Search PubMed⌕ Search

Biomedical subjects

R Block

Publications and source records attributed to R Block.

At least 19 recordsLinked to original sources
PubMed2001

State programs for medical diagnosis of child abuse and neglect: case studies of five established or fledgling programs.

OBJECTIVE: To describe the programs for medical diagnosis of child abuse and neglect in three states and efforts to establish state-wide programs in two states. To describe common themes and issues that emerged related to the establishment and maintenance of these programs. METHODS: Five states were selected as case studies to represent a range of experience and type of function embodied in programs that address medical diagnosis of child abuse and neglect. Individuals knowledgeable about the programs or efforts to establish state-wide programs in their home states described these in detail. Inductive analysis was used to identify themes and issues that emerged across the states studied. FINDINGS: Themes emerged in three general areas: funding, services, and training. Findings related to funding were: 1) State funding was vital for initiation of statewide programs; 2) Alliances with other groups with parallel interests were successfully used to garner support for child abuse programs; 3) Services needed to be adequately reimbursed to be sustained; 4) Political climate often affected funding. With regard to services we found: 1) There was no optimal way to organize services, but rather many ways that worked well; 2) It was critical to address local service needs; 3) Provision of standardized quality services was essential. With regard to training: 1) Professional training was an integral part of all statewide programs; 2) New technologies, including televideo, have been explored and implemented to assist in training in statewide programs. CONCLUSIONS: Each state has taken a unique approach to programs for the medical diagnosis of child abuse and neglect. However, there are commonalities, particularly among the states that have been successful in establishing and maintaining comprehensive services and/or training.

Child↗
PubMed1999

Hydrogen peroxide and catalase are inversely related in adult patients undergoing cardiopulmonary bypass: implications for antioxidant protection.

Adult patients undergoing cardiopulmonary bypass (CPB) surgery are subjected to increased oxidative stress and show a spectrum of lung injury. Increased levels of hydrogen peroxide (H2O2) are often seen during episodes of oxidative stress, such as the use of high FiO2s, and this molecule plays a key role in the formation of highly damaging oxidants such as the hydroxyl radical. Oxidative damage to plasma proteins was assessed by measuring free thiol groups, and antioxidant protection against H2O2 by measuring catalase activity. CPB patients (n = 39) receiving either 100% or 50% oxygen at the end of bypass were studied by measuring levels of H2O2 in breath condensate and levels of catalase in their plasma, and comparing these to pre-bypass levels. Post-bypass, all CPB patients exhaled significantly lower levels of H2O2 (P < 0.0001) at a time when they had significantly increased activity (0.809 +/- 0.11 versus 1.688 +/- 0.18 U/mg protein) of catalase in their plasma. There were no significant differences in these parameters between the 100% and 50% oxygen groups. At a time when oxidative stress is greatest, there appears to be a corresponding plasma increase in the antioxidant catalase. Whether this change is fortuitous or a response to oxidative stress is at present under consideration.

Adult↗
PubMed1999

Iowa Case Management for rural drug abuse. Preliminary results.

The Iowa Case Management Project (ICMP) was developed to evaluate the effectiveness of a comprehensive, solution-focused model of case management with rural clients in drug abuse treatment. For this preliminary report, 483 clients who were admitted to residential or outpatient treatment at a local facility volunteered to participate and were randomly assigned to one of four research conditions. Clients in three of the conditions received Iowa Case Management (ICM), while clients in the fourth condition received standard treatment services and served as the control group. Clients were assessed regarding psychosocial characteristics at intake and three additional times during the subsequent 12 months.

Case Management↗
PubMed1998

Tuberculosis and pregnancy--a provincial study (1990-1996).

