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Biomedical subjects

R G Carey

Publications and source records attributed to R G Carey.

At least 19 recordsLinked to original sources
PubMed1995

CQI case study: reducing medication errors.

BACKGROUND: This article describes how the Pharmacy and Therapeutics Committee at Lutheran General Hospital (Park Ridge, IL) formed a continuous quality improvement (CQI) team and used statistical process control (SPC) tools to assess efforts to reduce medication errors. METHODS: The team worked with the nursing quality council to develop an intravenous (IV) training module for nurses that effectively decreased the average number of errors per month. The article illustrates the effective use of a run chart, a Pareto chart, and two types of control charts (p-charts and np-charts) to identify an opportunity for improvement, develop an improvement strategy, and measure the effectiveness of the intervention. CONCLUSION: Lessons learned from this case include the following: 1) Although run charts can be used as a preliminary step to determine whether a process has common-cause or special-cause variation, p-charts or np-charts are more precise tools for identifying special causes and for measuring the impact of interventions; 2) Pareto charts are useful for focusing on the areas of a process that will have the greatest impact in achieving the desired results; 3) When p-charts show little variation in control limits from month to month, the np-chart is an appropriate and more user-friendly alternative; and 4) In addition to validating the overall effectiveness of the intervention, the np-chart also helped to identify where the intervention failed.

Health Services Research↗
PubMed1993

A patient survey system to measure quality improvement: questionnaire reliability and validity.

This study describes the results of a four-year research effort to develop inpatient and outpatient questionnaires that have sufficient validity and reliability to be used to measure patient perceptions of quality. As part of this effort, over 50,000 inpatients, emergency room patients, and ambulatory surgery patients from over 300 hospitals representing every US census region were surveyed. Separate questionnaires, called Quality of Care Monitors, were developed for inpatients and outpatients. The inpatient questionnaire consisted of 8 scales: Physician Care, Nursing Care, Medical Outcome, Courtesy, Food Service, Comfort and Cleanliness, Admissions/Billing, and Religious Care. The outpatient questionnaire had 7 scales: Physician Care, Nursing Care, Medical Outcome, Facility Characteristics, Waiting Time, Testing Services and Registration Process. The study found strong evidence of construct validity, predictive validity, and internal consistency for both questionnaires. Each questionnaire is capable of measuring separate dimensions of patient experience. A data bank developed from these questionnaires is currently accessed regularly by participating hospitals to assess quality improvement and to make benchmark comparisons with similar hospitals.

Health Services Research↗
PubMed1992

Reduced nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) profiles in the amygdala of human and New World monkey (Saimiri sciureus).

The topographic distribution of nicotinamide adenine dinucleotide-diaphorase (NADPH-d) stained profiles in the amygdala of the human and new world monkey (Saimiri sciureus) were studied histochemically. Fiber and terminal staining were heterogeneously distributed within the amygdala. The most intense staining occurred in the basolateral subdivision, consisting of the lateral, basolateral and accessory basal nuclei. Moderate staining intensity was observed throughout the cortical and media nuclei and cortical transition area, constituents of the corticomedial subdivision. The central amygdaloid area was characterized by minimal NADPH-d histochemical reactivity. NADPH-d positive neurons were pleomorphic and divisible into two classes based on their staining characteristics: intensely or lightly stained neurons. Their distribution was generally complementary, with the majority of intensely stained neurons occupying the basolateral subdivision. There were no appreciable species differences in the patterns of neuronal, fiber and terminal staining between monkey or human amygdala. These results may be relevant to our understanding of the selective vulnerability of neural systems within the human amygdala in neurodegenerative diseases.

Acetylcholinesterase↗
PubMed1990

Reduced nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) histochemistry in the hippocampal formation of the New World monkey (Saimiri sciureus).

Nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) containing fibers and neurons within the hippocampal formation and entorhinal cortex of the new world monkey were determined using a direct histochemical procedure. Occasional intensely stained bipolar NADPH-d positive neurons were seen in the polymorphic zone within the hilus of the dentate gyrus and molecular layer of the hippocampus. Although virtually no intensely stained cells were seen in the CA subfields, a few small oval lightly stained NADPH-d perikarya were found subjacent to CA2. An occasional intensely stained multipolar NADPH-d containing neuron was observed in the subiculum, presubiculum and parasubiculum. In the entorhinal cortex, NADPH-d cells were scattered in all layers with the greatest preponderance in layers 5-6 and underlying white matter. Dense bands of NADPH-d fibers occurred in the outer layer of the molecular layer of the dentate gyrus and the hippocampo-subicular border. NADPH-d fibers also were seen in pre- and parasubicular regions. NADPH-d fiber staining in entorhinal cortex varied mediolaterally with an increasing laminar distribution more caudally. The heaviest bands of NADPH-d fibers occurred in layers 1 and 4 and the white matter-layer 6 border. The distribution patterns of this select neuronal population may be relevant to the study of hippocampal and entorhinal areas in neurodegenerative diseases.

