Biomedical subjects
M Richards
Publications and source records attributed to M Richards.
Inhibition of yeast growth by streptomycin.
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Residential care for spastics.
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Creating a career ladder for nursing assistants in long-term care.
This article describes the development, implementation, and evaluation of a career ladder for certified nursing assistants in long-term care. A career ladder is an effective way to maximize the use of unlicensed workers without changing the skill mix (eg, no loss of licensed nursing positions) and allow the licensed nurse more time to perform higher-level clinical tasks, such as assessments, patient education, and documentation. Implementation of an unlicensed worker career ladder also can improve nursing assistant retention.
Effects of transfusion in anemia of prematurity.
The authors aimed to test the hypothesis that blood transfusions depress hematopoiesis in healthy infants with anemia of prematurity (AOP). They also set out to find markers that predict recovery from AOP. Thirty-nine premature babies underwent weekly and post-transfusion measurements of hemoglobin concentrations, reticulocyte counts (RCC), and erythropoietin levels (EPO). RCC and EPO dropped significantly 7 days after a blood transfusion but had normalized after 14 days. Elevated RCC or EPO levels were not predictive of an increase in hemoglobin. Postnatal HbFg/dL was higher in babies who had received transfusions. The authors conclude that blood transfusions depress erythropoiesis in infants with AOP and stimulate HbF synthesis but this effect is not sustained. Reticulocyte counts and erythropoietin levels are unhelpful in predicting recovery from AOP.
Atrial and brain natriuretic peptide response to exercise in patients with ischaemic heart disease.
1. The response of venous plasma natriuretic peptides (atrial natriuretic peptide, ANP, and brain natriuretic peptide, BNP) plasma cyclic guanosine monophosphate (cGMP) and vasoactive hormones to dynamic exercise has been studied in 16 subjects undergoing diagnostic exercise tolerance for ischaemic heart disease (IHD), and in five healthy control subjects. 2. In patients with IHD, plasma ANP increased 3-fold (mean 16 +/- 2.5 pmol/L pre-exercise, 51 +/- 11 pmol/L after exercise, P < 0.01). Increase in plasma BNP (10.5 +/- 1.6 pmol/L pre-exercise, 13 +/- 2 pmol/L after exercise, P < 0.01) was proportionately much less than ANP but more sustained. In exercising normal subjects, plasma ANP levels doubled (P < 0.01) but there was no significant change in plasma BNP levels. 3. In patients with IHD, there was a significant correlation between levels of plasma ANP and BNP before exercise (r = 0.97, P < 0.001) as well as during exercise (r = 0.79, P < 0.001). 4. Hormone responses in patients with positive exercise tests did not differ significantly from those with negative tests. 5. Although resting levels of plasma ANP and BNP in IHD are correlated, the findings indicate different mechanisms of secretion. The low BNP/ANP ratio in response to acute dynamic exercise presumably reflects the predominance of ANP in pre-secretory atrial stores.
Combination antiviral therapy controls severe post-liver transplant recurrence of hepatitis B virus infection.
The authors have successfully used combination ganciclovir and foscarnet chemotherapy to control viral replication following liver transplantation in a patient with severe recurrence of hepatitis B virus (HBV) infection. The disease was characterized by extremely high viraemias, deteriorating liver function, and high levels of intra-hepatic hepatitis B core antigen (HBcAg) and hepatitis B surface antigen (HBsAg). Treatment resulted in a greater than 30-fold reduction in serum HBV DNA and HBsAg levels. Liver function tests returned to normal and the histological progression of the disease was arrested. Hepatic cytoplasmic HBsAg decreased substantially but there was little change in HBcAg, implicating HBsAg rather than HBcAg in the liver injury. Combination antiviral chemotherapy using agents such as ganciclovir and foscarnet may offer a new approach to the management of post-transplant recurrence of HBV.
Apolipoprotein E genotype, vascular risk and early cognitive impairment in an African Caribbean population.
A reduced risk of Alzheimer's disease (AD) associated with the apolipoprotein E (APOE) epsilon4 allele is reported in populations of African origin. In order to clarify possible reasons for this, we examined the association between APOE genotype and early cognitive impairment in a community-based African Caribbean UK population aged 55-75 years. APOE genotype was available for 202 participants, 57 (28%) of whom were classified as having relative cognitive impairment on a battery of neuropsychological tests. Cognitive impairment was negatively associated with epsilon2 and positively but more weakly associated with epsilon4. Effects of both alleles increased markedly after age 70. The effect of epsilon4 was increased in combination with hypertension, diabetes or lower educational attainment, but these factors did not influence epsilon2 effects. Cholesterol and triglyceride levels partially explained effects of epsilon2, but did not account for those of epsilon4. A reduced association between epsilon4 and later AD in populations of African origin is unlikely to be explained by reduced cognitive effects or by differential mortality. However, it may be accounted for by vascular comorbidity. The different patterns of association between epsilon2 and epsilon4 alleles suggest different pathways of effect.