BACKGROUND: Several studies suggest that physiological changes in pregnancy mimic early symptoms of tuberculosis. If true, this could influence the diagnostic delay of the disease and the outcome of pregnancy. METHODS: From the register of the Public Health Centre, all female patients with culture-proven tuberculosis aged between 22 and 35 years in the Province of Zeeland in the period 1990-1996 have been identified. Data on symptoms, delay, therapy and outcome of the pregnancy have been collected. Risk factors for an early diagnosis have been identified. RESULTS: In nearly one-third of the patients with tuberculosis (n = 14), it has been possible to make a presumptive diagnosis on the basis of a chest X-ray only. Patients with tuberculosis associated with pregnancy are more likely than their non-pregnant counterparts to have non-specific symptoms which are, at most, moderate (p = 0.002). Diagnosis has also been hampered by non-cavernous, smear-negative presentation of the disease. In addition, women with pulmonary tuberculosis associated with pregnancy are more likely to postpone having a chest X-ray taken (p = 0.02), which contributes to the delay. CONCLUSION: As the clinical features of tuberculosis in pregnancy are moderate, a high index of clinical suspicion is necessary. Nevertheless, the favourable outcome suggests that (if all risk factors are taken into account) lung tuberculosis in pregnant women in The Netherlands can be discovered sufficiently early within the limits of the current screening programme to prevent harm to mother or child.

Adult↗
PubMed1996

Loss of contrast intensity during systole in the left ventricular cavity with the use of the contrast agent Albunex. An analysis of its correlation with pressure and velocity.

RATIONALE AND OBJECTIVES: Several investigators have observed a decrease in video intensity in the left ventricular cavity during systole when using contrast echocardiography. It has been suggested that this phenomenon is related to microbubble instability. The authors propose that this phenomenon is, in part, related to the effects of pressure and velocity on the acoustic reflectance of ultrasound contrast agents. METHODS: Using an in vitro flow tube model and varying concentrations of Albunex contrast agent, the effects of pressure and velocity on microbubble video intensity were investigated. Velocity and pressure were varied independently and the imaging tube was scanned using three transducer frequencies at different concentrations of Albunex. Contrast video intensity was analyzed using high and low velocities (at constant pressure) and high and low pressures (at constant velocity). In addition, the fluid from the system was collected and imaged in a nonflowing reservoir tank to investigate the video intensity of the microbubbles when exposed to variable velocity and pressure. RESULTS: The video-intensity measurements were inversely and irreversibly related to ambient pressure changes (independent of velocity) in a tube model. However, video intensity varied inversely but reversibly with velocity (independent of pressure). This observation could not be explained simply by the "laminar flow" theory, by a change in transducer angulation, nor by a change in ultrasound imaging frame rate. This phenomenon was limited to Albunex microbubbles and was not observed with a contrast medium (corn starch) devoid of the acoustic properties of Albunex.

Albumins↗
PubMed1994

The influence of nasal obstruction and its relief on oxygen saturation during sleep and the early postoperative period.

Nasal obstruction causes abnormal breathing patterns during sleep which often result in hypoxaemia. We studied the effect of nasal obstruction on arterial oxygen saturation in 20 healthy patients undergoing elective surgery which required bilateral nasal packing. Ten patients were subject to complete nasal obstruction while the remaining half had the obstruction relieved by the insertion of nasal cannulae. We found that nasal obstruction did not have any detrimental effect on the already low incidence of oxygen desaturation. There was no effect of the cannulae on the degree or frequency of hypoxaemia, although they did appear to improve the quality of sleep during the first postoperative night. They were more comfortable by day than simple packing alone and no adverse effects were observed.

Adolescent↗
PubMed1993

The administration of supplementary oxygen to prevent hypoxia during upper alimentary endoscopy.

A prospective, randomized, controlled trial was conducted in 200 consecutive patients undergoing endoscopy of the upper alimentary tract. One hundred patients received supplementary oxygen at 4 liters/minute through nasal cannulae, while 100 patients received no additional oxygen. Within each of these two groups, 50 patients were sedated with midazolam and 50 patients with diazepam suspension ("Diazemuls"). The patients' weights were recorded and correlated with their height to assess whether they were over or under their ideal weight. Oxygen saturation was recorded at baseline and throughout the endoscopic procedure. The principal finding of this study was that hypoxia (oxygen saturation less than 93%) was prevented in all cases by the administration of 4 liters/minute of oxygen, whereas 48 of the 100 patients who did not receive oxygen exhibited falls in oxygen saturation to less than 93% (p < 0.0001). Those with the highest risk were the obese patients (p < 0.01). There was no significant difference between the two sedative drug groups in either frequency or severity of associated hypoxia (p = 0.77, patients not given oxygen; p = 0.31, patients receiving oxygen). The cost of administering oxygen during upper gastrointestinal endoscopy would be an average of 95 pence ($1.60) per patient. In conclusion, the administration of oxygen during endoscopy is a worthwhile prophylactic measure to prevent hypoxia and its potential adverse effects.

