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R Bloch

Publications and source records attributed to R Bloch.

At least 19 recordsLinked to original sources
PubMed2002

The Swiss catalogue of learning objectives.

PBL philosophy may challenge the need for explicit and specific educational objectives in medical education. From a practical point of view, however, such objectives are essential to achieve a close overlap between learning, teaching and assessment. Since the 1970s medical licensing in Switzerland has been based, among other things, on passing a uniform, centrally prepared MCQ exam for the graduates of all five Swiss medical schools. The need for a set of jointly developed learning, teaching and assessment objectives has become apparent. The Joint Conference of Swiss Medical Schools has therefore charged a small taskforce with the development of such a catalogue. This paper describes the background, process and results of this work.

Education, Medical, Undergraduate↗
PubMed2002

Antimicrobial activity of Polyscias filicifolia cell biomass extracts.

Antibacterial activity of extracts of Polyscias filicifolia biomass from bioreactor and callus was determined using the agar disc-diffusion method. The microorganisms Staphylococcus aureus (three strains) showed the highest sensitivity to extracts of P. filicifolia biomass from a bioreactor. The values were comparable with nitrofurantoine used as a standard. Micrococcus flavus, Sreptococcus pyogenes and S. agalatiae were less sensitive. The effect of P. filicifolia callus extract on the above bacteria was less pronounced than that of extracts of biomass from a bioreactor.

Anti-Bacterial Agents↗
PubMed2001

Ehlers-Danlos syndrome mimicking mesenteric vasculitis: therapy, then diagnosis.

The etiology of acute intraabdominal bleeding is often unclear at the time emergent arteriography is performed. During localization and embolization, the arteriogram may suggest the diagnosis of vasculitis. However, controlling the bleeding remains the priority. Connective tissue diseases such as Ehlers-Danlos syndrome (EDS) may also cause bleeding and mimic vasculitis and must be included in the differential diagnosis. We present such a case in which the initial findings were misleading.

Adult↗
PubMed2001

Oral gossypol in the treatment of patients with refractory metastatic breast cancer: a phase I/II clinical trial.

Gossypol has demonstrated in vitro effects on cell cycle regulation and anti-tumor activity against mammary carcinoma cell lines. This Phase I/II study assesses both the effect of gossypol on cell cycle regulatory proteins in vivo and the clinical effect. Twenty women with refractory metastatic breast cancer received oral gossypol at daily doses between 30 and 50 mg per day. Gossypol plasma levels were measured (n = 8) and the modulation of the retinoblastoma (Rb) gene protein and Cyclin D1 was assessed by serial biopsies (n = 4). Grade I-II toxicities with gossypol treatment included nausea in 30% of patients, fatigue 15%, emesis 15%, altered taste sensation 15% and diarrhea in 10% of patients. Two of the three patients receiving 50 mg/day experienced dose limiting dermatologic toxicity (grade III). One patient had a minor response and two patients had stable disease with > 50% decline in serial assessments of the serum tumor markers. Immunohistochemical analysis of cyclin D1 and Rb expression in serial biopsies of four patients revealed both a concurrent decrease in cyclin D1 expression and an increase in nuclear Rb expression in three patients. The maximal tolerated dose (MTD) of gossypol was 40 mg/day. Gossypol appears to affect the expression of Rb protein and cyclin D1 in breast cancer metastases at doses achievable, yet had negligible antitumor activity against anthracycline and taxane refractory metastatic breast cancer. The cell cycle regulatory effects of gossypol suggest a potential role for gossypol as a modulating agent in conjunction with other cell cycle specific compounds.

Administration, Oral↗
PubMed2001

Sequential analysis for quality control in the neonatal intensive care unit.