Animals↗
PubMed1990

Gliomas: classification with MR imaging.

The findings at magnetic resonance (MR) imaging in a group of 36 pathologically verified supratentorial gliomas were analyzed and compared with the biopsy diagnoses (a) to determine whether MR imaging could be used to classify astrocytic-series tumors into a three-tiered system of low-grade astrocytoma, anaplastic astrocytoma, and glioblastoma multiforme; and (b) to evaluate MR imaging features that may aid in this classification. The MR characteristics evaluated were crossing of the midline, edema, tumor signal heterogeneity, hemorrhage, border definition, cyst formation or necrosis, and mass effect. The statistically significant MR characteristics (positive predictors) were mass effect (P = .0000) and cyst formation or necrosis (P = .0512). The MR accuracy rate approached that of neuropathologic diagnosis, which is subject to sampling errors. MR imaging may serve as an adjunct in case management when the clinical course and MR findings appear to be at odds with the neuropathologic diagnosis.

Anaplasia↗
PubMed1989

Immunohistochemical localization of GABAA receptors in the retina of the new world primate Saimiri sciureus.

A large population of amacrine cells in the retina are thought to use GABA as an inhibitory neurotransmitter in their synaptic interactions within the inner plexiform layer. However, little is known about their synaptic targets; the neurons that express the receptors for GABA have not been clearly identified. Recently, the GABAA receptor has been isolated and antibodies have been raised against it. These antibodies have proven useful for the immunocytochemical localization of the receptor, and two brief reports describing the distribution of GABAA receptor immunoreactivity in the retina have appeared (Richards et al., 1987; Mariani et al., 1987). We used a monoclonal antibody (62-3G1) against the GABAA receptor to study the retina of the New World primate Saimiri sciureus. Labeled somata were found in the inner nuclear layer (INL) and ganglion cell layer (GCL). The staining was confined to what appeared to be the cell's plasmalemma and small cytoplasmic granules. Most of the labeled neurons in the INL had small somata (5-7 microns in diameter) located at the vitreal edge of the layer. They arborized in two laminae (approximately 2 and 4) of inner plexiform layer (IPL). Ventral to the optic disc (2.5 mm) they comprised 29% of the cells present. A few of the labeled neurons appeared to be interplexiform cells or flat bipolar cells, with labeled processes that extended into both the IPL and the inner half of the outer plexiform layer. In the GCL, the labeled somata were among the largest present (13-20 microns in diameter), and 2.5 mm ventral to the optic disc they made up 15% of the cells present. Experiments in which immunoreactive somata were retrogradely labeled following the injection of fluorescent tracers into the optic tract provided a conclusive demonstration that some of the immunoreactive somata were ganglion cells. The antibody often labeled their axons in the optic fiber layer. This suggests that the GABAA receptors are transported anterogradely to the retinal terminal fields. The dendrites of the immunoreactive ganglion cells extended into the 2 laminae of labeled processes in the IPL, and their primary dendritic arbors were, at any given eccentricity, quite similar in appearance. This homogeneity suggests that they comprise a particular subset of the ganglion cells. Sections simultaneously labeled with the monoclonal antibody against the GABAA receptor and antisera against either L-glutamic acid decarboxylase (GAD) or GABA revealed that the GAD/GABA was distributed much more widely in the IPL than the GABAA receptor.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1988

New view of the organization of the pulvinar nucleus in Tupaia as revealed by tectopulvinar and pulvinar-cortical projections.

The projections of the superficial layers of the superior colliculus to the pulvinar nucleus in Tupaia were reexamined by injecting WGA-HRP into the tectum. The main result was finding two different patterns of terminations in the pulvinar nucleus: a zone remote from the lateral geniculate nucleus, which occupies the dorsomedial and caudal poles of the pulvinar nucleus, was almost entirely filled with terminals in every case irrespective of the location of the injection site; and a second division of the pulvinar nucleus, adjacent to the lateral geniculate nucleus, contained irregular patches--much more densely populated--and the distribution of patches varied from case to case. We call the first projection "diffuse" and the patchy projection "specific." Next we injected several divisions of the extrastriate visual cortex to find the cortical target of each pathway. The diffuse path terminates in the ventral temporal area (Tv). The specific path terminates in the dorsal temporal area (Td) and area 18. We speculated about the significance of the two pathways: the specific path may be responsible for the preservation of vision after removal of the striate cortex; the diffuse path may have an important place in the evolution of the visual areas of the temporal and occipital lobe. We argued that the target of the diffuse path is in a position to relate limbic and visual impulses and relay the product of such integration to the other visual areas, striate as well as extrastriate cortex.

