Biomedical subjects
Publications and source records attributed to M Martin.
Utilization review programs are increasing in number and type, but their true contributions to payers' health care and cost management efforts vary tremendously, according to evaluations of over 100 private UR firms by National Medical Audit. Three senior executives of that firm discuss state-of-the-art criteria and methods for gauging the effectiveness of a UR program.
To develop a safe method to target gene delivery into intrahepatic tumors, we examined the toxicity of intrahepatic (IH) injection of retroviral vector producer cells (VPC) into the canine liver. VPC have been demonstrated to effectively transfer genes in vivo. To evaluate for adverse effects form xenogeneic cell transplantation, mongrel dogs were injected IH with 1 x 10(9) murine LTKOSN.2 VPC divided into three aliquots. The animals were then monitored for acute toxicity induced by the VPC. The intraoperative IH injections of the cells were tolerated without difficulty. Starting 7 days after IH injection, the dogs then received intravenous ganciclovir (GCV) twice daily (5 mg/kg) for 7 days. GCV treatment did not cause significant toxicities. Dogs underwent serial blood tests to evaluate bone marrow, renal, liver and immunological function. Complete blood counts, electrolytes, liver function and renal function tests remained normal except for mild elevations of alkaline phosphatase. Histologic examination of liver tissues from the IH injection site revealed no apparent normal tissue destruction induced by the VPC. Two of the four treated dogs underwent liver biopsy on day 3. These biopsy specimens were cultured and persistent, viable VPC were recovered. The dogs mounted an antibody response to the murine VPC that was first demonstrated 5 days post injection. PCR analysis demonstrated low level gene transfer into dog liver tissue. Overall, our results demonstrate that IH xenogeneic VPC injections are not accompanied by significant adverse effects over a 1 month period following administration into the canine liver. These data support the safety aspects of using murine VPC in Phase I clinical trials.
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This study was designed to provide a diagnostic, symptomatologic and sanitary assessment of schizophrenic patients in the network of institutions of the Plate-Forme Psychiatrique Liégeoise (Liège, Belgium). The diagnosis of schizophrenia was based on the DSM IV. Demographic, social and global functioning (GAF scale) data were collected from the Résumé Psychiatrique Minimum (RPM) , a clinical summary which has been imposed for each psychiatric hospital stay by the Belgian Ministry of Public Health. Symptoms components were derived from the Psychosis Evaluation tool for Commom Use by Caregivers (PECC). In the 44 participating institutions, 793 cases of schizophrenia were reported (533 men and 260 women) with a mean age of 46.1 14.4 years. The study confirmed the predominance of men in schizophrenia (67%) but revealed that women were about 6 years higher than men. PECC symptoms were studied in a random sample of 184 patients extracted from the 793 initial patients and analysed with respect to age, sex and type of care (full-time or part-time hospitalization, ambulatory care). Negative, cognitive and total PECC scores did not vary with sex but were positively correlated with age. Hospitalized patients were significantly older than the others. The cognitive deficit was significantly higher in hospitalized patients than in other patients, while the perception of the disease tended to be more apparent in ambulatory than in hospitalized patients. Data were also related to social information and global functioning. The GAF scores increased with age but were comparable in men and women. Moreover, GAF scores were significantly lower in catatonic type schizophrenia patients than in others.
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INTRODUCTION: Older people are a significant source of emergency admissions to general hospitals relative to their proportion of the population. Little is known of the acuity of these admissions, aspects of which this study aims to determine. METHODOLOGY: A prospective survey of 1 in 10 acute general takes in a university teaching hospital over 11 months. Age, sex, acuity of presentation, premorbid functional status and cognitive impairment were recorded. RESULTS: Of 332 admissions, 127 (38%) patients were aged 65 years or over and 205 under 65. Of > or =65's, 53 (42 ) presented <2 days of symptoms compared to 117 (57%) <65's. Mean delay between onset of primary symptom and presentation was 8.76 days (> or =65's) and 6.77 days (<65's). Previous functional loss was present in 42% of > or =65's. On admission, 36% of > or =65's were deemed cognitively impaired. CONCLUSION: Acute on chronic illness represents a significant proportion of 'acute general take'. Older patients admitted in this fashion also tend to present to hospital later after the onset of their symptoms and with more physical and cognitive impairment than younger counterparts. These findings are supportive of the development of better models for managing chronic disease, such as acute geriatric medicine, stroke units, admission avoidance strategies and focussed community supports.
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The authors describes the particular relationship that links human beings to nature. Utilization of this essential bound in a therapeutic process involving socially excluded patients is proposed. A concrete experience of a nature-based social-reinstatement therapy is presented.
