Biomedical subjects
Publications and source records attributed to R C Reed.
The authors of this article present a new model of psychotherapy, the interactive model. The model is based on the assumptions that individual functioning is based not only on the cognitive, affective, and psychomotor (behavioral) domains but also on the interaction among these domains. This therapy model directs the clinician toward assessment and intervention of these interactions.
Explore the source record for details and available documents.
There has been an explosion of information on nursing diagnosis. A recent computer search of the literature revealed a total of 595 publications on nursing diagnosis. Only 6 of these manuscripts were released between the years 1971 and 1974 inclusively; 11 between 1975 and 1979, 178 manuscripts appeared between 1979 and 1985, while 400 were published from 1985 and 1989. In addition, a search of the Nursing and Allied Health Data Base revealed 1,068 articles published from 1982 to 1989. These data clearly emphasize the increased interest in this important topic. Consequently, a plethora of information has been made available to the educator, the clinician, the researcher, and the student. However, through over 15 years of experience with nursing diagnosis, this author has found the issue of cause and effect (etiology and problem) to be an ongoing problem.
Single high dose-large field irradiation (SHD-LFI) has been used for palliation of symptoms secondary to widely disseminated malignancy. Fifty patients with various malignancies were treated with this technique in a private free-standing radiation therapy center between May 1982 and December 1984. Sixty-four treatments were delivered to the 50 patients. Thirty-two treatments were delivered to upper half-body fields, 15 to midbody, and 17 to thoracic fields. The most frequently used dose was 6 Gy which was used for 55 treatments. Thirty-nine patients had favorable response to treatment. All 22 patients with performance status (PS) 1-2 improved following treatment and 17 of 28 PS 3-4 improved. Only mild hematologic and gastrointestinal toxicity was seen. One case of possible radiation pneumonitis developed. It is concluded that SHD-LFI is a valuable palliative technique for general clinical use.
Explore the source record for details and available documents.
The temporal variation in trough (i.e., predose) theophylline concentrations at steady state was examined. In general, adult subjects dosed with solid theophylline formulations have morning trough theophylline concentrations 10-16% greater than corresponding evening troughs; this morning-to-evening drop is statistically significant. Large-percentage diurnal changes (greater than +/- 20% and even greater than or equal to +/- 40%) in trough-to-trough serum theophylline concentrations are not uncommon in adults. However, the change in absolute trough theophylline concentrations is pronounced in only some individuals. Repetitive studies in four of five individuals tested generally demonstrated within-individual reproducibility in the direction (but not magnitude) of the temporal variation in trough theophylline concentration. This finding further substantiates the morning-to-evening change in trough theophylline concentration as a real phenomenon and not merely the result of random variability. It is believed that the temporal variability in trough concentration observed after peroral theophylline administration requires monitoring theophylline dosage needs by obtaining blood samples at the same time each day.
We examined the influence of a large-volume, therapeutic antacid regimen, administered for three full days, on the steady-state bioavailability of a conventional-release and sustained-release theophylline product, Aminophyllin and Theodur, respectively. Nine stable asthmatics voluntarily completed a four-phase investigation requiring a total stay of 12 days in the Clinical Research Unit. The treatments consisted of administration of the formulations mentioned with and without antacids to each patient in a randomized sequence. Four patients participated in an additional phase where antacids were administered q2h around the clock for three days. After coadministration of theophylline plus antacids for two days, theophylline therapy was discontinued while numerous blood samples were obtained over 22 hr and analyzed for theophylline content via radioimmunoassay. Antacids had no predictable, consistent influence on theophylline absorption rate as determined by the absorption rate constant, the time to maximal theophylline concentration, or the lag time for theophylline absorption. Antacids had no detectable influence on theophylline elimination half-life and had no consistent, statistically significant effect on the extent of theophylline bioavailability, according to measurements of maximal concentration, AUC measured over the appropriate steady-state dosing interval, or elimination-rate adjusted AUC. The substantial intraindividual changes for all parameters of theophylline bioavailability that occurred for control and treatment phases likely represent spontaneous, random between-day variability in theophylline disposition independent of antacid administration, as evidenced by the comparability of the percent coefficient of variation for parameters of bioavailability across all phases. Our data demonstrate that therapeutic antacid administration has no effect on steady-state theophylline bioavailability and does not alter the intrinsic variability in theophylline absorption. Based on the results of our data, it is unlikely that a clinically significant (greater than 20%) decrease in theophylline absorption would occur in any patient treated intensively with antacids concurrently.