OBJECTIVE: This article describes a novel application of a statistical technique for continuous quality assurance in the NICU. METHODS: We used prospective analysis of rates of survival to 28 days of life, without major IVH in ELBW infants in a single tertiary NICU, before and after the introduction of an evidence-based treatment protocol. By using the CUSUM function, each infant's results were sequentially plotted, and significant changes in outcomes were noted when the plot crossed predetermined boundary lines. RESULTS: Significant changes in outcomes were evident with this method sooner than traditional analyses on the basis of year-end or other arbitrary intervals. The introduction of the ELBW protocol was temporally associated with significant improvement in intact short-term survival. CONCLUSION: Sequential analysis techniques are useful tools for ongoing quality assurance; deviations in outcomes may be detected more quickly, which should assist in the identification of improvements or decrements in performance of the NICU.

Data Interpretation, Statistical↗
PubMed1999

The hazards of scoring the quality of clinical trials for meta-analysis.

CONTEXT: Although it is widely recommended that clinical trials undergo some type of quality review, the number and variety of quality assessment scales that exist make it unclear how to achieve the best assessment. OBJECTIVE: To determine whether the type of quality assessment scale used affects the conclusions of meta-analytic studies. DESIGN AND SETTING: Meta-analysis of 17 trials comparing low-molecular-weight heparin (LMWH) with standard heparin for prevention of postoperative thrombosis using 25 different scales to identify high-quality trials. The association between treatment effect and summary scores and the association with 3 key domains (concealment of treatment allocation, blinding of outcome assessment, and handling of withdrawals) were examined in regression models. MAIN OUTCOME MEASURE: Pooled relative risks of deep vein thrombosis with LMWH vs standard heparin in high-quality vs low-quality trials as determined by 25 quality scales. RESULTS: Pooled relative risks from high-quality trials ranged from 0.63 (95% confidence interval [CI], 0.44-0.90) to 0.90 (95% CI, 0.67-1.21) vs 0.52 (95% CI, 0.24-1.09) to 1.13 (95% CI, 0.70-1.82) for low-quality trials. For 6 scales, relative risks of high-quality trials were close to unity, indicating that LMWH was not significantly superior to standard heparin, whereas low-quality trials showed better protection with LMWH (P<.05). Seven scales showed the opposite: high quality trials showed an effect whereas low quality trials did not. For the remaining 12 scales, effect estimates were similar in the 2 quality strata. In regression analysis, summary quality scores were not significantly associated with treatment effects. There was no significant association of treatment effects with allocation concealment and handling of withdrawals. Open outcome assessment, however, influenced effect size with the effect of LMWH, on average, being exaggerated by 35% (95% CI, 1%-57%; P= .046). CONCLUSIONS: Our data indicate that the use of summary scores to identify trials of high quality is problematic. Relevant methodological aspects should be assessed individually and their influence on effect sizes explored.

Anticoagulants↗
PubMed1999

[Angiotensin converting enzyme (ACE) gene polymorphism in a diabetic cohort and diabetic nephropathy].

The renin-angiotensin system is thought to play an important role in the pathophysiology of kidney disease in diabetes. Previous studies have shown a possible association between the D allele of the angiotensin converting enzyme (ACE) gene, known to be associated with higher circulating levels of ACE, and increased risk of developing nephropathy in NIDDM. The present study investigated the distribution of ACE gene genotypes in the general population and patients with NIDDM, the association between the D allele and diabetic nephropathy, and the association between the ACE genotype and involvement of other target organs in NIDDM. The ACE genotype (insertion/deletion I/D) was determined in all subjects, subsequently divided into 3 groups based on their polymorphism (DD, DI and II). The presence of nephropathy was defined by an albumin-creatinine ratio of 30 mg/g or greater (mean of 2 first morning urine samples). In the general population most had the D allele (DD or ID) and a minority the II genotype. There was no association between genotype and hypertension, ischemic heart disease, hyperlipidemia, and cerebrovascular or peripheral vascular disease. In diabetics the genotype distribution was not different from that in the general population. Within the diabetic group, there was no association between genotype and hypertension, hyperlipidemia, duration of diabetes, or HbA1C levels. Nephropathy, found in 81 of the 156 with NIDDM, was not associated with genotype. Diabetic nephropathy was not associated with retinopathy, neuropathy, or ischemic heart, cerebrovascular or peripheral vascular disease. We conclude that in the population sampled, there was no association between the D allele of the ACE gene and the risk of developing nephropathy in NIDDM.

