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Biomedical subjects

M Sullivan

Publications and source records attributed to M Sullivan.

At least 451 records · Page 25Linked to original sources
PubMedDate not supplied

The treatment effectiveness project. A comparison of the effectiveness of paroxetine, problem-solving therapy, and placebo in the treatment of minor depression and dysthymia in primary care patients: background and research plan.

This report describes the background, rationale, and research plan for a comparative treatment trial of the effectiveness of paroxetine, problem-solving therapy (PST-PC), and placebo in the treatment of minor depression and dysthymia in primary care patients. Patients were recruited from a variety of primary care practice settings in four separate geographic locations (Hanover, New Hampshire; Pittsburgh, Pennsylvania, San Antonio, Texas; and Seattle, Washington). Patients were randomly assigned to each of the three intervention conditions the medication/placebo conditions were double-blinded. The treatment trial was 11 weeks, with independent assessments of patient clinical status at baseline, 6 weeks, and 11 weeks. There was a follow-up at 25 weeks. Since there are relatively few placebo-controlled trials in primary care settings on patients with these disorders, the background of this project and a description of it are presented at this time, prior to the availability of outcome data, to provide methodological detail and to increase awareness in the research community of this treatment trial, with results to appear subsequently.

Antidepressive Agents↗
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Human epidermal growth factor receptor cDNA is homologous to a variety of RNAs overproduced in A431 carcinoma cells.

The recently discovered similarity between the human epidermal growth factor (EGF) receptor and the avian erythroblastosis virus v-erb-B protein supports the hypothesis that viral oncogenes share a common evolutionary origin with genes encoding growth-regulating cell-surface receptors. To elucidate the relationship between receptors and malignant transformation, we have now used a fragment of v-erb-B as a probe to screen a cDNA library of mRNA from A431 human carcinoma cells, which possess a large number of EGF receptors. Of the six clones isolated, the largest (pE7) contains an insert of 2.4 kilobase pairs (kbp) whose deduced amino acid sequence is homologous to the v-erb-B protein and identical to reported EGF receptor peptide sequences. This pE7 cDNA hybridized to three prominent RNAs of approximately 10, 5.6 and 2.9 kilobases (kb), and to three minor species of 6.3, 4.6 and 3.3 kb. All were present in elevated levels in A431 cells. The prominent 2.9-kb RNA was homologous only to the 5' portion of the pE7 insert. This result raises the possibility that differential RNA processing is used by A431 cells to generate a variety of RNAs.

Amino Acid Sequence↗
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A collaborative research utilization approach to evaluate the effects of pain management standards on patient outcomes.

The generation of research-based knowledge is incomplete unless it reaches clinicians at the point of care. Despite major advances in clinical research related to pain management, inadequate pain relief has become a significant quality issue in hospitalized patients, which has created an imperative for research-based pain management. Using a collaborative research utilization model, multidisciplinary academic scientists were paired with clinicians and undergraduate and graduate students to form a partnership that (1) examined the research base in pain management, (2) generated a research-based standard for pain management, and (3) evaluated the effect of that standard on four patient outcome variables in a 230-bed teaching hospital. A 2-group, pretest-intervention-posttest, quasi-experimental clinical trial composed of 173 surgical and oncology subjects was conducted. Subjects whose caregiver used the new standard had less pain during their hospital stay, less interference by pain with quality-of-life indicators, and greater satisfaction with the interventions used as well as caregiver responsiveness to their pain. Interestingly, each of these improvements decreased after their discharge home. These results strongly suggest the need for better postdischarge preparation for pain management and for further development and testing of pain management standards in postdischarge settings. They also provide the basis for extending the model to address other situations in which there is a lag between the promising results of empirical research and their integration into practice.

Analysis of Variance↗
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Oropharyngeal penetrating injuries in 50 dogs: a retrospective study.

