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Biomedical subjects

M L Russell

Publications and source records attributed to M L Russell.

At least 55 records · Page 3Linked to original sources
PubMed1986

Successful program for recovery of dropouts to a clinical trial.

This is a report of a successful program to return dropout participants to active participation at a single clinic of a multicenter long-term clinical trial, the Coronary Primary Prevention Trial of the Lipid Research Clinics Program. The specific objectives were to re-engage dropouts into active participation and to have them resume study medication. Thirty-six men had been absent from the Baylor-Methodist Clinic for 10 months to over four years. The program focused on resolving the presenting problems: psychosocial, somatic, and drug adherence. It was based on six general principles with corresponding goals and employed 13 activities and procedures in a specific operational sequence for reinstitution of the Coronary Primary Prevention Trial protocol. Counseling techniques were used to improve protocol adherence. The recovery program was monitored bi-weekly by computer. The dropout group did not appear to exhibit any biases and approximated the remainder of the Baylor-Methodist cohort demographically. At six months into the recovery program, 90 percent of the dropouts had been recovered. Seventy percent of the recovered participants re-established medication-taking behavior. The mean rate of adherence to medication for all of the recovered group was 35 percent of the prescribed dose, 8 g per day. Review of the data for the cholesterol differential between the two treatment groups demonstrated a favorable effect of the reinstitution of the study medication. The program's methods are applicable to clinical practice.

Adult↗
PubMed1986

Atypical erosive osteoarthritis and Sjögren's syndrome.

An unusual, destructive form of erosive hand arthropathy is described in five postmenopausal women. Although early clinical and radiological findings were most in keeping with a diagnosis of erosive osteoarthritis (EOA), hand involvement progressed to a distribution intermediate between EOA and rheumatoid arthritis (RA). Although asymptomatic, all patients had features of Sjögren's syndrome (SS), including keratoconjunctivitis sicca (KCS) and lymphocytic foci in labial biopsy specimens. These cases, which are clinically unlike either RA or EOA, may represent a unique arthropathy associated with sicca features.

Female↗
PubMed1986

The microvascular localization of laminin and fibronectin in scleroderma muscle by immune electron microscopy.

Immune electron microscopy using a peroxidase-antiperoxidase (PAP) technique was done on muscle biopsies from patients with scleroderma (PSS), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and normal controls, in order to localize laminin and fibronectin in the muscle capillary basement membrane (BM). Three patterns of staining were noted for the 2 antigens: in/out, diffuse and negative. Staining patterns in PSS biopsies were markedly different from both the normal and disease controls. For laminin the expected in/out pattern was rare in PSS, with virtually all biopsies being either diffuse or negative. In the case of fibronectin, the staining patterns were of equal frequency in PSS, whereas in the control groups diffuse staining was rare. These findings suggest that in addition to the morphologic abnormalities previously noted in PSS muscle capillary BM, there is also an alteration in the distribution of specific BM components in PSS.

Arthritis, Rheumatoid↗
PubMed1986

Rheumatoid pleural effusion: lack of response to intrapleural corticosteroid.

Two cases of rheumatoid arthritis with large persistent, asymptomatic pleural effusions are presented. Repeated thoracentesis and intrapleural instillation of corticosteroid proved ineffective in management. However, the persistence of the effusion did not result in any respiratory complications. In one case the effusion disappeared spontaneously long after articular disease remitted, and in neither case did the size of the effusion parallel articular disease activity. It would appear that treatment directed solely at elimination of large rheumatoid pleural effusions is both unrewarding and unnecessary, as long as the underlying lung is normal.

Adult↗
PubMed1985

Examination of medical professions for counseling on medication adherence.

The abilities of 68 professional staff members (physicians, physician assistants, dietitians, nurses, and counselors) from 12 clinics of the Coronary Primary Prevention Trial of the Lipid Research Clinics Program in 28 specific skills fundamental to interviewing and counseling for medication adherence were examined. Each staff member was provided with confidential data regarding his or her abilities, and each clinic's trial director received the group data for his or her staff's possession and use of these skills. Analyses of trial-wide data showed substantial differences among clinics in possession and use of the skills, with overall greater strength in interviewing skills, as compared with assessment and counseling skills. No professional group consistently possessed most or fewest of these skills. It is suggested that trained non-physician personnel could be used to complement physician efforts to counsel patients for medication adherence.

Adult↗
PubMed1985

Evaluation of clinical skills for nutrition counseling.

