The need for psychiatry in a municipal general hospital.
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Health Services Needs and Demand↗
Biomedical subjects
M Moore
Publications and source records attributed to M Moore.
AFTERTHOUGHT OR A MEMORANDUM ON MEDICAL POETS.
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Journal Article↗
Current status of tumor markers in large bowel cancer.
The aim of a primary screening system is to detect premalignant lesions and carcinomas when amenable to "curative" surgery. Although a number of "classical" tumor markers have acquired potential for clinical management, none is presently adequate for presymptomatic diagnosis or screening. In colorectal carcinoma, the screening potential of carcinoembryonic antigen (CEA), the gastrointestinal-related antigen, CA19-9, and other more recently characterized "biochemical markers" is virtually nonexistent, even in patients at high risk to develop the disease. Promising new leads are beginning to emerge from somatic cell genetic and molecular biological approaches. In common with other epithelial neoplasms, perturbations in oncogene expression have been demonstrated in colorectal cancers, and probably reflect important events in malignant transformation and progression. Studies of oncogene expression have, however, not yet yielded clinically useful information. Recently, an intensive search for specific chromosomal and gene abnormalities in the hereditary colon cancer syndromes led to the location of the familial adenomatous polyposis (FAP) gene at chromosome 5q21-q22. Significant is that the loss of alleles on chromosome 5 has also been observed in the tumor cells of at least 20% of sporadic colon cancer patients. This type of association between constitutional genetic change and genetic aberration in the cells of sporadic tumors is reminiscent of other malignant diseases with a genetic component (e.g., retinoblastoma and Wilms' tumor).(ABSTRACT TRUNCATED AT 250 WORDS)
Biomarkers, Tumor↗
A survey of alcohol use in an inner-city ambulatory care setting.
OBJECTIVE: To measure the prevalence of current drinking and potential problem drinking in an inner-city ambulatory care setting, using the CAGE questionnaire. DESIGN: Survey of patients attending ambulatory care clinics, using structured personal interviews. SETTING: Three ambulatory care clinics serving an indigent, predominantly black population of metropolitan Atlanta: a general medical appointment clinic, a walk-in clinic, and a neighborhood primary care clinic. PATIENTS/PARTICIPANTS: Patients over the age of 18 who attended one of the above clinics on a day when interviewers were available and who were estimated to have more than a 45-minute wait prior to seeing their health provider. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: 15.3% of subjects had CAGE scores greater than or equal to 2 (95% CI 12.2, 19.0). A CAGE score of greater than or equal to 2 was almost three times more common in men than in women, 26.7% vs. 9.5%. Only 8.6% (95% CI 6.3, 11.7) of subjects reported drinking greater than or equal to 2 drinks per day. These findings suggest that problem drinking may affect as many as one in six people seeking care in inner-city ambulatory care clinics and provide support for the use of screening instruments such as the CAGE questionnaire for improved sensitivity in detecting alcoholism in these practice settings.
Alcohol Drinking↗
Simulect (basiliximab) reduces acute cellular rejection in renal allografts from cadaveric and living donors.
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Adult↗
Multidrug resistance in the embryos and larvae of the mussel Mytilus edulis.
Cells exhibiting the multidrug resistance (MDR) phenotype demonstrate a decreased intracellular drug accumulation due to an active outward transport and decreased intracellular flux. This study demonstrates the inhibition of MDR in mussel (Mytilus edulis) embryos and larvae based on a simple bioassay. The development of embryos was assessed and abnormalities identified at key stages of development, including gastrulation, trochophore and prodissoconch stages. The incidence of developmental abnormalities was significantly increased in the presence of vinblastine, MMS, chloroquine, mitomycin-C, cadmium chloride and colchicine, compared to clean seawater. Consistently, there was a further increase in the number and severity of deformities observed when each toxin was added in the presence of verapamil. Larval growth was also significantly impaired in the presence of verapamil. Increased accumulation of fluorescent MDR dyes, such as rhodamine B, has been measured and shown to be verapamil sensitive. This bioassay encompasses a period of intense cellular activity during which the impairment of a number of critical processes results in abnormal growth and development.
Animals↗
Family reports of cancer pain, pain relief, and prescription access.