Cohort Studies↗
PubMed1999

Short-term progressive resistance training increases strength and lean body mass in adults infected with human immunodeficiency virus.

BACKGROUND: To assess the efficacy of progressive resistance training (PRT) in increasing strength and lean body mass (LBM) in HIV-infected adults. METHODS: Twenty-five adults with HIV infection were trained using a highly intensive PRT regimen for 8 weeks, followed by an additional 8 weeks of observation under ad libitum physical activity conditions. RESULTS: Twenty-four of the 25 patients completed the first phase of the study. They had significant increases in strength on all four exercises tested (P < 0.0001), and an increase in LBM of 1.75 +/- 1.94 kg (mean +/- SD, P < 0.0002), with a concomitant decline in fat of 0.92 +/- 2.22 kg (P < 0.05), and no significant change in weight or bone mineral content. Twenty-one of the patients returned for follow-up 8 weeks after completing the PRT. Compared with their baseline values, their mean lean mass remained 1.40 +/- 1.8 kg higher (P < 0.003). Among those who continued to train to some extent, lean mass increased by a mean of 1.1 +/- 1.6 kg (n = 9, P < 0.05 versus end of PRT), whereas those who did no further training showed an increase in lean mass of 0.28 +/- 1.4 kg (n = 12, P = NS versus end of PRT). The difference between the two groups was not, however, significant (P = 0.25). Among six patients with AIDS wasting, the increase in LBM was larger than among non-wasted patients (2.8 versus 1.4 kg, P < 0.06), and there was an increase in both weight (+3.9 versus -0.2 kg, P < 0.002) and fat mass (+ 0.95 versus -1.5 kg, P < 0.002) at 8 weeks, which persisted at 16 weeks (weight: +4.0 versus -1.6 kg, P < 0.0002; fat: +1.6 versus -1.9 kg, P < 0.01). CONCLUSION: This preliminary study suggests that short-term, high intensity PRT can significantly increase LBM and strength in HIV infection, and may be used as an alternative or adjunct to pharmacological anabolic treatments in this disease.

Adult↗
PubMed1999

Prospective randomized comparison of valved versus nonvalved peripherally inserted central vein catheters.

OBJECTIVE: The purpose of this study was to evaluate whether a valved peripherally inserted central catheter (PICC) design would result in a lower incidence of occlusion, infection, and malfunction than a clamped catheter. SUBJECTS AND METHODS: Three hundred sixty-two study patients (233 men, 129 women; mean age, 44 years) were randomized to receive a clamped (n = 182) or valved (n = 180) 5-French single-lumen PICC. Catheters were placed under fluoroscopic (n = 331) or sonographic guidance (n = 31). The valved PICC was flushed with saline solution, and the clamped PICC was flushed with a heparin-saline solution. All patients were prospectively followed up at least weekly for catheter status and complications. RESULTS: Percutaneous placement with the catheter tip in the central veins was successful in 99% of patients. Mean dwell time was 34 days. Twenty-six occlusive or infectious complications occurred in the clamped catheter group and 12 in the valved catheter group (p = .02). The clamped and valved catheter groups had 13 and five occlusions, respectively (p = .06), and 12 and five catheter-related blood stream infections, respectively (p = .09). Most occlusions (68%) were treated successfully with urokinase, and site infection or sepsis was treated by catheter removal. CONCLUSION: We found a statistically significant difference in the complication rate for the valved PICC compared with the clamped PICC. With the valved PICC, occlusion and infection were reduced, and patients having these catheters did not require heparin flushes.

Adult↗
PubMed1996

High risk factors for rehospitalization within six months.