This report describes the procedures for and feasibility of an evaluation program that provides a direct assessment of the use of specific clinical skills during an interview with a simulated patient. The specific aims of this evaluation were to assess untrained graduate students in nutrition on their application of a set of 31 specific clinical skills for resolving dietary adherence problems. Each student conducted two interviews with each of two different simulated patients with hyperlipidemia presenting typical problems following a diet low in saturated fat and cholestrol. The evaluation program provided analyses that identified the strengths and deficits of each student and the performance of the entire group. It is suggested that the evaluation program offers a practical, objective method for examining the entry-level clinical skills of students in training and may be useful in other educational programs (eg, in-service, continuing education workshops).

Cholesterol, Dietary↗
PubMed1984

RNA and capsid accumulation in cowpea protoplasts that are resistant to cowpea mosaic virus strain SB.

Leaf protoplasts from the Arlington line of cowpea (Vigna unguiculata) support only a limited increase of cowpea mosaic virus strain SB (CPMV-SB), whereas cowpea severe mosaic virus, another member of the comovirus group, replicates efficiently in Arlington cowpea protoplasts. CPMV-SB replicates efficiently in protoplasts of cowpea line Blackeye 5. Some characteristics of the virus-specific resistance of Arlington protoplasts to CPMV-SB are reported. Differences between progeny CPMV-SB from Arlington and Blackeye 5 protoplasts were not detected. Inoculation with CPMV-SB RNA, rather than virions, did not make Arlington protoplasts fully susceptible. These results favor, for likely involvement in the CPMV-SB restriction phenomenon, events in the virus life cycle that occur after exposure of virion RNA to the cytoplasm and before assembly of particles is completed. The accumulation of CPMV-SB RNAs of both polarities was found to be depressed in inoculated Arlington protoplasts. However, (+)RNA (virion RNA polarity) accumulated to no lesser extent, per unit of (-)RNA, in Arlington protoplasts than in Blackeye 5 protoplasts. Capsid antigen accumulation, per unit of (+)RNA, was reduced in Arlington protoplasts as compared to Blackeye 5 protoplasts. A working hypothesis consistent with the above and other observations is that Arlington protoplasts have an inhibitory substance that interferes with the production or/and function of CPMV-SB specified proteins.

Capsid↗
PubMed1984

Agreement of self-reported and physiologically estimated fitness status in a symptom-free population.

A population of 204 symptom-free clerical and white-collar employees who volunteered for a corporate-based health promotion program was studied to determine agreement between self-reported and physiologically determined fitness status. Physiologic fitness was estimated using exercise treadmill performance. There were statistically significant differences between self-reported and treadmill-estimated fitness status. The study population rated their fitness substantially higher than that estimated by treadmill performance. Self-reported fitness was found to be poorly correlated with physiologic fitness, indicating independent distributions. These relationships persisted across gender. The results question the use of self-reported estimates of physical health in health services research.

Adult↗
PubMed1984

Behavioral aspects of the use of medical markers in clinical trials.

Nonadherence by trial participants to the study drug regimen threatens the satisfactory conduct of the best designed clinical trial. Reduced adherence confounds the interpretation of the study's results and may leave the study's primary question unanswered. Recent reports from multicenter clinical trials have reported adherence rates of 60%-90%. This presentation examines the use of a drug marker in counseling to improve participant adherence to a medication regimen. Potential benefits and problems are identified, and several recommendations are offered. Increasingly, behavioral counseling has been used by clinic staff members to improve the medication adherence of trial participants. Behavioral counseling is a data-based counseling process emphasizing patient collaboration with the clinician in identifying, diagnosing, and intervening in medication adherence problems. A valid, accurate drug marker would have direct application in both identifying and intervening on a medication adherence problem. However, a marker would not contribute substantially to the clinician's ability to diagnose accurately the nature of the medication adherence problem. A major concern is the manner in which the clinician introduces the drug marker into the counseling process. The use of data from a drug marker can have a strong positive or negative effect on the medication adherence problem. It also can significantly influence the continuing relationship between the clinician and the participant. Examples are presented. It is strongly recommended that the clinician identify the specific goals for the marker's use prior to the introduction of data from a medical marker into the participant counseling process. Further, the manner in which the marker is introduced into the interview with the participant must be considered carefully.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Trials as Topic↗
PubMed1984

The statistical analysis of adherence data obtained from markers.

Adherence markers provide new kinds of clinical trial data. Adherence data on individual participants obtained from markers can be used for designing the trial sample size and stratification, evaluating the adequacy of randomization, directing the management of adherence, and analyzing and interpreting the trial's final results. Examples of these are presented. Analyses of adherence data can employ conventional procedures. Box plot techniques are proposed for flagging extreme values of the distribution of adherence either at a single time point or in a time continuum. The effect of difference in distribution of the markers in two or more groups in a clinical trial is discussed. Survival analysis is illustrated as one technique in univariate and multivariate analysis of markers with covariate effects. Design considerations with markers in a clinical trial are discussed, with particular emphasis on some of the assumptions and biases that must be considered for the analysis.

