Search PubMed⌕ Search

Biomedical subjects

M Wells

Publications and source records attributed to M Wells.

At least 73 records · Page 4Linked to original sources
PubMed1997

Evaluation of a worksite injury and illness prevention program: do the effects of the REACH OUT training program reach the employees?

In this article the authors report the findings of a 2-year study evaluating the effectiveness of REACH OUT, a train-the-trainer program developed to assist small businesses comply with California legislation, Senate Bill 198 (1989), requiring employees to implement a worksite Injury and Illness Prevention Program. Data from a case study sample of 8 companies, drawn from 151 Southern California small businesses participating in the larger study, are reported. Diagnostic walk-throughs were performed, and employee surveys collected at the case study companies approximately 2 months before the treatment group received the intervention and again 1 year later. Results indicate that greater corporate compliance led to employees' perceptions of increased health and safety meetings and training sessions, which led to greater employee health and safety knowledge and improved employee health outcomes.

Accidents, Occupational↗
PubMed1997

Subcutaneous administration of interleukin-2 in human immunodeficiency virus type 1-infected persons.

The safety and efficacy were assessed of 5-day cycles of subcutaneous (sc) interleukin-2 (IL-2) every 8 weeks in human immunodeficiency virus type 1-infected outpatients with >200 CD4 cells/mm3. Immunologic, virologic, and toxicity parameters were measured in 18 patients receiving standard antiretrovirals plus 5-day courses of sc IL-2 (3-18 MIU/day) every 2 months. Systemic toxicities established the maximally tolerated dose (MTD) of IL-2 as 15 MIU/day. CD4 cell responses appeared to correlate directly with baseline CD4 cell counts, with several patients experiencing a dramatic rise after 3 cycles. Virus load increased only transiently in the peri-injection period. It was concluded that serial cycles of outpatient sc IL-2 can be administered safely, with an MTD of 15 MIU/day. Patients with higher baseline counts appear to have a greater CD4 cell response to sc IL-2 therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Establishment of behavioral parameters for the evaluation of osteopathic treatment principles in a rat model of arthritis.

Unilateral arthritis was produced in rats by use of methylated bovine serum albumin in a model of antigen-induced arthritis. The progression of arthritis was measured by computerized motion analysis, bilateral joint circumference, voluntary extension force of the hindlegs, and length of ankle extension. Animals with induced arthritis were assigned to treated and untreated groups on the basis of approximately equal deficits by the parameters measured. A third group of rats, which did not have arthritis induced and received no treatment, served to establish mean normal parameters. Modified techniques of muscle energy, passive movement of the ankle and knee, and passive myofascial stretch were applied to the animals, and the animals were exercised in a mechanized exercise wheel. Parameters associated with gait were examined by computerized motion analysis of walking. Animals treated with manipulation and exercise improved significantly relative to untreated animals with antigen-induced arthritis in vertical ankle lift, ankle-based and foot-based stride lengths, knee circumference, and normalized extension of the ankle. The results demonstrate that the parameters identified can be used to detect functional deficits and significant improvement from those deficits can be derived from a nonpharmacologic treatment paradigm that includes osteopathic manipulation and exercise in an animal model of arthritis. These parameters may be useful in the identification of the relative benefits of independent treatment variables including frequency of osteopathic manipulation and exercise and the relative benefits of each in this model. Also, they may elucidate how these treatments produce their beneficial effects clinically.

Animals↗
PubMed1997

Repeated automated versus daytime ambulatory blood pressure measurement in mild, moderate and severe untreated black hypertensive patients.

