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Biomedical subjects

M Smith

Publications and source records attributed to M Smith.

At least 505 records · Page 28Linked to original sources
PubMed1996

Advancing social work practice in health care settings: a collaborative partnership for continuing education.

This article describes a model for social work education and research established by a school of social work and the social work department of a metropolitan medical center. Social workers in the health care setting were surveyed on the knowledge and skills they needed to help them respond to new directions for the department. Results of the study identified a number of themes for staff development and research. Implications of the study, together with a description of the education and research programs developed to respond to these themes, are presented.

Academic Medical Centers↗
PubMed1996

Maternal factors contributing to asphyxia neonatorum.

The objective was to identify maternal risk factors for birth asphyxia, and took the form of a retrospective study over 3 years of 15,964 deliveries. The antenatal and intrapartum course of 68 mothers who delivered babies with birth asphyxia was studied. Babies < 34 weeks/< or = 2000 g at birth were excluded. A 5-min Apgar score < 6 was regarded as abnormal. The incidence of asphyxia neonatorum was 4.6/1000. Most mothers (76 per cent), resided locally, booked (91 per cent), and had satisfactory antenatal clinic attendance (average seven visits). The distribution showed a disproportionately large number of grand multiparas (10 per cent). Labour was characterized by prolonged first (49 per cent) and second (36 per cent) stages with a high incidence of meconium in the amniotic fluid (47 per cent). Most deliveries (53 per cent) were by caesarian section of which 44 per cent were performed for fetal distress. Meconium aspiration was common (34 per cent). High risk signs in labour can be recognized. The judicious use of the partogram, fetal scalp blood pH, and amino-infusion are encouraged.

Asphyxia Neonatorum↗
PubMed1996

Chiropractic and medical costs of low back care.

This study compares health insurance payments and patient utilization patterns for episodes of care for common lumbar and low back conditions treated by chiropractic and medical providers. Using 2 years of insurance claims data, this study examines 6,183 patients who had episodes with medical or chiropractic first-contact providers. Multiple regression analysis, to control for differences in patient, clinical, and insurance characteristics, indicates that total insurance payments were substantially greater for episodes with a medical first-contact provider. Most of the cost differences were because of higher inpatient payments for such cases. Analysis of recurrent episodes indicates that chiropractic providers retain more patients for subsequent episodes and that patient exposure to a different provider type during early episodes significantly affects retention rates for later episodes. Patients choosing chiropractic and medical care were comparable on measures of severity and in lapse time between episodes. The lower costs for episodes in which chiropractors serve as initial contact providers along with the favorable satisfaction and quality indicators for patients suggest that chiropractic deserves careful consideration in gatekeeper strategies adopted by employers and third-party payers to control health care spending. More research is needed, especially in developing alternative measures of health status and outcomes.

Adult↗
PubMed1996

A selective inhibitor of inducible in nitric oxide synthase prolongs survival in a rat model of bacterial peritonitis: comparison with two nonselective strategies.

We evaluated the effects on survival of three different strategies for blocking the actions of nitric oxide (NO) during Gram-negative sepsis in rats. Male Sprague-Dawley rats underwent placement of a jugular vein catheter and i.p. implantation of a gelatin capsule containing a paste (.11 +/- 0.1 g final weight) consisting of sterile rat feces mixed with a suspension (.2 mL) of viable Escherichia coli (strain sm 18; 5.7 x 10(5) colony-forming units) in saline. Beginning at T = 6h, all animals received i.v. ampicillin (85 mg/kg every 12 h) until death or the administration of five doses. At the same time points, pairs of animals received an i.v. dose of either an experimental treatment agent or an appropriate control substance. The following experimental regimens were tested: 5 mg/kg per dose of S-methylisothiourea sulfate (SMT), a selective inhibitor of the inducible isoform of nitric oxide synthase (NOS); 10 mg/kg per dose or 25 mg/kg per dose of NG-nitro-L-arginine methyl ester (L-NAME), an inhibitor of the inducible and constitutive isoforms of NOS; 200 mg/kg per dose of cross-linked human hemoglobin (HGB), an NO scavenger. SMT significantly prolonged survival in septic rats, although cumulative survival at T = 168 h was approximately equivalent in SMT- or saline-treated animals. In contrast, HGB and the higher dose of L-NAME significantly shortened survival times. At T = 20 h, arterial PO2 was significantly lower in rats treated with HGB as compared to time-matched controls. We conclude that SMT, a compound with reported activity as a selective inhibitor of the inducible isoform of NOS, prolongs survival in a rat model of antibiotic-treated Gram-negative sepsis.