OBJECTIVES: To summarize the presenting complaints and clinical signs associated with traumatic penetrating injuries to the canine oropharynx. To determine how the site of injury, causative agent, and duration of disease affect the presentation and clinical outcome of treatment. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: 50 client-owned dogs. METHODS: The medical records of 50 dogs with oropharyngeal penetrating injuries referred to Glasgow University Veterinary Hospital (GUVH) between 1979-1999 were reviewed. Data regarding signalment, owners' presenting complaint, history, physical examination, radiographic and endoscopic findings, surgical findings, and outcome were recorded and compared with the GUVH population. Estimates of individual breed-specific odds ratios were calculated. Outcome was evaluated by reexamination 6 weeks after surgery with recurrence of disease recorded as failure. RESULTS: Oropharyngeal injuries occurred most often in medium to large breed dogs. The majority of dogs presented with chronic disease (82%). The common findings on clinical examination were discharging sinus (72%) and swelling (70%). Acute cases typically presented with dysphagia and oral pain. The original site of injury was evident in only 34% of dogs, with the sublingual area the most frequently traumatized. The apparent cause of injury to the oropharynx was most commonly a piece of wood (72%). Other causes were metallic foreign bodies (3 dogs) and bones (2 dogs). In the remaining 9 dogs, the cause was not determined. The clinical signs resolved in all dogs that presented acutely compared with only 62% in dogs with chronic signs. CONCLUSION: Medium to large breed dogs appear to be prone to oropharyngeal injuries caused mainly by wooden foreign bodies. This may be attributable to stick chewing or retrieving behavior in these animals. CLINICAL RELEVANCE: History of trauma, stick retrieval, submandibular/cervical swelling, and discharging sinus are commonly encountered in the presentation of this condition. The sublingual area was the most frequent portal of entry recorded, although in chronic cases the initial site of injury was often unclear. Radiography and endoscopy, while offering definitive diagnosis with positive findings, often provide false negative findings. Aggressive surgical debridement of all sinus tracts is essential in obtaining a successful result, but recovery of a foreign body is not necessarily a determinant of success.

Animals↗
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[Non-conventional therapies in childhood cancer: guidelines for distinguishing non-harmful from harmful therapies: a report of the SIOP Working Committee on Psychosocial Issues in Pediatric Oncology].

This is the 11th official document of the SIOP Working Committee on Psychosocial Issues in Pediatric Oncology, instituted in 1991. There is a tendency for some physicians to make blanket statements against the use of non-proven, nonconventional therapies, even when these therapies are not harmful. There is an equal and opposite tendency on the part of many parents to do all that they possibly can for their children, including using any non-conventional therapy they feel might do some good. The health care team must open a healthy dialogue with parents that will lead to a clear distinction between those complementary therapies that are harmful and those that are not, indeed, might even be helpful psychologically if not therapeutically.

Adolescent↗
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Asthma prevalence among American Indian and Alaska Native children.

OBJECTIVES: Although asthma is the most common chronic childhood illness in the United States, little is known about its prevalence among American Indian and Alaska Native (AI/AN) children. The authors used the latest available household survey data to estimate the prevalence of asthma in this population. METHODS: The authors analyzed data for children ages 1 through 17 years from the 1987 Survey of American Indians and Alaska Natives (SAIAN) and the 1987 National Medical Expenditure Survey (NMES). At least one member of each AI/AN household included in the SAIAN was eligible for services through the Indian Health Service. RESULTS: The weighted prevalence of parent-reported asthma was 7.06% among 2288 AI/AN children ages 1-17 (95% CI 5.08, 9.04), compared with a US estimate of 8.40% for children ages 1-17 based on the 1987 NMES (95% CI 7.65, 9.15). The AI/AN sample was too small to yield stable estimates for a comparison between AI/AN children and all US children when the data were stratified according to household income and metropolitan vs non-metropolitan residence. The unadjusted asthma prevalence rates were similar for AI/AN children and for children in the NMES sample. CONCLUSIONS: In 1987, the prevalence of parent-reported asthma was similar for AI/AN children in the SAIAN sample and for children in the NMES sample. More recent data are needed to better understand the current prevalence of asthma among AI/AN children.