OBJECTIVE: To examine the extent to which one session of repeated automated (30-45 min) blood pressure measurements in non-treated, hypertensive patients can be used to predict daytime ambulatory blood pressure (ABP). METHODS: Two hundred untreated black hypertensive patients (mean age 50.2+/-11.2) were retrospectively stratified on the basis of the daytime ambulatory diastolic blood pressure (DBP) into mild, moderate and severe hypertensives (90 mmHg <DBP < 140 mmHg). Office blood pressure was determined at 3 min intervals for a total of 30-45 min using the Dinamap Critikon 1846 SX monitor. Twenty-four hour ambulatory blood pressure (ABP) was performed on the same day in all patients using a SpaceLabs 90207 device. RESULTS: The mean diastolic Dinamap measurements compared with the mean ambulatory daytime DBP were very similar in terms of 'traditional' statistics (mean: 114 +/- 14.6 versus 113 +/- 12 mmHg, correlation: 0.80). However, agreement analysis according to Bland and Altman showed a poor agtreement with an error as high as 19 mmHg. The mean systolic Dinamap measurements compared with the mean ambulatory daytime SBP were significantly overestimated (mean: 185 +/- 25.0 versus 170 +/- 19.3 mmHg, correlation 0.82) and the error was as high as 43 mmHg. On residual analysis, 75% of the diastolic Dinamap values and only 35% of the systolic Dinamap measurements were within an error of +/- 10 mmHg. The average of the first five Dinamap measurements had the greatest predictive ability for the daytime ABP. CONCLUSION: As a result of the poor agreement between the two methods, we suggest that, from the clinical point of view, the two techniques should be treated as two separate entities.

Journal Article↗
PubMed1997

Measurements of glomerular filtration in the intensive care unit are only a rough guide to renal function.

An estimate of glomerular filtration rate (GFR) is important in intensive care units (ICUs) to individualize drug dosages, and for the early detection of acute renal failure (ARF). Creatinine clearance or calculations based on plasma creatinine are the most widely used indicators of GFR, but may be very inaccurate in critically ill patients. We have assessed the accuracy of predictions of GFR by creatinine clearance and plasma creatinine in critically ill patients with variable creatinine kinetics. This is a retrospective record review set in a 24-bed multidisciplinary ICU. Eighteen patient records (9 normal renal function, 9 with ARF-250 patient days) were evaluated. Creatinine clearance measured daily over an 8-hour period, plasma creatinine, creatinine production and 8-hourly urine output were recorded for each day of ICU stay. The discrepancy between measured creatinine clearance and creatinine clearance predicted by the Cockcraft-Gault equation was determined. The coefficient of variation (CV) for each of the contributing variables and the final inherent error for the estimation of GFR were determined. The difference between measured and predicted creatinine clearance was large (predicted GFR may be from 60 ml/min above to 70 ml/min below measured creatinine clearance). The mean CV for creatinine production was 28% and for 8-hourly urine output it was 34%. The estimation of GFR from creatinine clearance can be made at +/- 52% of the calculated value, whereas the estimation of GFR by Cockcraft-Gault is accurate at +/- 37% of the calculated value. Unstable creatinine kinetics from variable urine output and creatinine production in critically ill patients make accurate estimation of GFR impossible. While prediction methods have fewer inherent sources of error, plasma creatinine may be influenced by factors other than renal function. The use of prediction equations is as inaccurate as measured clearance in unstable ICU patients.

Acute Kidney Injury↗
PubMed1997

The future perioperative role.

Technology will be the engine driving high speed changes in surgery. To remain viable, perioperative nurses will need more advanced education and expanded activities outside the clinical setting. A more technologically-driven specialty may be at odds with the values that attracted young nurses to OR nursing.

Forecasting↗
PubMed1997

Primary meningococcal arthritis: case report and review of the literature.

Meningococcal arthritis is a recognized manifestation of Neisseria meningitidis infection, the presentation of which may be confusing. Although arthritis occurs in the setting of meningococcal meningitis, it may also be seen as a primary event without neurological involvement and with or without cutaneous manifestations. We describe a patient with primary meningococcal arthritis and review the literature relating to the clinical types and pathogenic mechanisms. Comparisons of patient series from 1980 to the present with those reported before 1980 are described.