Animals↗
PubMed1996

Nitric oxide donors increase cytosolic ionized calcium in cultured human intestinal epithelial cells.

We used fluorescence spectrophotometry, digital-imaging fluorescence microscopy, and the fluorescent dye, Fura-2, to measure the effects of several different nitric oxide (NO.) donors on intracellular levels of ionized calcium ([Ca2+]i) in cultured Caco-2BBe cells, a human enterocytic cell line. Incubation of Caco-2BBe cells with sodium nitroprusside (SNP) or isosorbide dinitrate for 2 h significantly increased [Ca2+]i. The effects of both agents were concentration dependent. The lowest concentrations of SNP or isosorbide dinitrate capable of increasing [Ca2+]i were .625 mM and 10 mM, respectively. Chelation of extracellular Ca2+ with 2 mM EGTA abrogated the increase in [Ca2+]i induced by SNP. In contrast, blockade of voltage-gated Ca2+ channels with 2 mM NiCl2 or 200 microM verapamil failed to affect SNP-induced alterations in [Ca2+]i. Using NBD-phallicidin to stain polymerized (F)-actin, we found that incubation of Caco-2BBe cells with SNP results in actin polymerization, particularly in the periphery of cells. We conclude that NO. increases [Ca2+]i and promotes actin polymerization in a cultured enterocytic cell line.

Caco-2 Cells↗
PubMed1996

Pediatric phase I drug tolerance: a review and comparison of recent adult and pediatric phase I trials.

PURPOSE: We evaluated the ratio of pediatric to adult maximum tolerated doses (MTDs) from 70 Phase I studies conducted between 1975 and 1995. The aim of this study was to determine whether previously observed differences in drug tolerance between adult and pediatric Phase I patients have persisted over the 20-year period of this analysis. PATIENTS AND METHODS: Phase I trials of pediatric and adult patients with solid tumors as the predominant diagnosis and sharing similar dosing regimens were evaluated. For consistent comparison between Phase I studies, the MTD was defined as the drug dose one level below that yielding dose-limiting toxicity in >30% of patients. The ratio of pediatric to adult MTDs was calculated and plotted chronologically by year of pediatric study closure. Statistical evaluation of MTD ratios included regression and correlation analysis. The extent of therapy before Phase I study entry was also examined. RESULTS: Ninety-three Phase I studies were reviewed. Twenty-one drugs (70 studies) met our criteria for paired review of MTDs and analysis of the variation of ratio with time. The pediatric to adult MTD ratios ranged from 0.4 to 2.8, with a median of 1.2. Regression analysis of the ratio of MTD versus date of pediatric study closure supports a linear relationship of decreasing ratio with time (p<0.01). Analysis of the regression line predicts MTD ratios of 2.02 and 0.76 for 1974 and 1995, respectively. Of patients included in this analysis, 37.1% and 68.6% of adult and pediatric patients, respectively, were considered to have been heavily pretreated before study entry. A significant (p<0.001) downward trend with time was observed in the proportion of adult patients entering Phase I studies who had received both radiation and chemotherapy. CONCLUSIONS: The results of this review continue to show an equal or greater drug tolerance in the pediatric population when compared with adult patients for most drugs studied during Phase I trials. However, there appears to be significant trend of decreasing differences in drug tolerance between pediatric and adult Phase I patients with time, as defined by the descent of the MTD ratio toward values <1.0. Mechanisms to explain greater drug tolerance in children and the observation of decreasing maximum tolerated dose ratios with time are discussed. Limited data suggest that changes in degree of therapy before Phase I study entry may be influencing the MTD ratio.

Adult↗
PubMed1996

A double-blind comparison of codeine and morphine for postoperative analgesia following intracranial surgery.

Codeine and morphine were compared in a double-blind study of postoperative analgesia in 40 patients after intracranial neurosurgery. Eighteen patients received codeine phosphate 60 mg and 18 morphine sulphate 10 mg, both by intramuscular injection; 4 patients (10%) required no analgesia. Both drugs provided analgesia within 20 min of injection but morphine was more effective than codeine beyond 60 min (p = 0.01). Fewer doses of morphine than codeine were required (p = 0.003). Nine patients requested one dose of morphine and 9 two doses. Seven patients required three doses of codeine and 1 patient required four doses. Neither drug caused respiratory depression, sedation, pupillary constriction or unwanted cardiovascular effects. We conclude that, in the doses used, morphine is a safe alternative to codeine for analgesia after neurosurgery and has a more persistent action.

Adult↗
PubMed1996

Identification and characterization of a novel type of replication terminator with bidirectional activity on the Bacillus subtilis theta plasmid pLS20.