Adolescent↗
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Improving collaboration between researchers and communities.

Active collaboration between communities and researchers is critical to developing appropriate public health research strategies that address community concerns. To capture the perspectives of inner-city Seattle communities about issues in community-researcher partnerships, Seattle Partners for Healthy Communities conducted interviews with community members from the ethnically diverse neighborhoods of Central and Southeast Seattle. The results suggest that effective community-researcher collaborations require a paradigm shift from traditional practices to an approach that involves: acknowledging community contributions, recruiting and training minority people to participate in research teams, improving communication, sharing power, and valuing respect and diversity.

Community Health Planning↗
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Reducing child hazards in the home. A joint venture in injury control.

Injuries are a leading cause of childhood mortality and morbidity in the home, particularly in children less than 6 years of age. In an effort to prevent childhood injuries, the Hennepin County Burn Center began a joint venture with a public health agency to reduce home hazards for children less than 6 years of age who were treated at the burn center. Children were referred to a public health nurse for a home safety assessment. During the initial visit, child hazards were identified and recommendations were made for reducing injury risk. Parental compliance with recommendations was evaluated during a second home visit approximately 1 month later. Home safety assessments were completed in 21 homes, and a total of 131 recommendations were made. Burn prevention recommendations accounted for 43.5% of the total recommendations, poison control recommendations accounted for 36.6%, and other injury control recommendations accounted for 19.9%. Parents complied with 43.5% of the total 131 recommendations. Burn prevention recommendations had a compliance rate of 42%. Poison control recommendations had the highest rate of compliance at 58%. Other injury control recommendations had a compliance rate of 19%. The program had a positive effect on reducing home hazards. It was an appropriate response by practitioners already involved in the care of children, many of whom are at risk of injury.

Accidents, Home↗
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Psychosocial factors in fibromyalgia compared with rheumatoid arthritis: I. Psychiatric diagnoses and functional disability.

OBJECTIVE: Recent studies of the relationship between fibromyalgia and psychiatric disorders have yielded conflicting findings, and many of these inconsistencies seem to result from methodological differences. METHOD: We compared 36 patients with fibromyalgia and 33 patients with rheumatoid arthritis from a tertiary care clinic using physician-administered, structured psychiatric interviews and self-reported measures of illness appraisal, coping, and functional disability. RESULTS: Patients with fibromyalgia had significantly higher lifetime prevalence rates of mood and anxiety disorders, as well as higher mean numbers of medically unexplained physical symptoms across several organ systems. Ninety percent of the patients with fibromyalgia had a prior psychiatric diagnosis compared with less than half of the patients with rheumatoid arthritis. CONCLUSIONS: Despite the absence of organic pathology, the patients with fibromyalgia had equal or greater functional disability and were less well adapted to their illness. Although the pathophysiology of fibromyalgia remains unclear, co-morbid psychiatric disorders and functional disability remain an important focus of treatment in this population.

Activities of Daily Living↗
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Psychosocial factors in fibromyalgia compared with rheumatoid arthritis: II. Sexual, physical, and emotional abuse and neglect.

OBJECTIVE: Two recent reports have found associations between fibromyalgia and sexual victimization, but had methodologic characteristics that limited their interpretation. METHOD: We compared 36 patients with fibromyalgia and 33 patients with rheumatoid arthritis by using structured interviews for sexual, physical, and emotional victimization histories, as well as dimensional self-report measures of victimization severity. RESULTS: Compared with the patients with rheumatoid arthritis, those with fibromyalgia had significantly higher lifetime prevalence rates of all forms of victimization, both adult and childhood, as well as combinations of adult and childhood trauma. Although childhood maltreatment was found to be a general risk factor for fibromyalgia, particular forms of maltreatment (eg, sexual abuse per se) did not have specific effects. Experiences of physical assault in adulthood, however, showed a strong and specific relationship with unexplained pain. Trauma severity was correlated significantly with measures of physical disability, psychiatric distress, illness adjustment, personality, and quality of sleep in patients with fibromyalgia but not in those with rheumatoid arthritis. CONCLUSIONS: Fibromyalgia seems to be associated with increased risk of victimization, particularly adult physical abuse. Sexual, physical, and emotional trauma may be important factors in the development and maintenance of this disorder and its associated disability in many patients.

