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Biomedical subjects

M Williams

Publications and source records attributed to M Williams.

882 records · Page 49Linked to original sources
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Natural history of chronic bilateral internal carotid artery occlusion.

Chronic bilateral ICA occlusion was found in 15 of 3200 patients studied with duplex scanning during a six years period. Ten of these patients had a history of stroke. Mean follow-up was 28.9 months. Six patients died during follow-up, coexisting cardiac ischaemia being the major cause of death. Two patients suffered a stroke (one fatal) resulting in an annual stroke rate of 5.5%, three patients continued to have TIAs and 5 remained asymptomatic. Chronic bilateral ICA occlusion is not always associated with neurological deficit. Coronary ischaemia, more than stroke is the leading cause of death in these patients.

Adult↗
PubMedDate not supplied

Prognostic criteria in intra-abdominal sepsis.

Forty-two patients with proven intra-abdominal sepsis were studied in a prospective clinical trial. The following parameters were evaluated: (1) Nine parameters on admission: age, sex, obesity, malnutrition, history of cardiac, respiratory or renal disease, diabetes mellitus and malignant neoplasia. Four of these parameters had a prognostic value (p less than 0.05): age 65 years, diabetes mellitus and cardiac disease. (2) Thirty parameters representing the functional status of six organic systems during sepsis: respiratory, cardiovascular, nervous, kidneys, blood coagulation, liver. Six of these parameters had a prognostic values: PEEP 0-10 cm H2O to keep PaO2 greater than 60 mmHg (p less than 0.001), serum creatinine greater than 3.6 mg/dl (p less than 0.01), prothrombin time greater than 15'' or platelet count less than 100,000/mm3 (p less than 0.001), need of vasoconstrictive drug to keep arterial pressure greater than 100 mmHg (p less than 0.001), bilirubin greater than 3 mg/dl (p less than 0.01) and mental confusion. The combination of these ten statistically significant prognostic criteria for each patient showed that the mortality was 0 with 0-2 criteria, 36% with 3-5 criteria, 94% with 6-8 criteria and 100% with 8-10 criteria. Patients with more than five of these criteria had a significant higher mortality risk (p less than 0.001).

Abdomen↗
PubMedDate not supplied

Ampligen inhibits human herpesvirus-6 in vitro.

The recently discovered human herpesvirus-6 (HHV-6) is being associated with an increasing number of conditions in which there is evidence of immunologic dysfunction. A number of widely available antiviral agents have shown little or no activity against the virus. We found that Ampligen [Poly (1): Poly (C12U), a synthetic, mismatched, double-stranded RNA, has potent, previously unexpected antiviral effects. Cells known to allow replication of HHV-6 were infected with the virus and treated with Ampligen under various conditions. When cells were pretreated with Ampligen (concentrations of 100 or 200 micrograms/ml) prior to infection or treated shortly after infection, viral replication was inhibited by 46-98%. At 100 and 200 micrograms/ml, Ampligen also inhibited the DNA polymerase activity of HHV-6 by 42-98%. When lower concentrations of Ampligen (10 and 50 micrograms/ml) were used, only pretreatment of cells, with Ampligen, followed by virus infection and carrying the infected cells with Ampligen, significantly inhibited HHV-6 infection (83.7 and 89.1% respectively). Indirect evidence suggests that Ampligen may inhibit viral attachment to cellular receptors and/or inhibit intracellular maturation of the virus. The above concentrations of Ampligen were not toxic to the cells used in the study. Given these in vitro findings, and the low frequency of toxicity reported with the use of Ampligen, clinical trials of this drug in patients with evidence of reactivated HHV-6 infection would seem to be warranted.

Antigens, Viral↗
PubMedDate not supplied

Essential support.

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Back Pain↗
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Care coordination in an academic medical center.

Care coordination/case management models provide a method to measure expenditures within the context of health-care outcomes. High costs are predictable in a high skill, technology-intensive service industry such as academic medical centers. A care-coordination model provides a means to reduce the cost per case and influence patient satisfaction. In this article, the authors describe a Care-Coordination Model for neurologically impaired patients in an academic medical center. The Care-Coordination Model serves as a structure for cost containment within a diagnostic reimbursement grouping (DRG) category and provides an opportunity to develop alternative care programs to support those disabled in their community setting. Clinical and financial outcomes are presented as well as follow-up in the form of a patient survey. The results demonstrate cost savings in several charge categories, a reduction in the length of stay, a reduction in the variation of clinical treatment, and an increase in patient satisfaction regarding discharge preparation.

Academic Medical Centers↗
PubMedDate not supplied

Three alternative methods of developing critical pathways cost and benefits.

Three common methods of determining optimum pathways and their attendant cost and time requirements will be evaluated. Popular methods used for the development and adaptation of pathways are the use of published guidelines, the creation of pathways within an existing health care system and the use of an automated tool. The cost and time required for each of these methods vary tremendously.

Cost-Benefit Analysis↗