OBJECTIVE: 1. To identify risk factors associated with psychiatric rehospitalization within six months, using global clinical assessments and demographic information and; 2. To determine if risk factors for a hospital in a rural region are similar to those reported for urban hospitals. METHOD: The setting was a psychiatric unit within a general hospital. All adult admissions for one year were assigned scores on the North Carolina Functional Assessment Scale (NCFAS) and the Global Assessment of Functioning (GAF) scale. Patients were interviewed six months after discharge to determine if they had been rehospitalized and to assign new NCFAS and GAF scores. RESULTS: Significant risk of rehospitalization was predicted by: 1. NCFAS score > 90; 2. history of prior hospitalization; 3. nursing home residence; 4. referral from a small community hospital and; 5. non-compliance with outpatient appointments. CONCLUSIONS: Global assessments and demographic information collected during an index admission can generate factors to identify patients at risk for rehospitalization within six months. History of prior admissions and non-compliance with outpatient treatment, reported as risk factors in urban settings, were found also to be risk factors in a rural region.

Adult↗
PubMed1995

Percutaneous endoscopic gastrostomy: a community hospital experience.

Percutaneous endoscopic gastrostomy (PEG) is a well established procedure for establishing a feeding port in patients unable to take oral nutrition. As these patients are often elderly with multiple ailments, mortality due to comorbidities is common. This retrospective study reviewed the experience with PEG in a community hospital, with particular attention paid to morbidity and mortality rates. Randomly selected charts of 100 patients who had PEG performed at our hospital between 1987 and 1991 were examined. These records were reviewed for patients' age, gender, indications, intraoperative complications, and final disposition. Procedure-related morbidity was defined as any untoward event or death that could not be directly attributed to the patient's primary disease process. The sample consisted of 33 males and 67 females whose ages ranged from 47 to 102 years, with a mean of 82 years. The most common indications were malnutrition (n = 48) and dysphagia due to neurological problems (n = 38). The only procedure-related intraoperative complication involved a patient with uncomplicated umbilical hernia who developed strangulation. The morbidity rate was 4% and the 30-day mortality rate was 16%. Only one death was directly related to the PEG tube, and a second death was possibly related to the PEG tube. This community hospital's experience with PEG reveals low morbidity and mortality rates compared to Stamm gastrostomy. These results confirm that PEG is the procedure of choice for providing aging patients with a safe route for enteral nutrition.

Aged↗
PubMed1993

Reliability of the modified-modified Schöber and double inclinometer methods for measuring lumbar flexion and extension.

BACKGROUND AND PURPOSE: The primary purpose of this study was to determine the reliability of lumbar flexion and extension range-of-motion measurements obtained with the modified-modified Schöber and the double inclinometer methods on subjects with low back pain. SUBJECTS: Fifteen patients (8 women, 7 men), aged 25 to 53 years (mean = 35.7, SD = 9.9), with chronic low back pain were measured by three physical therapists with 3 to 12 years (mean = 8.3, SD = 4.7) of clinical experience. METHODS: The therapists used the modified-modified Schöber and double inclinometer techniques to measure, in random order and on two occasions, the subjects' lumbar flexion and extension. RESULTS: Pearson Product-Moment Correlation Coefficients for test-retest reliability for the modified-modified Schöber technique varied from .78 to .89 for lumbar flexion and from .69 to .91 for extension; for the double inclinometer method, Pearson correlation coefficients varied from .13 to .87 for lumbar flexion and from .28 to .66 for extension. Analysis of variance-derived intraclass correlation coefficients for interrater reliability for the modified-modified Schöber technique were .72 for flexion and .76 for extension; for the double inclinometer technique, they were .60 for flexion and .48 for extension. CONCLUSION AND DISCUSSION: The modified-modified Schöber method thus appears to be a reliable method for measuring lumbar flexion and extension for patients with low back pain, whereas the double inclinometer technique needs improvement.

Adult↗