We have sequenced and analysed a 3.1 kb fragment of the 55 kb endogenous Bacillus subtilis plasmid pLS20 containing its replication functions. Just outside the region required for autonomous replication, a segment of 18 bp was identified as being almost identical to part of the major B. subtilis chromosomal replication terminator. Here, we demonstrate that this segment is part of a functional replication terminator. This newly identified element, designated TerLS20, is the first replication terminator identified on a theta plasmid from a Gram-positive bacterium. TerLS20 is distinct from other known replication terminators in the sense that it is functional in both orientations. The region required for bipolar functionality of TerLS20 was delineated to a sequence of 29 bp, which is characterized by an imperfect dyad symmetry.

Bacillus subtilis↗
PubMed1996

Promotion of children's early psychosocial development through primary health care services.

The paper presents the study design of the development and organisation of an EU/WHO multicentre study on the promotion of children's early psychosocial development through primary health care services. The aim of the programme is to develop training for primary health care workers (PHCWs) that improves their ability to assess factors relevant to psychosocial development and gives them preventive approaches to foster that development, building on families' strengths. The focus is on the period from conception to the end of the second year of the child's' life. Two main components are the training of the PHCWs and the semi-structured interviews that guide the workers in practice. The training has content and structure that is feasible within primary health care resources working in collaboration with mental health services. The programme is evaluated in terms of (a) the impact of training on both the PHCWs' knowledge and attitudes with regard to infant behaviour and development, and on practice as assessed by the delivery of the semi-structured interview; and (b) the effect of the intervention on maternal well-being, infant language development and behavior, home environment and mother-infant interaction. The programme is taking place in Cyprus, Greece, the Federal Republic of Yugoslavia, Portugal, Slovenia and Turkey.

Child Development↗
PubMed1996

Self-concept clarity and preferred coping styles.

This study examined the relation between self-concept clarity and (a) preferred general coping styles, (b) coping with a specific event, and (c) coping with a specific ongoing situation in 175 undergraduate students. The results of the regression analyses for general coping styles indicated that self-concept clarity made a reliable but weak positive contribution to active coping styles (e.g., planning and taking action) and a strong negative contribution to passive coping styles (e.g, denial). The unique negative contribution of self-concept clarity to passive coping was replicated with respect to coping with a specific event and to coping with a specific ongoing situation. However, the weaker positive contribution of self-concept clarity to active coping was not replicated with respect to coping with specific events or specific ongoing situations.

Adaptation, Psychological↗
PubMed1996

Multicenter study of creatine kinase-MB use: effect on chest pain clinical decision making.

OBJECTIVE: To determine whether creatine kinase-MB isomer (CK-MB) levels affect initial physician decisions regarding patients with potential cardiac chest pain. METHODS: A prospective, multicenter, observational cohort study was performed at seven university teaching hospital EDs. Hemodynamically stable chest pain patients > or = 25 years old and without ST-segment elevation on their ECGs were observed with one to two sets of CK-MB level determinations obtained three hours apart prior to disposition. The physicians committed to a dichotomous (yes/no) absolute decision regarding the diagnosis of myocardial infarction (MI), need for hospital admission, and need for coronary care unit (CCU) admission both before and after enzyme results were obtained. The physicians ranked the perceived importance of initial history and physical, serial clinical observation, initial ECG, and CK-MB level to their decision making (rank score: 1 = most important, 4 = least important). RESULTS: Of the 1,042 patients enrolled, 777 (74.6%) were admitted to the hospital. For the 67 MI patients (8.6% of the admissions), changes in absolute decisions about the diagnosis of MI and planned CCU admission were associated with increased CK-MB importance (p = 0.04 and p = 0.02, respectively). Of the 146 patients who had new-onset angina or unstable angina, changes in absolute decisions were not associated with CK-MB importance. No patient who had MI or unstable angina was released from the ED. There were three of 67 (4%) MI patients and one of 146 (1%) unstable/new-onset angina patients initially slated for release home who were admitted to the hospital. CONCLUSIONS: For a minority of the patients who had subsequently proven MI, the CK-MB result helped guide disposition decisions. The CK-MB availability did not adversely impact the disposition of the patients who had unstable or new-onset angina.

Aged↗
PubMed1996

The effect of fluoxetine on anxiety and depression symptoms in cancer patients.