PURPOSE: The authors 1) describe family caregiver reports of degree of pain, pain relief, and prescription access in persons with advanced cancer during the last 4 weeks of life and 2) test for differences according to geographic location and care setting. DESCRIPTION OF STUDY: A randomized, stratified sample of 375 caregivers was produced from a list of all state residents who died of cancer in 1994. Written informed consent was received from 170 family caregivers (46%) who were then interviewed by telephone. Caregiver responses regarding pain intensity, pain relief, prescription access, and care setting were analyzed. RESULTS: Eighty-six percent (n = 147) of caregivers reported that pain was a problem, and 61% (n = 103) recalled a great deal to quite a bit of pain compared with 25% (n = 44) who recalled some or little pain. The mean degree of pain was 2.23 (SD +/- 1.32) on a scale of 1 (a great deal) to 5 (no pain). Of 140 caregivers reporting pain relief data, 46% (n = 64) reported that interventions either stopped the pain or that pain became much better, whereas 54% (n = 76) reported that interventions made the pain a little better, had no effect, or made it worse. The overall mean of pain relief was 2.62 (SD +/-.87) on a scale of 1 (usually stopped the pain) to 5 (made it worse). Greater degrees of pain were associated with reports of less pain relief (r = -19; P =.02). No differences in pain or pain relief were found across county type or patient care setting. Caregivers in the institution-only group (n = 18) recalled lower degrees of pain and the home-only group (n = 61) reported the most pain relief. Many in this latter group were served by hospice and home health nurses, and only 4% of the entire sample were served by physicians alone. Notably, 12% (n = 21) of the sample reported problems filling prescriptions. Of these, half had difficulty obtaining medicine because it was "not available." A total of 48 problems with prescription access were found that were distributed evenly across county types and patient care settings. CLINICAL IMPLICATIONS: Findings suggest that caregiver reports about the degree of pain or the effectiveness of pain interventions do not vary by residence or care setting at the end of life. Pain relief is moderate at best. Health professionals in all patient care settings should routinely address the issue of obtaining and paying for prescriptions, and local cancer pain task forces should be formed to advocate for better pain relief. An additional solution is to equip families with problem-solving skills specific to cancer pain.
Adult↗
The pathogenicity of louping ill virus for mice and lambs.
Mice and lambs were infected with the LI/I, LI/31 or MA54 strain of louping ill virus (LIV) to provide information relevant to testing the efficacy and biosafety of a new generation of flavivirus vaccines based on a Semliki Forest virus (SFV) vector. Whereas clinical signs and neuropathological lesions were consistently severe in mice, the majority of lambs showed lesions of moderate severity and only lambs with severe lesions were clinically affected. For both species, dispersal of viral antigen occurred along neuronal cell processes, and neuronal degeneration and death were confirmed as central events after infection with LIV. In contrast to lambs, in which most lesions remained localized, mice showed widely dispersed lesions which were associated with less intense leucocytic infiltrates. Among the infiltrating cells, histiocytes predominated and apoptotic forms were prominent in severely affected animals. The intranasal route of infection provided an efficient avenue for entry of LIV into the brain and resulted in lesions which were more severe than those produced by subcutaneous or intraperitoneal inoculation.
Animals↗
Memory complaint and performance in normal and depressed older adults.
The present study investigated the influence of depression on memory complaints and performance in a sample of community dwelling older adults (N = 41). Complaints were significantly more frequent in the clinically depressed subsample. However, their actual performance on tests of immediate and delayed recall did not differ significantly from the performance of nondepressed older adults. In addition, results indicated that depressives who responded favorably to a program of psychotherapy demonstrated significant reductions in levels of memory complaints at post-treatment assessment. Implications of these data for further research are discussed.
Aged↗
Control of paralytic poliomyelitis in the United States.
The changing annual vaccination status of the population and the greater than 1,000-fold drop in reported annual incidence of paralytic poliomyelitis between the early 1950s and early 1970s indicate that the control of poliomyelitis in the United States must be attributed to the use of both the inactivated poliovirus vaccine and oral poliovirus vaccine. The containment, in 1972 and 1979, of rare epidemics in poorly vaccinated subpopulations and the existence of only three reported cases of paralytic poliomyelitis clearly attributable to wild poliovirus in the last three years document a major triumph for public health. The continuing occurrence of vaccine-associated paralysis (six or seven reported cases per year, 1980-1982) indicates the necessity, despite the accomplishments, for continued review of the current vaccination strategy.