Adult↗
PubMed1997

Urinalysis.

Explore the source record for details and available documents.

Humans↗
PubMed1997

Audit of acute appendicitis in a black South African population.

This is a prospective study of 212 black South African patients operated on with a pre-operative diagnosis of acute appendicitis. There were 143 male and 69 female patients. Forty-four patients had normal appendices and 122 non-perforated and 46 perforated acute appendices. The appendix was normal in 12 male and 32 female patients. Most presenting signs had a high positive predictive value but few had a high negative predictive value. There was no significant difference in the systemic response between perforated and non-perforated groups. Delay in presentation accounted for the majority of perforated appendices, while there was no causal relationship between in-hospital observation and perforation. The complication rate was higher and hospital stay longer in the perforated group. We concluded that the presentation and clinical course of acute appendicitis in the population of black South Africans catered to by our hospital is not very different from that in the white population elsewhere in the world.

Acute Disease↗
PubMed1996

Detection of HIV-1 infection with a green fluorescent protein reporter system.

Several systems for the detection of HIV-1 have been described in which HIV-1-susceptible cells contain a reporter gene (chloramphenicol acetyltransferase, beta-galactosidase, or alkaline phosphatase) under the control of the HIV-1 long terminal repeat (LTR). Upon infection by HIV-1, the expression of the viral tat product increases transcription from the HIV-1 LTR promoter, leading to high-level expression of the reporter gene product. Previously described reporter systems require processing of the cells by lysis, fixation, or other steps following infection to detect the reporter gene product. In the present study, the Aequorea green fluorescent protein S65T variant (GFP-S65T) was used in a reporter system for detecting HIV-1. HeLa-CD4 cells transfected with the plasmid pRH1, which encodes GFP-S65T under the control of the HIV-1 LTR promoter, and either co-transfected with a plasmid encoding the HIV-1 tat product or superinfected with HIV-1, expressed high levels of GFP-S65T, which was readily detected by fluorescence microscopy and fluorescence-activated cell-sorting analysis. The advantages of this system include its simplicity, sensitivity, and ability to detect and sort live HIV-1-infected cells using readily available instruments. The construction of cell lines stably transfected with pRH1 will provide a tool for titering HIV-1 and sorting HIV-1-infected cells.

CD4-Positive T-Lymphocytes↗
PubMed1996

The effect of inhaled albuterol in moderate to severe asthma.

BACKGROUND: Some recent clinical investigations suggest that regular use of inhaled bronchodilators may lead to deterioration in asthma control. OBJECTIVE: The purpose of this study was to evaluate the effect of albuterol dosing schedule on clinical outcome in subjects with moderate to severe stable asthma. METHODS: Seventeen adults were randomized to two 15-week treatment periods in a double-blind crossover design. Throughout the study, subjects were instructed to take two inhalations four times daily from an unlabeled "test" canister. In the four times daily and as-needed (QID + PRN) period, this canister contained albuterol; in the as-needed (PRN) period, it contained placebo. A "rescue" albuterol canister was available for as-needed use at all times. Inhaler actuations from both the test and rescue canisters were electronically recorded. Outcome measures included prednisone requirements, morning and evening symptoms and peak expiratory flow rates, total and nighttime rescue albuterol use, and asthma-specific quality of life. RESULTS: The two treatment periods did not differ in symptoms, nighttime albuterol use, or asthma quality of life. During the QID+PRN period both morning and evening peak expiratory flow rates were significantly higher (p < 0.01 and 0.001, respectively) and total rescue use of albuterol was significantly less (p < 0.05) than the PRN period. Days on prednisone tended to be lower in the regular dosing period (p = 0.08). CONCLUSION: In our sample of patients with moderate to severe asthma, four times daily dosing of albuterol did not lead to deterioration of asthma control.

Administration, Inhalation↗
PubMed1996

Poor discriminatory performance of the Pediatric Risk of Mortality (PRISM) score in a South African intensive care unit.