Little has been done to study the effectiveness of antidepressants in controlling anxiety/depression in a population of cancer patients. A double-blind placebo-controlled study was therefore designed to assess the effectiveness of 20 mg fluoxetine. Of 115 cancer patients who fulfilled entry criteria for levels of distress, 45 patients were randomized to a fluoxetine treatment group (FA) and 46 patients to a placebo group (PA) after a 1-week placebo period designed to exclude placebo responders. The Montgomery and Asberg Depression Scale (MADRS), the Hamilton Anxiety Scale (HAS), the Hospital Anxiety and Depression Scale (HADS), the Revised Symptom Checklist (SCL90-R) and the Spitzer Quality of Life Index (SQOLI) were used to assess the efficacy of fluoxetine. The response rate, defined by a HADS score lower than 8 after 5 weeks of treatment, was not significantly higher in the FA group (11%) compared to the PA group (7%). Compared to the PA group, patients in the FA group showed a significantly greater decrease in SCL90-R mean total score after 5 weeks, but not a greater decrease in HADS mean score. No difference between the two groups was found in observer-reported assessments (MADRS, HAS and SQOLI). Significantly more drop-outs were observed in the FA group (n = 15) than in the PA group (n = 7), although the frequencies of side-effects were not significantly different.

Adult↗
PubMed1996

Frequency discrimination and speech recognition by patients who use the Ineraid and continuous interleaved sampling cochlear-implant signal processors.

Patients who use the Ineraid cochlear implant were tested in four experiments with materials which assessed frequency discrimination and speech understanding. In each experiment both frequency discrimination and speech recognition varied among patients. Correlations between the two measures were significant and ranged from 0.60 to 0.83. Most generally, frequency discrimination was better in the frequency domain of F1 than in the domain of F2. In experiment 5, both the Ineraid signal processing strategy and a continuous interleaved sampling (CIS) strategy were implemented for a single patient. The CIS strategy improved frequency discrimination in the domain of F2 and improved speech understanding.

Adult↗
PubMed1996

Amino acid profile in Down's syndrome.

Fasting plasma and urinary amino acid concentrations were studied under carefully controlled conditions in 22 children with Down's syndrome and in age matched controls. The only significant difference between the groups was a higher mean plasma lysine concentration in Down's syndrome patients compared to controls.

Amino Acids↗
PubMed1996

Hyperpermeability and ATP depletion induced by chronic hypoxia or glycolytic inhibition in Caco-2BBe monolayers.

Previous studies have documented that the barrier function of epithelial or endothelial monolayers is deranged when cellular ATP levels are rapidly decreased to very low levels by inhibitors of mitochondrial and glycolytic function. We hypothesized that lesser degrees of ATP depletion also might affect epithelial permeability, particularly if the perturbation were sustained for a prolonged interval. Using Caco-2BBe cells grown on permeable supports mounted in bicameral chambers, we assessed permeability by measuring the apical-to-basolateral clearance (flux divided by apical compartment concentration) of fluorescein disulfonic acid. ATP was depleted by incubating cells in glucose-free (Glu-) medium containing 10 mM 2-deoxyglucose (2-DOG) for 12, 24, or 48 h or under an anoxic atmosphere for 24, 48, or 72 h. Although both models of energy depletion were characterized by significant derangements in barrier function, metabolic inhibition with 2-DOG/ Glu- resulted in greater increases in permeability and more profound decrements in cellular ATP content. Morphological studies using electron and confocal fluorescence microscopy showed structural changes in individual cells and derangements in the normal distribution of perijunctional actin after monolayers were incubated with 2-DOG/Glu- but not after incubation under an anoxic atmosphere. Addition of 10 mM lactic acid (final pH 6.7) provided significant protection against both hyperpermeability and ATP depletion induced by 2-DOG/Glu-. We conclude that moderate degrees of ATP depletion are sufficient to increase the permeability of Caco-2BBe monolayers and that lactic acidosis helps to preserve ATP content, barrier function, and morphological integrity in hypoxic intestinal epithelial cells.

Acidosis, Lactic↗
PubMed1996

Reduction of the activity of ribosomal genes with age in Down's syndrome.

The hypothesis of the coparticipation of ribosomal genes in controlling the differential expression of genes with age is analyzed in Down's syndrome. The activity of ribosomal genes was tested cytogenetically by Ag-stained nucleolar organizer regions and by satellite association in lymphocytes from 40 patients with Down's syndrome. Twenty patients were between 0 and 25 years old, and the others were between 29 and 48 years old. Our results showed a significant decrease with regard to total Ag staining and in relation to each chromosome pair in the older Down's syndrome group as compared with the younger group. The total number of associated chromosomes and the number of associations of each chromosome pair were both significantly lower. The results show a decreased activity of ribosomal genes with age. This reduction may originate from changes in regulation and expression of these genes that might result in differing cell translation ability.

Adolescent↗