Adolescent↗
Cross-matching TB and AIDS registries: TB patients with HIV co-infection, United States, 1993-1994.
OBJECTIVES: Because of limited reporting of HIV status in case reports to the national tuberculosis (TB) surveillance system, the authors conducted this study to estimate the proportion of US TB cases with HIV co-infection and to describe demographic and clinical characteristics of co-infected patients. METHODS: The 50 states, New York City, and Puerto Rico submitted the results of cross-matches of TB registries and HIV-AIDS registries. The authors determined the number of TB cases reported for 1993-1994 that were listed in HIV-AIDS registries and analyzed data on demographic and clinical characteristics by match status. RESULTS: Of 49,938 TB cases reported for 1993-1994, 6863 (14%) were listed in AIDS or HIV registries. The proportions of TB-AIDS cases among TB cases varied by reporting area, from 0% to 31%. Anti-TB drug resistance was higher among TB-AIDS cases, particularly resistance to isoniazid and rifampin (multidrug resistance) and rifampin alone, In some areas with low proportions of multidrug-resistant TB cases, however, the difference in multidrug resistance between TB-AIDS patients and non-AIDS TB patients was not found. CONCLUSIONS: The proportion of TB cases with HIV co-infection, particularly in some areas, underscores the importance of the HIV-AIDS epidemic for the epidemiology of TB. Efforts to improve HIV testing as well as reporting of HIV status for TB patients should continue to ensure optimum management of coinfected patients, enhance surveillance activities, and promote judicious resource allocation and targeted prevention and control activities.
AIDS-Related Opportunistic Infections↗
Competence and physical impairment of pediatric survivors of burns of more than 80% total body surface area.
Children who survive massive burn injuries are challenged by the physical sequelae of their injuries as they return to normal daily routines. The purpose of this study was to assess the impact of physical impairment on the competence of such children as they pursued their lives. It was hypothesized that children who survive burn injuries of more than 80% total body surface area would be less competent than their unburned peers, and that competence would decrease with increased physical impairment. Competence for the 19 patients was assessed by parental report using the Child Behavior Checklist and by the patient's self-report on the Youth Self-Report. Physical impairment scores were calculated from range of motion measurements of upper and lower extremities according to AMA guidelines. Competence scores for the sample were within normal ranges. Physical impairment was significantly related to competence only in the area of activity on both the Child Behavior Checklist and the Youth Self-Report.
Activities of Daily Living↗
Do custom-fitted pressure garments provide adequate pressure?
Pressure garment therapy has become the worldwide standard of care for the prevention and treatment of hypertrophic scars. There are many reports in the literature on pressure garment therapy but few studies state the amount of pressure actually provided. The purpose of our study was to determine the amount of pressure applied to the scar/garment interface by custom-fitted pressure garments. The Iscan (Tekscan, Inc.) system was used to document scar/garment interface pressures of 144 new custom-fitted pressure garments. Average pressure readings for garments for the anterior thigh, anterior trunk, abdomen, buttocks, posterior trunk, posterior thigh, and arm were less than 22 mm Hg. Average pressure readings for the dorsal hand, leg, forearm, and dorsal foot were more than 28 mm Hg, with smaller relative standard deviations. The pressure readings varied greatly between garments in this group, frequently resulting in standard deviations that were higher than the pressure readings. The data show that despite precise fitting techniques, pressure garments do not provide a consistent amount of pressure at the scar/garment interface. This means that studies that report results of pressure therapy, but do not verify the amount of pressure applied, are of limited value. Precise determination of pressure "dose" must be made before the efficacy of pressure garment therapy can be determined objectively.
Burns↗
Improved burn scar assessment with use of a new scar-rating scale.