Animals↗
PubMed1988

Origin of butyrylcholinesterase in the lateral geniculate nucleus of tree shrew.

We examined the distribution and possible origins of pseudocholinesterase activity within the lateral geniculate nucleus (LGN) of the tree shrew. Butyrylcholinesterase (BuChE) activity was spread diffusely throughout the LGN and not localized to neuronal perikaryon. Lesions of the LGN eliminated this BuChE activity while not affecting acetylcholinesterase (AChE) activity; however, removal of retinal input by unilateral ocular enucleations failed to affect the BuChE activity within the denervated layers of the LGN. This lack of effect suggests that, unlike the macaque monkey, retinal terminals within the LGN of tree shrew are not the source of BuChE. Thus, in the tree shrew LGN it appears that BuChE is not metabolically related to or dependent upon AChE nor does it originate from retinal sources, but rather BuChE appears to represent an enzyme that is endogenous to the LGN.

Acetylcholinesterase↗
PubMed1988

Who makes the most progress in inpatient rehabilitation? An analysis of functional gain.

This study describes the functional gain made by 6,194 inpatients in 22 rehabilitation facilities in 1985 and 1986. Functional gain was measured by the Revised Level of Rehabilitation Scale (LORS-II). Results showed that age, length of stay, and functional ability at admission were all factors in patient progress, but not always in the way expected. Younger patients and those with a longer length of stay generally made more progress, but there were variations by impairment group. A curvilinear relationship between functional status at admission and functional gain was observed for several impairment groups. Head injury patients made the most functional gains. However, orthopedic patients made the most gains of all impairment groups when length of stay, age, functional ability at admission, and consistency of progress were considered.

Activities of Daily Living↗
PubMed1987

Topographic projections to the visual cortex from the basal forebrain in the rat.

Recent studies have shown that cholinergic neurons within the basal forebrain give rise to a projection that terminates throughout the neocortex. The purpose of the present study is to determine the topographic organization of the basal forebrain projection to a single cortical region: the visual cortex. Injections of wheat germ agglutinin-horseradish peroxidase were placed within the infragranular layers of areas 17, 18a or 18b in Long-Evans hooded rats. Following injections placed within area 18a, retrogradely labeled neurons were located primarily within the caudal components of the basal forebrain including the basal nucleus of Meynert. Injections placed within area 18b, on the other hand, resulted in retrograde labeling of numerous neurons within rostral basal forebrain nuclei, including the horizontal limb of the diagonal band of Broca, whereas only a few labeled cells were located within the basal nucleus. Two patterns of labeled cells were evident following injections placed within area 17 and they resembled the results from injections within the adjacent extrastriate area; i.e. either area 18a or area 18b. Thus, injections restricted to the lateral portions of area 17 resulted in retrograde labeling of neurons located within the caudal levels of the basal forebrain, whereas injections within the medial portions of area 17 were followed by retrograde labeling of neurons within the rostral levels of the basal forebrain. Based on these results we suggest that the cholinergic corticopetal projection terminates within the visual cortex in a medial to lateral pattern.

Animals↗
PubMed1987

Kainic acid-induced terminal degeneration in the dorsal lateral geniculate of tree shrew.

The dorsal lateral geniculate nucleus of tree shrews is very susceptible to the neurotoxic effects of kainic acid. In addition to neuronal loss, there is a profound loss of retinal terminals that is manifested through a disruption of anterograde transport of WGA/HRP from the retina to the kainic acid-lesioned area of the geniculate nucleus. The actions of kainic acid upon both the presynaptic terminals and geniculate neurons may be mediated by a glutamatergic pathway and questions the hypothesis that kainic acid is solely neuron-specific in its toxic action.

Animals↗
PubMed1986

Reciprocal connections between the claustrum and visual thalamus in the tree shrew (Tupaia glis).