Costs and Cost Analysis↗
PubMed1992

Does hypothermia protect against the development of hepatitis in paracetamol overdose?

A 24-year-old female presented in hospital following self-poisoning with a dose of greater than 30 g of paracetamol (acetaminophen), taken both as co-proxamol (dextropropoxyphene and paracetamol) and paracetamol. She arrived in hospital more than 18 h after ingestion of the drug. On admission, she was profoundly hypothermic, with a rectal temperature of 19 degrees C. Her paracetamol level was 943 mumol.l-1 which, when related to the time of ingestion, implied a very high risk of hepatocellular damage as well as fulminant liver failure, even if she was treated with the antioxidant n-acetylcysteine. The patient's condition was stabilised by initial resuscitation with fluids, vasoactive drugs, and active rewarming. N-acetylcysteine therapy was begun promptly. This patient's liver function tests remained entirely normal in spite of the delay in presentation and she made a rapid and complete recovery. This remarkable clinical course indicates a possible role for therapeutically induced hypothermia in the management of severe paracetamol overdose, particularly in the group of patients who seek medical attention some hours after ingestion of the drug and who therefore remain at high risk, despite treatment with n-acetylcysteine.

Acetaminophen↗
PubMed1991

Expression and functions of very late antigen 1 in inflammatory joint diseases.

In the human immune system, very late antigen 1 (VLA-1), a putative collagen receptor, is expressed on the surface of T lymphocytes that have undergone mitogenic or antigenic stimulation. A new VLA-1-specific monoclonal antibody, 1B3.1, was used to probe the expression and function of VLA-1 on T lymphocytes in patients with arthritis. Synovial mononuclear cells from the joints of patients with rheumatoid arthritis or other joint diseases contained 32.9 +/- 13.8% 1B3.1-positive cells (42.8 +/- 10.4% in patients with rheumatoid arthritis and 28 +/- 12.6% in non rheumatoid patients). In the peripheral blood, patients with active rheumatoid arthritis expressed VLA-1 on 11.7 +/- 6.0% of their mononuclear cells, compared to 1.9 +/- 1.5% in controls (P less than 0.001). Using dual fluorescence analysis, virtually all the 1B3.1-positive synovial cells were CD3+ T lymphocytes and included both CD4+ and CD8+ T cells. When 1B3.1-expressing synovial mononuclear cells or in vitro activated T lymphocytes were triggered with anti-CD3 antibodies, marked augmentation of their proliferation occurred if they were simultaneously cross-linked with mab 1B3.1. Collagen type IV, a putative ligand of VLA-1, also augmented T-cell proliferation to anti-CD3. The data suggest that the VLA-1 molecule could play an important role in the pathophysiology of arthritis by modulating T-cell activation in these diseases.

Antigens, Differentiation, T-Lymphocyte↗
PubMed1991

Self-assessment of medical knowledge: do physicians overestimate or underestimate?

The relationship between doctors' medical knowledge and their inability to assess correctly what they know was investigated. Sixty out of 65 hospital physicians sat a MRCP Part 1 multiple-choice examination. In addition to the factual questions, they had to estimate how certain they were that their answers were correct. We confirmed that factual knowledge increased with clinical experience from the grade of house officer through to that of senior registrar. The self-assessment of likelihood of being correct revealed that, on average, doctors underestimated their knowledge by 8%. However, those who had passed their MRCP examination within the past three years over-estimated on average by 6%. We suggest that this inadequacy of self-assessment could have serious clinical implications, and should be assessed.

Educational Status↗
PubMed1990

Equivalence of five forms of the Selective Reminding Test in young and elderly subjects.

This study evaluated the equivalence of five forms of the Selective Reminding Test, a widely used measure of verbal learning, 45 normal young and 45 normal elderly subjects were randomly administered three of the five test forms on three separate sessions. The five forms generally correlated well with one another and were of comparable difficulty, suggesting adequate test equivalence. Four of the five forms were particularly well matched.

Adolescent↗