Activities of Daily Living↗
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A comparison of the effects of unilateral thyroarytenoid lateralization versus cricoarytenoid laryngoplasty on the area of the rima glottidis and clinical outcome in dogs with laryngeal paralysis.

OBJECTIVE: To compare the clinical effects of unilateral thyroarytenoid lateralization versus unilateral cricoarytenoid laryngoplasty for the treatment of canine laryngeal paralysis. Study Design-A prospective, clinical trial. ANIMALS: Twenty client-owned dogs admitted to Glasgow University Veterinary Hospital (GUVH) between 1997 and 1999 with a diagnosis of laryngeal paralysis. METHODS: A thorough evaluation of each dog was undertaken that included history, physical and neurologic examinations, complete blood count, serum biochemistry profile, serum thyroxine (T4) level, and thyroid-stimulating hormone (TSH) assay. The exercise tolerance of each dog was investigated by assessing respiratory rate and arterial blood gas analysis at rest and after 5 minutes of mild exercise. Animals were included in the study on the basis of a definitive diagnosis of laryngeal paralysis made by endoscopic observation of the larynx in the lightly anesthetized patient. The animals were randomly assigned to 1 of 2 treatment groups: unilateral thyroarytenoid lateralization or unilateral cricoarytenoid laryngoplasty, with all procedures being performed by the same surgeon. Video images of the rima glottidis were recorded pre- and postoperatively using video endoscopy. Video images were digitized and the area of the rima glottidis measured using image-analysis software. An increase in the area of the rima glottidis was expressed as a percentage of the preoperative area. All animals were reassessed 6 weeks' postoperatively, and exercise tolerance tests were repeated. RESULTS: The mean increase in the area of the rima glottidis postoperatively when compared with the preoperative area was 140% for those animals undergoing unilateral thyroarytenoid lateralization (range, 120%-158%) and 207% for those animals undergoing unilateral cricoarytenoid laryngoplasty (range, 183%-228%). This difference was statistically significant (P < .0001). At the 6-week postoperative examination, there was no significant difference in improvement between the 2 groups when compared on either a clinical basis or exercise tolerance tests. The mean surgical time in the 2 groups was 25 minutes for thyroarytenoid lateralization and 43 minutes for cricoarytenoid laryngoplasty. This was a statistically significant difference (P = .002). CONCLUSION: Although increase in area of the rima glottidis was significantly greater after unilateral cricoarytenoid laryngoplasty compared with unilateral thyroarytenoid lateralization, no difference in clinical outcome could be detected. However, the cricoarytenoid laryngoplasty procedure required significantly more surgical time. CLINICAL RELEVANCE: Both unilateral cricoarytenoid laryngoplasty and unilateral thyroarytenoid lateralization are successful methods for the treatment of laryngeal paralysis; however, thyroarytenoid lateralization requires less surgical time to perform.

Animals↗
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Radiographic anatomy of the cribriform plate (Lamina cribrosa).

The radiographic appearance of the cribriform plate was investigated in 16 canine cadaver heads. The cribriform plate appeared as a "V"-shaped multilinear bone-opaque stripe in the caudal nasal region in projections perpendicular to the hard palate in 6 dogs with a skull index between 50.00 and 54.00. In 9 dogs with a skull index between 55.40 and 74.40, the cribriform plate had a more "C"-shaped and sharp appearance. In vertically oblique projections with an obliquity greater than 20 degrees, the cribriform plate lost its sharp outline and finally (40 degrees) disappeared. In lateral projections the cribriform plate appeared as a "C"-shaped interrupted bone-opaque stripe in all 16 dogs. In more brachycephalic dogs frontal bone structures superimposed on the cribriform plate on ventrodorsal and dorsoventral views and accentuated the radiographic appearance of the plate. Vertically oblique views separated both structures to produce two lines.