Clinical Trials as Topic↗
PubMed1984

Clinical trials methods and the practice of medicine.

An important potential byproduct from clinical trials is validated clinical methods applicable to clinical practice. The potential for improved patient care is separate from the scientific and intellectual answers gained in such trials. The current mechanisms for the transfer of methodological information from clinical trials are inefficient and have identifiable barriers. Methods validated in clinical trials must be recognized and accentuated as a valuable resource. A central repository of clinical trials' methods and a retrieval system dedicated to this unique body of scientific literature is warranted. Reports of methodological advances from clinical trials should be published in the literature read by clinical practitioners. The effective transfer of methods information from clinical trials to the office of the clinical practitioner is possible but requires increased efforts on the part of clinical trials scientists.

Clinical Trials as Topic↗
PubMed1984

Reduced disability and health care costs in an industrial fitness program.

A prospective longitudinal study of a group of participants in an industrial physical fitness program during a five-year period compares the disability and major medical costs incurred by the subjects before and after entry into the program. The members of the cohort were employees of an insurance company; most were well educated and held sedentary, white-collar jobs. Participation was voluntary and without financial incentives. The group experienced 45.7% reduction in major medical costs in the postentry year, rather than the expected inflationary increase. There was a reduction of 20.1% in the average number of disability days, and a 31.7% reduction in direct disability dollar costs in the one-year postentry period. The average combined savings per participant were $353.38; the average operational cost was $120.60. Results suggest that work-site wellness programs can make a substantial contribution to the reduction of health care and disability costs.

Absenteeism↗
PubMed1984

Intervention specialist: new role for dietitians' counseling skills.

Dietitians who want to expand their clinical responsibilities beyond dietary counseling should consider the role of the intervention specialist. The role is a logical expansion of the duties of the dietitian who is already serving as a health behavior counselor. The concept of dietitians' functioning as intervention specialists originated in clinical trials, when they served as adherence counselors. The intervention specialists in the clinical trials used the health behavior counseling process to help research participants adhere to the trials' protocols. This counseling process uses a systematic, problem-solving approach to assess, diagnose, intervene, and follow up on a targeted behavioral problem. Dietitians can prepare for the expanded counseling role of intervention specialist through interviewing and counseling skill assessment and further training. They must take an active role in defining how the services of an intervention specialist can be beneficial to physicians as well as to their patients. They should address the cost-effectiveness of behavior counseling in order to justify the increased initial costs. Dietitians will need to actively promote the role of intervention specialist in the medical community if they want this opportunity for increased professional responsibility.

Behavior Therapy↗
PubMed1983

Development of standardized simulated patients for quality control of the clinical interview.

The evaluation and training of clinical trial staff who counsel patients in lifestyle changes for disease prevention is aided by a review of videorecorded interviews conducted with a simulated patient. This report describes the Inventory of Simulated Patient Characteristics, a listing of 34 generic parameters for developing a simulated patient for use in staff training and evaluation in counseling. The Inventory creates a complete person in all critical aspects of counseling for lifestyle change (e.g., daily routines, family, job). The Inventory was used in the Lipid Research Clinics' Coronary Primary Prevention Trial (CPPT) to examine the trial staff's skills in counseling for regimen adherence. In 1979 and 1980, 85 and 52 clinic staff, respectively, conducted a total of 548 interviews with four different simulated patients developed using the Inventory, and rated the portrayals as highly realistic. The Inventory also was used to verify that the simulated patient portrayals were greater than 90% faithful to their characterizations. While simulated patients limited to specific clinical syndromes have been used widely in medical education, no guidelines exist for their use in training trial staff in regimen counseling. The Inventory provides a simple template for creating simulated patients with broad characterizations that closely mimic actual trial participants.

Clinical Trials as Topic↗
PubMed1983

Differential effects of induced mood on the recall of positive, negative and neutral words.

Previous investigations have consistently found differential effects of induced moods on the accessibility of personal memories differing in hedonic tone. Findings for effects of retrieval mood on recall of verbal material have been less consistent. This study examined the effect of induced mood on the recall of previously learned personality trait words. Trait words were presented in normal mood and recall tested in elated or depressed mood. More positive words were recalled in elated than in depressed mood. Conversely, more negative words were recalled in depressed than in elated mood. There was no effect of mood on the recall of neutral words. Subjects in whom the mood induction procedures had failed to affect mood substantially did not show differential word recall. Differential effects of retrieval mood on recall of verbal material can be shown, but the nature of the material may be important. It may be necessary for the material to have been differentially associated with mood states in the subjects's life experience. This suggestion is discussed within Bower's (1981) associative network theory of mood and memory, and the implications for models of depression are considered.

Adult↗