OBJECTIVE: The use of the Pediatric Risk of Mortality (PRISM) score or other scoring systems in the intensive care unit (ICU) is of great importance for evaluating the efficacy and efficiency of a particular ICU. However, the PRISM score was developed and validated in the United States and subsequently validated in Europe, but has not been evaluated in a less affluent society. In general, scoring systems should be used only in populations similar to the reference population in which the prediction model was developed. We set out to determine the applicability of the PRISM score at Baragwanath Hospital, South Africa. DESIGN: Prospective, descriptive study. SETTING: Twenty-four-bed multidisciplinary ICU. PATIENTS: We analyzed 1,528 consecutive pediatric admissions from January 1989 to June 1994. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: PRISM scores, Therapeutic Intervention Scoring System scores, demographic, and clinical data collected prospectively were entered and stored by means of a commercial software package at the time of admission of each patient. The prediction of actual mortality by PRISM scoring was evaluated by the Hosmer and Lemeshow goodness-of-fit test (chi2[8 degrees of freedom]). Receiver operating characteristic curves were constructed and compared with those curves from pediatric ICU populations in the United States and Europe. Individual receiver operating characteristic curves were constructed for surgical and nonsurgical patients, age categories, and diagnostic categories. Compared with European and American ICU populations, our patients were younger, were mostly nonsurgical emergency admissions, stayed longer in the ICU, and were more severely ill with a higher admission PRISM score and overall mortality rate. Respiratory and septic diagnoses predominated, with very few surgical cases admitted. The Hosmer and Lemeshow goodness-of-fit test showed a significant failure of the PRISM scoring system to accurately predict mortality over a wide range of expected mortality rates (chi2[8 degrees of freedom] = 465, p = 0). Similarly, receiver operating characteristic analysis indicated a poor predictive power (Az = 0.73 +/- 0.01 [SEM]), with an area under the curve significantly less than that for the PRISM reference population (p = 0). PRISM showed equally poor discriminatory function at all age groups and diagnostic categories. CONCLUSIONS: The PRISM score needs to be recalibrated or recalculated for our patient population in view of the high discrepancy and poor discriminatory function shown. Part of the inaccuracy may derive from different demographic characteristics of our ICU population and a different pattern of diseases. It appears that PRISM is not population independent.

Child↗
PubMed1996

Penetrating ureteral injuries: the impact of associated injuries on management.

The ideal management for penetrating ureteral trauma is primary repair, but the effect of other abdominal injuries might preclude this. We attempted to determine what factors could be used to predict a poor outcome of a ureteral anastomosis, so that the initial management can be modified appropriately. The case notes of 41 patients treated for penetrating ureteral trauma were studied retrospectively. Any factors that could influence postoperative complications and outcome were statistically analyzed in order to determine which could be used pre- or intraoperatively to indicate a poor prognosis for the ureteral anastomosis. The presence of shock on admission (P = 0.013), intraoperative bleeding (P = 0.006), colonic injury and specifically injury requiring colectomy (P = 0.006) were associated with a high complication and mortality rate. Patients presenting with penetrating ureteral trauma who are severely shocked and have complicated intraoperative hemostasis and patients who require colectomy should not have a primary ureteral anastomosis, but rather initial ureteral exteriorization or even nephrectomy.

Abdominal Injuries↗
PubMed1996

The significance of alterations in p53 expression in gynaecological neoplasms.

Current interest in abnormalities of the p53 gene and the abnormal expression of its protein is no less in gynaecological cancer than in the study of neoplasms of other sites. Knowledge of normal p53 gene function (particularly with regard to the regulation of apoptosis) and its derangement through mutation or the influence of viruses is contributing to our understanding of pathogenesis. However, despite the burgeoning amount of new data, critical assessment shows that the required consistency in findings that may have direct clinical application (in terms of prognosis for example) is proving elusive.

Cell Division↗