Animals↗
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Radiographic detection of defects of the nasal boundaries.

The sensitivity of conventional radiography for lesions of the cribriform plate, naso-orbital wall, lateral nasal wall and hard palate was investigated in 13 canine cadaver heads by creating measured defects in these structures. The location of the perforations were marked with a thin copper wire and the radiographic appearance of the defects was evaluated retrospectively by a single reviewer. Despite demarcation cribriform plate destruction of 2 mm could not be detected. Defects of 3 mm were detected in only 2 heads, 4 mm defects in 1 further head, an oblong 4 x 10 mm defect in 7 heads and in the remaining 3 heads only a 10 x 10 mm defect became visible as such. The naso-orbital wall had to be destroyed in its whole vertical length for detection of a defect in ventrodorsal or dorsoventral views. Therefore conventional radiography is of low diagnostic value for these lesions. Defects of 2 mm in the lateral nasal wall and the hard palate could be detected confidently in all heads indicating high sensitivity of conventional radiography. Soft tissue opacification did not alter the detectability of any nasal border structure lesion.

Animals↗
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Nodular fat necrosis in the feline and canine abdomen.

The radiographic appearance of nodular fat necrosis is described in ten cats and one dog. The most common radiographic sign was the presence of a focal mineralized circular to oval soft tissue mass in the abdominal fat as present in 9 cats. These masses had a distinct eggshell-like rim encapsulating the lesion. In one cat and one dog multiple masses were present, without radiographic signs of mineralization. Abdominal ultrasound was performed in three cats and one dog, findings included the presence of hyperechoic masses with associated acoustic shadowing, some with a hypoechoic centre. Almost all animals were old and obese. In three cats and one dog, changes were confirmed with biopsy or post mortem examination. Lesions having the appearance of those in this paper are most likely incidental findings and should not be confused with abdominal masses of neoplastic origin. Ultrasound can be helpful in identifying such lesions.

Abdomen↗
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The effect of obliquity on the radiographic appearance of the temporomandibular joint in dogs.

The temporomandibular joint is formed between the condyloid process of the mandible and the mandibular fossa of the temporal bone. The basic anatomy of this joint was assessed and described in a series of skulls including dolichocephalic, mesaticephalic and brachycephalic breeds. The facial index and rotational angles were measured with the facial index providing a useful method of classifying skull types but the rotational angle being of limited use in assessment of the temporomandibular joint until normal breed values are established. Equipment was designed to allow repeatable positioning of the temporomandibular joint for radiography at a variety of lateral and long axis rotational angles relative to the central x-ray beam. The regions of the joint and anatomic features visualized in each view are demonstrated. 10 degrees rotation was required in either axis to project the joints independently of each other. Lateral rotational angles of 10 to 30 degrees in mesaticephalic and dolichocephalic breeds and 20 to 30 degrees in brachycephalics and long axis rotational views of 10 to 30 degrees depending on the region of interest were considered to be the most useful.

Animals↗
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Treatment of canine nasal aspergillosis with enilconazole.

Twenty-four dogs with nasal aspergillosis were treated with enilconazole (10 mg/kg bid for 7-14 days) administered topically through tubes surgically implanted into the nasal chambers. Aspergillosis was eliminated in 19 dogs over a median follow-up period of 18 months. Another dog died, but at necropsy there was no evidence of causative fungus. Two of the four dogs that were not cured had infection of periorbital soft tissues. An additional seven dogs received 6 weeks ketoconazole (5 mg/kg bid PO) and enilconazole therapy topically. Six of these dogs were disease-free over a median follow-up period of 35 months. The seventh dog responded to repeated treatment with enilconazole. Twenty-six of the 29 dogs (90%) without extranasal aspergillosis were cured.

Administration, Intranasal↗