Interaction of heat with X-rays and cis-platinum; cell lethality and oncogenic transformation.
There is increasing concern for the oncogenic potential of agents used to treat cancer. Hyperthermia is one of the few modalities that does not, of itself, produce transformed foci in vitro. The adjuvant use of heat with X-rays or chemotherapy agents is an interesting approach to increasing the cell-killing potential while decreasing the oncogenicity of combined-modality therapy. Following a priming heat dose in C3H 10T1/2 cells, resistance to cell killing by a second heat dose develops and is maximal by 10 h. This is known as thermotolerance, and can be monitored by the appearance of proteins of specific molecular weight known as heat-shock proteins. By contrast, a priming heat dose does not confer resistance to killing by cis-platinum (cis-DDP). Indeed, heat potentiates the cytotoxicity due to cis-DDP. The interaction is greatest if heat and drug are applied simultaneously, but is still substantial if the drug is applied many hours after heating. The loss of interaction between heat and cis-DDP occurs slowly, but by 48 h, heat and drug act independently. Thermotolerant cells are less sensitive to the induction of transformation by X-rays than previously unheated cells. On the other hand, 48 h after a heat exposure, when cells have regained their normal sensitivity to killing by cis-DDP, their sensitivity to the induction of transformation by cis-DDP has also returned to normal.
Interaction of hyperthermia and chemotherapy agents; cell lethality and oncogenic potential.
Hyperthermia was combined with bleomycin, melphalan and cis-platinum in order to examine cell lethality and oncogenic transformation in C3H10T1/2 cells from the adjuvant use of heat with chemotherapy agents. When cells were exposed concurrently to 42.5 degrees C and each of the three chemotherapy agents, heat enhanced both the cytotoxic and oncogenic potential of the drugs. Hyperthermia-enhanced ratios were largest for bleomycin-treated cells. Examination of transformation incidences expressed as a function of surviving fraction, i.e. the cytotoxicity of treatment and therefore drug-heat efficacy, showed that for a given level of cell killing the combination of heat and cis-platinum resulted in fewer transformants per surviving cell than for cis-platinum alone. Hyperthermia appears to reduce the oncogenic potential of low concentrations of melphalan but has no effect on bleomycin-induced oncogenic transformation.
The efficacy of bilingual health advocacy in ethnic minority patients with cancer.
AIM: This research aims to establish the efficacy of introducing trained bilingual health advocates to non-English speaking cancer patients. METHOD: Male and female Bengali advocates received appropriate training. They were then given a group of patients to manage, while a control group received no such intervention. Outcomes were determined at the baseline and after three months. The study finally concludes in April 2000. RESULTS: The progress so far shows that the advocates had only recruited half of the expected number of Bengali cancer patients. Focus groups showed, however, that healthcare professionals felt that their training was inadequate to overcome the language and cultural barriers, and many were distressed that they were not meeting the needs of minority ethnic patients. CONCLUSION: The authors anticipate that this study will concur with research in other health sectors where bilingual health advocacy has been beneficial, and that future care will be better informed as a result.
Teaching about the family of the institutionalized elderly--an interdiscipline approach.
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Effects of improved glycemic control on microalbuminuria in adolescents with insulin-dependent diabetes mellitus.
The effect of improved glycemic control on microalbuminuria was evaluated longitudinally in 13 adolescents with insulin-dependent diabetes mellitus (IDDM) of 8.4 +/- 0.8 years duration. Glycemic control and microalbuminuria were assessed under three treatment regimens: conventional therapy (Period A); after 6 weeks of intensified conventional therapy (Period B); and at three periods during continuous subcutaneous insulin infusion (CSII) (Period C = 10-14 days, Period D = 2-4 months, and Period E = 6-8 months, of CSII). Although euglycemia was not achieved, there was a decrease in mean 24-hour blood glucose concentrations measured hourly in the hospital, with values averaging 239 mg/dl in Period A, 202 mg/dl in Period B, and 156-184 mg/dl in Periods C to E. This was accompanied by significant reductions in the values for whole blood, and to a lesser extent, in stable glycosylated hemoglobin A1 (GHbA1) (p less than 0.05), but not in creatinine clearance, albumin clearance, or in albumin excretion rate. Significant correlations were found between whole blood GHbA1 levels and albumin clearance in each of Periods B to E and between albumin clearance and albumin excretion in Periods B to D (p less than 0.05) but not in Period A. Our data suggests that the degree of improvement in glycemic control obtained in our adolescent population with IDDM using either intensive conventional therapy or CSII does not reduce the microalbuminuria. If modulation of microalbuminuria is achievable it may require euglycemia or may involve other factors which have a more direct effect on the transit of albumin across the glomerular basement membrane.
Prolonged spinal nerve involvement after epidural anesthesia with etidocaine.
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