The subjective assessment of scar appearance is a widely used method in the evaluation of burn outcomes and the efficacy of treatment methods. The purpose of this study is to design a numeric scar-rating scale with better interrater reliability than has previously been reported. The rating scale assesses scar surface, thickness, border height, and color differences between a scar and the adjacent normal skin. Eight raters were trained with use of a standardized set of photographs that provide examples of the scores to be assigned to each level of severity of each scar characteristic. The raters then rated 10 photographs of different scars, referring to the teaching set of pictures for comparison. The intraclass correlation (interrater reliability) was 0.94, 0.95, 0.90, and 0.85 for scar surface, border height, thickness, and color, respectively. This rating system has proved to be a useful tool for the evaluation of scar surface, thickness, border height, and color.
Burns↗
Standard 3 policies...guidelines for action.
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Nursing Care↗
Clinical and radiographic outcome of patients treated with double innominate osteotomy for congenital hip dysplasia.
In this study, 21 patients who had undergone double innominate osteotomy for congenital hip dysplasia (CDH) were studied to determine if significant improvements in clinical and radiographic indexes were present at follow-up. Quantitative data reflecting functional status, pain level, and range of motion were obtained and analyzed statistically, as were standardized measurements from preoperative and postoperative radiographs. Statistically significant improvements at follow-up were observed in pain level, functional status, acetabular index, center-edge angle, and relative lateral displacement. Significant correlations were found between the postoperative functional score and several clinical indexes, but none were found between radiographic indexes and the final functional score.
Adolescent↗
Evaluation of canine-derived fibrin sealant as a hemostatic agent.
The purpose of this study was to determine whether canine-derived fibrinogen concentrate applied with bovine thrombin was a safe and effective topical hemostatic agent. A canine liver biopsy model was selected to test this product. Cryoprecipitate was prepared from frozen canine plasma using two freeze/thaw/centrifugation cycles. Six healthy adult dogs (weighing more than 18 kg) were used in the fibrin sealant study, and an additional three dogs were used as controls for the liver biopsy. A 1 x 3 cm liver biopsy specimen was obtained, digital pressure was applied to reduce bleeding, and the fibrinogen concentrate was immediately sprayed on the bleeding surface simultaneously with bovine thrombin (1,000 IU/mL). The mean +/- standard error of the mean (SEM) blood pressure at time of biopsy was 98 +/- 9 mm Hg, and the rate of hemorrhage from the cut liver edge was 8.0 +/- 1.1 mL/min. The total blood loss during fibrin sealant application was 37 +/- 9 mL and total time for hemostasis was 5.5 +/- 1.3 minutes. There was no additional hemorrhage after application of the fibrin sealant. In the three control dogs, fibrin sealant was not applied and only digital compression was used to decrease hemorrhage. Before digital compression, the rate of hemorrhage from the cut liver edge was 13.1 +/- 3.1 mL/min. Bleeding had not stopped after 10 minutes of compression and the mean postcompression rate of hemorrhage was 4.0 +/- 2.6 mL/min. Signs of secondary bleeding after fibrin sealant was applied were not evident during the immediate postoperative period or over the next 14 days.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Expression of MHC class II products on human colorectal cancer. An immunohistological and flow cytometric study.
The MHC status of epithelial cells from 32 primary colorectal neoplasms, villous adenomata (VA; 2) and inflammatory bowel disease (IBD; 3) were evaluated using a panel of monoclonal antibodies (mAbs). Class I antigens and beta 2 microglobulin (beta 2m) were expressed on all normal, benign, inflammatory and malignant epithelia with the exception of two carcinomas. A more complex pattern of reactivity was encountered with anti-class II mAbs. Some expression was detected on normal glandular and luminal epithelium, particularly adjacent to the tumour. Inflammatory tissues, VA and 23/32 carcinomas were also antigen-positive, the proportion of stained epithelial cells ranging from 5% to 90%. Expression was usually non-coordinate, DR being the predominant specificity followed by DP and DQ, which is suggestive of independent D region gene regulation. The hypothesis that class II expression is induced in vivo by locally generated IFN gamma was not confirmed by in vitro treatment with this agent of epithelial colorectal carcinoma-derived cell lines. These provisional data suggest that although IFN gamma may be a necessary stimulus for class II expression it is insufficient and that other factors also influence the responsiveness of tumour cells in this respect.
Adenoma↗