 produced in goats have been previously shown in experimental animals to functionally mimic the epitope defined by the Ab1. For the purposes of studying immune responses, this Ab2 preparation was administered to 12 patients who had previously been diagnosed with CRC but whose tumors were excised prior to Ab2 therapy. Patients were injected subcutaneously with escalating doses (0.5-4 mg) of Ab2 precipitated to alum. Ten of the 12 patients produced antibodies to the administered Ab2. In six patients a fraction of these antibodies bound specifically to the Ab2 and not to normal goat IgG. These anti-anti-idiotypic antibodies (Ab3) shared idiotopes with the Ab1 and bound to antigen-positive, but not antigen-negative, cultured tumor cells. The Ab3 specifically inhibited binding of the Ab1 to tumor cells and therefore may bind to the same epitope as Ab1. Our studies demonstrate that Ab2 are highly specific modulators of cancer patients immune responses to their tumors.

Antibodies, Anti-Idiotypic↗