We examined the biological effects induced by both human recombinant interleukin-1 alpha (IL-1 alpha) and beta (IL-1 beta) in five different cell types of human, rat and mouse origin. IL-1 alpha and beta preparations were standardized in terms of biological activity in the EL-4/CTLL bioassay and, in parallel, employed to stimulate PGE2 secretion in human fibroblasts, mesangial cells (MC), C57B1/6 mouse MC, DBA/2 mouse macrophages and Sprague Dawley rat MC. In addition, the co-mitogenic effects of IL-1 alpha and beta were determined in freshly prepared Sprague Dawley rat thymocytes. No significant differences in IL-1 alpha and beta concentration dependent PGE2 production were detectable in the different cell types (MC, fibroblasts and macrophages) of human or mouse origin. Incubation of Sprague Dawley rat MC with both IL-1 alpha and beta resulted in a concentration dependent production of PGE2. However, in contrast to mouse or human MC the potency of IL-1 beta to induce PGE2 in Sprague Dawley rat MC was 26-fold higher compared to IL-1 alpha. In addition, the potency of IL-1 beta to enhance co-stimulated proliferation of Sprague Dawley thymocytes was 200-fold higher than that of equal biological activities of IL-1 alpha. When we tested the additive effects on Sprague Dawley cells, increasing IL-1 beta concentrations added to a fixed IL-1 alpha concentration resulted in a cumulative rise in both, PGE2 secretion by MC and thymocyte proliferation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Women are entering the professional workforce in increasing numbers, and male professionals are more likely than ever to be involved in dual-career families. For primary care physicians the traditional 50-70-hour work week increasingly creates conflict between professional and other personal goals. Many believe that unless physicians work these long hours they will be unable to successfully provide personal, high-quality continuing care to their patients. Long-term career development for physicians who choose nontraditional arrangements has also presented problems. The authors review the literature on part-time work for physicians, then discuss their experiences as part-time family physicians at an academic health center. Various specific strategies are recommended for physicians and institutions considering part-time employment.
Fifteen patients were given vindesine (VDS) either by iv bolus injections at doses ranging from 0.7 to 1.2 mg/m2 or by 5-day infusions (total dose: 5 mg/m2), in combination with cisplatin (20 mg/m2/day) and bleomycin (6 mg/m2/day) for 5 days. For bolus injections, the total dose of VDS in one treatment was completed to 5 mg/m2 by infusion on Days 4 and 5. Drug concentrations in plasma and urine were measured by radioimmunoassay. Plasma concentration decay curves after bolus injection presented the expected triphasic shape, whereas for infusions, plasma concentrations increased and reached steady-state after about 30 hours and declined in a biphasic way after infusion discontinuation. Steady-state concentrations ranged from 4 to 15 micrograms/L and showed important variations among patients. Clearances estimated from the area under the concentration-time curves were significantly smaller for infusions than for bolus injections. This observation was interpreted as an indication of VDS pharmacokinetic nonlinearity. Terminal half-lives and renal clearances were not significantly different for the two types of administration. Toxicity of the treatment was generally limited, except for one major renal failure; two patients showed objective tumor regression after therapy.
Six geriatric patients are presented who were treated because of normal pressure hydrocephalus. A tentative diagnosis was made if dementia, gait disturbance, and incontinence together with a typical CAT-scan were present. In these cases an operation was carried out. After ventriculo-peritoneal shunting clinical improvements were seen in four patients. Postoperative complications were hygromas in three patients and a shunt-dislocation in another patient. A chronic subdural bleeding was recorded also in one of these patients with only a temporary success in this case. Two patients showed no clinical improvement at any time. However, in these cases additional neurologic symptoms together with typical CAT-scan changes were present. Before making a decision for an operation vascular processes and Alzheimer's disease should be ruled out.
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Family physicians care for patients in all stages of the life-cycle, while at the same time proceeding themselves through the course of adult development. The purpose of this study was to examine, from the doctor's point of view, changes in the doctor-patient relationship resulting from the physician's pregnancy and child-bearing. Five faculty family physicians participated via individual interviews and group discussion. Two women without children, the clinical psychologist interviewer, and other faculty family physicians joined in the review of the interviews and the group discussion. Comprehensibility, reciprocity, mutuality, identification, credibility, availability for long-term relationships, nurturing, and support emerged as themes in the evolution of relationships with patients. The process of examining the effect of childbearing on our relationships with patients unexpectedly revealed how the dual expectation of career and motherhood causes colleagues without children to feel inadequate. On the other hand, the study itself had the positive effect of facilitating the resolution of long-standing tensions among group members. We conclude that becoming mothers, a significant life change, had a transforming effect on our clinical work with patients and that studying this effect as a group fostered growth in the relationships among the participants.
The difficulty in developing clinical assessment tools for the clinical evaluation of nursing students which will motivate the students is a problem faced by all nurse educators. At the University of Wollongong, New South Wales, the lecturing staff in the new Diploma of Applied Science (Nursing) programmes have formulated a Student Competence Profile (SCP) for the clinical evaluation of students. This SCP, which they describe here, has been organized to reflect the objectives of the course curriculum.
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