We previously described the existence of reciprocal connections between the dorsal claustrum and striate cortex in the tree shrew, Tupaia glis. These projections were found to originate and terminate in a distinct topographic manner within the mid region of the upper portion of the dorsal claustrum. In this investigation, we examined the afferent and efferent projections between the claustrum and the lateral intermediate nucleus (Li) of the visual thalamus using small electrophoretic injections of anterograde and/or retrograde tracers (horseradish peroxidase, wheat germ agglutinin/horseradish peroxidase, or tritiated amino acids) into the claustrum, as well as the Li. Following tracer injections in the dorsal claustrum, labeled cells and/or terminal grains were found throughout the Li, except at the more caudal levels where the activity was confined to the lateral and medial borders. Tracer injections within the same nuclear region of the dorsal thalamus confirmed the existence of reciprocal projections between the Li and the claustrum. Following anterograde tracer injections, labeled terminals were found only within the most ventral zone of the dorsal claustrum--the 'hilum'; while retrograde tracer injections, produced labeled cells principally along the outer margins of the claustrum, including the hilum and tended to encapsulate the nucleus at all levels. Both sets of labeled activity were found to extend in this specific fashion over the majority of the dorsal claustrum, but appeared not to overlap with regions interconnected with striate cortex. These results thus suggest that the claustrum is capable of exerting a neural influence on cortex directly as well as indirectly via the visual thalamus. However, since the thalamic projection terminates in a claustral region not known to project to visual cortex, it is uncertain what function such projections have within the claustrum. It is possible that since Li receives ascending projections from the pretectum and superior colliculus, that it provides a multisensory input to the claustrum for relay onto areas outside of primary visual cortex.

Animals↗
PubMed1985

Organization of the rostral thalamus in the rat: evidence for connections to layer I of visual cortex.

The present study demonstrates the organization of a thalamocortical projecting system which terminates within layer I of the visual cortex in the hooded rat. Horseradish peroxidase (HRP) injections restricted to layer I resulted in retrograde labeling of large and medium-sized multipolar and fusiform neurons that are located within the ventromedial (VM) nucleus and a dorsomedial subunit of the ventral anterolateral nucleus (VAL). Retrograde cellular labeling also occurs within the anteromedial nucleus (AM) following these injections. After restriction of HRP injections to layer I, peroxidase labeling was not found within neurons of the classically defined intralaminar system, i.e., central medial, paracentral, and central lateral nuclei, or within the rostral continuations of the intralaminar system. Since the VM, dorsomedial VAL, and AM nuclei are directly adjacent to portions of the internal medullary lamina, we refer to this amalgam of rostral thalamic nuclei that project to layer I as the "paralaminar" system. We also provide cytoarchitectonic criteria that can be used to distinguish three separate subdivisions within the VAL complex, including that portion of the VAL which is part of the "paralaminar" system. In contrast, when control injections of WGA-HRP are placed within either the cellular supragranular or infragranular layers of the visual cortex, no appreciable number of neurons are labeled within the VM, VAL, or AM.

Animals↗
PubMed1985

The rat claustrum: afferent and efferent connections with visual cortex.

We have examined the afferent and efferent projections between the claustrum and visual cortex in the Long-Evans rat using anterograde and retrograde axonal transport techniques. Injections of either wheat germ agglutinin/horseradish peroxidase (WGA/HRP) or Fast Blue were made into each of the main visual regions (17, 18a or 18b) as well as directly into the claustrum. The cortical injections were placed in either the upper, middle or deep layers so as to assist in determining the laminar organization of these connections. Of the 3 visual areas, only area 18b appears to have extensive and reciprocal connections with the claustrum. After a WGA/HRP injection of this area, dense labeled terminals and numerous labeled cells were found intermixed throughout the full extent of the claustrum. The density of this labeled activity was found to vary directly with the amount of the infragranular layers involved by the injections. Injections in the other visual areas did produce labeled cells in the claustrum, but their number was always small or even negligible. There was never any evidence of anterograde labeled terminals in the claustrum from any injection of areas 17 or 18a. Tracer injections directly in the claustrum confirmed and extended these findings by showing that the labeled terminals and/or labeled cells were localized predominantly in layer VI of area 18b of visual cortex. On the basis of these injections, two major conclusions are reached. First, the pattern of connections between the claustrum and visual cortex in the rat differs fundamentally with that found in other species.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1984

Evidence for a laminar organization of basal forebrain afferents to the visual cortex.

The present study shows that restriction of HRP injections to layer I within the visual cortex results in negligible retrograde labeling within the nuclei of the basal forebrain. In contrast, when the injections of either HRP or WGA-HRP are restricted to the granular and infragranular layers of visual cortex, extensive retrograde labeling occurs within the basal forebrain. Based upon these findings, we argue that the projection from the basal nucleus terminates preferentially within the deep layers of the visual cortex, and thus contributes minimally to the supragranular layers, including layer I.

Acetylcholinesterase↗