The routine utilization of a commercially available radioimmunoassay (RIA) for theophylline (GammaDab), although reliable, is currently prohibited by the high cost of the reagents. In an effort to reduce these costs we have diluted the [125I]theophylline tracer and theophylline antiserum reagents by one-half, contrary to the manufacturer's recommendations. We have demonstrated that an excellent correlation exists (r = 0.968) between our modified RIA method and a conventional high-performance liquid chromatographic technique, despite reagent dilution. Accordingly, our reagent costs have been reduced by half. We conclude that the GammaDab kit reagents can be diluted twofold and still provide an accurate determination of serum theophylline. We must also emphasize that any further alteration(s) of this theophylline RIA procedure would require a thorough evaluation before its routine use could be substantiated.
The usefulness of five drug information services in obtaining bioavailability data from journal literature is compared. The deHAEN Drugs in Use system, the Iowa Drug Information Service (IDIS), Index Medicus, MEDLINE and International Pharmaceutical Abstracts (IPA), each for a 10-year period, were searched for citations on bioavailability studies on the oral dosage forms of acetaminophen, lithium carbonate, phenytoin, nitrofurantoin and theophylline. Both quantity of references indexed and quality of data were considered. No significant difference was found in the mean value scores for the five services. Index Medicus provided 79 citations but required 7.7 hours of search time. MEDLINE yielded 62 citations but required only 1.1 hours to search. IPA, IDIS and deHaen had lower numbers of citations and intermediate search times. IPA, deHaen and Index Medicus all cited unique articles, with 11%, 7% and 3%, respectively. Index Medicus had the lowest percent of articles duplicated by two or more services (49%). The most comprehensive serch with the fewest duplicate citations would be obtained from searching deHaen's Drugs in Use, IPA and Index Medicus.
Serum complement levels were assayed in 26 patients with disseminated cancer, who received immunotherapy with infusion of C. parvum. Complement activation, indicated by the consumption of C3 or C4 or both, was found in 46% of the patients. Serum samples showed direct correlation between decreased C3 and conversion of C3 proactivator, whereas such conversion did not occur when C4 alone was decreased. It is concluded that the bypass (properdin) pathway was activated in patients in whom C3 consumption was detected, while the classical (C1) pathway was activated in the patients with C4 consumption unaccompanied by C3 decrease. Direct correlation was observed between delayed cutaneous hypersensitivity reactions to recall antigens and the incidence of C. parvum-associated complement activation.
Fifty-eight patients with Dukes' C classification of carcinoma of the large bowel were placed on adjuvant immuno- or chemoimmunotherapy with Bacillus calmette guerin (BCG) or combination of 5-fluorouracil (5-FU) plus BCG following primary and definitive surgery, and were followed for up to 21 months. Of twenty-six patients receiving BCG alone by scarification, five have relapsed with 75% of freedom from disease estimated at 15.1 months compared with 10.1 months in a group of carefully selected historical controls who had surgery alone (p = 0.12). The survival of all patients receiving BCG alone has not reached the 75 percentile yet, and the difference from controls is currently estimated at the 18% level. The combination of 5-FU plus BCG (studied in 32 patients) may be superior to BCG alone at this time, in that it appears to more effectively protect against tumor recurrence (75 percentile not yet reached compared to control, (p = 0.08). The survival of patients on 5-FU plus BCG also appears to be improved (p = 0.09). No patients have expired compared to a 75 percentile survival of 16.6 months in the control. Serial determination of plasma CEA was crucial in the clinical follow-up of these patients. Frequent CEA detetminations have led to early detection of clinical relapse. In the elevation of CEA suggests tumor recurrence with a high degree of probability in patients with past history of cancer of the large bowel.
Rosette formation between sheep erythrocytes (SRBC) and human thymus-derived lymphocytes (T cells) is used to monitor T cells in various human diseases. Rosettes are usually counted in a hemacytometer immediately after preparation. This paper reports a technique for permanently fixing and staining rosettes for serial and comparative studies, a procedure which has probably been less well standardized, less reproducibly performed, and less widely used than many investigators appreciate. The technique describedhas the advantages of providing distinct morphological identification of the rosette-forming cell and it produces a permanent mount for further reference.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Human gut associated lymphoid tissues were studied in terms of the presence of subpopulations of thymus dependent and thymus independent lymphocytes. Both thymus dependent and thymus independent lymphocytes were present in substantial numbers, as judged from their ability to form spontaneous and complement mediated rosettes with sheep red blood cells and the presence of surface bound immunoglobulins. The relationship between this finding and the question of what is the lymphoid organ which may be the human equivalent of the avian bursa is discussed.
Explore the source record for details and available documents.
Explore the source record for details and available documents.